Parotitis (Parotid Gland Swelling)

Medically reviewed by John Carew, MD

Parotitis is inflammation of one or both parotid glands, two large salivary glands responsible for making approximately 50% of your saliva. The parotid glands are located in each cheek over the jaw and in front of the ears.

Saliva is important for health as it contains electrolytes, which support many bodily functions from transporting water in the body to supporting nerve and muscle function. Saliva also contains enzymes, such as salivary amylase which helps break down carbohydrates.

Parotitis occurs equally among all genders, but some types of parotitis, such as acute bacterial parotitis, are more common in older populations.

Types

There are several types of parotitis, based on what causes the parotitis to develop and whether the parotitis is acute or chronic. Acute parotitis is when symptoms like pain and swelling come on suddenly while chronic parotitis is long-lasting and recurring, meaning the symptoms will come and go.

Acute Bacterial Parotitis

Acute bacterial parotitis happens when a bacterial infection causes inflammation in the parotid glands. An infection of the bacteria Staphylococcus aureus, or Staph infection, is the most common cause of this type. This type of parotitis is uncommon among the general population. It most frequently affects older people but can affect people of any age, including infants.

Chronic Bacterial Parotitis

Chronic bacterial parotitis may be caused by stones (calculi), or concentrations of mineral salts, that become lodged in the salivary glands. It can also occur from an injury that causes narrowing of the salivary ducts. Another common cause of this type is decreased salivary flow, which can lead to inflammation that causes the infection.

Acute Viral Parotitis

Acute viral parotitis occurs from a viral infection. Most often, the cause is mumps, a contagious paramyxovirus characterized by symptoms such as swelling of the salivary glands and a tender, swollen jaw. Other viral causes include influenza (the flu) and enteroviruses (viruses primarily transmitted via the intestines) such as Coxsackie A and echovirus.

Chronic Parotitis

Chronic parotitis, also known as autoimmune parotitis, happens as a result of a chronic disease. Conditions that can cause this type include autoimmune disorders such as rheumatoid arthritis (RA), Sjögren's syndrome (a disorder where the immune system attacks parts of the body that make moisture), and systemic lupus erythematosus (a condition where the immune system attacks tissue in the body). This type of parotitis is characterized by recurring infections and symptoms.

Parotitis Symptoms

The main symptom of parotitis is swelling of the parotid glands, but there are other symptoms that may indicate parotitis. These include:

• Sore throat

• Fever

• Cloudy-appearing saliva

• Unpleasant or abnormal tastes in the mouth

• Redness over the upper neck or side of the face

• Chronic, non-tender swelling in the gland (in parotitis caused by certain conditions)

• Lump in the gland (in parotitis caused by tuberculosis)
  

In acute bacterial parotitis, increasingly painful swelling of the gland can occur. This pain is often made worse by chewing.

In acute viral parotitis, pain and swelling of the gland will typically last 5-9 days. Other symptoms include a lack of appetite, fever, and a general feeling of discomfort.

These are just some of the symptoms of parotitis. If you think you might have parotitis, visit a healthcare provider for diagnosis.

What Causes Parotitis?

When you have parotitis, your parotid glands swell and may be accompanied by other symptoms such as pain, loss of appetite, and sore throat. Many different factors can lead to this inflammation of the glands, including:

• Bacteria, such as staphylococcus aureus (staph), viridans streptococci, and escherichia coli (E. coli)

• Viruses, such as human immunodeficiency virus (HIV), influenza, and enteroviruses

• Mumps

• Decreased salivary flow

• Salivary gland blockage from calculi, or salivary duct stones

• Injury that causes narrowing of the salivary ducts

• Malignant (cancerous) and benign (non-harmful) salivary gland tumors

• Metabolic disorders, such as diabetes
  

• Inflammatory diseases such as rheumatoid arthritis, Sjögren's syndrome, and sarcoidosis (a condition that causes growths in the lungs, lymph nodes, eyes, and skin)

• Tuberculosis (TB), an infectious disease that mainly affects the lungs
  

• Certain types of drugs, such as drugs containing iodines or propylthiouracil, used to treat Graves' disease and hyperthyroidism (overactive thyroid)

Risk Factors

Risk factors of acute bacterial parotitis include dehydration, malnutrition, dental infections, and cystic fibrosis. There is also a higher risk of acute bacterial parotitis among older people, particularly as a complication after abdominal surgery or due to medication use. This demographic often takes medications that reduce salivary flow, which increases their risk of developing infected parotid glands.

Diagnosis

If you think you may have parotitis, schedule an appointment with a healthcare provider. The provider will discuss your symptoms with you and perform a physical exam to look for enlarged glands. They will also look for any pus or drainage in the mouth.

