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Sialolithiasis
SAMUEL KIM AND JOHN H. BURTON
n Agents
n NSAIDs
n Opioids
n Sialogogues
n Evidence
Conservative treatment of sialolithiasis pain consists of sialagogues (e.g.
lemon drops), mild analgesics (e.g. acetaminophen [paracetamol],
NSAIDs), opioids, mechanical stimulation, and warm compresses. 1 A variety
of nonpharmacological treatment modalities may be necessary if, as is often
the case, pharmacotherapy fails. 2,3 The goal of drug therapy is to temporize
until, and hopefully facilitate (in the case of sialogogues), passage of the
stone. 4
Unfortunately, in many cases, the stone moves into the salivary gland (e.g.
parotid) rather than passing externally. Surgical intervention is frequently
needed and analgesic approaches in acute care do not obviate the need for
ENT evaluation.
Given the importance of surgical intervention to relieve salivary tract stone
disease (and symptoms), it is not surprising that no clinical trials assess the
comparative efficacy of drug treatment options for treating sialolithiasis pain.
Textbooks recommend traditional analgesics, separately or in combination.
NSAIDs, acetaminophen, and various opioids (e.g. hydrocodone, oxycodone)
are usually recommended. Given the inflammatory component to
parotitis and sialolithiasis, NSAIDs are the most reasonable initial choice,
but it must be acknowledged that there is little evidence basis for treatment
decisions in this population.
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