FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

NECK LUMPS THAT DON'T GO AWAY NEED FURTHER INVESTIGATION

Question: I have been going to a doctor for a lump under my chin now for about three years. Literally, it has been a pain in the neck. I have recently developed another lump further down my neck, so I went back to the doctor. He thinks it is a swollen gland that is a consequence of my chronic sinus problem. I have a feeling that I am not going to the right doctor. What kind of a doctor would one go to for constant swollen glands?

Answer: A "lump" below the chin can be caused by several different problems. A swollen lymph gland can appear as a lump, just as your doctor suggested. My concern is that a swollen lymph gland shouldn't stay tender and swollen for three years. This problem certainly needs more evaluation, particularly now that there is a second lump.

Lymph nodes - also called lymph glands, or sometimes simply "glands" - are part of the body's defense system. They can become enlarged in response to an infection or other challenges to the immune system. Most of us have had swollen "glands" in the neck when suffering from a sore throat, particularly a strep throat. If everything is working normally, the swelling goes down in a few days as your body's defense system overcomes the infection. Your three-year bout of swelling is unusual and makes further investigation appropriate.

Chronic infectious illnesses, like tuberculosis, can cause a lymph node to be swollen for extended periods. Other serious conditions, such as AIDS, can also produce similar symptoms. Typically though, most individuals with these ailments have more than one swollen lymph node, and they have other symptoms as well. Another possible cause would be cancer of the lymph system. Your history doesn't fit the typical picture for this malady either.

I'm suspicious that the "lump" may be from a cause other than your lymph glands. Swelling in one of the salivary glands - the glands that make "spit" - can produce the symptoms you describe. Perhaps that is the cause. You may also have chronic infection in a congenital abnormality called a branchial cleft cyst. Your "lump" could even be a problem with the thyroid gland.

You obviously are not satisfied with the quality of advice you have received from your doctor. Certainly you should see another doctor! You bought the advice that doesn't mean you need to believe it or that you should be satisfied with only one opinion. I'd suggest that you see another family doctor, an ear-nose-throat specialist, or a general internist. I'm sure that another physician can help you find the cause and then the proper treatment for your "lump." And if I were a betting man, and I'm not, I'd wager your sinus condition has nothing to do with it.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.