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Suggest Treatment For Pain Due To Salivary Gland Stones

Posted on Fri, 28 Feb 2014

Question: hello im in need of some advise please im a 22 yr old female I suffer from salivary gland stones and currently having a really bad flare up ive taken co-codamol 30/500 amd it didnt do anything I then 3 hrs later tookone paracetamol as im in a lot of pain and will do anything to try to get relief im over tired and csnt sleep ive used the Diflam mouth wash agakn doesnt do anything I have really bad ear ache too amd nothing helps I have also used salt water rinse im also feeling sick amd dizzy is this part of the gland problem im crying in pain. I see my ent surgeon on Thursday but the pzin is so bad what can I do to help it also would he remove the gland as these bouts are more often and extremely painful and I suffer from fibromyalgia which is controlled but im struggling with the pain of the gland please help

Answered by Dr. Prahlad Duggal (1 hour later)

Brief Answer: Take antibiotics along with analgesics Detailed Answer: Hi, Thanks for the query. Sialedinitis because of salivary gland stones is very annoying sometimes. Presently you are having severe pain because of that. Pain if it is not responding to the pain killers and mouth washes, needs to be tackled with antibiotics. So, you need to consult your GP and a suitable antibiotic needs to be prescribed by him/her as the pain is because of infective process. Otherwise also the infective part needs to be tackled before any definitive intervention in the form of surgery is instituted. There is another option other than surgery which can be availed in suitable candidates known as sialoendoscopy which you need to discus with you ENT. THis can help in removing stones from the gland in few cases without surgery. Also take plenty of fluids/water. Feel free to ask another query. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prahlad Duggal (10 hours later)

Hello, Thank you for getting back in touch with me I forgot to put my GP has started me on yet more Antibiotics they are called Clarithromycin liquid 250mg/5ml and I am on 10mls twice a day......... These were prescribed on Friday 31st XXXXXXX 2014 though I haven't noticed them working, I have had antibiotics every week since XXXXXXX 2013 due to the gland playing up and causing a lot of pain and swelling. May last yr it flared so badly I was hospitalized for 3 days as the swelling was very bad and painful ..... Two large stones about 2cm burst through my mouth and caused a lot of damage I now have a hole in my mouth under my tongue which has healed but has scarred badly, Also I have had a Sialoendscopy which showed very bad scaring and swelling in the gland but no stones at the time this was back in XXXXXXX of last yr but since then I have had 4 stones come out and one got wedged in the gland and I was advised to just pull it out I think I made things worse by doing this as it bleed for 3 hrs and the pain was very bad,,,, This was December it happened but a week ago a stone came away with a lot of puss and messy coloured liquid Which I think may of been saliva Which had built up. I saw my GP on Friday 31st XXXXXXX and he put me straight back on antibiotics though I hadn't finished the Ethromycin 10mg/5mls because he can feel a stone in the gland or stones as when he pushed it, it crunched and hurt like mad. What can I do to help the pain I am on Difflam mouthwash every 1 half hrs to 3 hrs helps for a little while but then stops, I am also using salt mouth washes which stings a lot, and I am co-codamol 30/500 for pain, I also took Paracetamol 500mg one tablet 2 hrs after the co-codamol as I wasn't coping with the pain and it helped for about 20 minutes, What else can I do??? I am in a lot of pain and discomfort I haven't eaten for a week due to pain, I am barely managing to drink, Am I doing wrong by taking co-codamol and Paracetamol I am realluy really struggling to cope and really don't know what to do. I am also not sleeping at all due to pain. I feel really low and depressed mainly due to the gland and don't know what else to do. What would the next steps be?

Answered by Dr. Prahlad Duggal (2 hours later)

Brief Answer: A scarred gland is not good for sialoendoscopy Detailed Answer: Thanks for the query. I share your concern and please understand that no intervention is possible without resolving or at least containing the infection although it may be temporary. So, you need to continue antibiotics as long as your ENT says and when the infection gets contained, go ahead with surgery and gland will be excised. A scarred gland is not a candidate for sialoendoscopic correction of problem. Surgical excision of the gland is the option. Also Co-codamol is a combination of codeine and paracetamol. So additional paracetamol will not be of additional use. But the analgesic dose of paracetamol is more than 500mg thrice daily and a 1000mg thrice daily can be safely taken and should tackle the pain sufficiently. So, for you, take antibiotics and analgesics with oral rinses and then go ahead with surgery after the infection is contained. Feel free to ask another query. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prahlad Duggal (1 hour later)

