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Ear, Nose and Throat altogether
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Ear, Nose and Throat altogether

MALE 31, no history of respiratory diseases.

December 25th traveled to Thailand for Christmas holidays 2009-2010. All was great, until ran into a local lady with whom I had my share of fun (always protected vaginal sex) other than deep mouth kissing (no oral sex involved whatsoever).

After about 3-4 days of being together with a lady i got a throat problem, I did not have a sore throat, it was more like swelling around neck, neck glands were swollen and I had a really bad case of swollen uvula and some redness around it with some small white patches. I am typically non-drinker and do not smoke. But on holidays, I did have around 5-7 tonics each night going out. So, I initially thought that swollen uvula was due to dehydration and tried to drink and spray it with some antiseptic sprays for around 2 days to no success. I had no appetite and I assume I was running a low grade fever, but it is hard to tell since I have never measured temperature and it was too hot in Thailand to understand if my body temperature was above norm.

So eventually, I went to the doctor who gave me pills named Starclav 500 (which i found out was Amoxicillin and clavunic acid). I took the pills for three days, which made the symptoms go away. After that I seemed to be alright and was back home by mid Jan.

Mid Feb 2010, I have had some strange discomfort below jaw (what seemed like a swollen lymph node), went to check neck lymph nodes no problem. Went ENT doctor told him about Thailand, and swollen gland on the right side. He said it was nothing. Blood work and urine test, as well as neck ultrasound clear. No problems with throat or nose at this point.

End March, another visit to the ENT, now both of glands (bean shaped one's on each side of the throat just
made mouth swab and found Staph Aureus 4th levevel of growth or smth like that and E.coli 2. Was prescribed antibiotics named Avelox. Went through five day course of the Avelox. Noticed strange muscle twitching all over body and flu like symptoms, no increased temperature, basically weakness as the main symptom.

Went to ENT month after taking Avelox for another mouth swab, no Staph, no E.Coli, but this time he found Strep Pyogenes 3rd level growth and said it was nothing and not to worry about it. Anyway, the nagging pain and neck glands were still swollen and still tender, I was not really happy, but was patiently waiting for it to resolve on its own.

End of April, ear dullness adds to the nice array of feelings I have been experiencing. Desperate, I went to yet another doctor who without much investigation prescribed Ceftriaxone (shots intramuscular). Finished five day course Ceftriaxone 1 shot every twelve hours for five days. After the course of Ceftriaxone course, more problems started. Here are the symptoms:
* tongue turned yellowish black (I assume antibiotics did that)
* uvula was swollen, so it was hard to swallow
* I was swallowing constantly
* left nostril started dripping with bitter salty mucus
* neck got swollen
* throat and nose insides felt as if they were cut by knife

Went to ENT again for endoscopy, he found nothing. Sinuses clear, the mucus was clear. I have gone to an infection specialist who found increased titres for HHV-6 antibodies and EBV. I did blood PCR tests which revealed no active virus in blood other than Herpes type 7, as for saliva test, only antibody test above were positive no virus was found.

So all in all, I am here now with constant ear crackling resembling tinnitus. I have been to 5 different ENTs who seem to find nothing. Endoscopy, blood work, and urine are clear, the only attachment they make is that HHV-6.

Below is the list of med tests I have done and all are normal:

HIV antibody test - 3 times (10 weeks, 16 weeks, 6 months)

Blood parasites - negative

Syphilis - negative

All genital infections - negative (did them three times in different clinics)

MRI of the head - no inflammation

CT of neck and soft tissues - no issues found

CT of jaws and sinuses - no issues

Thyroid test - no issues

Malaria - negative

All herpes tests blood tests - found HHV6, Varicella Zoster, and EBV antibodies in blood. (had Valtrex to treat HHV6 to no effect), Valtrex had no effect on my overall condition whatsoever

No active viruses found in blood - via PCR tests (other than Herpes 7)

What I am experiencing now: Dull ear ache with crackling (like that of tinnitus) constant, especially when swallowing, internal dripping of the left nostril and some type of cut like feeling inside the nostril or between the nostril and throat, clear mucus accumulating in throat with constant need to spit it out due to foreign body feeling. Somewhat stiff neck, but less than before. Ears seem to cause the most pain. I have not been drinking alcohol since Feb 2010. I can also feel the around jaws, which has somewhat of muscle ache feeling.

