Friday, July 19, 2024

Parotitis: When your taste buds go awry

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Do you often sense a bad taste in your mouth? Then be alert because this can be a common sign of Parotitis. This week, The Pioneer focuses on this issue, which causes a painful swelling of your parotid gland.

Tejal Sinha
Bad taste in the mouth! Doesn’t that just make you get uncomfortable and cranky at times? Sometimes, it even spoils your day. You may have a terrible taste in your mouth as a result of whatever you ate, dental difficulties, or other medical ailments such as an infection or neurological abnormalities.
It normally goes away as you brush your teeth or rinse your mouth. However, in certain circumstances, the unpleasant taste persists due to an underlying cause. Regardless of the cause, a terrible taste in your mouth can suppress your appetite, perhaps leading to nutritional shortages and other issues.
This is when you need to worry about it, because having a bad taste in your mouth is a common sign of parotitis.
Parotitis is the inflammation of the parotid glands, the major salivary glands, located on either side of the face. Parotitis can be diagnosed through a combination of medical history, physical examination, and diagnostic tests. A healthcare provider may look for swelling, pain, and redness over the parotid glands. Imaging studies like ultrasound or MRI, and sometimes a biopsy, can help confirm the diagnosis.
“The parotid gland is the largest of the major salivary glands located in the preauricular compartment, palpable between the ramus of the mandible and the mastoid process. Parotitis is an acute, subacute, or chronic inflammation of the parotid glands, which is the most common inflammation of the major salivary glands,” shares Dr. Praveen Kurapati, an orthodontist  at Park Dental.
Patients with parotitis, he shares, complain of progressive enlargement and pain in one or both parotid glands, pain with mastication localising to the parotid and radiating to the ear, often subsiding within 30 to 60 minutes after eating.
Meanwhile, Dr. Aditi Ravindra, Consultant ENT, Head and Neck Surgery, SPARSH Hospital, shares a few common signs and symptoms, including swelling of the cheek, pain and tenderness over the parotid gland, fever, dry mouth, bad taste, and difficulty opening the mouth or chewing.
She shares further, “Parotitis can affect people of all ages but is more common in older adults, infants, and individuals with weakened immune systems. Conditions like dehydration, poor oral hygiene, and chronic illnesses can increase the risk.”
Chronic bacterial parotitis and acute viral parotitis
Dr. Santosh Shivaswamy, Consultant-ENT and Head and Neck Surgeon, Manipal Hospital, shares that acute viral infections have a viral prodrome, the inflammatory signs are more marked, and usually the infections are self-limiting provided they don’t develop secondary bacterial infections. Meanwhile, he shares, “Chronic metal Parotitis is usually associated with structural pathology in the glands. For example, there could be a stone formation in the salivary duct, and there can be stenosis of the salivary duct, due to which there is a blockage in the outflow of the saliva, resulting in stasis of the secretions and causing bacterial infection. This can lead to abscess formation and can also spread to the surrounding regions and complicate the condition.”
Parotitis and mumps
“Patients with parotitis complain of progressive enlargement and pain in one or both parotid glands. Bilateral parotid involvement is typical for mumps. Both diseases have similar manifestations of parotid salivary gland inflammation, but the consequences of the two diseases are different. Mumps complications include orchitis, oophoritis, mastitis, meningitis, encephalitis, pancreatitis, and hearing loss,” shares Dr. Praveen.
Meanwhile, Dr. Aditi too highlights that parotitis can cause significant discomfort, impede eating and speaking, and sometimes lead to complications like abscess formation or the spread of infection to other areas. “While mumps is a specific viral infection caused by the mumps virus, leading to parotitis, parotitis itself can result from various causes, including bacterial infections, other viruses, or non-infectious factors.”
“Mumps is usually seen in children, and there is an infection of both parotid salivary glands,” explains Dr. Santosh as he continues, “Their self-limiting and symptomatic treatment will resolve the infection. They can also be associated with orchitis as well. Parotitis is usually one-sided and seen in adults, it has both viral and bacterial etiology, and it can transform into abscess formation, which is usually not the case in mumps.”
Juvenile recurrent parotitis
Juvenile recurrent parotitis is distinguished by repeated episodes of parotid gland enlargement. A child with juvenile recurrent parotitis may experience several episodes of swelling over the course of several years, which are frequently accompanied by fever, pain, or discomfort. The syndrome usually occurs between the ages of three and six, but it can start earlier or later. In most cases, the episodes terminate between the ages of 10 and 15, leaving no additional symptoms.
Some children experience minor, sporadic episodes. Others experience frequent and intense bouts that cause them to miss school.
Treatment
The treatment of parotitis is primarily symptomatic control with a focus on the local application of heat, gentle glandular massage from posterior to anterior, sialagogues, and adequate hydration.
“Simple anti-inflammatory analgesics, such as acetaminophen or ibuprofen, are sufficient for discomfort. Bacterial parotitis should include intravenous (IV) hydration, analgesics, and 7 to 10 days of IV antibiotics. In cases of dental infection, use of clindamycin or metronidazole (anaerobic coverage) and ceftriaxone or piperacillin-tazobactam as an alternative. Universal immunization has made mumps an uncommon disease in developed countries. All children must receive their first measles, mumps, and rubella vaccine at one year and a second shot at the age of 4 to 6 years,” shares Dr. Praveen.
Management
The management of parotitis depends on the cause. “Bacterial parotitis is typically treated with antibiotics and measures to promote saliva flow, such as hydration and sialogogues. Viral parotitis may require supportive care, including pain management, hydration, and rest. In severe cases, drainage of abscesses or surgical intervention may be necessary. Good oral hygiene and regular hydration can help prevent recurrences,” shares Dr. Aditi.
Meanwhile, Dr. Santosh also explains that the management of parotitis is usually done with medications. “It could include antibiotics to prevent secondary infection and anti-inflammatory drugs to reduce swelling painkillers control. The pain, adequate hydration interest, and majority of the time they respond well to medications. There is also a group of patients in whom the infection evolves to become an abscess. Once an abscess is formed, it needs surgical intervention to allow the pus to be drained out.”

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