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Parotitis

Parotitis is the inflammation of one or both parotid glands, the largest of the major salivary glands located anterior to the ears and inferior to the external auditory canal, and it represents the most common inflammatory condition affecting these glands.^[1] It manifests as painful swelling of the affected gland(s), often accompanied by tenderness, fever, and reduced salivary flow, and can be classified as acute or chronic based on duration and recurrence.^[1] While generally self-limiting in viral cases, untreated bacterial parotitis can lead to serious complications such as abscess formation or sepsis.^[2] The etiology of parotitis is diverse, encompassing infectious, obstructive, and systemic causes. Acute parotitis is most frequently viral, with mumps (caused by the paramyxovirus) being the classic example, accounting for over 70% of symptomatic infections and presenting with bilateral glandular swelling in many cases.^[1] Bacterial parotitis, typically suppurative and unilateral, is commonly due to Staphylococcus aureus or oral flora, often precipitated by dehydration, poor oral hygiene, sialolithiasis (salivary stones obstructing ducts), or immunosuppression in hospitalized elderly patients, with an incidence of 0.01% to 0.02% in this population.^[1] Chronic parotitis may arise from recurrent infections, autoimmune disorders like Sjögren's syndrome, radiation therapy, or rarely, underlying malignancies, with 80% to 85% of salivary gland tumors occurring in the parotid and 75% of these being benign.^[1] Epidemiologically, the incidence of parotitis has declined significantly due to widespread vaccination against mumps; in the United States, reported mumps cases fell from over 6,000 annually in the mid-2010s to fewer than 500 per year by 2021, and have remained low since, with 226 cases reported as of September 2025.^[1]^[3] Acute bacterial forms are more prevalent in postoperative or debilitated individuals, while chronic recurrent non-suppurative parotitis affects children and adults without a clear gender predominance.^[1] Globally, viral parotitis remains a concern in unvaccinated populations, particularly in outbreak settings.^[4] Diagnosis relies on clinical history and physical examination, revealing tender, erythematous swelling over the parotid region, sometimes with purulent discharge from Stensen's duct.^[2] Imaging modalities such as ultrasound (first-line for its non-invasiveness) or CT scans help identify abscesses, stones, or masses, while laboratory tests including cultures, viral serology for mumps, or autoantibodies for autoimmune etiologies confirm the cause.^[1] Treatment varies by etiology but emphasizes supportive care and addressing the underlying cause. Viral parotitis, such as mumps, is managed symptomatically with hydration, analgesics, warm compresses, and rest, typically resolving in 5 to 10 days.^[5] Bacterial cases require intravenous antibiotics (e.g., anti-staphylococcal agents), sialagogues to promote saliva flow, and drainage for abscesses; chronic or refractory cases may necessitate sialendoscopy or parotidectomy.^[1] Prognosis is favorable with early intervention, though complications like facial nerve injury, chronic sialadenitis, or, in mumps, orchitis and meningitis, underscore the need for prompt medical attention.^[1]

Overview

Definition

Parotitis refers to the inflammation of one or both parotid glands, which are the largest of the major salivary glands located anterior and inferior to the ears, on the sides of the face between the ear and jaw.^[1]^[6] These glands are responsible for producing primarily serous saliva, a watery secretion that aids in digestion and oral lubrication.^[7] The parotid gland is an irregularly shaped, lobulated structure enveloped by a thin capsule and divided into superficial and deep lobes by the branches of the facial nerve, which courses through the gland without innervating it directly but providing motor innervation to the muscles of facial expression.^[7]^[8] The main excretory duct of the parotid gland, known as Stensen's duct or the parotid duct, arises from the anterior border of the gland, travels across the masseter muscle, and opens into the oral cavity opposite the upper second molar tooth, facilitating the drainage of saliva.^[7]^[9] This anatomical arrangement makes the gland susceptible to inflammatory processes that can obstruct ductal flow or involve surrounding structures.^[7] Parotitis is classified into acute and chronic forms based on its onset, duration, and characteristics. Acute parotitis typically presents with sudden onset and is often suppurative, involving pus formation due to bacterial infection.^[10] In contrast, chronic parotitis is recurrent or persistent and frequently non-suppurative, associated with autoimmune or recurrent inflammatory changes without abscess formation.^[10]^[11] The term "parotitis" derives from the Greek words "para-" meaning "beside" and "otis" meaning "ear," reflecting the gland's position adjacent to the ear, with its earliest recorded use in English medical literature dating to the late 1700s.^[12]^[13]

