Parotitis is the medical term for inflammation of the parotid gland, located just in front of the ears. This condition causes noticeable, often painful, swelling in the area between the ear and the jaw, sometimes making it difficult to open the mouth or chew food. Accompanying symptoms frequently include a fever, general feeling of illness, and tenderness over the swollen gland. Effective treatment depends entirely on identifying the source of the inflammation.
Determining the Underlying Cause
The initial step in managing parotitis involves determining the specific cause, as the treatment approach varies significantly. Parotitis is broadly classified into three main categories: viral, bacterial, and obstructive. Viral parotitis is the most common cause, frequently associated with the mumps virus, though other viruses like influenza or Epstein-Barr can also be responsible. This form is typically self-limiting.
Bacterial parotitis often develops when the flow of saliva is reduced, creating an environment where bacteria can multiply and cause infection. This type is more common in elderly individuals, those who are dehydrated, or people with other systemic illnesses. The bacteria, often Staphylococcus aureus, ascend from the mouth into the gland, leading to a sudden, painful swelling that may present with pus draining from the duct.
Obstructive parotitis occurs when the duct becomes blocked. The most frequent cause of this blockage is a salivary stone, or sialolith, which is a concentration of mineral salts. Blockages can also be caused by scar tissue or mucous plugs, causing saliva to back up and the gland to swell, often noticeably increasing in size when a person begins to eat.
General Management and Home Care
Supportive care measures are effective for managing symptoms. Staying well-hydrated is important, as sufficient fluid intake helps to maintain and promote saliva production, which can flush out the gland and ease symptoms. Adequate hydration helps to prevent the salivary stasis that often precedes a bacterial infection.
Managing pain and swelling can be accomplished with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, or with acetaminophen. Applying moist heat or a warm compress to the swollen area for 10 to 20 minutes several times a day can also help reduce inflammation and soothe the tenderness. The warmth may also encourage the flow of saliva through the blocked duct.
Another therapeutic measure involves stimulating the flow of saliva using sialagogues. Sucking on sour candies, especially those with lemon flavor, or using lemon drops can help increase salivary output. Gently massaging the parotid gland, starting from the back near the ear and moving toward the front of the face and jaw, can physically help to push trapped saliva or a stone out of the duct.
Specific Medical Interventions
For cases of parotitis caused by a viral infection, such as mumps, the treatment remains largely supportive. There are generally no specific antiviral medications given, as the infection resolves on its own. However, prompt evaluation by a healthcare provider is still necessary to confirm the diagnosis and rule out other causes.
When bacterial parotitis is confirmed, treatment requires a course of antibiotics to target the infection, often beginning with a broad-spectrum drug like amoxicillin-clavulanate. If pus is present, a sample may be taken and cultured to identify the specific bacteria. If the infection progresses and forms a localized collection of pus, known as an abscess, aspiration or surgical drainage may be necessary to remove the infected material.
Treatment for obstructive parotitis focuses on relieving the blockage caused by salivary stones or strictures. Small stones can sometimes pass naturally with increased hydration, massage, and the use of sialagogues. For stones located closer to the duct opening, sialendoscopy can be performed, which involves inserting a tiny scope to visualize and remove the stone. If the stone is large, deeply embedded, or if the parotitis is chronic and recurring, surgical removal of the stone or even the parotid gland itself, known as a parotidectomy, may be considered.