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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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Global Rise In The Incidence Of IBD A Cause For Concern, Say Experts

A capsule packed with electronics and genetically engineered living cells displayed by researchers at MIT. A smaller version of the capsule could eventually be used in humans to find signs of ulcers and inflammatory bowel disease. Image for representational purpose only.Photo Credit: AP

The rising incidence of Inflammatory Bowel Disease (IBD) across the globe has become a concern for doctors. While early diagnosis is lacking, diagnosis in itself is challenging considering that other conditions could mimic IBD.

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"IBD is a significant problem. It comprises Ulcerative Colitis and Crohn's Disease and is characterised by inflammation. It is different from Irritable Bowel Syndrome which is predominantly non-inflammatory," said Jonathan Leighton, president at the American College of Gastroenterology, U.S.

"Both Ulcerative Colitis and Crohn's Disease are complex immune-mediated diseases; there is a dysregulated immune response. We do believe there are genetic markers that contribute to the disease but not in isolation. There is a synergy between the external environment and gut bacteria," he added.

There is an increasing incidence of IBD across the globe. Including in North America and western Europe. "The prevalence is also rising… From 0.5% right now, the prevalence will increase to 0.6% in America," he said.

Early onset

There is also a rise in early onset cases among those under 18. For the Indian perspective, Vineet Ahuja, Professor of Gastroenterology, All India Institute of Medical Sciences, New Delhi, has pinpointed a challenge in diagnosing Crohn's disease. "We have peculiar issues such as intestinal tuberculosis, which is common in India and resembles Crohn's disease. The phenotype is very similar, and so is the clinical presentation. As a result, the challenge is greater," he said.

"What was an uncommon condition three decades ago has become much more common."Vineet Ahuja, Professor of Gastroenterology, All India Institute of Medical Sciences, New Delhi

On incidence in India, Dr. Ahuja observed that lifestyle changes have contributed. "What was an uncommon condition three decades ago has become much more common. Changes in lifestyle, a Westernised diet with high fat and high sugar, processed and packaged food cause an insult to the gut epithelium, precipitating inflammation."

T. S. Chandrasekar, founder and chief gastroenterologist, MedIndia Hospitals and Academy, and the Governor of American College of Gastroenterology, India region, said the incidence of IBD has almost doubled in India from 1990 to 2019, with a rise in the death rate as well.

A study in Tamil Nadu showed that there were more cases of Crohn's Disease than Ulcerative Colitis. Nearly 50% of IBD were Crohn's Disease and 40% were Ulcerative Colitis. It is important to catch patients early so treatment is better, he said.

Dr. Leighton noted that in terms of diagnosis there is still a delay in diagnosis, particularly among the young. "The symptoms of IBD overlap with Irritable Bowel Syndrome. This does delay diagnosis. Individuals with alarming symptoms such as bleeding and severe abdominal pain need a complete evaluation," he said.

Also ReadUrbanisation spurs rise of Inflammatory Bowel Disease in rural Telangana

Delay in diagnosis

There are other diseases that mimic IBD, and there is a need to rule out infections as well. "There is no single diagnostic test for Ulcerative Colitis or Crohn's Disease. It is a combination of a physical, laboratory, and endoscopy tests. We have come a long way in the treatment of IBD. Over the last 25 years, biological therapy has emerged that uses monoclonal antibodies specifically directed at inflammatory pathways. Several biologics have been developed to target different parts of the inflammatory pathways to control the disease thereby decreasing hospital stays and surgeries. In addition, we have developed small molecules that can be given orally that have had a significant impact."

Both stressed that the cost was a challenge. "There is no cure. It is a lifelong disease. So, in India, we are looking at low cost therapy such as faecal microbiota transplantation along with regular medication," Dr. Ahuja added.

Environmental factors play a big role in IBD, Dr. Leighton said, adding: "This includes smoking and antibiotics. There are no human studies that have proved the role of diet, but we do think some foods such as super processed foods have the potential to be pro-inflammatory. A healthy diet avoiding highly processed food, and consuming wholesome food — for instance a Mediterranean diet — is recommended."

Dr. Ahuja said patients are advised to avoid being restrictive about their diet as they could become malnourished. "Packaged and processed foods should be avoided. We have an anti-inflammatory diet containing curd and buttermilk, and less milk, more rice and millets, fresh fruits, and vegetables. Avoid red meat and consume fish. This seems to be helpful," he said.

What Is Amyloidosis?

Medically reviewed by Brigid Dwyer, MD

Amyloidosis is a rare protein-related condition that occurs when your body produces too many amyloid proteins, causing damage to your organs and tissues. Amyloid proteins are a type of protein that cannot be broken down by the body. Because of this, these proteins build up in your cells and organs, causing a variety of symptoms like pain, fatigue, and shortness of breath.

There are many types of amyloidosis and symptoms depend on the exact type you have and the organs the condition is affecting. Amyloid proteins can develop in your kidneys, brain, and heart, among other organs. Unfortunately, there is no cure for this condition at the time, but several treatments can help you manage the condition and reduce symptoms.

Types

There are four main types of amyloidosis. Each type depends on the exact protein buildup you have and how the condition developed.

AL amyloidosis: The most common type of amyloidosis, which occurs when there is a buildup of light chain proteins. This condition affects plasma cells, a type of immune system cell that helps your body fight infections. AL amyloidosis can affect several organs in your body and is more common in adults over the age of 65.

