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Pain under the jaw, sore throat and fever. MRI and echography done. Took Aerius for sinusitis. Pain persisting

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ENT Specialist
Practicing since : 2001
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for about 5 months a have a pain under the corner of my jaw (right side, XXXXXXX below). Its constant. I went to many doctors - with no results. Did echography twice. And MRI scan of my neck. At the end of April I started to feel bad and weak. I got a sore thorat and fever.

After 10 days I was better, but the sore throat remains until today. Around month ago I started to be very weak and tired. Did my blood analysis again and Mononucleosis poped up.

No other changes in a very complex blood analysis.

2 weeks ago my cheecks, head, eyes and ears started to hurt very badly (mostly the right side). I went to doctor for the X time and he gave me AERIUS for the sinusitis. It helped a bit with the headache but not with the way I feel.

I did another blood check results below:


4,47 – NORM is 4,80

Parvovirus B19 IGG:

More than a 5.00

Ebstein-Barr Nuclear Antigen AC IGG

7,78 – NORM is 1.10

Ebestein-Barr Anticuerpos IGG

3,85 – NORM is 1.00

Toxoplasmosis IGG


Sedimentation rate


HIV- negative (2 independent checks), have one heterosexual partner, don't take drugs

Everything else looks fine (liver,thyroid,pancreas). I also got a TC scan of my abdominal cavity, and colonoscopy. Results are ok.

Since 2 days I have a white mucus on my tongue and a lie bump on the front of it (metallic taste and it burns). I have pain all over my face, especially the eyes, ears (mostly right side), and bones below the eyes. I also have a red rush on my hands and arms (it pops up and disappears and its itchy). I have pain in my wrists and arms.

My jaw and neck on right side hurts all the time (5th month), as well as my throat. (I did neck echography twice and an MRI on it and it was ok). LYMPH NODES on my neck are ok.

I went to the 2 times to a dentist and 3 times to otolaryngologist and they couldn't find anything, but I will have a CT scan end of next week.

The thing is, for some reason my immune system does not work at all. And I feel like I would black out any minute and don't know if I will last until next week. Non of the doctors game my any medicine cause they told me my body has to handle it itself - well it does not! :(

I take a lot of Vitamin C, B6, Calcium and Magnesium but with no result.

All this sickness and pain in the jaw/neck area takes so many months and I’m getting more and more diseases and I become weaker and weaker. I have no fever at all. I think I should be in a hospital so they could diagnose me really good within few days, but I can’t go there just like that, right? What can I do and where can I look for help? Im in Spain - Madrid.

If ur are not the right doctor please forward it to the correct one... thank you in the advace.

P.S. My profession is a software tester. I love this job. I don't smoke. Drink alcohol like a normal person (few beers during the weekend, sometimes some drinks).

Posted Sat, 7 Jul 2012 in Ear, Nose and Throat Problems
Answered by Dr. Naveen Kumar 19 hours later


Thanks for the query and an elaborate history which has made my work easier.

You seem to be suffering from sinusitis and pharyngitis.

To explain to you detail:

1. The symptoms of facial pain, mucus over the tongue, throat discomfort are all the features of sinusitis. Sinusitis is the inflammation of the paranasal sinuses causing blockage of the sinuses. Secondary to the blockage there is retention of the sinus secretions in the sinus cavities leading to facial pain, headache and pain around the eyes. Due to accumulation of the secretions in the sinuses, it gets infected and once the infected secretions pass into the back of the nose and into the throat, it causes inflammation all over the region traversed by these secretions. This inflammation in the throat is perceived as sore throat and pain at the junction of the ear and the mandible just below the ear lobe.

2. Pharyngitis (sore throat) caused secondary to trickling of the sinus secretions into the throat can give rise to pain below the jaw. This is because of two reasons (i) the lymphatic drainage of the throat is to the junction of the region below the mandible and the ear and (ii) the nerves supplying the throat has the same innervations as that of the neck hence the perception of pain.

