Recurrent Unilateral Parotitis: Causes and Next Steps - Otolaryngology

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Recurrent unilateral parotitis, or inflammation of the parotid gland, can be a perplexing condition, especially when common causes such as salivary stones have been ruled out. Given your history of multiple episodes over the past six months, along with symptoms of dry eyes and mouth, it is essential to consider a range of potential underlying causes and appropriate next steps.

One of the primary considerations in recurrent parotitis is the possibility of an autoimmune condition, even if initial tests for Sjögren's syndrome (such as RF, ANA, Anti-SSA, and Anti-SSB) have returned negative. Autoimmune diseases can sometimes present with atypical symptoms or may not meet all diagnostic criteria initially. Therefore, it may be worthwhile to continue discussions with your rheumatologist or immunologist about the possibility of other autoimmune conditions that could cause similar symptoms, such as systemic lupus erythematosus or other connective tissue diseases.

In addition to autoimmune causes, recurrent parotitis can also be associated with infections. Viral infections, particularly mumps, can lead to parotitis, although this is less common in vaccinated populations. Bacterial infections, particularly those related to the oral cavity, can also cause recurrent inflammation. A thorough dental evaluation may be warranted to rule out any underlying dental issues, such as periodontal disease or abscesses, which could contribute to recurrent infections.

Another potential cause to consider is ductal obstruction or dysfunction. Even in the absence of stones, the ducts of the salivary glands can become obstructed due to thickened saliva, which can occur in conditions like dehydration or certain medications. Evaluating your hydration status and reviewing any medications that may contribute to dry mouth could be beneficial.

If you experience another episode of parotitis, it would be advisable to consult with an ear, nose, and throat (ENT) specialist, as they can perform a more detailed examination of the salivary glands and may recommend imaging studies, such as an ultrasound or MRI, to assess for any structural abnormalities. Additionally, they may consider performing a sialography, which involves injecting a contrast dye into the salivary ducts to visualize any blockages or abnormalities.

In summary, recurrent unilateral parotitis can stem from various causes, including autoimmune conditions, infections, and ductal dysfunction. It is essential to maintain open communication with your healthcare providers, including rheumatologists and ENT specialists, to explore these possibilities further. If symptoms recur, prompt evaluation by an ENT specialist is recommended to determine the underlying cause and appropriate treatment. Regular follow-ups and monitoring of your symptoms will also be crucial in managing this condition effectively.