In some cases, the provider may need to run certain diagnostic tests to properly diagnose stones in the salivary ducts or abscesses (pus-filled bumps). These include:

• Computed tomography (CT) scan: An imaging test that uses X-ray technology to take detailed images of the inside of the body
  

• Magnetic resonance imaging (MRI) scan: A medical imaging technique that uses radio waves and a powerful magnetic field to produce detailed, three-dimensional images of the inside of the body

• Ultrasound: An imaging test that uses high-frequency sound waves to take pictures of the inside of the body

• Sialendoscopy: A medical technique that uses a tiny camera and other instruments to diagnose and treat salivary gland infections such as parotitis

If you are experiencing drainage or pus, the provider may send a sample for medical analysis to test for a bacterial infection and confirm bacterial parotitis.

Treatments for Parotitis

Treatment goals for parotitis are to kill bacteria, reduce swelling and pain, speed up healing, and reduce potential complications that could occur.

For milder cases, your provider may recommend the following:

• Drink plenty of water

• Apply warm compresses

• Perform a gentle glandular massage from back to front to help alleviate symptoms and aid in healing

• Take sialagogues, which are substances—usually lemons or sour candies—that help promote the production of saliva

• Try Tylenol (acetaminophen) or Advil (ibuprofen) to reduce pain and inflammation

Treatment for acute bacterial parotitis typically requires a course of antistaphylococcal antibiotics. Treatment may also include gentamicin (an antibiotic), analgesics (pain-relief medications), or intravenous (IV) hydration. During these treatments, it is important to stay hydrated by drinking enough water.

For cases of parotitis caused by inflammatory conditions or other health conditions such as tuberculosis, treatment or management of the underlying health condition is essential to relieve symptoms.

Prevention

You can't completely prevent parotitis as it can be caused by bacteria, viruses, and underlying health conditions. However, you can implement a few habits to reduce your risk. Try to:

• Drink plenty of water to stay hydrated

• Limit or avoid smoking

• Brush your teeth and floss at least twice per day, as good oral hygiene can help prevent bacterial parotitis

Related Complications

If left untreated, parotitis can result in a few potential complications. It's important to see a healthcare provider promptly if you experience any symptoms of parotitis to avoid complications. These complications include:

• Chronic bacterial parotitis: Long-lasting bacterial parotitis with symptoms of inflammation can result from autoimmune diseases or bacterial infections that are not treated. In rare cases, fistulas, or an abnormal connection between the salivary gland and the skin, can form.

• Xerostomia: Also known as dry mouth, xerostomia is a chronic condition where the mouth does not produce enough saliva to keep the mouth moist. It is a common side effect of Sjögren's syndrome and can lead to parotitis.

• Facial paralysis or facial nerve injury: This rare complication can result from chronic inflammation caused by an inflammatory disorder such as Sjögren's syndrome or lupus. Also, while rare, one of the risks of surgery or biopsies on the parotid is facial nerve injury.

• Septic thrombophlebitis: In rare cases, internal septic thrombophlebitis can occur. This is an extremely rare condition where a blood clot occurs, causing swelling or inflammation of the internal jugular vein. Thrombophlebitis is a serious condition that can be life-threatening if left untreated so it's important to get medical attention immediately.

A Quick Review

Parotitis is the inflammation of one or more of the parotid salivary glands, located in front of the ears. There are various types of parotitis, including bacterial and viral parotitis.

Symptoms of parotitis may include sore throat, swelling, fever, and an unpleasant or abnormal taste in the mouth. Causes include bacteria such as E. coli and viruses such as HIV and mumps. Health conditions such as autoimmune and metabolic disorders can also lead to parotitis, as can injuries that cause narrowing of the salivary ducts.

It isn't always possible to prevent parotitis, but it is possible to reduce your risk by limiting or avoiding smoking and maintaining good oral hygiene to prevent bacteria growth. You should see a healthcare provider if you think you may have parotitis. Leaving parotitis untreated can lead to chronic or serious complications so get it treated as soon as possible.

Frequently Asked Questions

Will parotitis go away on its own?

In some cases, parotitis will resolve on its own with self-care at home, but certain types (such as bacterial parotitis) will require treatment with antibiotics or further medical care. It is important to treat bacterial parotitis promptly to avoid further health complications.

How contagious is parotitis?

Parotitis caused by inflammation is not contagious. However, viral or bacterial parotitis is caused by infectious viruses or bacteria and can be spread from person to person.

Is it OK to massage the parotid gland?

Yes, it is safe to self-massage the parotid glands. When massaging the parotid glands to help treat parotitis, make sure to use gentle pressure and massage in the direction of back to front. A healthcare provider may also perform the massage to extract sialolithiasis (salivary stones), one of the causes of parotitis.

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