Chronic parotitis is the persistent or recurrent inflammation of the parotid glands, the largest salivary glands located in front of the ears and over the jawline. These glands produce a significant portion of the saliva that moistens the mouth and aids in digestion. When inflammation becomes chronic, it disrupts the normal flow of saliva, leading to long-term discomfort and potential complications. The condition is characterized by repeated episodes of swelling and irritation, differentiating it from acute parotitis, which is a sudden, short-lived event.
Common Causes and Risk Factors
A major factor contributing to chronic inflammation is the obstruction of the salivary ducts, most commonly due to salivary stones (sialolithiasis). These blockages prevent saliva from draining correctly, leading to stagnation and subsequent swelling. This physical obstruction creates an environment susceptible to recurrent bacterial infections, as oral bacteria can ascend the ductal system.
Autoimmune diseases represent another cause of chronic parotid inflammation. Sjögren’s syndrome frequently targets the salivary and tear glands, leading to chronic swelling and dry mouth. Systemic factors, including diabetes mellitus, also increase vulnerability by affecting the body’s overall inflammatory response and immune function.
Risk factors often center on anything that reduces the production or flow of saliva. Dehydration and certain medications, such as antihistamines or psychotherapeutics, can decrease salivary flow, promoting conditions necessary for infection. Poor oral hygiene and advanced age also contribute to risk by altering the oral environment and reducing the natural flushing mechanism of the glands.
Recognizing the Signs of Inflammation
The primary presentation involves recurrent or persistent swelling of the gland, visible near the ear and the angle of the jaw. This enlargement can range from a subtle fullness to noticeable facial asymmetry. While acute episodes are intensely painful, chronic parotitis often presents with less severe discomfort.
Patients frequently report tenderness or pain in the affected area, often exacerbated when eating or drinking. Stimulating saliva production increases pressure within the inflamed gland and causes a flare-up of symptoms. Other signs may include xerostomia (dry mouth) or a change in the consistency of the saliva.
During acute exacerbations, systemic symptoms can develop. These flare-ups may be accompanied by a fever, general malaise, and sometimes a foul taste in the mouth due to cloudy or purulent drainage from the duct. The persistence of these signs differentiates the chronic condition from a single, self-limiting inflammatory event.
Diagnostic Testing for Parotitis
Diagnosis begins with a thorough clinical examination, assessing the patient’s symptoms and history of recurrent swelling. The examiner may gently massage the gland to check for discharge from the duct, which can be sent for a bacterial culture and sensitivity test. This step confirms inflammation and helps identify an active bacterial infection.
Imaging is necessary to determine the underlying cause, with salivary gland ultrasound often used as the preferred first modality. Ultrasound is effective for visualizing the gland’s structure, detecting stones (sialolithiasis), or identifying chronic inflammatory changes. If the ultrasound is inconclusive or a mass is suspected, a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) provides more detailed visualization of the gland and surrounding structures.
More specialized procedures include sialography, which involves injecting a contrast dye into the salivary duct to map the internal ductal system and identify strictures or blockages. In cases of ductal obstruction, sialendoscopy, a minimally invasive technique using a tiny scope, allows the physician to directly visualize and potentially treat the blockage simultaneously. Blood tests may also be ordered to check for markers associated with underlying systemic or autoimmune conditions, such as Sjögren’s syndrome.
Treatment and Management Strategies
Management of chronic parotitis starts with conservative measures aimed at improving salivary flow and reducing inflammation. Patients are encouraged to maintain excellent hydration and practice gentle gland massage, moving toward the duct opening near the cheek. Using sialogogues, such as sugar-free lemon drops or sour candies, helps stimulate saliva production and naturally flush the ductal system.
During an acute infectious flare, antibiotics are prescribed, often guided by a culture and sensitivity test, to eliminate the bacterial pathogen. For inflammation not caused by infection, nonsteroidal anti-inflammatory drugs (NSAIDs) help manage pain and swelling. Warm compresses applied to the swollen area also provide symptomatic relief.
When conservative methods fail, more advanced interventions address mechanical blockages or chronic inflammation. Sialendoscopy, used diagnostically, can also be therapeutic by allowing for the removal of small stones or the dilation of narrowed ducts. In cases linked to autoimmune disease, a short course of oral corticosteroids may rapidly reduce pain and swelling during flare-ups.
For patients with severe, persistent, or recurring symptoms that significantly affect their quality of life, surgical options may be necessary. Procedures like tympanic neurectomy disrupt the nerve signals that cause excessive saliva production, leading to gland atrophy. The ultimate surgical option, reserved for refractory cases that fail all other treatments, is a partial or total parotidectomy, involving the surgical removal of the affected gland.