From the Guidelines
Bilateral parotid enlargement should be initially managed by identifying the underlying cause, with a focus on ruling out autoimmune disorders like Sjögren's syndrome, and then treated accordingly, as seen in the EULAR recommendations for Sjögren's syndrome management 1.
Causes and Initial Management
Bilateral parotid enlargement can be caused by various factors including viral infections, bacterial infections, autoimmune disorders, metabolic conditions, medication side effects, or rarely tumors. Initial management involves a thorough history, physical examination, and possibly blood tests, ultrasound, or biopsy if needed.
Autoimmune Causes
For autoimmune causes like Sjögren's syndrome, treatment may involve immunosuppressive therapy, as recommended by the EULAR guidelines, which suggest the use of hydroxychloroquine, glucocorticoids, and immunosuppressive agents like rituximab or belimumab in certain cases 1.
Metabolic Causes
Metabolic causes, such as those related to alcohol consumption, require management of the underlying condition, and public health policies aimed at reducing alcohol consumption can be effective in reducing morbidity and mortality associated with alcohol-related liver disease, as suggested by the EASL clinical practice guidelines 1.
Symptomatic Relief
Warm compresses applied to the area for 15 minutes several times daily can help relieve discomfort, as can ensuring adequate hydration and gentle massage of the glands. If the enlargement persists beyond two weeks, is associated with significant pain, difficulty swallowing, breathing problems, or is accompanied by fever, immediate medical attention is necessary to rule out more serious conditions.
Diagnostic Considerations
In diagnosing the cause of bilateral parotid enlargement, it's also important to consider other conditions that may present with similar symptoms, such as sarcoidosis, which can cause parotid swelling among other systemic manifestations, as outlined in the American Thoracic Society clinical practice guideline 1.
Treatment Approach
The treatment approach should be tailored to the underlying cause, with a focus on reducing morbidity, mortality, and improving quality of life, as emphasized by the most recent and highest quality studies 1.
From the Research
Causes of Bilateral Parotid Enlargement
- Bilateral parotid enlargement can be caused by various disease entities, including sialadenosis, infection, neoplasm, autoimmune, iatrogenic, and miscellaneous conditions 2
- The differential diagnosis of a parotid lesion is broad, and the otolaryngologist must consider inflammatory, neoplastic, autoimmune, traumatic, infectious, or congenital causes 3
Diagnostic Approach
- A comprehensive history and physical examination, in conjunction with judicious use of radiographic imaging and laboratory studies, facilitates making an accurate diagnosis 3
- An algorithm-based approach, using data obtained from the history and physical examination, can reduce the differential diagnosis and aid the clinician in deciding on further workup and treatment 2
Specific Conditions
- Sjögren's syndrome is a chronic autoimmune disorder that can cause bilateral parotid swelling, characterized by dryness of the mouth and eyes, and can be associated with other autoimmune disorders 4, 5
- The diagnosis of Sjögren's syndrome is based on characteristic clinical signs and symptoms, as well as on specific tests including salivary gland histopathology and autoantibodies 5
Radiological Evaluation
- A multimodality approach, including radiographic imaging, can be useful in evaluating bilateral parotid swellings 6