Epidemiology

Parotitis represents the most common inflammatory condition of the major salivary glands, comprising a substantial portion of salivary gland disorders worldwide. Acute bacterial parotitis, in particular, has an incidence of 0.01% to 0.02% among hospitalized older adults and 0.002% to 0.04% in postoperative patients. Globally, viral parotitis due to mumps has seen a decline, with an average of about 500,000 cases reported annually to the World Health Organization from 1999 to 2019, though incidence remains higher in unvaccinated populations; reported cases continued to decrease, reaching 245,032 in 2024.^[1]^[14]^[15]^[16] Demographically, acute parotitis disproportionately affects neonates under 1 year, elderly individuals over 60 years due to age-related physiological changes such as reduced salivary flow, and postoperative patients. Mumps-related parotitis is more prevalent in unvaccinated children under 15 years, particularly those aged 2 to 9 in school or college settings. Chronic parotitis tends to occur in adults aged 40 to 60, with juvenile recurrent parotitis showing highest incidence in Black males aged 2 to 8.^[1] Key risk factors include dehydration, poor oral hygiene, immunosuppression from conditions like HIV or treatments such as chemotherapy, and ductal obstruction. Sialolithiasis, a common obstructive cause, has an estimated incidence of 28 to 59 cases per million per year in the general population. Immunodeficiency, international travel, and crowded living conditions further elevate mumps risk.^[1]^[17]^[14] Geographically, mumps incidence is elevated in developing regions with MMR vaccination coverage below 90%, where outbreaks occur approximately every 5 years in unvaccinated communities; global first-dose measles (proxy for MMR) coverage stood at 83% in 2023 and increased to 84% in 2024, with lower rates in low- and middle-income countries. Trends indicate a continued decline in viral parotitis attributable to vaccination programs, contrasted by a rise in bacterial cases among aging populations in high-income settings due to increased elderly demographics and medication use that impairs salivary flow.^[14]^[18]^[19]^[1]

Signs and Symptoms

Acute Parotitis

Acute parotitis is characterized by the sudden onset of unilateral or bilateral swelling over the parotid region, often accompanied by severe pain and tenderness that intensifies during mastication.^[1] Patients typically experience fever and chills, with overlying erythema of the skin contributing to the inflammatory appearance.^[20] In bacterial cases, purulent discharge may be expressed from Stensen's duct, often presenting with a foul taste in the mouth.^[21] Systemic manifestations include leukocytosis indicative of infection, alongside signs of dehydration such as dry mouth and reduced salivary flow.^[22] Trismus, or jaw stiffness, can occur due to the proximity of the inflamed gland to masticatory muscles, complicating oral intake.^[23] These effects are more pronounced in vulnerable populations, such as the elderly or debilitated individuals. The condition typically develops over hours to days.^[20] Progression may lead to abscess formation within the gland or systemic sepsis, particularly in cases of bacterial involvement.^[24] Unlike chronic parotitis, which involves recurrent and less acutely painful episodes, acute parotitis demands prompt intervention to prevent complications.^[10]

Chronic Parotitis

Chronic parotitis is characterized by recurrent or persistent inflammation of the parotid gland, often presenting with an insidious onset and episodes that recur over months to years, distinguishing it from the more abrupt and suppurative nature of acute parotitis.^[1] This form typically involves milder glandular involvement without prominent systemic features, focusing instead on ongoing low-grade changes in salivary gland function.^[25] Primary symptoms include intermittent unilateral or bilateral swelling of the parotid gland, accompanied by mild discomfort that is generally less severe than in acute episodes. Episodes often occur around mealtimes.^[26] Xerostomia, or dry mouth resulting from reduced salivary flow, is a common feature.^[25] These swellings may cause facial fullness and tenderness, with episodes persisting for days to weeks before subsiding.^[1] In cases associated with autoimmune disorders like Sjögren's syndrome, additional signs such as fatigue and weight loss may emerge due to systemic involvement.^[27] Foul breath can arise from secondary bacterial infections, particularly if purulent material accumulates in the ducts.^[1] Long-term complications encompass an elevated risk of salivary gland tumors, including mucosa-associated lymphoid tissue (MALT) lymphoma, particularly after years of chronic inflammation in autoimmune contexts.^[27] Chronic parotitis is more prevalent among middle-aged women, with peak incidence in those aged 40 to 60 years and a slight female predominance overall.^[26]

