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Noticed lump below ears. Not cured by medicine. Could it be chronic sialadenitis parotid glands?

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Pediatrician, Neonatology
Practicing since : 1970
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Hi, my daughter has a lump below her ears and it has been two weeks. A local doctor is unsure and she thinks it maybe "chronic sialadenitis parotid glands XXXXXXX After 1 week of medication there is no result.
Posted Sat, 24 Nov 2012 in General Health
Answered by Dr. Uma Rajah Ananth 4 hours later
You have written a very nice and detailed history! Thanks!
First I have a question for you.
At what age your daughter got mumps? Was it bilateral(both sides)?Did she receive MMR vaccine?
From what you describe, the swelling seems to be that of parotid gland.
There are many causes for recurrent parotid swelling.
1-acute bacterial parotitis.which is rare nowadays.
2 Viral parotitis including HIV and tuberculosis (Rare)
3- parotid duct obstruction due to inflammation of the duct following acute parotitis.
4 there are some other causes of obstruction like stenosis of he duct or small stone.

Unfortunately there are no specific blood tests to confirm the diagnosis.
Ultrasound of the parotid can be done to look for the abnormalities.
Sialography is another test which is done rarely nowadays and is invasive test to be done in the small infant.
I am not convinced about radiation treatment.
Why don't you wait and see as she has shown some improvement already.
Why she improves after getting up may be because as the child eats something or chews something saliva will flow thro the duct and swelling reduces.This itself is a good sign.
Is there no way you can get a second opinion there or with a dentist( pediatric maxillo faciary specialist)?
Reg radiation,my suggestion is to wait ,to make more enquiries and get second opinion there by showing the child to another.

All the best
God bless
Dr Uma

Above answer was peer-reviewed by
Follow-up: Noticed lump below ears. Not cured by medicine. Could it be chronic sialadenitis parotid glands? 6 hours later
Hello Dr. Uma,

1) She didn't have MMR vaccine.
2) She is now 2 years and 10 months old. Her first bump was 1 month ago.
her second appeared 10 days ago.
3) The bump has always been on her left side.

May I ask for some specific answers? If you can be little more specific that would help. Unfortunately, a second opinion is not available at the time and that why I' turning to this website.

1) It has been almost 2 weeks she has had bumps. Is that serious or normal?
All readings I have done says it goes away within a week. Is that true?

2) What is the downside of doing radiation? Why do you think we should wait?

3)What should a doctor look for to diagnose her condition?

4)How do we know if it is bacterial infection or viral infection? What test can be done to know this?
Answered by Dr. Uma Rajah Ananth 3 hours later
Hi again,
Your Question1
It is not normal and not serious. She has responded to antibiotics and now swelling is intermittent. She has no pain or fever or redness of the swelling.p
SoI feel you can wait for 1-2 weeks more

Question of radiation
Still I can not understand whether they want to do radiological investigations or lithotrypsy ( used for stones in parotid duct)
Or radiation theraphy which they use for tumors.
For radiation therapy there are some long term hazards especially in a growing child.It can cause fibrosis.
As you rightly pointed out what investigations they have done?
Ultrasound or MRI or sialography?
Anyway you have to discuss with them pros and cons of radiotherapy!
There is also scope for endoscopy to see the duct for partial obstruction. Please discuss with them.

Reg bacterial or viral infection
Blood counts in CBC will show high polymorphs( neutrophils) and a high total wbc count in bacterial infection. In viral infection lymphocytes will be predominant.

Why I suggested a second opinion there is, somebody can examine the child and get first hand information.A ENT or faciomaxillary specialist will be ideal.
By the way who is seeing the child now?( what speciality?
Take care Dr Uma
Above answer was peer-reviewed by
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