Ok thank you. Is there anything I can do, as I am not sleeping with this flare up and i feel so tired I'm not functioning as I should be I have for past few days been sleeping with a Ice pack on my neck is this ok to continue ? Also I have extremely bad ear ache I have also lost hearing in my Right ear is this from the Gland and I know the Ear nose and throat are all interconnected..................... Also I was wondering, what can be done regarding a sinus infection which isn't responding to antibiotics I also have a post nasal drip which is making me feel physically sick, (Three weeks ago I was headbutted very hard ion my nose by a two year old could this be from that?) which isn't helping the eating (Not eaten since last monday) Due to pain, I am struggling with drinking as well I have tried to drink just water and I am gagging on it ? Is this the pain as a reaction or Something else? 1)Sleeping with a Icepack on my neck! 2)Lack of Sleep! 3)Ear Ache/ Hearing loss 4)Sinus Infection (Ongoing)! 5)Lack of drinking and eating! 6) Gagging! 7) Post Nasal Drip 8) COuld being head butted caused majority of these problems? I have had Functional Endoscopic Sinus Surgery 6 years ago, Also septoplasty 2 years ago and Rhinoplasty both due to Sinus's and being unable to breath through my nose not for cosmetic reasons.

Answered by Dr. Prahlad Duggal (8 hours later)

Brief Answer: Descriptive Detailed Answer: Thanks for the query. Pain or generalized discomfort can be cause of lack of sleep. Antibiotics and analgesics are the options you have at the moment and then follow it up with surgery. Ear ache can be because of infection in the floor of mouth as a referred pain. But hearing loss because of salivary gland problem is unlikely. It can be because of sinusitis which you have stated or because of long term medicine use as some antibiotics and analgesics can lead to hearing loss. An audiometry can put more light on the type of hearing loss and suggest about the cause. Sinus infection needs to be evaluated and an ENT consultation and may be a CT scan PNS will be required. Otherwise, the antibiotics you already using should be supplemented with steam inhalation and mucolytics along with intra nasal steroid sprays. Loss of appetite should improve as your acute phase of infection and pain gets resolved with treatment. Post nasal drip can be a cause of gagging and steam inhalation should help. Proton pump inhibitors in consultation with the GP should also help in this. A trauma to head is unlikely to cause so many problems and the systemic reaction to the infections in the head & neck region can be a more likely cause. Feel free to ask another query. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prahlad Duggal (21 hours later)

Hello, Thank for getting back in touch with me, I'm currently finding it really hard eating and drinking due to pain in my gland, which is provoked and made worse by eating, I was told to continue a normal diet but this is proving hard to do What should I do? Also I am currently Taking co-codamol 30/500, then two-3 hrs later taking Paracetamol 2 500mg tablets because nothing is helping Should I be doing this or is it likely to do more harm than good? What is a PNS mean? Is there anything |I can do to help me sleep due to the pain I am not sleeping at night, Which is really bad I am so tired and dizzy I am finding it hard to cope

Answered by Dr. Prahlad Duggal (4 hours later)

Brief Answer: 3 grams/day under physician guidance can be taken Detailed Answer: Hi, Thanks for the query. Paracetamol can be taken safely in analgesic doses of 1000mg thrice daily . Just take a proton pump inhibitor (PPI) or ranitidine along with. Also you are to take the anlagesics after eating something and not empty stomach. PPI or ranitidine should be taken empty stomach. But please understand that these measures are temporary measures and need to be followed up with definitive measures like surgical removal of gland. So, please discus with your ENT so as to achieve an optimum level of infection control and go ahead with surgery as the agony is too much. PNS means Para nasal sinuses that is the sinuses around the nose. You can add a small dose of sleeping drugs with analgesics or amitriptyline for two three days but only in consultation with your GP. That will give you a days' sleep and will relax you a bit but please do not use these regularly as these are habit forming drugs. Feel free to ask another query. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prahlad Duggal (21 hours later)

ok thank you I justvwanted to check as I know that there is paracetamol in co-codamol how would he remove the gland ? is it painful afterwards please could you tell me more about the procedure to remove the gland

Answered by Dr. Prahlad Duggal (3 hours later)

Brief Answer: excised by an external incision Detailed Answer: Thanks for the query. Submandibular salivary is excised by a skin incision in the neck crease on the side of neck. The gland is mobilized from the surrounding structures and is removed. It is not painful in post operative period as analgesics are given for few days pist operative. The area remains somewhat tender for few more days but is not otherwise painful. Feel free to ask another query. Regards

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar