From the Guidelines
Parotiditis should be treated supportively, as indicated by the most recent evidence 1, which emphasizes the importance of rest, hydration, and pain management. The treatment approach for parotiditis, an inflammation of the parotid gland, varies depending on whether the cause is viral or bacterial.
- For viral parotiditis, which is commonly caused by the mumps virus, treatment is primarily supportive, including:
- Rest
- Adequate hydration
- Pain relievers such as acetaminophen or ibuprofen
- Warm or cold compresses applied to the swollen area
- The diagnosis of viral parotiditis can be made through clinical presentation, including symptoms such as febrile prodrome and morbilliform rash, and confirmed by tests like the heterophile antibody test or IgM antibodies versus viral capsid antigen, Epstein-Barr virus 1.
- For bacterial parotiditis, antibiotics may be prescribed, and maintaining good oral hygiene and stimulating saliva production through sour candies or lemon juice can help clear the ducts.
- Prevention of mumps, a common cause of viral parotiditis, is achievable through vaccination with the MMR vaccine, which is administered in childhood.
- It's crucial to note that while most cases of viral parotiditis resolve without complications, rare cases can lead to serious outcomes such as hearing loss, meningitis, or testicular inflammation in males, emphasizing the need for prompt and appropriate management based on the latest medical evidence 1.
From the Research
Causes of Parotiditis
- 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 recently recognized as an important cause of this infection 2
- Drug-induced parotitis has been associated with medications such as l-asparaginase, clozapine, and phenylbutazone 3
Diagnosis and Management
- Assessment of the disease process should differentiate local primary parotid infection from systemic infection when this gland is also involved as part of a generalized inflammatory condition 2
- 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
- Early and proper antimicrobial therapy may prevent suppuration 2
- Surgical drainage may be indicated when pus has formed 2
- Sialography remains the investigation of choice for chronic parotitis, but diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice 4
Complications and Risk Factors
- Predisposing factors to suppurative infections include dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation 2
- Diabetes mellitus is a significant comorbid factor for parotid abscess 5
- Facial nerve palsy and overwhelming septicaemia are potential complications of parotid abscess 5