Causes

Infectious Causes

Infectious causes of parotitis primarily involve bacterial, viral, and less commonly fungal or mycobacterial pathogens, leading to acute or chronic inflammation of the parotid gland through microbial invasion and suppuration.^[1] Bacterial infections are the most frequent etiology in acute suppurative parotitis, particularly in dehydrated or elderly patients where reduced salivary flow promotes retrograde ascent of oral flora through Stensen's duct. Staphylococcus aureus predominates, accounting for 50% to 90% of cultured cases, followed by Streptococcus species and anaerobic bacteria such as Peptostreptococcus and Prevotella. This mechanism is facilitated by risk factors including poor oral hygiene, immunosuppression, and conditions causing salivary stasis, resulting in glandular suppuration and potential abscess formation. In elderly individuals, bacterial parotitis represents a rising proportion of acute cases due to age-related hyposalivation and polypharmacy with anticholinergic medications.^[28]^[1]^[10] Viral infections typically cause acute, often self-limiting parotitis via viremia or lymphatic spread, with mumps virus (a paramyxovirus) being the classic example, presenting as bilateral glandular swelling in approximately 70% of cases. Other viruses include influenza A and parainfluenza, coxsackievirus, Epstein-Barr virus, and enteroviruses like echovirus, which enter through the respiratory tract and disseminate hematogenously to the salivary glands. Human immunodeficiency virus (HIV) can lead to chronic parotitis through persistent viral replication in immunocompromised hosts. The introduction of the mumps vaccine in 1967 has reduced U.S. incidence by over 99%, though outbreaks persist in under-vaccinated populations.^[14]^[29]^[1]^[30] Fungal pathogens, such as Candida species (particularly C. albicans and C. glabrata), rarely cause parotitis but occur in immunocompromised patients via ascending ductal infection or hematogenous dissemination, often in the context of prolonged antibiotic use or HIV/AIDS.^[31]^[32] Mycobacterial infections are uncommon and include Mycobacterium tuberculosis in endemic areas, typically via hematogenous spread or ascending infection coexisting with pulmonary disease in up to 25% of cases, and nontuberculous mycobacteria (e.g., M. avium complex) ascending via Stensen's duct in susceptible individuals.^[1]^[33]

Non-Infectious Causes

Non-infectious causes of parotitis encompass a range of mechanical, autoimmune, metabolic, and iatrogenic factors that lead to inflammation of the parotid gland without microbial involvement. These etiologies often result from obstruction of salivary flow, immune-mediated damage, or reduced glandular function, promoting stasis and subsequent sterile inflammation. Unlike infectious forms, they may present as acute, recurrent, or chronic swelling, frequently bilateral in systemic conditions.^[1] Obstructive causes, particularly sialolithiasis, involve the formation of calcified stones within the parotid ducts or gland, leading to blockage and glandular distension. Although 80-90% of salivary stones occur in the submandibular gland, approximately 6-20% affect the parotid, often causing intermittent painful swelling exacerbated by meals due to increased salivary demand. This obstruction creates salivary stasis, which can precipitate inflammation and, in some cases, secondary bacterial overgrowth, though the primary mechanism is mechanical. Pathophysiologically, stones form from calcium phosphate and carbonate deposits around a nidus of desquamated cells or mucus in stagnant saliva.^[17]^[34] Autoimmune and systemic disorders frequently underlie chronic or recurrent parotitis through lymphocytic infiltration and glandular destruction. Sjögren's syndrome, an autoimmune condition targeting exocrine glands, causes bilateral parotid enlargement in up to 30-60% of cases via T-cell mediated inflammation and fibrosis, resulting in xerostomia and recurrent swelling. Sarcoidosis may present with granulomatous involvement of the parotid, mimicking chronic sialadenitis. Metabolic factors like uncontrolled diabetes contribute through autonomic neuropathy and sialosis, leading to painless hypertrophy, while bulimia nervosa can cause sialadenosis, leading to painless bilateral parotid enlargement due to recurrent vomiting-induced glandular hyperactivity and nutritional deficiencies.^[1]^[35]^[36] Iatrogenic and dehydration-related causes arise from interventions or physiological states that impair salivary secretion. Radiation therapy to the head and neck, such as for malignancies, can induce transient acute parotitis due to inflammatory edema, occurring in approximately 5% of patients shortly after initial treatments and long-term xerostomia from acinar atrophy and fibrosis. Medications like anticholinergics (e.g., atropine) or diuretics reduce saliva flow by inhibiting glandular secretion, while prolonged nil per os (NPO) status during surgery or dehydration in critically ill patients leads to viscous saliva and ductal stasis. These factors collectively diminish parotid perfusion and secretion, fostering inflammation.^[1]^[37]^[25] Other non-infectious triggers include trauma, which can cause direct glandular injury or hematoma leading to swelling, as seen post-surgical manipulation like carotid endarterectomy. Masseter muscle hypertrophy may mimic parotitis with unilateral swelling but lacks true inflammation. Juvenile recurrent parotitis of childhood (JRPC), often idiopathic, affects children aged 2-8 years with episodes of unilateral or bilateral swelling, potentially linked to ductal anomalies or immune dysregulation, though its exact pathophysiology remains unclear and involves recurrent sterile inflammation resolving by adolescence in most cases. Overall, non-infectious parotitis pathophysiology centers on salivary stasis from obstruction or hypofunction, triggering innate immune responses, or autoimmune T-cell infiltration causing acinar damage without infection.^[1]^[38]^[39]