AA amyloidosis: This type of amyloidosis occurs as a side effect of other chronic inflammatory conditions, such as rheumatoid arthritis (RA), diabetes, or inflammatory bowel disease (IBD). This condition causes an abnormal buildup of a protein called serum amyloid A and can affect organs like the spleen, liver, and kidney.

Hereditary amyloidosis: Also known as familial amyloidosis, this condition is a rare type that occurs when amyloidosis gets passed down from generation to generation. The most common type of hereditary amyloidosis is known as ATTR, which carries gene mutations (changes) in the transthyretin (TTR) gene. This condition commonly affects the liver, but can also cause problems in your kidneys and heart.

Dialysis-related amyloidosis: This condition occurs when dialysis (a common kidney procedure that helps remove waste from your blood) can't remove enough beta-2 microglobulin from the blood—a protein that your kidneys usually filter. The buildup of this protein can affect your bones and joints and is more common in people who have kidney disease or kidney failure.

Amyloidosis Symptoms

The exact symptoms of amyloidosis will depend on what type you have and which organs have the excess buildup of proteins. Common systemic (body-wide) symptoms of amyloidosis include:

This condition can also affect several specific organs.

Organ

Symptoms

Kidneys

Excess protein in the urine, high cholesterol, swelling in the legs and abdomen, and changes in kidney size

Heart

Heart failure, thick ventricular walls, enlarged heart, irregular heartbeat, and low blood pressure

Brain

Tingling and numbness in the hands and feet, constipation, fainting, erectile dysfunction, and decreased sweating

Bones and joints

Joint stiffness, bone pain, and cysts on the bones

Causes

Amyloidosis occurs when your body produces an abnormal amount of amyloid proteins that can't be broken down and removed by the body. This can happen when amyloid proteins fold into an incorrect and dysfunctional shape, causing them to lose their normal function and making it difficult for your body to break them down properly. When too many of these abnormal proteins accumulate, organ dysfunction or failure can occur.

Why the folding of these proteins happens depends on the type of amyloidosis you have. For example, AL amyloidosis occurs when plasma cells create misfolded proteins in the immune system which can travel throughout your body and build up in other organs. AA amyloidosis develops as a secondary effect of inflammatory conditions like diabetes or IBD. However, hereditary amyloidosis happens when you have a genetic mutation that causes a change in how amyloid proteins fold.

Risk Factors

While anyone can develop amyloidosis, some factors can increase your risk, such as:

Diagnosis

Amyloidosis is a difficult condition to diagnose due to how variable symptoms can be. If you are experiencing symptoms of the condition, it's a good idea to see your healthcare provider and get tested. Your healthcare provider may order one or more of the following tests to learn more about your symptoms and confirm a diagnosis of amyloidosis:

Tissue biopsy: Collects tissue samples from your organs and checks for a buildup of amyloid proteins

Urinalysis (urine test): Takes a sample of your urine to check for the presence of amyloids in your urine

Blood test: Assesses whether you have amyloid proteins in your blood

Imaging scan: Utilizes tests like X-rays, CT scans, and MRIs to visualize your body's tissues to check for amyloid proteins

Genetic testing: Involves giving a blood or tissue sample to analyze and look for specific gene mutations that are associated with hereditary amyloidosis

Amyloidosis Treatment

Unfortunately, there is no cure for amyloidosis at this time. However, treatment focuses on reducing the amount of amyloid proteins you have in your body and improving symptoms. Common treatment options include:

Chemotherapy: Helps keep misfolded plasma cells from spreading

Stem cell transplant: Removes stem cells from a person without amyloidosis to inject them into someone with the condition to lower the presence of amyloid proteins in your blood and bone marrow

Medications: Uses medicines like Dolobid (diflunisal), Vyndamax (tafamidis), or Tegsedi (inotersen) to reduce the amount of abnormal transthyretin proteins

Organ transplant: Replaces damaged organs (such as the kidney, heart, or liver) with a donor organ

If you have amyloidosis as a result of an underlying inflammatory disorder, your healthcare team will also focus on treating the condition in hopes of also improving symptoms of amyloidosis.

Prevention

The only type of amyloidosis that can be prevented is AA amyloidosis. That's because underlying inflammatory conditions like rheumatoid arthritis, diabetes, and, inflammatory bowel disease can cause symptoms of amyloidosis to occur. Healthcare providers recommend the following prevention strategies for the following inflammatory conditions:

Diabetes: Monitoring blood pressure, reducing cholesterol, eating a nutritious diet, getting daily physical activity, and stopping smoking

Rheumatoid arthritis: Quitting smoking and exercising

Inflammatory bowel disease: Taking medications to reduce intestinal inflammation and avoiding trigger foods that worsen your inflammation

Complications

Because amyloidosis affects several different organs, people with this condition are at a higher risk of developing complications. The risk of complications rises if you don't receive treatment for your condition. Common complications include:

A Quick Review

Amyloidosis is a rare condition that occurs when your body produces an excess amount of misfolded amyloid proteins. This buildup can damage your organs and tissues, causing a variety of symptoms like fatigue, shortness of breath, and pain. The condition can affect several organs in your body including your kidneys, heart, and brain.

While a cure is not currently available, medications, chemotherapy, and medical procedures can all help manage symptoms.

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