June throat swab showed klebsiella pneumoniae level 3 growth.

Currently trying Cipro for a ten days course to take of the problem, could it be the cause of above symptoms? I have never had any allergies, I am not overweight, I used to go to gym 3 times a week before this problem happened.

Does anyone have any idea what to do or what to check for? I am very tired of living in pain for basically 3 months now. Please advise. Any questions are welcome.



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17 Comments Post a Comment
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Avatar_n_tn
Forgot to mention I did ask doctors to check for cancer, none seem to have found even a hint of it. Do these symptoms sound like cancer of some sort?
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Avatar_f_tn
With all the very strong antibiotics you have taken, acid reflux is a possibility.  Laryngeal-Pharyngeal Reflux (LPR) can cause most of the symptoms you describe if not all of them (well, not the actual infections found).  LPR is a form of acid reflux where the acid does not stay in the esophagus where it would cause hert burn, but goes up into the throat and sinuses instead.  I would be surprised though if all the ENTs you have seen missed this though, but still trying some OTC GERD meds might be worth a try.  I would recommend something like Prilosec or Zantac.

Another possibility is that you have caught something particular to Thailand.  Doing some research on diseases prevelent in Thailand might be helpful.  Also, have the tested you for mono?  Simple, but still might be over looked.

Feel better.
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Avatar_n_tn
Thank you very much for your response.

First of all I have tested for mono (which I believe is EBV) and the blood is clear, I do not have an active infection, but I do have increased antibodies in blood and saliva according to infection specialist.

I will try Prilosec, since my level of desperation is immense and I am ready to try anything at this point. I was on the brink of doing lumbar puncture to test for bacterial meningitis due to dull ear ache, which caused headache.

The most painful part is ears, could LPR cause such ear pain and this clicking like in tinnitus?

I was also thinking about something particular to Thailand, but I can not locate any particular information. I will look into it though and try Prilosec.

Thank you for your reply and best wishes.

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1268057_tn?1379102055
Definitely is NOT any cancer.  Sounds like whatever this is it is throwing your immune system into overdrive.  

People fail to remember you can be exposed to disease from kissing too.  

Agree with bsmsl, this could be something native to Thailand too.  I would recommend trying to find an ID (Infectious Disease) physician who specializes in Travel Medicine.  
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Avatar_n_tn
Thank you for Londres70, for your reply.

Do you think it could be some undetectable strain of HIV or would it not manifest in such a way and for that long?  I mean I have tested 3 times and I specified the periods that have passed since then, but at this point in time I am somewhat paranoid, since I usually don't care when I am sick. I have tested for all TORCH infections all came back negative. Checked for Hepatitis all types. I mean, never in my life have I undergone such an intense medical testing routine. Yet this case is way too painful with localization in Ear, Nose and Throat and it is going on for way too long if you ask me.

I have been trying to find a ID physician for a while now, they all seem to be fixated on Herpes type 6 antibody titres found in saliva and blood. I have spent so much time and money that I am already getting sick of myself. :)

As for failing to remember, I was a bit drunk, and I am single, so it was not like I was cheating on someone or anything like that. Anyway, you know how these things go, but this was the first and definitely the last time for me. I am not blaming the girl, but I am hard pressed guessing what is happening since I have not been sick with anything other than runny nose for 2 days since 2001.
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1268057_tn?1379102055
By no means am I passing judgement on you at all; completely understand these things can happen.  

I don't think this is any HIV; you cleared the testing ok.  

What worries me is that you have  HHV4, HHV5, HHV6, and HHV7 exposure; not good especially the HHV4 and the HHV5.  These viruses can lay dormant and become activated at any time, so in other words, they can "take turns" being active so to speak.  After reading your posts over and over again, your problems are DEFINITELY these viruses you have been exposed to; that IS the problem.  

