August 5, 2014 at 1:00 am

To Your Health

An ENT can handle a blocked salivary gland

Dear Dr. Roach: Several weeks ago, I noticed that my face was swollen in front of my ear. I went to my primary doctor, and he put me on Augmentin and methylprednisolone, but that did not work, and the area is still swollen. I searched the Internet and found that the parotid gland is in the swollen area. A dentist told me that it IS the parotid gland, and it could be a sinus blockage. Who should I see next, an ENT doctor? This all started with my teeth on that side hurting. Could it be a dental problem?

D.N.

Dear D.N.: The parotid glands are the largest of the salivary glands and are located behind the teeth and in front of the ear in both cheeks. In my experience, the most likely cause of a swollen parotid gland on one side is a salivary gland stone, called sialolithiasis.

I can’t understand why both your parotid glandw would be swollen and your teeth hurting from the same condition. Parotid stones typically hurt worse with eating or anticipation of eating.

If the dentist who examined you said it’s the parotid gland (and presumably not a dental problem), then an ENT physician is certainly the expert on disorders of the parotid glands. If it’s a stone, it usually can be removed by the ENT physician.

Dear Dr. Roach: Last summer, I went to a podiatrist, who did an ultrasound on both of my feet. He concluded I have Morton’s neuroma in both feet. He gave three options: Cut the nerve and have a possible stump grow back, which didn’t sound very appealing; freeze, then shoot alcohol once a week for seven weeks; or do a ligament release, which seems to be best.

I cannot get a single doctor to give me a referral of one person with a successful ligament release. They all cite privacy issues.

My question is, since my situ­ation is getting worse — feet nu­mbing, etc. (I don’t have diabe­tes) — would you have a surgery without any validation of its success from one who had that surgery?

L.

Dear L.: An interdigital, or Morton’s, neuroma is a localized swe­lling, usually between the third and fourth toes, which causes pain or numbness. It is thought to be due to nerve damage at the nerve ending. It’s usually diagnosed by ultrasound.

In my opinion, conservative management is best for Morton’s neuroma, unless surgery is absolutely necessary. Cutting pressure on the area by using an ort­hotic, metatarsal support or pad­ded shoe insert usually relieves symptoms. Sometimes foot exercises are recommended also.

If conservative management doesn’t relieve pain, most doctors recommend a single injec­tion of steroid and topical anesthetic. Most people get relief.

If all else fails, both ligament release and removal of the damaged nerve area have been sho­wn to be very effective. I personally wouldn’t insist on a reference from a patient. My concern is that you might not have had a sufficient trial of conservative treatment to avoid surgery.

Email questions to ToYourGoodHealth@med.cornell.edu.