UPSC-CMS 2022 — ENT

Question 1: A 6-year-old boy has recurrent history of pain and swelling below his left ear, which generally lasts for 3–7 days and improves mildly after a course of antibiotics. Sialography shows punctate sialectasis. He should be treated by

• A. endoscopic washouts and antibiotics (Correct Answer)
• B. radiotherapy
• C. prolonged low-dose antibiotics
• D. total conservative parotidectomy

Explanation: ***endoscopic washouts and antibiotics*** - The recurrent parotid swelling with **sialographic findings of punctate sialectasis** is characteristic of **juvenile recurrent parotitis (JRP)**. - For **recurrent cases** like this (multiple episodes requiring treatment), **sialendoscopy with ductal irrigation/washout combined with antibiotics** is now considered **first-line treatment** in modern practice. - **Sialendoscopy is minimally invasive** and has been shown to significantly reduce recurrence rates by removing debris, dilating stenotic ducts, and washing out inflammatory mediators. - Multiple studies demonstrate that endoscopic intervention provides superior outcomes compared to medical management alone in recurrent JRP. *prolonged low-dose antibiotics* - While antibiotics are important for **acute exacerbations**, prolonged prophylactic antibiotic therapy is **no longer recommended** as primary management for recurrent JRP. - This approach has limited evidence for effectiveness and raises concerns about **antibiotic resistance**. - Conservative measures (hydration, gland massage, sialagogues) with antibiotics for acute episodes may be used for **initial or infrequent episodes**, but this patient has established recurrent disease. *radiotherapy* - **Radiotherapy is absolutely contraindicated** in juvenile recurrent parotitis due to unacceptable risks in children. - Radiation exposure carries high risks of xerostomia, secondary malignancies, and other long-term complications. - This has no role in the management of benign inflammatory conditions like JRP. *total conservative parotidectomy* - **Parotidectomy** is a major surgical procedure carrying risks of facial nerve damage, Frey's syndrome, and cosmetic deformity. - It is reserved only for **severe, refractory cases** that have failed both medical management and endoscopic interventions. - Given this is the patient's initial presentation for definitive management, surgery is premature and overly aggressive.