I doubt if this is a situation that will JUST go away.

I know I mentioned in my last post that this is NOT any cancer, but HHV4 has been linked with some cancers, in particular, lymphomas and Nasopharyngeal Cancer (seen in East Asia and Africa).  

Have you had any other labs drawn recently?  eg. CBC

Glands swollen still?

Were any of the ID physicians you have seen specialized in Travel Medicine at all?  

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Avatar_n_tn
Thank you for your response once again.

I definitely do not have HHV-5 (Citomegalovirus was negative), HHV-7 was found in blood PCR test.

HHV6-blood PCR negative  (anitbodies high titre blood and saliva)

HHV4-blood PCR negative  (antibodies high titre blood and saliva)

HHV3-blood PCR negative (antibodies high titre blood)

I had a course of Valtrex, which somewhat lowered HHV3 antibody count, but increased titres to HHV6.

I had a complete CBC and the only slightly elevated value was that of RBC, it was 5.11 at the reference norm of 5.00 (upper range). The rest of the CBC was norm.

I also had CEA (Carcinoembryonic Antigen) which was 0.937 while the upper normal reference value was 3.4, so I would assume this would show up if there was some cancerous process involved, but then again I am not a doctor.

Glands swollen still?  Glands are not swollen any longer, they have remained somewhat larger than they were initially, but not as big and painful as they were when I had initial outbreak of ear pain.

Like I said, I have been all around to different IDs and all they have come up with was Zovirax and Valtrex, which seem to have no effect whatsoever.

I started CIPRO as of Monday according to the IDs recommendations, I have mixed feelings about it. Do you think I should finish the course 10 days of 1 pill every 12 hours or it would not make sense? The only reason I started since it is effective klebsiella pneumonia according to bacterial resistance chart I was given.

Should I concern myself with that  klebsiella pneumonia in mouth or is it something typically found in mouth swab?

Also, I did endoscopy of throat, ears, and nose when I had the worst pain and running nose, is carcinoma easily spotted? I mean would ENT see it?
Cause he showed me insides recorded on video and said that all organs looked fine to him, the only thing he noticed was some redness surrounding vocal cords that looked like irritation to him and asked me if I were singing, and I do not sing even remotely :).
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Avatar_n_tn
We do not Travel Medicine doctors, so I am unfortunate in this respect.
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Avatar_n_tn
Here is what I have for blood work in terms of Herpes tests:


Antibodies IgG for Herpes type 6 ELISA II - 12.98
(Reference less 0,9 - negative;от 0,9 to 1,1 - tentative; more 1,1 - positive)

Antibodies IgG Herpes type Varicella Zoster (3 type) CLIA - 1739
(Reference less 135 - negative;от 135 to 165 - tentative; more 165 - positive)

Antibodies IgG for nuclear antigen Ebstein-Barr Virus-EBNA CLIA - > 600
(Reference less 5- negative;от 5 to 20 - tentative; more 20 - positive)

These results are actually a second time blood work (July 6) with first one done in June 2010. The June had lower titre for HHV-6 and higher titre for HHV-3 and EBV titre remained unchanged. All of that after a course of Valtrex with antibiotics.

I am confused as to what to do if there is no medicine to treat Herpes infections, what is there to do about them? Suffer and hope they go away on its own?







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1268057_tn?1379102055
Finish the Cipro.

Valtrex is for HHV1 and HHV2, which you do not have.  

Has anyone biopsied tissue from your throat and/or your swollen glands?

K. Pneumoniae is found in the normal flora in your mouth; it is a problem when the flora is out of balance, eg infection.  

I would post in the EBV and Herpes Forums as well.  
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Avatar_n_tn
Thank you for being patient and answering my questions.

I will repost in EBV and Herpes. I have not had tissue biopsied since no one seems to have offered it as a clinical test. Other than that I am pretty lost in pain and despair.
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1268057_tn?1379102055
Finish the cipro and go from there.  

You can request a tissue biopsy of your throat and see what your physician thinks about that.  

