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Column originally published Jun 14, 2000

Sinus Infection Can Cause Enlargement Of Lymph Glands In The Neck

Question: Several weeks ago we found a lump in the neck of our two-year-old son. At that time he had a cold. Our doctor checked him and said that he had sinus infection, and the lump that we found was an enlarged lymph gland. He gave our son an antibiotic. His cold is better now, but the gland is still there, although it is much smaller. Our friends told us that this could be cancer. We are worried. What should we do?


What you have described is a very common problem in children, and you should not be overly alarmed. Your doctor was correct; your son most likely had a sinus infection. The enlarged lymph gland is a common complication of sinusitis. Let me explain to you in a little greater detail here.

Lymph glands can be regarded as the first line of defense in our body. There are numerous lymph glands, usually present in groups, located in different parts of our body. Because they are normally very small, most of us don’t even know that they exist. They are present behind the ears, under the jaw, in our neck, under the armpits and in our groins. There are also many lymph glands inside our chest and abdomen.

Inside the lymph glands are many different kinds of cells, each of them carry a different function. Some of them are designed to swallow and kill bacteria. Others are used to recognize the identity of germs, and to mount an immune response to protect the body from future attacks of the same bacteria or viruses.

If I get a small cut in my finger, a few bacteria will enter the wound, travel along the lymphatic channels to the lymph glands under my armpit. These bacteria will be picked up and destroyed by cells inside the lymph glands very quickly. The lymph glands may not appear to be inflamed, because of the small number of bacteria involved.

However, if I have a big cut in my finger, and if dirt gets inside the wound, a large number of bacteria may enter my body. They will travel to the lymph glands. These bacteria, because of their large number, can overwhelm the local defense. The surviving bacteria can actually multiply in the lymph glands.

When this happens, the body’s immune system will send additional white blood cells in our body to the lymph glands involved, to try to fight these bacteria. The resulting inflammation will lead to enlargement of the lymph glands, which are often painful to touch. This condition of lymph gland infection is called lymphadenitis.

Once in a while, this infection can spread from lymph glands into the blood, causing blood poisoning (also called septicemia). When this happens, the person will get high fever and become very sick.

In your son’s situation, the bacteria from his infected sinuses traveled to the lymph glands in his neck. Very likely he had a significant sinus infection so that bacteria could multiply in the lymph glands and produce lymphadenitis. Most likely at that time there was some pain in the glands. Some children may also have difficulty moving the neck.

By giving antibiotics to treat the sinus infection, the bacteria in the lymph glands were also eradicated. As a result, inflammation in the lymph glands gradually decreased. The pain will disappear, and the lymph glands will gradually reduce in size over a few weeks. It may remain palpable, and may stay slightly larger than before the infection.

Is it ever possible that an enlarged lymph gland is because of cancer? Of course it is possible. Cancer can start from the lymph gland (usually called lymphoma), or spread from cancer in another part of the body.

Cancerous lymph glands are usually quite firm, and often has little or no pain. At the beginning, it is easy to move the glands under the skin, but as the cancer spread, the glands can become fixed to the skin or underlying tissue. Antibiotics cannot reduce the size of cancerous lymph glands.

If your son’s lymph gland is getting smaller after treatment with antibiotic, it is unlikely that he has cancer. However, I would suggest that you examine the gland in a few weeks. If it is still enlarged at that time, bring him back to see your doctor. If there is any question, I am sure your doctor can arrange for consultation and tests to make sure that he does not have cancer.