Diagnosis

Clinical Assessment

The clinical assessment of parotitis begins with a detailed history to characterize the presentation and identify potential etiologies. Clinicians inquire about the onset of symptoms, distinguishing acute cases, which often present with sudden unilateral swelling and pain, from chronic or recurrent episodes that may involve intermittent enlargement triggered by meals or dehydration.^[1] Associated symptoms such as fever, chills, malaise, dry mouth (xerostomia), or difficulty chewing are elicited, along with risk factors including recent dehydration, immunosuppression (e.g., from diabetes, HIV, or chemotherapy), poor oral hygiene, and vaccination status, particularly for mumps in unvaccinated individuals.^[25]^[1] Physical examination focuses on the parotid region to confirm glandular involvement and assess severity. The parotid gland, normally soft, smooth, and non-palpable, is palpated for tenderness, warmth, and swelling that may obscure the angle of the jaw; bimanual palpation of the gland and Stensen's duct is performed to evaluate for induration or masses.^[1] Gentle compression over the gland may express pus or cloudy saliva from the papilla of Stensen's duct in infectious cases, while lymph nodes in the preauricular, submandibular, and cervical regions are examined for enlargement or tenderness.^[25] Erythema overlying the skin or foul-tasting discharge further supports an inflammatory process.^[1] Differential diagnosis considers conditions mimicking parotid swelling, such as dental abscess (often with odontogenic pain and intraoral findings), lymphoma (presenting as painless, firm enlargement), sialadenitis of submandibular or sublingual glands, masseter hypertrophy (causing firm, non-tender prominence without ductal involvement), and Ludwig's angina (a rapidly spreading floor-of-mouth infection with bilateral swelling and trismus).^[1]^[40]^[41] Red flags warranting urgent evaluation include facial nerve palsy (indicating possible malignancy or severe infection), severe trismus suggesting underlying abscess, and signs of systemic compromise such as high fever or respiratory distress.^[1]^[42]

Diagnostic Tests

Laboratory tests play a crucial role in evaluating parotitis by identifying signs of infection or inflammation and guiding etiological diagnosis. A complete blood count (CBC) often reveals leukocytosis with neutrophilia in cases of bacterial parotitis, indicating an acute infectious process.^[43] Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are typically elevated, reflecting the degree of systemic inflammation, though they lack specificity for parotitis alone.^[1] For suspected bacterial causes, Gram stain and culture of pus expressed from Stensen's duct or obtained via aspiration provide essential information on the causative organism and antibiotic susceptibility, with Staphylococcus aureus being the most common isolate.^[44] Viral etiologies, particularly mumps, are confirmed through real-time reverse transcription polymerase chain reaction (RT-PCR) on buccal swabs or saliva, which is the preferred method due to its higher sensitivity and specificity compared to IgM serology, especially when samples are collected within 3 days of parotitis onset.^[45] In cases of unilateral cystic enlargement or risk factors, HIV testing via antigen/antibody immunoassay is recommended to rule out associated parotitis.^[1] Imaging modalities are essential for visualizing parotid gland abnormalities, detecting complications, and differentiating causes. Ultrasound serves as the first-line imaging test, offering high-resolution assessment of glandular enlargement, abscesses, calculi, and ductal dilation with approximately 90% sensitivity for detecting stones greater than 2 mm; it is particularly preferred in children to avoid ionizing radiation exposure.^[46] For more complex evaluations, such as suspected deep abscesses, fistulas, or neoplasms, contrast-enhanced computed tomography (CT) provides detailed anatomical information on gland size, shape, and surrounding structures, though it involves radiation and is used judiciously in pediatrics.^[44] Magnetic resonance imaging (MRI), often with gadolinium enhancement, excels in soft tissue characterization and is indicated for chronic cases or suspected tumors, while magnetic resonance sialography non-invasively delineates ductal abnormalities without contrast injection.^[46] Conventional sialography, involving contrast injection into the ductal system, is reserved for chronic parotitis to identify strictures or obstructions but has largely been supplanted by MRI due to its invasiveness.^[1] Procedural interventions aid in definitive diagnosis when imaging is inconclusive. Fine-needle aspiration (FNA) biopsy allows for cytological examination, culture, and sensitivity testing in suspected bacterial abscesses, tuberculosis (via Ziehl-Neelsen stain or PCR), or malignancy, providing targeted material for analysis.^[44] In chronic or recurrent parotitis, salivary scintigraphy using technetium-99m pertechnetate assesses glandular function and uptake/excretion dynamics, helping differentiate obstructive from inflammatory pathologies, particularly in conditions like Sjögren's syndrome.^[47] These tests collectively confirm parotitis and its etiology, enabling tailored management.

Management and Treatment

Supportive Measures

Supportive measures for parotitis focus on alleviating symptoms, promoting salivary flow, and preventing complications across all cases, regardless of etiology. Adequate hydration is essential to maintain salivary gland function and reduce stasis, with oral fluids encouraged for most patients; intravenous fluids are recommended for those with dehydration, particularly in severe or suppurative presentations.^[1]^[48]^[25] To stimulate saliva production and relieve dryness, sialogogues such as sugarless gum, lemon drops, or lemon swabs can be used, alongside mouth rinses for oral hygiene to minimize the risk of secondary bacterial infections. Pain and swelling are managed with analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, and application of warm compresses to the affected area, often combined with gentle massage to promote drainage.^[49]^[6]^[50]^[1]^[39]^[48] Dietary modifications include consuming soft, easy-to-swallow foods to minimize discomfort during mastication, while avoiding irritants such as acidic or spicy items that could exacerbate inflammation. In cases of severe swelling, close monitoring for airway compromise is necessary, as significant edema may threaten respiratory function.^[51]^[52]^[53] Hospitalization is advised for vulnerable populations, including the elderly and immunocompromised individuals, to facilitate close observation and IV support if needed. Patients should be monitored for signs of abscess formation, such as persistent fever beyond 48 hours despite initial therapy, which may warrant further intervention. For bacterial cases, supportive measures are often combined with targeted antibiotics, as detailed in cause-specific interventions.^[1]^[11]^[10]^[54]^[43]

