View source for Bilateral parotitis

==Background==
[[File:Gray1024.png|thumb|Parotid anatomy.]]
*Bilateral parotid gland swelling has a broad differential
*May be infectious, inflammatory, or systemic in etiology
*[[Mumps]] was the most common cause historically; now rare due to vaccination

==Clinical Features==
*Swelling over both parotid glands (preauricular, extending to angle of mandible)
*+/- overlying erythema, tenderness, constitutional symptoms
*Purulent discharge from Stensen duct suggests bacterial [[parotitis]]
*Bilateral painless enlargement raises concern for systemic disease (HIV, [[sarcoidosis]], [[Sjögren syndrome]], bulimia)

==Differential Diagnosis==
{{Bilateral parotitis DDX}}

==Evaluation==
*History: fever, duration, vaccination status, HIV risk factors, sicca symptoms, medication review
*Exam: palpate glands, express Stensen duct (purulence suggests bacterial infection), assess trismus
*Labs: CBC, [[lipase]]/amylase (elevated in parotitis), consider mumps IgM if unvaccinated
*CT with contrast if concern for abscess, deep space infection, or malignancy
*Consider HIV testing, ESR/CRP, and SS-A/SS-B antibodies if systemic cause suspected

==Management==
*'''Infectious:''' Antibiotics (cover staph and streptococci — [[amoxicillin/clavulanate]] or [[clindamycin]]), warm compresses, sialagogues, hydration, parotid massage
*'''Viral (mumps):''' Supportive care, droplet precautions, report to public health
*'''Abscess:''' ENT/surgery consult for I&D
*'''Systemic:''' Treat underlying condition

==Disposition==
*Discharge most viral and uncomplicated bacterial parotitis with antibiotics and follow-up
*Admit for abscess, severe infection, airway compromise, or inability to tolerate PO

==See Also==
*[[Parotitis]]
*[[Mumps]]

==References==
<references/>

[[Category:ENT]]