Parotitis

Parotitis is the inflammation of the parotid gland. The parotid gland is one of your system's most critical salivary glands that release saliva in your oral cavity to help with the chewing of food and keep your oral cavity from drying out. These glands are situated on either side of the face in front of our ears. The parotid gland is the most commonly affected among the three major salivary glands. Although the symptoms can cause discomfort for a certain period, the inflammation of the parotid gland usually heals within a short time.

Common causes of parotitis include viral and bacterial infections. The well-known cause of parotitis is mumps. Mumps is a viral disease caused by a paramyxovirus. The parotid glands become swollen and enlarged during this infection and are usually tender to touch. This infection resolves itself within two to three weeks. Another viral cause of parotitis is Human Immunodeficiency Virus (HIV). The disease by this virus can also result in enlargement of the parotid glands and dry mouth.

Bacterial parotitis is most commonly caused by Staphylococcus aureus. In most cases, only one parotid gland is enlarged and swollen. Pus formation is also common and released into the oral cavity. Another cause is Mycobacterium tuberculosis which can affect the parotid glands as well, along with causing chest infection. Extreme dehydration or oral cavity can also result in enlargement of the parotid glands. Other causes include blockage of the parotid duct, parotid gland tumor, Sjogren’s syndrome, sialadenosis, sarcoidosis, bulimia, and pneumoparotitis.

The typical symptoms of parotitis include enlargement of the parotid gland on one or both sides of the face, swelling, redness, tender to touch, and pain, especially while chewing and swallowing food. The size of the gland can also restrict the opening and closing of the mouth. In a viral or bacterial infection, fever and other generalized body symptoms are also present. Pus drainage from the parotid duct opening is frequent in a bacterial infection. You may experience an abnormal taste and an overall dry mouth. The facial muscles overlying the parotid gland might also become inflamed in some cases.

As mentioned earlier, the most common cause of parotitis is mumps. Therefore, children between 6 months to 16 are at high risk if they have not been vaccinated for this virus. Once vaccinated, the risk of mumps can be prevented for a lifetime in most cases. People diagnosed with HIV are a high risk as well. Bacterial parotitis usually occurs due to poor oral hygiene, so anyone with ill-maintained oral hygiene is at stake. If you are frequently dehydrated or take medications that cause dryness of the oral cavity, there’s a risk of parotid gland enlargement to compensate for the decreased salivary flow. Women can develop parotitis during or after menopause since they’re at risk for Sjogren’s syndrome at that age.

Ever since the vaccine for mumps virus was discovered, the cases of mumps and parotitis have significantly reduced worldwide. Sjogren’s syndrome-related parotitis occurs more frequently in females than males.

The diagnosis of parotitis requires a detailed history and a thorough clinical examination to list out the possible causes. Since the most common causes are viral or bacterial infections, a swab is taken from the cheek or mouth region to identify the particular virus or bacteria. If a blockage of the parotid duct is suspected by a possible salivary stone, a CT scan or MRI might be necessary to visualize the obstruction. In rare cases, a parotid gland biopsy rule out parotid gland tumors. 

The enlargement or inflammation of the parotid gland can be mistaken with other myofascial tissue enlargements. Other diseases that present with similar symptoms as parotitis include sialadenitis of the submandibular salivary gland, retropharyngeal abscess, salivary gland neoplasia, and angioneurotic edema.

The treatment of parotitis is based on the cause of inflammation. In the case of mumps, generally, no treatment is required since the infection resolves by itself within two or three weeks. If pain is intolerable or you’re having difficulty chewing food, over-the-counter analgesics such as aspirin or ibuprofen can be helpful. It is also beneficial to massage the affected parotid gland from the outside and use warm saline rinses to aid from the inside. Lemon drops can be used in some cases to stimulate saliva production. Antibiotics and surgical pus drainage might become necessary in pus from the parotid duct opening. A parotid gland tumor will require partial or complete gland removal.

Analgesics such as aspirin, Tylenol, or ibuprofen can help in reducing pain and inflammation of the parotid gland. Broad-spectrum antibiotics such as penicillin would only be prescribed in pus drainage or abscess formation.

In the majority of the cases, parotitis heals well within a short period. Mumps-related parotitis does not require medications or extensive treatment and generally has a good prognosis. However, the prognosis of TB or HIV-related parotitis depends on the severity and treatment of the primary disease. Similarly, the prognosis of parotitis due to a parotid gland tumor depends on the grade of the tumor and its stage of diagnosis.

The primary prevention against mumps-related parotitis is vaccination. Avoiding direct contact with an infected person is essential. Vaccination is also necessary for Mycobacterium tuberculosis to prevent the risk of this disease. Sexual contact with a person infected with HIV should be avoided. Proper oral hygiene maintenance by brushing twice a day and rinsing with antiseptic mouthwashes is the key to preventing the risk of parotitis. Drinking an adequate amount of water every day is an excellent way to prevent your oral cavity from drying out. Alcohol and smoking can also be contributing factors that increase the risk of parotitis, so they should be limited or avoided if possible.

https://www.ncbi.nlm.nih.gov/books/NBK560735/

https://my.clevelandclinic.org/health/diseases/23577-parotitis-parotid-gland-swelling

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on Nov 09th, 2023.