Cause-Specific Interventions

For infectious causes of parotitis, treatment targets the specific pathogen identified through culture or clinical suspicion. Bacterial parotitis, often due to Staphylococcus aureus or anaerobic bacteria, is managed with intravenous antibiotics such as amoxicillin-clavulanate or clindamycin for 7-14 days, with a reported cure rate of approximately 80% when combined with hydration.^[48]^[1] Viral parotitis, such as mumps, is typically supportive only and resolves within 7-10 days without specific antiviral therapy.^[14] Antivirals like acyclovir are rarely used but may be considered for herpes simplex virus-associated cases.^[55] If an abscess forms, ultrasound-guided needle aspiration or surgical incision and drainage is performed alongside antibiotics to prevent complications.^[56] In obstructive parotitis, interventions focus on relieving ductal blockage from sialoliths or cysts. Sialendoscopy enables minimally invasive visualization and removal of stones from the parotid duct, often with laser or basket extraction for stones up to 8 mm.^[57] For ranula-like parotid cysts, intraoral marsupialization creates an open drainage pathway while preserving gland function.^[58] Small stones may pass spontaneously with increased hydration and sialogogues, as referenced in supportive measures.^[25] Autoimmune-related parotitis, commonly associated with Sjögren's syndrome, requires immunomodulation to reduce glandular inflammation. Corticosteroids like prednisone are used for acute flares, providing rapid symptom relief in severe cases.^[59] For refractory glandular swelling, rituximab infusions target B-cell hyperactivity, showing efficacy in reducing parotid enlargement.^[60] Xerostomia, a frequent sequela, is alleviated with pilocarpine to stimulate saliva production.^[61] For chronic or recurrent parotitis unresponsive to conservative approaches, superficial or total parotidectomy is considered in refractory cases, with surgery required in a minority of patients after failed sialendoscopy or medical therapy.^[62] Radiation therapy is generally avoided due to risks of permanent xerostomia and secondary malignancies.^[48]

Prevention

Vaccination Strategies

The measles-mumps-rubella (MMR) vaccine is the primary immunization strategy for preventing parotitis caused by mumps virus, a common viral etiology of the condition. The standard regimen consists of two doses: the first administered at 12-15 months of age and the second at 4-6 years of age. This schedule provides 88% efficacy against mumps after two doses, significantly reducing the incidence of mumps-associated parotitis. Outbreaks of mumps parotitis continue to occur disproportionately among unvaccinated adults, highlighting the need for high population-level immunity.^[63] In addition to MMR, the annual influenza vaccine can help mitigate rare cases of parotitis linked to influenza A virus, particularly H3N2 strains, by preventing underlying respiratory infections that may complicate into salivary gland inflammation. For adults lacking prior vaccination, catch-up dosing with MMR is recommended, especially for high-risk groups such as healthcare workers, to ensure at least two doses and bolster protection against mumps transmission in clinical settings. Globally, the World Health Organization (WHO) endorses achieving at least 95% coverage with two doses of MMR vaccine in national immunization programs to interrupt mumps transmission and prevent parotitis outbreaks. Despite vaccination, mumps outbreaks can occur due to waning vaccine-induced immunity over time, underscoring the importance of maintaining robust vaccination rates.^[64] For special populations, a third dose of MMR may be considered as a booster during outbreaks for those with two prior doses, though severely immunocompromised individuals are generally contraindicated for live vaccines like MMR due to risks of vaccine-derived disease; alternative strategies, such as post-exposure prophylaxis, are prioritized instead. Unlike viral causes, bacterial parotitis lacks a specific vaccine, necessitating focus on other preventive measures for those etiologies.

