From the Guidelines
Parotitis is characterized by symptoms including fever, bilateral parotid gland swelling, headache, nausea, vomiting, and conjunctivitis/keratitis that follows parotid gland involvement, as seen in mumps 1. The symptoms of parotitis can vary depending on the cause, but common signs include pain, swelling, and tenderness in the area between the ear and jaw.
- Facial pain that worsens when eating
- Redness and warmth over the affected gland
- Fever
- Dry mouth
- Sometimes pus draining from the salivary duct Treatment options for parotitis depend on the underlying cause, with viral parotitis typically managed with supportive care, including rest, hydration, warm compresses, and pain relievers such as acetaminophen or ibuprofen.
- For bacterial parotitis, antibiotics are necessary, and the choice of antibiotic may depend on the severity of the infection and the patient's allergy history.
- Maintaining good oral hygiene, staying well-hydrated, and gently massaging the gland while sucking on sour candies can help stimulate saliva flow and relieve symptoms. The most effective treatment approach for parotitis, especially in cases of mumps, is supportive care, as outlined in the study on conjunctivitis preferred practice pattern 1, which highlights the importance of managing symptoms and preventing complications. In severe cases, hospitalization for IV antibiotics may be required, and surgical drainage may be needed if an abscess forms.
- Chronic parotitis may require additional interventions like sialendoscopy or, rarely, removal of the gland. Prompt treatment is crucial to prevent complications such as abscess formation or spread of infection to surrounding tissues.
From the Research
Symptoms of Parotitis
- Painful swelling of the parotid gland 2
- Dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation can predispose to suppurative infections 2
- Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses 2
- Acute suppurative parotitis is generally caused by Staphylococcus aureus, Streptococcus species, and rarely, gram-negative bacteria 2
- Anaerobic bacteria, mostly Peptostreptococcus species and Bacteroides species, and pigmented Porphyromonas species and Prevotella species have been recognized as an important cause of this infection 2
Treatment Options for Parotitis
- Early and proper antimicrobial therapy may prevent suppuration 2
- Initial empiric therapy that is directed against both aerobic and anaerobic bacteria may be required until a specific causal diagnosis is available 2
- Surgical drainage may be indicated when pus has formed 2
- Antibiotic concentrations in saliva of purulent parotitis can be determined to guide treatment 3
- Management options for chronic parotitis include conservative or surgical methods, such as injection of methyl violet, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy 4
- Palliative treatment may be used for chronic parotitis, and early clinical recognition can lead to appropriate and successful care 5
- Drug-induced parotitis is a rare adverse drug reaction, and medications that are associated with drug-induced parotitis include l-asparaginase, clozapine, and phenylbutazone 6