What is the treatment for chronic parotiditis?

Treatment of Chronic Parotiditis

The treatment of chronic parotiditis should begin with conservative management including gland massage, sialagogues, and antibiotics, with surgical options reserved for refractory cases.

Conservative Management (First-Line)

Initial Approach

• Gland massage and sialagogues to stimulate salivary flow 1, 2
• Local application of superficial moist heat to reduce inflammation 3
• Periodic pus drainage by manipulating the parotid glands 3
• Adequate hydration to prevent dehydration which can worsen symptoms 4

Antibiotic Therapy

• Broad-spectrum antibiotics based on culture and sensitivity results 3
  • Target common pathogens including Staphylococcus aureus (accounts for 80% of cases), streptococci, anaerobes, and gram-negative bacilli 3
  • Consider fluconazole (200-400 mg daily for 14-21 days) if fungal etiology is suspected 5

Advanced Conservative Options

• Sialendoscopy with duct rinsing and cortisone instillation for more severe cases 2
  • Particularly useful for diagnosing and treating strictures or stenoses typical in adult forms 2

Surgical Management (For Refractory Cases)

Indications for Surgical Intervention

• Failure of prolonged conservative management 6
• Persistent symptoms affecting quality of life 1
• Recurrent severe infections unresponsive to medical therapy 6

Surgical Options (in order of increasing invasiveness)

1. Ductal procedures:

   • Ductoplasty for strictures 1
   • Ductal ligation 1, 2

2. Tympanic neurectomy - disrupts parasympathetic innervation 1, 4

3. Parotidectomy - ultimate surgical option for refractory cases 6, 1, 2

   • Consider the risk of complications including:
     • Temporary facial weakness (occurs in ~27% of cases)
     • Permanent facial weakness (occurs in ~2.5% of cases)
     • Frey's syndrome (gustatory sweating)
     • Greater auricular nerve anesthesia 7

Special Considerations

Juvenile vs. Adult Chronic Parotiditis

• Juvenile form (ages 3-6, predominantly males):

  • Self-limiting in ~90% of cases as patients grow up 2
  • More conservative approach recommended 4

• Adult form (post-puberty, predominantly females):

  • May require more aggressive intervention if symptoms persist 4

Associated Conditions

• Sjögren syndrome patients with chronic suppurative parotiditis:
  • Conservative management with local heat application and periodic drainage may be effective even when antibiotics fail 3
  • Address underlying hyposalivation

Monitoring and Follow-up

• Regular ultrasound imaging to monitor disease progression 2, 4
• Evaluate treatment response based on:
  • Reduction in frequency and severity of acute episodes
  • Improvement in pain and swelling
  • Patient's quality of life

Diagnostic Workup

• Ultrasound as initial imaging modality 2, 4
• Sialography to evaluate ductal anatomy (may itself provide therapeutic benefit) 1, 4
• Diagnostic sialendoscopy to visualize ductal abnormalities 1, 2

Remember that chronic parotiditis is often a challenging condition that may require multiple treatment approaches before achieving symptom control.