From the Guidelines
Parotitis should be managed supportively, as the most recent and highest quality evidence suggests that treatment is usually none, with a focus on relieving symptoms. The diagnosis of parotitis can be made clinically, and in some cases, through heterophile antibody tests or PCR of saliva [ 1 ]. The condition commonly presents with pain, swelling, and tenderness in the affected area, and the most frequent cause is viral infection, particularly mumps.
Key Considerations
- The management of parotitis depends on the underlying cause, with viral parotitis being managed supportively with adequate hydration, warm compresses, and pain relievers like acetaminophen or ibuprofen.
- Bacterial parotitis requires antibiotics, but the provided evidence does not specify the exact antibiotic regimen for this condition [ 1 ].
- Increasing fluid intake, using warm compresses, and sucking on sour candies can stimulate saliva flow and help relieve symptoms.
Important Symptoms and Signs
- Pain, swelling, and tenderness in the affected area are common symptoms of parotitis.
- Fever and difficulty swallowing can be indicative of a more severe infection, such as abscess formation, which may require surgical drainage.
- Crops of papules, vesicles, and crusts can be confused with exudative pharyngitis, but the diagnosis of parotitis can be confirmed through PCR of saliva or serology [ 1 ].
From the Research
Causes of Parotitis
- 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 3, 2
- Predisposing factors to suppurative infections are dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation 2
Diagnosis of Parotitis
- Sialography remains the investigation of choice for chronic parotitis 4
- Diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice 4
- Pus, aspirated from a suppurative parotic abscess, should be plated on media that are supportive for the growth of aerobic and anaerobic bacteria, mycobacteria, and fungi 2
Management of Parotitis
- Therapy includes maintenance of hydration and administration of parenteral antimicrobial therapy 3
- Once an abscess has formed, surgical drainage is required 3, 2
- The choice of antimicrobial depends on the etiologic agent 3
- Management options for chronic parotitis are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention 4
- Surgical methods that have been described include injection of methyl violet - a sclerosing agent, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy 4