Wednesday, August 29, 2012

Problematic Parotids

My friend Susan caught this little guy in her house recently. I wish I would have looked that cute when I had chipmunk cheeks. 

A few days ago, Sheri left an interesting comment on my Sjogren's vs Saliva post written in 2009:

"Not sure if this is the right place to ask.... I have been recently labeled but lip biopsy was negative. Now, wicked swelling in the parotid gland, swollen lymph nodes, drainage and icky taste. Primary care said to take a wait and see attitude. Now 8 weeks later it's hard to chew and ear has fluid behind it. Primary care prescribe clynamycn and put in referral for ENT. No fever but my face looks like a chipmunk and antibiotics haven't made any difference. Thoughts? Could this just be sjogrens swelling and it will eventually calm down?"

What an interesting question, and one that I'm sure many of us has asked. My parotids were swollen and I, too, felt like a chipmunk before my diagnosis was made and treatment begun. Although I didn't notice the drainage and unpleasant taste that Sheri described, I wondered what was happening to me that would make my co-worker ask: What's WRONG with your face?

Oh, brother.

.::Julia slaps on her nursing cap and adopts that fast-talking-disclaimer-heard-at-the-end-of-commercials voice::.

I can't offer medical advice since I'm not qualified to do that as a retired RN, but I would be happy to share my experiences and suggest reliable sources for more information. Always check with your health care provider before making any changes in your health practices.

.::Tosses cap back into corner of closet::.

OK. With THAT out of the way, let's continue the conversation......This is a great question to ask your physician. It also would be an excellent question to ask of your rheumatologist, which is the specialty that most frequently manages Sjogren's syndrome patients' care.

I'm glad that your primary care doctor has made a referral to an ear, nose, and throat specialist. Obviously, SOMETHING is going on in your parotids, and if an antibiotic hasn't changed the situation, further evaluations would be warranted. You can read more here about several conditions including Sjogren's syndrome which may cause the parotids to be problematic. Saliva gland swelling, regardless of cause, should always be taken seriously.

If your doctor makes a diagnosis of Ss, several things can happen to a Sjoggie's parotid glands: infections, generalized swelling, and stone formation are just a few. Occasionally thickened mucous plugs the opening of the gland into the mouth causing swelling and pain.

If your swelling is caused by mucous plugs or other minor obstructions to the salivary duct, you may want to try gently massaging your parotids. This excellent patient education sheet below from the Sjogren's Syndrome Foundation, found here, illustrates the simple massage technique. My salivary glands were swollen in a direct response to my Sjogren's syndrome inflammation, and not due to stones or mucous plugs. Treatment with Plaquenil, prednisone, and non steroidal anti-inflammatory drugs have reduced the size of my parotids considerably.

Keep us in the loop regarding your pesky parotids, Sheri.

Have YOU had swollen salivary glands? How did you and your physician deal with this problem?


Christine said...

I had quite a few issues with the parotid glands last year which prompted my rheum. to do another lip biopsy and finally got me the Sjogren's diagnosis.

I had swelling, the foul taste, and pain. I actually on 2 occasions had a stone expelled into my mouth. I didn't realize the first time that was what it was; I though I had lost a very tiny portion of a tooth filling!

I was treated with prednisone and antibiotics. The massage technique and warm compresses helped tremendously and I can't stress the importance of this enough. Since then I do regular massage once a day and take pilocarpine to stimulate salivary flow and have had no further issues.

sue said...

I had mild swelling of my parotids a few summers ago. I noticed it when I was doing my hair and of course it was a weekend so no doctor. I asked one of my former nursing instructors to check it out after mass and she confirmed it. I did the massage and applied some heat and it went away in a few days. I have never had it again. Mentioned it to my rheumy and was told to come in the next time. I didn't have a bad taste in my mouth but I did notice some pressure on my ear canals, one side more than the other.

Anonymous said...

Yes, I have had swelling on and off for a couple of years. This summer I had a couple of weeks where my right parotid was extremely painful and also the other salivary glands were swollen and tender. I looked it up and the nerves to the lower face run right through the parotid. I guess that's why it hurt so badly. I do not have a firm SS dx yet but do have RA.