OVERVIEW

What is cervical lymphadenitis?

Normally, lymph nodes should not be palpable. Due to inflammatory reactions, lymph nodes may become enlarged, making one or more lymph nodes palpable and tender.

Clinically, the terms lymphadenitis and lymphadenopathy are often used interchangeably. However, strictly speaking, lymphadenitis refers to inflamed lymph nodes, while lymphadenopathy includes both inflamed and non-inflamed lymph nodes.

Cervical lymphadenitis has many infectious and non-infectious causes. Different locations, acute or chronic conditions, etc., suggest different diseases, with varying treatment methods and outcomes.

In adults, cervical lymphadenitis is commonly caused by Staphylococcus aureus or Streptococcus pyogenes infections. In children, it is usually caused by viral upper respiratory infections, which are self-limiting and resolve on their own.

SYMPTOMS

What are the manifestations of cervical lymphadenitis?

Enlarged lymph nodes in the neck, including those in the preauricular, postauricular, parotid, submental, submandibular, anterior cervical, posterior cervical, and occipital regions of the head and neck, can be either inflammatory or non-inflammatory in nature.

In lymphadenitis, one or more lymph nodes may become enlarged, painful, and tender. Depending on the underlying condition, other symptoms such as fever, cough, toothache, or breast tenderness may also occur. Of course, there may be no accompanying symptoms other than lymph node enlargement and tenderness.

Symptoms of acute lymphadenitis usually appear within a few days but may persist for weeks to months. Subacute/chronic lymphadenitis manifests over weeks to months.

CAUSES

Why is cervical lymphadenitis relatively common?

The neck is rich in lymph nodes, which receive lymphatic drainage from the corresponding areas of the head, face, and neck. Since the oral cavity, upper respiratory tract, and face are more prone to bacterial and viral infections, cervical lymph nodes are also more susceptible to inflammation.

Additionally, cervical lymph nodes are located relatively superficially, making pain and swelling more noticeable. Therefore, cervical lymphadenitis is clinically common.

What causes cervical lymphadenitis?

Infectious causes of cervical lymphadenitis are generally divided into the following four categories:

• Acute bilateral cervical lymphadenitis, often caused by respiratory infections such as rhinovirus, herpes simplex virus, adenovirus, enterovirus, Mycoplasma pneumoniae, or group A streptococcus.
• Acute unilateral cervical lymphadenitis, often caused by odontogenic or oral infections, injuries to the skin of the head, face, or neck, boils, carbuncles, or tonsillitis, such as Staphylococcus aureus, group A streptococcus, or anaerobic bacteria.
• Subacute/chronic bilateral lymphadenitis, commonly seen in infections like Epstein-Barr virus or cytomegalovirus.
• Subacute/chronic unilateral lymphadenitis, often caused by nontuberculous mycobacteria, cat-scratch disease (Bartonella henselae infection), tuberculosis, or toxoplasmosis.

Non-infectious causes of cervical lymphadenopathy in children are relatively rare. Important non-infectious causes include connective tissue diseases, leukemia, lymphoma, Kawasaki disease, histiocytic necrotizing lymphadenitis (Kikuchi disease), PFAPA syndrome, and medications.

In adults, non-infectious factors such as malignancies—including lymphoma and metastatic lymph nodes from head and neck cancers (e.g., nasopharyngeal carcinoma, oral cancer, thyroid cancer)—can also cause lymphadenopathy, though inflammatory symptoms like tenderness are less common. Patients who are older, have a long-term smoking history, or present with very hard lymph nodes should be especially cautious, as these may indicate tumor-related lymphadenitis.

DIAGNOSIS

What tests are needed for swollen lymph nodes?

The purpose of testing is to identify the cause of lymph node enlargement for further treatment.

When swollen neck lymph nodes are detected, a detailed medical history is usually taken first—such as recent upper respiratory infections, skin infections on the head or face, or oral ulcers. The swollen lymph nodes are then examined for size, texture, and whether they have clear boundaries with surrounding tissues to determine if they are truly enlarged and whether the cause is likely benign or malignant.

If caused by infection, only anti-infection treatment is needed, without specific therapy for lymphadenitis.

If malignancy is suspected, more comprehensive tests such as blood tests, pathogen testing, imaging studies, or even a lymph node biopsy may be required.

TREATMENT

How to Treat Cervical Lymphadenitis?

Treatment methods vary depending on the cause and severity of symptoms, including: waiting for self-recovery, oral antibiotics, targeted treatment of the underlying disease, or incision and drainage of swollen lymph nodes.

Acute Bilateral Cervical Lymphadenitis:

• Most cases are caused by upper respiratory or head/face infections. Viral infections often resolve on their own—rest, a healthy diet, and adequate hydration are sufficient.
• For symptoms like fever or cough due to upper respiratory infections, antipyretics or cough expectorants can relieve discomfort.
• If bacterial infections are present in the head/face, antibiotics may be prescribed under medical guidance.

Unilateral Cervical Lymphadenitis:

• Often caused by bacterial infections. If symptoms are mild (slight swelling, tenderness, no breathing difficulties), observation without medication may suffice.
• For moderate symptoms, oral antibiotics are recommended.
• Severe cases with expanding abscesses may require incision/drainage and intravenous antibiotics.
• If linked to other conditions (e.g., tuberculosis, malignancy, connective tissue diseases), treat the primary disease.

Can Cervical Lymphadenitis Be Completely Cured?

Most cases caused by viral or bacterial infections resolve spontaneously or with timely treatment.

Can Cervical Lymphadenitis Recur?

Recurrence is possible, especially if triggered by recurrent head/face or upper respiratory infections.

DIET & LIFESTYLE

What should patients with cervical lymphadenitis pay attention to in their diet?

There are no special dietary restrictions. Maintain a healthy, balanced diet as usual and ensure adequate nutrition.

What should patients with cervical lymphadenitis pay attention to in daily life?

Get adequate rest, take medication on time, and cooperate with treatment.

If undergoing incision and drainage, avoid getting the wound area wet until it has fully healed (after the doctor removes sutures and surface dressings).

PREVENTION

Can cervical lymphadenitis be prevented?

By addressing the causes, paying attention to personal and household hygiene, washing hands frequently, and reducing cross-infection of viruses and bacteria, the occurrence of this disease can be reduced.