3. The MRI, blood and the sonography results are all normal, which denotes that there is no life threatening diseases.

My suggestion to you is to do steam inhalation 3-4 times a day, this will loosen-up the secretions in the sinus and the throat, drink plenty of warm water, use saline nasal spray to keep the nasal mucosa moist and help in clearing of the nasal and sinus secretions. Also, avoid coffee, chilled and hot beverages. These above measures should take care of your problem. Do not take Aerius tablets, as this worsens your sinus related problems. Try taking mucolytics such as bromhexine or ambroxol, this helps in reducing the viscosity of the sinus secretions and your facial problems.

Hope I have answered your query; I will be available for the follow-up queries.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
Follow-up: Pain under the jaw, sore throat and fever. MRI and echography done. Took Aerius for sinusitis. Pain persisting 8 hours later
Thank you for the answer.

Im a bit confused now, because Aerius has been perscribed by the family doctor for the sinusitis and now u are telling me that I should not take it.

Additionally, the Otolaryngologist told me this is def. not sinusitis but he has no idea what can cause all this pain.

Today I was at ER beacuse of the pain (they did just give me Paracetamol). My stomack startet to hurt now ( I cant sleep on it, and I can bow forward 2 much) , and combined with my face and head makes the sleep impossible :(

You did also not reffered to my EBV and Parvovirus B19 infections. I have no fever at all and my Leucocitos are low :(

Can that really take that long (couple of months) and why im not being threated with no medicin? Im getting weaker and weaker and more things starts to hurt really bad:(
Answered by Dr. Naveen Kumar 16 hours later

Thanks for writing back

1.     Im a bit confused now, because Aerius has been perscribed by the family doctor for the sinusitis and now u are telling me that I should not take it? Additionally, the Otolaryngologist told me this is def. not sinusitis but he has no idea what can cause all this pain.

A: According to the description given by you, the features seem to be of sinusitis. The same was initially diagnosed by your doctor and Aerius (Desloratidine) was prescribed. Desloratidine is an antihistaminic prescribed in allergic conditions of the nose. It causes dryness of the mucosa and makes the secretions of the nose and throat more viscid. That was the reason why I suggested you to stop Desloratidine as the viscid secretions clog the sinus opening.

Secondly, was any X-ray or CT scan of the nose and the paranasal sinuses (PNS) performed by your Otolaryngologist to rule out sinusitis? This is because, usually, in the case of sinusitis there will be either collection of the secretions or swelling of the mucosa in the sinuses, which can be confirmed with the above mentioned investigations. In my previous response I had suspected sinusitis based on the clinical features described by you.

2.     Regarding EBV and parvovirus

A: The most commonly used diagnostic criterion is the presence of 50% lymphocytes with at least 10% atypical lymphocytes (large, irregular nuclei), associated with fever, sore throat and lymphadenopathy (enlarged lymph nodes). Although the symptoms of infectious mononucleosis usually resolve in 1 or 2 months, EBV remains dormant in a few cells in the throat and blood for the rest of the person's life. A positive heterophile antibody test (monospot test) with the above mentioned symptoms can confirm the diagnosis of Infectious Mononucleosis. If you also have positive VCA-IgG, then it is highly likely that you have, or recently had, an EBV infection.

A chronic mononucleosis-like syndrome is noticed in certain individuals who experience persistent or relapsing episodes of fatigue, depression, low-grade fever, lymphadenopathy and weight loss. Actively replicating Epstein Barr Virus may be responsible for the persisting illness and fatigue associated with this viral infection.

Parvovirus B19 can affect any age group but, it is commonly seen in children aged six to ten years. Once a person has been exposed to parvovirus B19, they will have some measurable amount of IgG antibody in their blood for the rest of their life. If only parvovirus B19 IgG is present, then the person had a parvovirus infection at some time in the past and has protection against the virus, and the presence of IgM antibodies denotes that the patient may have very recently been infected. If a parvovirus B19 DNA test is positive, then the person is currently infected with parvovirus B19.

Thus the above result shows that there is no active parvovirus infection but, the possibilities of the recent EBV infection (i.e. Infectious Mononucleosis) cannot be ruled out.

As Infectious mononucleosis is generally self-limiting, only symptomatic and/or supportive treatments are used.

To conclude; CT Scan of the nose and PNS can be helpful in diagnosing your sinus related problems and to differentiate with that of EBV infection. Also, please continue with the suggestions made in my previous response.

Wish you good health

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
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