Question:

I have Sjögren’s syndrome and my salivary glands often swell up.  It is mostly my parotid glands and sometimes they get quite large. Many times when the glands are swollen, they become hard and very painful.  Why does this happen?  Is this normal in Sjögren’s?  Why are the glands painful sometimes and not others?  Is there anything I can do for the pain?  Is there anything I should be watching for?

Answer:

The pain and swelling of the salivary glands is part of Sjögren’s syndrome.  This is due to inflammation as well as a build-up of thickened saliva and mucus within the gland.  This causes a stretching of the gland and leads to discomfort and pain.  The pain is likely related to the amount and acuity of the inflammation and swelling.  Maintaining hydration, frequent small meals, hydration and occasionally massage of the glands may help to alleviate some of these symptoms.

Question:

I’ve heard that massaging the parotid glands is a good idea.  Is this true?  Would you please explain when and how to massage the glands?

Answer:

For some patients, massage of the parotid and submandibular glands may be helpful.  This will help move thickened saliva and mucus through the glands’ ductal system.

For the parotid gland, begin with moderate to firm pressure between the ear lobe and the angle of the jaw (mandible) and move your hand forward toward the corner of the lips.  For the submandibular gland, use the same amount of pressure, however begin just below the angle of the jaw and move forward under the jaw toward the undersurface of the chin.  Each movement should take 3-5 seconds.  Do this for 2 or 3 minutes, five times a day, especially after meals or when the glands feel swollen.

Question:

My rheumatologist said that I should irrigate my nostrils with a saline system to improve my Sjögren’s in the nose.  I don’t quite understand why this would benefit me.  There seems to be all kinds of products on the market and I am confused which type I should use or if I need to use one at all.  Is nasal irrigation worthwhile doing?  Does it matter which product and how often it is done?

Answer:

Generally, with few exceptions, there is little downside to using nasal saline irrigation.  Higher volume irrigation is usually better than small bottle/fine mist if tolerated.  Use of gentle pressure is recommended for irrigation as higher pressure may bother your ears.  Most systems are somewhat beneficial for cleaning thickened mucus and secretions.  Saline may be used two to four times per day.  However, if you are not experiencing any nasal problems, there is likely to be little or no benefit to the use of nasal saline.  If you are using a reusable systems, make sure to clean and dry the bottle nightly and change bottles every three months.

*excerpt taken from “Ask an Expert”, SjSC “Connections” Newsletter, Volume 5, Issue 4, questions answered by Dr. Doron Sommer*

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