What could be causing my sore throat, post-nasal drainage, nausea, and jaw pain that radiates to my ear and neck, without fever or chills?

Likely Diagnosis: Acute Bacterial Sinusitis with Post-Nasal Drainage

Your constellation of symptoms—sore throat, post-nasal drainage, jaw pain radiating to the ear and neck, and nausea without fever—most strongly suggests acute bacterial sinusitis with secondary pharyngeal irritation from post-nasal drainage. 1, 2

Clinical Reasoning

Primary Diagnosis: Acute Bacterial Sinusitis

Your presentation fits the diagnostic criteria for acute bacterial sinusitis, particularly the "persistent illness" pattern:

• Persistent symptoms beyond 10-14 days from your initial illness strongly correlates with bacterial rather than viral infection 2
• Post-nasal drainage with sore throat is a cardinal symptom of bacterial sinusitis, where purulent secretions drain posteriorly causing pharyngeal irritation 2, 3
• Nausea can occur with sinusitis, particularly when associated with gagging on mucus drainage 2
• Absence of fever does not exclude bacterial sinusitis, as fever is less frequent and not required for diagnosis 2

Jaw and Ear Pain Explained

The jaw pain with movement radiating to your ear and neck has two likely mechanisms:

• Referred pain from maxillary sinusitis: The maxillary sinus sits directly above the upper jaw, and inflammation causes facial-dental pain that can radiate to the ear 2, 4
• Eustachian tube dysfunction: Post-nasal drainage causes ear pressure and fullness, which is a recognized supporting symptom of sinusitis 2
• The pain-with-movement pattern suggests musculoskeletal referred pain from sinus inflammation rather than temporomandibular joint pathology 4

Post-Nasal Drainage as the Unifying Feature

Post-nasal drainage is the key symptom connecting your presentation:

• Sore throat from PND: The "reddish curtain sign" on the posterior pharyngeal wall is characteristic of PND-induced throat irritation 5
• Cough and throat clearing: PND commonly causes these symptoms through pharyngeal irritation rather than actual secretion volume 6, 7
• Halitosis: If present, this would further support bacterial sinusitis with post-nasal drainage 3

Diagnostic Criteria Met

You meet the American Academy of Allergy, Asthma, and Immunology criteria for acute bacterial sinusitis:

• Persistent illness pattern: Symptoms lasting beyond 10-14 days without improvement 2
• Cardinal symptoms present: Post-nasal drainage, sore throat (from drainage), and facial pain (jaw/ear) 2

Critical Differential Diagnoses to Consider

Less Likely but Important Alternatives

• Allergic rhinitis: Would typically present with clear (not purulent) discharge, nasal itching, sneezing, and seasonal pattern—none of which you describe 1
• Migraine masquerading as "sinus headache": A common pitfall, but your post-nasal drainage and recurrent pattern make sinusitis more likely 1
• Viral upper respiratory infection: Unlikely given symptom duration beyond 10-14 days 2

Red Flags to Monitor

Return immediately if you develop 1:

• Eye pain, swelling, or visual changes (orbital complications)
• Severe headache, altered mental status, or neck stiffness (neurological complications)
• High fever ≥39°C/102.2°F with worsening symptoms

Treatment Approach

First-Line Antibiotic Therapy

Amoxicillin-clavulanate is the preferred antibiotic for acute bacterial sinusitis caused by beta-lactamase-producing organisms (H. influenzae and M. catarrhalis), which are the most common pathogens 8:

• Standard dosing per FDA labeling for sinusitis 8
• Covers beta-lactamase-producing strains that plain amoxicillin would miss 8

Alternative if penicillin-allergic: Azithromycin is FDA-approved for acute bacterial sinusitis, though resistance patterns should be considered 9

Symptomatic Management

• Nasal saline irrigation: Helps clear purulent secretions and reduce post-nasal drainage 1
• Adequate hydration: Thins secretions and reduces halitosis from dry mouth 3
• Decongestants: May provide temporary relief of nasal congestion 1

Common Pitfalls to Avoid

• Don't diagnose based on colored nasal discharge alone: Mucopurulent secretions occur normally after several days of viral infection and are not specific for bacterial disease 2
• Don't order imaging routinely: Reserve CT scans for treatment failures, confusing presentations, or surgical planning 2
• Don't attribute all "sinus headache" to sinusitis: Many are actually migraines, but your post-nasal drainage makes sinusitis the more likely culprit 1
• Don't miss serious pathology: If symptoms persist despite appropriate treatment, consider referral to otolaryngology to rule out anatomic abnormalities, nasal polyps, or rarely, malignancy 1, 6

Follow-Up Expectations

• Symptoms should improve within 3-5 days of starting antibiotics 2
• If no improvement after 7 days of appropriate antibiotics, reassess for complications or alternative diagnoses 2
• Recurrent episodes (≥4 per year) warrant evaluation for underlying predisposing factors such as anatomic abnormalities, allergic rhinitis, or immunodeficiency 1