
Suggest Treatment For Sinusitis, Fluid In Ear And Malaise

I corresponded with you approximately a month ago about bilateral parotid swelling. The CT results of the neck from that were normal and showed no signs of adenopathy or masses otherwise. You reassured me of the soft tissue stranding not being of concern.
I also had a submandibular stone(s) that temporarily blocked the duct on the left side. After a few weeks, these apparently have left. I did notice one as it left the duct. The swelling in this area has subsided.
On the same side, under the jaw, there is a lump. It varies in size, no more than 1-1.5cm including the surrounding tissue and generally is up under the jaw, about midline. Occasionally it drops down and can be felt in more detail. It feels firm, can be compressed a little, and seems to vary some in size, but there is a firm part that remains. It is movable vertically, and somewhat horizontally if manipulated.
My general doctor indicated based on the review of the CT in January that waiting until our next appointment on 3/2 is fine, and if it is still swollen, to obtain more imagery at that time.
I generally have felt fine, but did develop sinusitis and some fluid in the ear -on the other side of my head. There was a mild fever, azithromycin seems to be resolving this fairly quickly. I occasionally feel malaise, but it resolves quickly. I have no changes in appetite and have maintained my weight. I am somewhat thirsty from the dry sinuses.
Is this swelling typical being related the submandibular salivary stone?
The doctor felt all other lymph nodes in my head/neck area and had no concerns.
I am anxious about waiting another 3 weeks to see if the swelling/hardness has discontinued and possible imaging at that time. Should I pursue a more urgent meeting?
Most likely swelling is due to enlarged lymph node.
Detailed Answer:
Hello XXXX
Your findings suggests that most likely swelling is due to enlarged lymph node.This is common site of lymph drainage.
I don't think it is an emergency,you can wait for some time for to get naturally resolved.
You may need ultrasound of swelling.Besides clinical assessment,Ultrasound is very helpful in assessment of such lesions.Further investigations like biopsy can be done if needed in such cases but I don't think you will require it.
Lymph node may be related to your recent ear infection.It is good that you have taken antibiotics.
I suggest you to wait for some time.
Most likely swelling is not related the submandibular salivary stone.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX


What is a typical time for lymph node swelling to resolve, after the underlying infection goes away?
Is the hard part likely a fluid buildup?
Is a heating pad helpful for these?
It may take 4-6 weeks for complete resolution.
Detailed Answer:
Hello XXXX
Sorry for replying late.
It may take 4-6 weeks for complete resolution if it is enlarged lymph node.
It is not due to fluid build up because cyst(contain fluid)is soft in consistency.
Lymph nodes slips in between fingers and these are firm in consistency.
There is no need of heating pad application.It will resolve its own.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX


The area around the lymph node seems to swell overnight. The actual node or bump doesn't change in size. I often get some excessive saliva during the day.
Is this node inside the submandibular gland?
When the area is swollen, I get a feeling of malaise. When it drains or whatever, I feel much better.
Also, any recommendations for improving energy levels? I have been on 3 antibiotics in the last 3 months for these infections.
Below are my lab results from recent testing.
Thyroid Stimulating Hormone (TSH) 0.77 uIU/mL
Total Protein 7.9 g/dL
Albumin 4.3 gm/dL
Total Bilirubin 0.98 mg/dL
Direct Bilirubin 0.17 mg/dL
Indirect Bilirubin 0.81 mg/dL
Aspartate Amino Transf (AST/SGOT) 10 U/L
Alanine Aminotransferase (ALT/SGPT) 38 U/L
Alkaline Phosphatase 60 U/L
Group A Streptococcus Screen/Cult Select to view results
Group A Streptococcus Screen NEG/CUL
Urine Color Yello
Clarity Clear
Leukocyte esterase Negative
Nitrites Negative
Occult Blood Negative
Specific Gravity 1.02
Ketone Negative
Bilirubin Negative
Glucose, Urine Negative
Albuminum, Urine Negative
PH-Urine 5.5
WBC 7.36 K/uL
RBC 4.83 M/uL
Hemoglobin 14.5 g/dL
Hematocrit 44.30%
MCV 91.7 fl
MCH 30 pg
MCHC 32.7 g/dL
Platelet Count 289 K/uL
RDW-CV 12.80%
RWD-SD 42.8 fl
NRBC % 0
ABS NEUT 4.95 K/uL
ABS LYMP 1.67 K/uL
ABS MONO 0.55 K/uL
ABS EOS 0.12 K/uL
ABS BASO 0.04 K/uL
ABS IMMATURE GRAN 0.03 K/uL
Potassium 4 mmo/L
Hemoglobin A1C 5.3
Estimated Average Glucose 105 mg/dl
Glucose 144 mg/dL
Glucose Non-Fasting
Rheumatoid Factor BLD 11 IU/ml
ANA Screen Negative
Erythrocyte Sed Rate 13 mm/hr
Mumps Negative
Mumps AB IGG 0.05
Mumps IGG Index Value 1.1
Creatnine 0.82 mg/dL
Estimated GFR 109
Vitamin B12 529 pg/mL
Glucose 133 mg/dL
Non-Fasting
Thanks again for your responses. J
Most likely lesion is situated in subcutaneous region.
Detailed Answer:
Hello XXXX
Since you can palpate the lesion,it is most likely present in subcutaneous region(below the skin).Most likely it is not in sub mandibular gland.
Increase in swelling may be due to persistent infection.You need clinical evaluation and ultrasound of local region can be done if needed.
Mentioned lab test are normal.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX


in my lower jaw, the swelling increases at night or when I eat. As I trace the duct in my lower mouth, the lump is near the back of the duct, near what I believe to be the saliva gland.
When touched, I squirt saliva with a unusual taste.
I will ask my doctor or dentist for an evaluation.
What is this indicative of?
Thank you.
Definitely,you need proper evaluation.
Detailed Answer:
Hello XXXX
Definitely,you need proper evaluation.It is important to exclude obstruction in the duct as swelling increases at night and during eating.This may be due to secretions from salivary glands.But point against retained secretion is that secretion must be soft in palpation(you have firm feeling) and CT scan findings is also normal in your case.CT can is best investigation to detect calcification.
So,you need proper clinical examination and investigations like ultrasound of local region.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX

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