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Dr. Andrew Rynne

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What causes recurrent sore throat?

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Dr. Deepak Sundriyal

Oncologist

Practicing since :2005

Answered : 1492 Questions

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Posted on Thu, 2 Mar 2017 in Blood Disorders
Question: Hello,

My lymph node submandular in my upper neck has been swollen for 5 years. I have had it biopsied to reveal nothing, and ultrasounded and had two MRI's of the soft tissues of the neck. I have also been battling a sore throat that varies day to day, that all ENT's have told me is reflux/allergy related. I feel like they are wrong. Could there be any other reason for this lymph node to swell for so long, and my throat to be sore for so long?
doctor
Answered by Dr. Deepak Sundriyal 3 hours later
Brief Answer:
Hello dear, if biopsy is negative, nothing to worry

Detailed Answer:
Hello dear. I have gone through the details.

With a long standing node, only concern is of a lymphoma,

However, if the biopsy is negative, there is nothing to worry.

Your doctor is right in saying that it looks related to chronic allergy that you are suffering from recurrent sore throat, which can also cause node enlargement. You require allergic testing to find a probable cause and then anti-allergic drugs. That is all which is required.


Thanks and regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Deepak Sundriyal 3 hours later
But how do I know that the biopsy got the right lymph node. I pointed to where it was, but the biopsy needle went in about two inches below. This has been going on for two years, and the lymph node has been swollen for five years. Would cancer have shown up in many more ways by now?

And from everything I've read, allergy can't cause lymph nodes to swell. Would a chronic infection do this, and if so, how would you test for this, since no dr. seems to care about finding the answers for me!

This lymph swelling is only on one side, and this is also a side I have had a fair bit of dental work, ..ie. root canals. Would also my MRI, and ultrasounds that I've had shown the cancer in the lymph node too? I guess I want more reassurance as I didn't trust the biopsy!
doctor
Answered by Dr. Deepak Sundriyal 2 hours later
Brief Answer:
Please upload the biopsy report

Detailed Answer:
Hello
If you can upload the biopsy report, i can tell you whether it hit the right place or not. Had it been a cancer, it would have manifested till now. Moreover, chronic infections wont last so long. As you said, recent dental work of course can lead to infection. A sore throat, viral or allergic can lead to enlarged node as i said earlier. You can upload mri report so that i can have a look.
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Deepak Sundriyal 32 hours later
Also, I discussed with an ENT in the states the reasons for why my lingual tonsils were still enlarged with two different MRI's noticing this after two years. His response was below and has super freaked me out! Does this mean along with my tonsillectomy that I just had, that I should get my lingual tonsils out as well! Is there any other way that is full proof?

His response is here:

Infection typically causes a LOT of pain or soreness in the back of the tongue. If there’s not much pain, unlikely to be infection. Appearance-wise, very red/inflamed and pus may be seen on the surface. With the exception of infection, in all other situations, you can’t tell just by looking.

Lymphoma typically causes a painless enlargement and MRI scan can NOT diagnose this. Even if present for 2 years, can’t necessarily rule it out. It could be indolent. The only way to determine if it is lymphoma is to remove it and get it analyzed by pathology. There is no reliable way to visually tell if lymphoma versus benign lingual tonsil hypertrophy. If there is asymmetry in appearance, this possibility does increase.

LPR can at times cause lingual tonsil hypertrophy. If this is a significant concern, would recommend getting a 24 hour multichannel impedance testing with manometry. This test should pretty much provide info whether LPR may be a cause or not.

Allergy is pretty much at the very bottom of possibilities that may cause lingual tonsil hypertrophy and not something I would even usually consider.


Honestly, given this sounds like it has been an ongoing concern, you really should just get it removed and checked out… and be done with it."
doctor
Answered by Dr. Deepak Sundriyal 10 hours later
Brief Answer:
Iam sorry to say, but you got wrong information

Detailed Answer:
Hello dear. Iam afraid that you got information about lymphoma from an ent guy instead of an onco doctor. Lymphoma can very well picked on ct scan as suspicious lesion and not merely an enlarged node. Of course, confirmation requires biopsy. We usually get biopsy done only if ct is suspicious of lymphoma and the node is more than 2 cm in size. If it is of that much size, then get it biopsied. No need to afraid.
Thanks and regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Deepak Sundriyal 11 hours later
I had an MRI, not a CT scan. Is this the same?
The MRI said, still Prominent hypertrophy of lingual tonsils, unchaged from last year.

And this is for my lingual tonsils, behind my tongue that are still enlarged. The MRI said unchanged but still enlarged.
doctor
Answered by Dr. Deepak Sundriyal 34 minutes later
Brief Answer:
MRI is ok

Detailed Answer:
Hello. MRI is ok. If they are significantly enlarged and suspicious, then only biopsy is indicated.
You can undergo serum LDH. If that is elevated, it may points towards lymphoma.
Thanks and regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Deepak Sundriyal 9 minutes later
How do you do serum LDH? Is this a bloodtest? Can it be ordered online, since my dr's are sick of me!
doctor
Answered by Dr. Deepak Sundriyal 1 minute later
Brief Answer:
Yes. it is a blood test.

Detailed Answer:
Hello. YEs it is a blood test. It is elevated in lymphoma. IT can be ordered online.
Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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