Risk Reduction Practices

Maintaining good hydration is essential for preventing parotitis, particularly non-infectious forms caused by salivary stasis or ductal obstruction, as adequate fluid intake promotes salivary flow and reduces the risk of gland swelling.^[1]^[6] Dehydration can lead to thickened saliva, increasing susceptibility to bacterial infections or stone formation in the parotid ducts. Individuals at higher risk, such as those with reduced salivary production due to medications or medical conditions, should aim for at least 2-3 liters of water daily unless contraindicated.^[1] Practicing rigorous oral hygiene significantly lowers the incidence of bacterial parotitis by minimizing oral bacterial load and preventing dental issues that could obstruct salivary ducts. This includes regular brushing, flossing, and professional dental cleanings to avoid plaque buildup or caries that might contribute to ascending infections.^[1]^[6] For those prone to sialolithiasis, chewing sugar-free gum or using sialogogues like lemon drops can stimulate saliva production, further reducing stagnation.^[1] Frequent handwashing and avoiding close contact with infected individuals are key measures to curb the spread of viral parotitis, such as mumps, by interrupting transmission through respiratory droplets or saliva. The CDC recommends washing hands with soap for at least 20 seconds, especially after touching the face or shared surfaces, and using alcohol-based sanitizers when soap is unavailable.^[65] In outbreak settings, self-isolation for five days after symptom onset helps contain spread, though this applies more to case management than primary prevention.^[65] Managing underlying health conditions plays a crucial role in risk reduction, as uncontrolled diabetes or autoimmune disorders like Sjögren's syndrome can impair salivary function and heighten parotitis vulnerability. Regular monitoring and treatment of these conditions, including glycemic control in diabetics, can mitigate this risk.^[1] Additionally, avoiding smoking and excessive alcohol consumption prevents mucosal irritation and dehydration that exacerbate gland inflammation.^[6] Ensuring balanced nutrition supports immune function, indirectly reducing infection susceptibility.^[6] Patients on anticholinergic drugs, which decrease salivation, should consult providers for alternatives or adjunctive therapies to maintain flow.^[1]

References

[1]
Parotitis - StatPearls - NCBI Bookshelf - NIH
Jun 23, 2025 · Parotitis, or inflammation of the parotid glands, is the most common inflammatory condition affecting the major salivary glands.Etiology · History and Physical · Treatment / Management · Differential Diagnosis
[2]
Salivary gland infections: MedlinePlus Medical Encyclopedia
### Summary of Salivary Gland Infections (Focusing on Parotitis)
[3]
Mumps - StatPearls - NCBI Bookshelf
May 1, 2024 · Mumps parotitis is the most common manifestation of the virus, occurring in over 70% of infections. Parotid swelling is typically bilateral, but ...<|control11|><|separator|>
[4]
Clinical Overview of Mumps - CDC
Jan 17, 2025 · Common clinical features include parotitis (swollen salivary glands in cheek and jaw area) and fever. Mumps spreads through direct contact ...Key Points · Clinical Features · Diagnosis And Laboratory...
[5]
Clinical Features of Mumps - CDC
Jun 5, 2024 · Parotitis usually lasts on average 5 days and most cases resolve after 10 days. Mumps infection is most often confused with swelling of the ...
[6]
Parotitis: Parotid Gland Swelling Causes, Symptoms & Treatment
“Parotitis” is the medical term for a swollen parotid gland. Your parotid glands are located on the side of your face, between your ear and your jaw.
[7]
Anatomy, Head and Neck, Parotid Gland - StatPearls - NCBI Bookshelf
Sep 10, 2024 · The parotid main excretory duct (Stensen duct) projects from ... The facial nerve courses through the parotid gland, providing motor ...Introduction · Structure and Function · Blood Supply and Lymphatics · Nerves
[8]
https://teachmeanatomy.info/head/organs/salivary-glands/parotid/
[9]
Parotid gland: Anatomy, innervation and clinical aspects - Kenhub
Parotid duct (Stensen Duct) Two major ducts arising from the parotid gland unite within the substance of the organ to form the parotid duct of Stensen . The ...
[10]
Parotitis: Practice Essentials, Background, Pathophysiology
Aug 13, 2024 · When surgery is required for chronic parotitis, the standard treatment is superficial parotidectomy, but if CT scanning or surgery reveals ...
[11]
Parotitis overview: an integrated approach from classification to ...
Parotitis features 5 subtypes, namely: (1) acute viral, (2) acute suppurative, (3) sialolithiasis-associated, (4) chronic non-neoplastic, and (5) chronic ...
[12]
parotitis, n. meanings, etymology and more | Oxford English Dictionary
The earliest known use of the noun parotitis is in the late 1700s. OED's earliest evidence for parotitis is from 1796, in the writing of Erasmus Darwin, ...
[13]
Parotid - Etymology, Origin & Meaning
Originating from Greek parotis meaning "tumor near the ear," via Latin and French, parotid refers to the gland or area situated beside the ear.
[14]
Chapter 9: Mumps | Manual for the Surveillance of Vaccine ... - CDC
Jun 18, 2025 · Mumps is an acute viral illness caused by a paramyxovirus and typically presents as swelling of the parotid (parotitis) or other salivary gland.<|control11|><|separator|>
[15]
Sialolithiasis - StatPearls - NCBI Bookshelf - NIH
Sialolithiasis is the most common benign cause of salivary gland swelling; however, it remains a relatively rare diagnosis with an incidence of 1 in 10,000 to 1 ...Missing: adults | Show results with:adults
[16]
Global childhood vaccination coverage holds steady, yet over 14 ...
Jul 15, 2025 · Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated – WHO, UNICEF · Access to vaccines remains ...Missing: mumps incidence
[17]
Parotitis Clinical Presentation: History, Physical, Causes
Aug 13, 2024 · Acute viral parotitis (mumps): Pain and swelling of the gland last 5-9 days. Moderate malaise, anorexia, and fever occur. Bilateral involvement ...
[18]
Salivary Gland Problems: Identification, Causes & Treatment - WebMD
Feb 10, 2025 · This condition causes a painful lump in the gland, and foul-tasting pus drains into the mouth. Sialadenitis is more common in older adults ...<|separator|>
[19]
Parotitis, Acute and Chronic | 5-Minute Clinical Consult
Acute bacterial parotitis: dehydration, debilitation, poor oral hygiene ... Acute bacterial parotitis can be associated with leukocytosis and elevated ...
[20]
Suppurative Parotitis - Consultant360
Acute bacterial parotitis is generally caused by Staphylococcus aureus ... This is associated with localized tenderness, fever, chills, marked toxicity, trismus, ...
[21]
acute bacterial infection of the salivary glands
Treatment of viral salivary gland infection is primarily supportive, including rest and adequate hydration, because the disease is self-limited. Antipyretics ...Missing: leukocytosis | Show results with:leukocytosis
[22]
Salivary Gland Disorders - AAFP
Jun 1, 2014 · Recurrent parotitis of childhood is an inflammatory condition of the parotid gland characterized by recurrent episodes of swelling and pain. ...Missing: progression | Show results with:progression
[23]
Chronic Parotitis: A Challenging Disease Entity - Sage Journals
Chronic parotitis is a troubling clinical condition char- acterized by repeated infection and inflammation of the parotid gland caused by decreased salivary ...Missing: middle- sialectasia
[24]
Sjogren Syndrome - StatPearls - NCBI Bookshelf - NIH
Jul 6, 2025 · Sjögren syndrome is a systemic autoimmune disease ... Extraglandular features may include dry skin, joint pain, fatigue, or symptoms affecting ...Sjogren Syndrome · History And Physical · ComplicationsMissing: parotitis | Show results with:parotitis
[25]
Acute bacterial suppurative parotitis: microbiology and management
The most common pathogens associated with acute bacterial parotitis are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include gram ...Missing: prevalence 70-90%
[26]
Mumps: resurgence of a vanquished virus - PMC - NIH
The clinical hallmark of mumps is parotitis, which is bilateral in 70% of patients. When inhaled, the virus enters the upper respiratory tract, travels to local ...
[27]
Diagnosis and Management of Parotitis - JAMA Network
Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses. Acute suppurative ...
[28]
Candida Infection Associated with Salivary Gland—A Narrative ... - NIH
Dec 30, 2020 · Mostly, salivary gland infection with Candida occurs in individuals with impaired immunity, including persons impacted by HIV/AIDS [55]. ...
[29]
[PDF] Suppurative Parotitis Due to Candida glabrata - DukeSpace
10 Risk factors for oral colonization of C. glabrata are dentures, immunosuppression, antibiotic therapy, and aging.11 One of the major risk factors for both ...
[30]
Non-tuberculous mycobacterial infection of the parotid gland in ... - NIH
Oct 16, 2013 · It was suggested that most NTM infections of the parotid gland are caused by Mycobacterium ascending via Stensen's duct in the oral cavity.
[31]
Parotid sialolithiasis - PMC - NIH
Sialoliths, or salivary stones, are the most common disease of the salivary glands in middle-aged patients. More than 80% of salivary sialoliths occur in the ...
[32]
Recurrent Parotitis as a Presentation of Primary Pediatric Sjögren ...
Jan 1, 2012 · Parotitis is encountered relatively frequently in the pediatric population. It is typically acute and self-limiting and usually represents viral ...
[33]
Chronic Parotitis in Primary Sjögren's Syndrome - PMC - NIH
The patient was diagnosed with Sjögren's syndrome with acute exacerbation of chronic parotitis with multiple calcifications.
[34]
Sialadenitis | Radiology Reference Article - Radiopaedia.org
Aug 27, 2025 · Other causes of acute sialadenitis include dehydration, immunosuppression, iatrogenic (drug-induced) and rarely hematogenous spread 10. Rarely ...
[35]
Juvenile recurrent parotitis - PMC - NIH
It is a rare condition and characterized by multiple episodes of parotid swelling and/or pain associated with fever or malaise over a period of years.
[36]
Juvenile Recurrent Parotitis - Children's Hospital of Philadelphia
Care is taken to distinguish between conditions that can have similar symptoms, such as salivary duct stones (sialoliths), salivary gland tumors, autoimmune ...
[37]
Salivary Swelling (Parotid and Submandibular Glands)
May 20, 2017 · Differential Diagnosis. Obstructive Sialadenitis. Sialolithiasis ... Submandibular abscess can mimic Ludwig's angina. Viral Parotitis or ...
[38]
Bilateral parotid swelling: a radiological review - PMC
The main differential diagnosis for this appearance is lymphoma. In the diffuse form, parotid glands are symmetrically enlarged and show increased signal ...<|control11|><|separator|>
[39]
Approach to sialadenitis - PMC - NIH
Red flags such as suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue should prompt ...
[40]
EM@3AM: Suppurative Parotitis - emDocs
Jul 29, 2023 · Bacterial: Staph aureus is the most common bacterial cause. Other bacterial causes include anaerobic oral flora, Strep viridans, E. · Less common ...
[41]
Parotitis Workup: Laboratory Studies, Imaging Studies, Procedures
Aug 13, 2024 · CT scanning and MRI with gadolinium enhancement. These studies may be used to determine the size, shape, and some qualities of neoplasms or ...Laboratory Studies · Imaging Studies · Procedures
[42]
Laboratory Testing for Mumps - CDC
Jun 11, 2024 · Real-time RT-PCR is the preferred method to confirm mumps; it's more sensitive and specific than serologic assays to detect IgM. The successful ...
[43]
https://www.emdocs.net/em3am-suppurative-parotitis/
[44]
Sequential quantitative scintigraphy of parotid glands with chronic ...
Scintigraphy is considered to be a useful method for evaluation of parotid function and as a diagnostic aid for SS and COP, especially in patients in whom ...
[45]
Parotitis Treatment & Management - Medscape Reference
Aug 13, 2024 · Acute bacterial parotitis is caused by bacteria that ascends from the mouth and most frequently occurs in chronically ill patients. The patient ...
[46]
Parotitis | Johns Hopkins ABX Guide
Mar 16, 2025 · Acute parotitis: severe pain, tenderness, erythematous swelling--pre-auricular to the angle of the jaw, not necessarily infectious.Missing: prevalence | Show results with:prevalence
[47]
Salivary Gland Infection: Care Instructions
Eat soft foods that do not have to be chewed much. Use sugar-free gum or candies such as lemon drops. They increase saliva. Avoid over-the-counter medicines ...
[48]
Parotitis: Care Instructions - MyHealth Alberta
Parotitis is a swelling of your parotid glands. These are salivary glands located between the ear and jaw. The most common cause is a virus.
[49]
Parotitis: Care Instructions - Kaiser Permanente
To prevent dehydration, drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase ...Missing: measures management
[50]
[PDF] Acute Infantile Suppurative Parotitis - Annals of Clinical Case Reports
Nov 18, 2022 · Blood Smear: Leukocytosis - Neutrophilia and Monocytosis and Microcytic Anemia. Seen on the same day by the PICU team due to concerns on ...<|control11|><|separator|>
[51]
Parotitis, Acute and Chronic | 5-Minute Clinical Consult
Antibiotic therapy for bacterial parotitis combined with adequate hydration should result in improvement within 48 hours; if not, patient should be reevaluated.
[52]
Acyclovir - StatPearls - NCBI Bookshelf - NIH
Acyclovir is an agent used to treat infections caused by the herpes simplex virus (HSV). Acyclovir is FDA-approved to treat genital herpes and HSV encephalitis.
[53]
Ultrasound-Guided Needle Aspiration vs. Surgical Incision of Parotid ...
Ultrasonography-guided needle aspiration of parotid abscess offers a less invasive alternative to surgical incision and drainage. A sonographic approach is ...
[54]
Sialendoscopy for the Management of Obstructive Salivary Gland ...
Sialendoscopy offers a minimally invasive approach to disease management. This technique allows endoscopic intraluminal visualization and offers a mechanism to ...
[55]
A case of retention cyst of the parotid gland treated successfully by ...
Intraoral marsupialization for retention cysts of the parotid gland is a minimally invasive method without the risk of skin scarring and facial nerve paralysis.
[56]
EULAR recommendations for the management of Sjögren's ...
The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, ...
[57]
Rituximab Therapy for Primary Sjögren's Syndrome: An Open-Label ...
The treatment of primary Sjögren's syndrome is largely based on alleviation of symptoms and includes the use of topical cyclosporine for management of dry eyes, ...Missing: parotitis | Show results with:parotitis
[58]
Treatment of Primary Sjögren Syndrome: A Systematic Review
Jul 28, 2010 · Conclusions In primary Sjögren syndrome, evidence from controlled trials suggests benefits for pilocarpine and cevimeline for sicca features ...Missing: parotitis | Show results with:parotitis
[59]
Surgical Treatment of Chronic Parotitis - PMC - PubMed Central
Oct 24, 2018 · This study shows parotidectomy to be a safe and effective treatment for chronic recurring parotitis. After failure of conservative therapy, 80% ...
[60]
Strategies for the Control and Investigation of Mumps Outbreaks - CDC
Sep 20, 2024 · Suspected mumps patients should self-isolate for 5 days after onset of parotitis or other salivary gland swelling, even while lab results are ...