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Does anorexia cause parotid gland swelling?

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Anorexia nervosa (AN) does cause parotid gland swelling, particularly if AN is accompanied by bulimia that includes vomiting. Enlargement of the parotid glands is the same thing as enlargement of the salivary glands. The technical term for this is sialadenosis or sialadenitis.

Swelling of the salivary glands as a symptom of AN is one that is less commonly named.

However, parotid gland swelling does occur in those with anorexia nervosa when purging behaviors in the form of vomiting are present as well.

The condition usually affects both parotid glands that sit on both sides of the face just in front of the ears. The enlargement usually develops two to six days after self induced vomiting has stopped. In cases where a parotid gland biopsy was done, the results have usually shown no abnormal cells (such as cancer). (1)

Electrolyte imbalance may also be seen when the parotid gland swelling is present. This electrolyte imbalance usually goes along with episodes of purging.

It is also common to find that the swelling of the parotid glands usually is seen along with dry lips and a burning tongue. (2)

Last updated on 
October 24, 2023
In this article

How often does parotid gland swelling occur?

Below are a few three different studies that were done for the purpose of answering this question.

Study #1

Who did the study?

Four scientists at a German university, 1990. (3)

How the study was done

Oral examination of 11 patients with anorexia and 41 with bulimia, compared to 50 healthy control patients.

Findings of the study

27 or 41 bulimia patients had the parotid gland swelling on both sides of the face (66%). They also found erosion of the enamel simultaneously.

Study #2

Who did the study?

Four scientists at the University of London, 2008. (4)

How the study was done

MRI exams of only 5 subjects with a purging form of eating disorder were compared to 5 controls. The exam was done 6-9 weeks after the cessation of vomiting.

Findings of the study

Enlarged parotids were not consistently seen in the eating disorder patients; however, only five patients were in the study.

Study #3

Who did the study?

Seven researchers from Italy, 2021. (5)

How the study was done

Six patients suffering from eating disorders (4 with anorexia-bulimia) and recurring symptoms of gland swelling were followed up with clinical and radiographic analysis as well as a technique that allows the actual visualization of the salivary glands and their ducts.

The plaques were washed out of the ducts; any strictures in the ducts were dilated and mucous plugs and debris from the ducts were removed with irrigation or forceps.

Findings of the study

Both glands were affected in 5 out of 6 patients. In 50% of the parotid glands, one of the major ducts was affected; in 33% of the glands, only secondary ducts were affected; and in 17% of the glands, both the primary and secondary ducts were affected. Improvement in symptoms was recorded in 83% of the patients. One patient did not have symptom relief or volume reduction after four procedures during six months. Another patient did not have immediate improvement but did improve within 3-5 months.

The most recent study in 2021 reported an incidence of anywhere between 10% and 50%, with the condition presenting itself on either one side of the face or both. (5)

How is this swelling confirmed by the doctor?

The way that the parotid gland swelling is diagnosed is with an ultrasound test. In one German study, doctors performed an ultrasound exam of the parotid glands of 70 women between 16 and 40 years old. Twenty of them were individuals without eating disorders. 

There was a significant difference in the results between the different groups. The parotid gland volume in the subgroup bulimia nervosa was 62,708 mm which was twice as high as the group without an eating disorder. Only the parotid glands were enlarged; the glands underneath the jaw were not. They concluded that eating disorders influence the size of the parotid glands although in the year of this study – 2008 – no one knew what exactly was causing this to happen. (6)

However, one medical report in 2004 commented that a 28-year-old patient affected by bulimia/anorexia nervosa had the parotid gland swelling on both sides of her face and also had swelling of the hard palate. This secondary swelling was painless and also was symmetrical. This location is where the minor salivary glands are located. (7) 

One of the early reports of the enlargement of the parotid glands goes back to 1981 when three researchers reported it in the International Journal of Psychiatry Medicine. In that report, the psychiatrists stated that sometimes the enlargement of the salivary gland persists when the eating disorder has gone away and the patient is weight restored. (8)

An earlier report goes back to the beginning of the 1950s when doctors called the combination of anorexia, stopping of the periods, and swelling of the parotid glands the “mannequin syndrome”. (9) At that time, this syndrome was seen in young women These patients expressed a desire to remain thinThis was commonly seen in fashion models and airline stewardesses. (4)

Treatment of the condition

Treatment involves the ducts being cleaned out, as reported in study 9 found in the table. However, this treatment hasn’t been performed on a high number of patients yet. In that study alone, only six patients received the treatment. 

In many cases the parotid gland swelling will resolve on its own as the eating disorder behaviors, specifically repeated bouts of vomiting have ceased.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Resources Levin PA, Falko JM, Dixon K, Gallup EM, Saunders W. Benign parotid enlargement in bulimia. Ann Intern Med. 1980 Dec;93(6):827-9.
  2. Romanos GE, Javed F, Romanos EB, Williams RC. Oro-facial manifestations in patients with eating disorders. Appetite. 2012 Oct;59(2): 499-504. https://pubmed.ncbi.nlm.nih.gov/22750232/
  3. Willershausen B, Phillipp E, Pirke KM, Fichter M. Oral complications in patients with anorexia nervosa and bulimia nervosa. Zahn Mund Kieferheilkd Zentralbl 1990;78(4):293-9. https://pubmed.ncbi.nlm.nih.gov/1700561/ 
  4. Price C, Schmidt MA, Adam EJ, Lacey H. Parotid gland enlargement in eating disorders: an insensitive sign? Eat Weight Disord. 2008 Dec;13(4):e79-83. https://pubmed.ncbi.nlm.nih.gov/19169067/ 
  5. Colella G, et al. Interventional sialendoscopy in parotidomegaly related to eating disorders. Journal of Eating Disorders. Feb 17, 2021; 25. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-021-00378-9 
  6. Bozzato A, Burger P, Zenk J, Uter W, Iro H. Salivary gland biometry in female patients with eating disorders. Eur Arch Otorhinolaryngol. 2008 Sep;265(9):1095-102. https://pubmed.ncbi.nlm.nih.gov/18253742/ 
  7. Mignogna MD, Fedele S, Lo Russo L. Anorexia/bulimia-related sialadenosis of palatal minor salivary glands. J Oral Pathol Med. 2004 Aug;33(7):441-2. https://pubmed.ncbi.nlm.nih.gov/15250838/
  8. Walsh BT, Croft CB, Katz JL. Anorexia nervosa and salivary gland enlargement. Int J Psychiatry Med. 1981;11(3):255-61. 
  9. Cosins JM, Frederickx Y, Yousif A, Hamoir M, Van den Eeckhaut J. Mannequin syndrome. Acta Otorhinolaryngol Belg. 1986;40(4):678-81. https://pubmed.ncbi.nlm.nih.gov/3799184/

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