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Noticed Swelling On Neck,face, Have Chest Pain And Mild Pain In Ear. Any Suggestion?

Posted on Tue, 18 Dec 2012

Question: Hi. I'm 37 y.o. healthy, active female. Recently, I have had progressive swelling on the LEFT side of my neck/face, such as swollen eye lid, swollen/heaviness in cheek, mild pain in ear. Over the summer, I had an ultrasound on several swollen left superclavical lyphnodes. negative. the lyphnodes are still the same size, although i do have another enlarged node under my left ear/back of jaw line. Been taking various forms of antibiotics for nearly 4 weeks. No change. Now I'm getting random chest pains and pains in my upper back between the shoulderblades, change in mood (more irritable), hair loss, cloudy memory, general feeling of being unwell, etc. What do you think? Any tests should I request from my doctor at tomorrow's follow-up visit?

Answered by Dr. Dr. Naveen Kumar Nanjasetty (1 hour later)

Hi

Thanks for the query

The clinical description given by you seems to be the features of acute sinusitis with associated complications.

Swollen eyelids, cheeks and earache are all the features of acute sinusitis. You will require a CT scan of the nose and the paranasal sinuses to rule out sinusitis and osteomeatal complex blockage.

Secondly, the lymph nodes in the neck and over the angle of the jaw are the nodes popped up due to some insignificant infection in the throat and the neck. Most of the times, these nodes might not regress even after taking the antibiotics.

Finally, the chest discomfort is because of the reflux of the acid from the stomach into the esophagus.

My suggestions to you are:
1. Drink plenty of warm water – this helps in improving the blood circulation, keeping the mucosa moist and relief from pain.
2. Continue taking augmentin and finish the course.
3. Try taking anti-inflammatory medicines such as diclofenac or ibuprofen for the relief of pain.
4. Use saline nasal spray followed by steam inhalation 3-4 times a day - this helps in removing the thick secretions from the sinuses and thus reduces the nasal block and earache.
5. A mucolytic such as bromhexine or ambroxol will help in clearing the blocked secretions in the sinuses.
6. Also, avoid smoking/chilled food & beverages/alcohol/coffee if any.
7. Try taking medicines such as proton pump inhibitor (Esomeprazole, Pantoperazole) and a prokinetic (Domperidone), this helps in reducing the acid reflux and heart burn.
8. Get a CT scan of the paranasal sinuses to assess the extent of sinusitis.

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

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (9 hours later)

Thank you Dr. XXXXXXX I do have a follow-up questions. Over the past few hours, I have since developed a red, slighly raised rash only on my left cheek (where I have complained of the puffiness/heaviness). What could this be attributed to? Should I be concerned?

Thank you for your prompt reply.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (11 minutes later)

Hi

Welcome back

Red rash over the cheek could be the inflammation of the subcutaneous tissue following acute sinus infection. Yes, it is definitely a matter of concern. Kindly get a CTscan of the Paranasal sinuses done at the earliest to rule out the same.

If the present regimen of antibiotic is not effective, you will have to take a combination of antibiotics after discussing with your doctor.

I wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar