History

Symptoms include the following:

Infectious parotitis
- Acute bacterial parotitis: The patient reports progressive, painful swelling of the gland and fever; chewing aggravates the pain.
- Acute viral parotitis (mumps): Pain and swelling of the gland last 5-9 days. Moderate malaise, anorexia, and fever occur. Bilateral involvement is present in most instances.
- HIV parotitis: Nonpainful swelling of the gland occurs; otherwise, patient is asymptomatic.
- Parotitis in tuberculosis: Chronic, nontender swelling of one parotid gland occurs, or a lump is noted within the gland. Symptoms of tuberculosis are found in some cases.
Chronic punctate parotitis (chronic autoimmune parotitis)^[1]
- Mikulicz disease: This is a historical disease only; it should not be diagnosed today.
- Sjögren syndrome: Recurrent or chronic swelling of one or both parotid glands with no apparent cause is noted. It is frequently associated with autoimmune disease. Discomfort is modest in most cases and is related to dry mouth and eyes.
- Lymphoepithelial lesion of Godwin: This is a historical category that is not used today.
Diseases of uncertain etiology
- Recurrent parotitis of childhood: Repetitious episodes of unilateral or bilateral mumps-like episodes in a young child are indicative.
- Sarcoidosis: Chronic, nontender swelling of parotid gland occurs.
- Chronic, nonspecific parotitis: Most commonly, patients experience episodes of painful parotid inflammation that last for hours to weeks with relative asymptomatic periods between. Pain varies from mild to incapacitating.

Physical

See the list below:

Physical examination of the parotid gland consists of visual examination for swelling and erythema of the overlying skin.
The acutely inflamed gland is exquisitely tender, while the gland is usually nontender in chronic autoimmune parotitis.
Massaging the gland from posterior to anterior expresses clear saliva from the parotid duct in normal glands.
Purulent saliva is expressed with bacterial parotitis, and clear saliva with small yellow curds is expressed in chronic punctate (autoimmune) parotitis.

Causes

See the list below:

In the vast majority of instances, risk factors are unknown.
Occasionally, drugs such as iodides or guanethidine cause transient swelling of the gland.
Autoimmune disease causes most cases of chronic parotitis.
Recurring bacterial parotitis may be caused by stone formation or stenosis of the duct, but this also occurs in a minority of cases of chronic parotitis.
HIV may cause a type of indolent parotitis that suggests an autoimmune process.
Dehydration with stasis of salivary flow may cause of acute parotitis. Drugs with an atropine effect (eg, antihistamines) may precipitate parotitis on rare occasions.

Differential Diagnoses

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Media Gallery

Elderly man with parotid abscess.
Six-year-old girl with recurrent parotitis of childhood.
Sialogram of patient with sialectasis. Notice the appearance of a tree with leaves.
Incision outlined for incision and drainage of parotid abscess.
Parotid gland anatomy.

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Author

Jerry W Templer, MD Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

Jerry W Templer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, Missouri State Medical Association, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Benjamin Daniel Liess, MD Assistant Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

Benjamin Daniel Liess, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Medical Association, Missouri State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Emeritus Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Neosoma; MI10;<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10 advisor.

Additional Contributors