For several months, a 46-year-old man kept noticing swelling in front of both ears, most prominently on the left. It brought a sense of fullness and mild discomfort, and it usually faded on its own within a few hours.
The cause turned out to be a habit. He regularly puffed his cheeks hard against pursed lips, creating a Valsalva-type pressure surge to relieve discomfort in his jaw joints, and he used the same maneuver during episodes of anxiety. A CT scan showed air inside the ducts of both parotid glands, within the glands themselves and in the overlying facial tissue.
