How is parotitis managed in adults?

Management of Parotitis in Adults

Parotitis can occur in adults and should be managed with supportive care including adequate hydration, analgesics for pain relief, and warm or cold compresses to reduce parotid pain and swelling. 1

Diagnosis

• RT-PCR of oral/buccal swab specimens from the parotid duct (Stensen's duct) is recommended for viral parotitis
• Serology for mumps IgM antibodies and paired acute/convalescent serum samples to demonstrate a 4-fold rise in mumps IgG antibodies
• Ultrasound is the appropriate initial imaging investigation for recurrent or chronic parotitis 2
• Sialography may supplement ultrasound for evaluation of ductal anatomy

Types of Parotitis in Adults

1. Acute Bacterial Parotitis

• Most commonly caused by Staphylococcus aureus and Streptococcus species 3
• Management:
  • Aggressive hydration to stimulate salivary flow
  • Intravenous antibiotics (initially broad-spectrum, then tailored based on culture results)
  • Analgesics and anti-inflammatory medications
  • Surgical drainage if abscess formation occurs 3

2. Viral Parotitis (including Mumps)

• Management:
  • Supportive care with adequate hydration
  • Analgesics for pain relief (acetaminophen or NSAIDs)
  • Warm or cold compresses to reduce parotid pain and swelling
  • Isolation of infected individuals to prevent spread 1

3. Recurrent/Chronic Parotitis

• Often caused by congenital abnormality of salivary gland ducts with recurrent ascending infection 2
• Management algorithm:

  1. Initial conservative approach:

     • Hydration
     • Sialagogues (lemon drops, sugar-free gum) to stimulate salivary flow
     • Massage of the gland
     • Antibiotics during acute exacerbations
     • Analgesics for pain control

  2. If conservative management fails:

     • Consider interventional radiology procedures:
       • Removal of stones with Dormia basket
       • Dilation of parotid duct strictures with balloon catheter 4

  3. For persistent severe cases:

     • Surgical options including parotid duct ligation, parotidectomy, or tympanic neurectomy 2, 5

Special Considerations

• Recurrent parotitis in adults may resolve spontaneously, with sialographic recovery occurring 3-5 years after clinical symptoms disappear 6
• Females are more commonly affected when disease starts after puberty 2
• Complications of untreated chronic parotitis may include marked degeneration of the parotid gland or chronic obstructive parotitis 6

Monitoring and Follow-up

• Regular follow-up to assess response to treatment
• Repeat imaging may be necessary to evaluate disease progression
• For recurrent cases, long-term follow-up (0.5-23 years in some studies) may be required 6

Pitfalls to Avoid

• Inadequate hydration can worsen symptoms and prolong recovery
• Failure to identify and treat underlying causes (stones, strictures) in recurrent cases
• Premature surgical intervention before adequate trial of conservative management
• Overlooking potential complications such as abscess formation requiring drainage

Remember that while most cases of acute parotitis respond well to supportive care and appropriate antimicrobial therapy when indicated, recurrent or chronic parotitis may require more aggressive interventions to achieve symptom control.