parotitis

Parotitis: description

A distinction is made between acute and chronic forms of parotitis (parotitis):

Acute parotitis is bacterial or viral. The best known example is the mumps (goat peter, parotitis epidemica), which is caused by the mumps virus. Especially unvaccinated toddlers get sick.

Doctors speak of a chronic-recurrent parotitis, if the parotitis repeatedly recurring. It is the most common form of parotitis and can occur in both children and adults.

Parotitis: anatomy of the gland

The parotid gland (Glandula parotidea, shortly called Parotis) is located on both sides of the facial rim in front of the ears. It is one of the major salivary glands and ensures the secretion of saliva while chewing. The excretory duct of the gland is located on the oral mucosa opposite the upper molars.

The parotid is surrounded by a connective tissue capsule. Inflammation of the parotid gland swells it, and the capsule is put under tension. This capsule tension is painful.

Inflammation of other salivary glands

In addition to the parotid gland, there are two other large salivary glands. You can read more about their inflammation in the article Salivary Inflammation.

Parotitis: symptoms

In parotitis, the affected parotid gland can swell up. The swelling is visible on the outside: it runs from the cheeks to the ears, on one or both sides.

The swelling can lead to a jaw clamp, which makes it difficult for patients to take food. In addition, they complain of pain in the parotid gland. These are often based on the tension of the capsule surrounding the parotid.

While chronic-recurrent parotitis may be associated with pus, which may discharge into the oral cavity, the secretion in epidemic parotitis is rather watery. Fever can occur in both diseases, as well as fatigue and a general malaise.

Parotitis: causes and risk factors

Acute parotitis is caused by viruses or bacteria. The most common viral pathogen is the mumps virus (parotitis epidemica): Here, the first symptoms (incubation period) show up about 17 to 21 days after the infection.

Rarely, other viruses trigger acute parotid gland inflammation, such as the cytomegalovirus.

Bacterial pathogens of acute parotitis usually belong to the staphylococci or streptococci. The germs can ascend from other body regions via the blood or lymph channels in the parotid gland. Also disturbed salivation with inadequate fluid intake and a weakness of the immune system sometimes lead to a bacterial parotid inflammation.

The causes and pathogenesis of chronic recurrent parotitis have not been conclusively clarified. It is believed that viruses or bacteria are responsible for the acute relapses. It is unclear why the germs multiply and can cause inflammation over and over again. Various causes are discussed:

• decreased saliva production
• Blockage of the excretory ducts
• allergy
• wide excretory ducts

sialoliths

If the saliva thickens, so-called salivary stones can develop in the ducts of the salivary glands. They can block the drain and cause inflammation. Here you can learn more about the saliva stone.

Parotitis: examinations and diagnosis

If you notice persistent swelling of the parotid gland and have pain or other signs of illness, seek medical attention. The specialist in the treatment of parotitis is the ear, nose and throat doctor.

First, this interviews you in detail about your medical history (medical history). Possible questions include:

• Since when are you having those complaints?
• Do you have fever? If yes, how much does this increase?
• Do you suffer from a chronic illness?
• Are you vaccinated against mumps?
• Have you had similar symptoms in the past?

Parotitis: physical examination

Then follows the physical examination. First, the doctor looks at the head and neck region closely. He pays attention to possible swelling of the parotid gland and a reddening of the skin. Then he scans the parotid and the neck. In addition to swelling of the salivary glands, it can also detect swelling of the lymph nodes on the neck.

In case of acute bacterial parotitis, the physician will massage out the accumulated pus from the duct of the gland. Sometimes the pus also empties itself. The doctor can take a smear and have the exact bacterial pathogen determined. Then he can choose the optimal antibiotic for therapy.

The diagnosis of acute parotitis can often be based on the symptoms, the physical examination and the history of the disease.

Sialography in chronic recurrent parotitis

Especially with a chronic-recurrent parotitis sometimes a further diagnosis is necessary. With the help of a so-called sialography – a special X-ray examination – the doctor can represent the parotid gland as well as its excretory duct and its branching in the gland. For this, contrast medium is injected into the gland duct and then an X-ray image is taken:

In the case of chronic recurrent parotitis, the first signs are the cord-like ganglia that have developed as a result of scarring. In the further course of the disease, the corridors are destroyed. In sialography, only a few passages are visible. Salivary stones, benign and malignant tumors can also be detected with the examination.

In order to detect salivary stones, abscesses or tumors, an ultrasound examination is sometimes sufficient. In rare cases, magnetic resonance imaging (MRI), computed tomography (CT) or endoscopy of the gland duct (sialendoscopy) may be necessary to clarify parotitis. The latter examination is performed under local anesthesia and also allows the removal of a tissue sample. In addition, it can be used therapeutically to flush the gland duct.

Parotitis: treatment

Ample fluid intake, soft nutrition, and careful oral hygiene are common treatments for parotitis. Envelopes of cool water, cottage cheese or ointment can relieve the pain. In addition, saliva stimulating agents (Sialogoga) such as sweets, chewing gum or sour juices are recommended: The increased salivation cleans the gland ducts.

These symptom-alleviating measures are the only one that can be done with viral parotitis (as in mumps). If necessary, you can also give antipyretic analgesics such as acetaminophen or ibuprofen. Ibuprofen also inhibits inflammation.

If you have bacterial parotitis, your doctor will prescribe you antibiotics. These kill bacteria or prevent their reproduction. If an abscess (encapsulated pus buildup) has already formed, it must be surgically opened. So the pus can drain.

If antibiotics do not help and / or the parotitis repeatedly occurs, removal of the parotid (parotidectomy) may be necessary.

Parotitis: disease course and prognosis

Acute parotitis usually heals completely in treatment within a few days. However, if a narrowing of the gland duct is the trigger for the parotid gland inflammation and is not treated, the inflammation can recur again and again.

Chronic recurrent parotitis, as the name implies, is a recurrent inflammation of the parotid gland. When children get sick, it usually heals without consequences at puberty. In adults, however, often scarred changes remain behind. These can hinder the flow of saliva and eventually necessitate a parotidectomy later on. There is a risk that the facial nerve, which is responsible for the facial movements, is damaged. Then no or only limited facial expressions are possible on the affected half of the face.

Mumps can cause serious complications. These include deafness, an inflammation of the brain or meninges (encephalitis, meningitis) and inflammation of the pancreas (pancreatitis) or testes (orchitis) possible. To children before the parotitis epidemica and the possible consequences, there is a vaccine. This is usually given in combination with a vaccine against measles and rubella (MMR vaccine).