Unfortunely, this is not going to be an easy road for you.

I am not sure if you have an Immunologist you can consult nearby since you are not really getting anywhere with the ID Specialists.  
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Avatar_n_tn
Thank you Londres70, I am happy that there are people like you.

One more thing I forgot to mention that I generate tons of saliva and mucus, which comes either from nose or from throat, also can be from both since for me it is very difficult to tell.

I spit pretty much every minute or so, I am not even sure where so much liquid (which is sputum) comes from, within my body. My voice is a bit hoarse, but I believe it is because I am clearing my throat and nose way too often.

The best way i feel is when I lay horizontally, which is odd since dripping of sputum stops, not sure how this works. When I sit it is average, when I walk it is crazy.
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1268057_tn?1379102055
Sounds like the majority of this drainage is coming from your nasal passages down into your throat.  When you are upright, gravity is giving you a helping hand unfortunately.  

Thanks for the nice comment.  
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Avatar_n_tn
Hello Londres,

Just wanted to update you as to what i have been through thus far.

I have been to Israel to a medical clinic to see if they would help me diagnose my problem. Unfortunately, the time and money was spent to no avail.

Here is what I had checked in Israel:

Blood check - tested for CBC and other biochemical parameters that came out fine. No HIV or anything.

ENT- was really bad. He put endoscopic tube in my throat and I could see on the monitor a lot of phlegm, which I continue to spit out daily. His advice was to drink more water. I am drinking more water than an any average person that is for sure and still he made nothing out of the phlegm. That was rather pathetic for 400$ consultation advice.

Neck Ultrasound was ok. The professor performing ultrasound basically said that I have reactive lymph nodes and funny enough said that it might be something local to Thailand. She objected against biopsy, since she argued that lymph nodes do not have any mass in them and there is little material for biopsy. I decided to listen to her, since she should know better.

As a result the trip was expensive and totally unnecessary since I am still left with the same problems as before.

My disease has progressed a little as well, since now I keep waking up in the middle of the night due to over dry mouth and feeling of salt inside the mouth. Ears are still making clicking sounds when i swallow, or breathe in deeply. Strangely enough it has affected gums as well, since the feeling is that my gums are inflamed. I went to oral surgeon and he could make nothing out of it. I even asked the dentist if we should pull out wisdom teeth that are already in place to see if it helps and he said no need.

I keep spitting mucus in the morning and ENT here said that it is a lot of mucus. He looked at CT scans and it is clear that right sinus is all filled with some fluid, yet could not suggest anything regarding treatment. Ear pressure is still there and so is the lack of appetite.

I do not know what to do, since I am running out of ideas and money and it keeps bugging me.

I was wondering if I try Augmentin, do you think it might help? (that is the stuff that took care of my initial infection in Thailand).  Or does it not make any sense since I have tried Ceftriaxone and Cipro before?

Do you think it is stupid to just randomly try antibiotics in search of solution?

I am in a way desparate and too tired to be in pain.

When i press my teeth together I get a dull ache in gums and ears. I am lost since I have no HIV or Cancer. My head MRI is fine and so is CBC, I do not have fever, how do i go about solving this problem?

Isn't there anything to at least kill the nose dripping and throat mucus?

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Avatar_f_tn
Hi this may sound silly but you may have developed an allergy to dairy foodstuffs. This allergy or sensitivity can make you produce lots of thick sputum, l mean lots, it can be thick and viscous and keeps finding its way into the throat. I know this because I and several other people I know have all had the symptoms which I have highlighted.
I noticed that every time I had a hot chocolate before bed ( the kind made with hot water) although it has milk in it ,l would wake in the night almost choking with mucous from my throat and continue all the next day spitting and bringing up more mucous Add to this other dairy foods you might consume and you have a constant stream of throat mucous ,I also have clicking in my ears that comes and goes ,and constant tinnitus. You could try cutting out dairy foods and see if this helps you have nothing to lose, I hope it helps molly
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Avatar_m_tn
Some form of meningitis ? Ever have any bad itching?
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