Parotitis

Parotitis is an inflammation of the parotid glands, the largest of the salivary glands, located on either side of the face, in front of and below the ears. It can be unilateral (affecting one gland) or bilateral (affecting both glands).

Causes:

Parotitis can be caused by a variety of factors, including:

• Viral Infections: The most common cause is the mumps virus. However, other viruses such as Epstein-Barr virus, Coxsackievirus, and influenza viruses can also cause parotitis.

• Bacterial Infections: Bacterial parotitis, often caused by Staphylococcus aureus, is more common in individuals who are dehydrated, have poor oral hygiene, are malnourished, or have a chronic illness. Blockage of the salivary duct can predispose to bacterial infection.

• Autoimmune Disorders: Sjögren's syndrome is an autoimmune disorder that can cause chronic parotitis.

• Ductal Obstruction: Blockage of the parotid duct (Stensen's duct) by a salivary stone (sialolithiasis) or other mass can lead to inflammation and infection.

• Medications: Certain medications, such as diuretics and anticholinergics, can decrease saliva production, increasing the risk of parotitis.

• Radiation Therapy: Radiation to the head and neck area can damage the salivary glands and cause parotitis.

Symptoms:

Symptoms of parotitis may include:

• Swelling and tenderness in the parotid gland area (cheek, jaw, or in front of the ear).
• Pain, especially when chewing or swallowing.
• Fever.
• Redness or warmth over the affected gland.
• Difficulty opening the mouth.
• Pus draining from the parotid duct (in bacterial infections).
• Dry mouth.

Diagnosis:

Diagnosis typically involves a physical examination. The physician will check for swelling and tenderness of the parotid glands. Additional tests may include:

• Blood tests: To check for infection or autoimmune disorders.
• Salivary Amylase Levels: Elevated levels might indicate parotid inflammation.
• Viral culture: To identify a viral cause (e.g., mumps).
• Imaging studies: Ultrasound, CT scans, or MRI scans may be used to identify ductal obstruction, abscesses, or other abnormalities.
• Sialography: X-ray of the salivary ducts after injecting a contrast dye.

Treatment:

Treatment depends on the underlying cause:

• Viral Parotitis: Management is primarily supportive, including rest, fluids, and pain relief with over-the-counter medications like acetaminophen or ibuprofen. Warm or cool compresses can help relieve pain and swelling.

• Bacterial Parotitis: Antibiotics are the mainstay of treatment. Hydration and good oral hygiene are also important. In some cases, drainage of an abscess may be necessary.

• Ductal Obstruction: Conservative measures, such as massage of the gland, warm compresses, and increased fluid intake, may help to dislodge a salivary stone. If conservative measures fail, surgical removal of the stone or, in rare cases, the entire gland may be necessary.

• Autoimmune Parotitis: Treatment focuses on managing the underlying autoimmune disorder. This may involve medications such as corticosteroids or immunosuppressants.

Prevention:

• Vaccination: The MMR vaccine (measles, mumps, rubella) is highly effective in preventing mumps parotitis.
• Good Oral Hygiene: Regular brushing and flossing can help prevent bacterial parotitis.
• Adequate Hydration: Staying well-hydrated can help prevent salivary duct blockage.
• Salivary Gland Stimulation: Sucking on sugar-free candies or chewing gum can stimulate saliva flow and help prevent salivary stasis.

Complications:

Possible complications of parotitis include:

• Abscess formation.
• Spread of infection to other areas.
• Meningitis or encephalitis (in mumps parotitis).
• Orchitis (inflammation of the testicles) or oophoritis (inflammation of the ovaries) in mumps parotitis, potentially leading to infertility.
• Facial nerve paralysis (rare).
• Recurrent parotitis.