Objectives/HypothesisTo describe the findings and therapeutic role of salivary endoscopy for idiopathic chronic sialadenitis.Study DesignRetrospective case series.MethodsThe records of 258 patients who underwent salivary endoscopy between November 2008 and May 2012 were reviewed. Included cases presented with recurrent inflammation and swelling of a single major salivary gland, without identifiable etiology on examination and imaging.ResultsA total of 51 cases (20%) were identified. These patients had a mean age of 54.4 years (range, 23–75) and 57% were female. Mean duration of symptoms was 22.8 months (range, 1–102), with most cases (75%) involving the parotid gland. The primary imaging modalities used were ultrasound (62%) and computed tomography (31%). The most common findings on imaging included ductal dilation (42%), enlarged lymph nodes (23%), normal glandular imaging (15%), and possible sialoliths (14%). The most common findings on salivary endoscopy included stenosis (57%), strictures (27%), and inflammatory debris (18%). Occult stones were the cause of sialadenitis in only 4 (8%) cases. Outcomes included complete symptom resolution in 31 patients (61%), improved but occasional symptoms in 14 patients (27%), and no improvement in 6 patients (12%) after a mean follow‐up time of 20.0 months (range, 4–45). Excision of the involved gland was required in 2 (4%) patients.ConclusionSalivary endoscopy is a minimally invasive technique that is effective in the management of idiopathic chronic sialadenitis refractory to medical therapy. It provides diagnostic information in most patients and offers a therapeutic intervention with gland preservation.Level of Evidence4. Laryngoscope, 123:3016–3020, 2013