Drooling and sialorrhoea
AETIOLOGY AND PATHOGENESIS
Drooling is caused either by increased saliva flow (sialorrhoea) that cannot be compensated for by swallowing, or by poor oral and facial muscle control in patients with swallowing dysfunction (secondary sialorrhoea), or by anatomic or neuromuscular anomalies (Table 7.1).
Table 7.1
| Excessive saliva production (sialorrhoea) | Decreased swallowing | Anatomic abnormalities | Neuromuscular diseases |
| Oral lesions or foreign bodies Neurologic disorders (especially Riley–Day syndrome, Ch. 56) Otolaryngologic diseases Pregnancy Gastrointestinal causes Liver disease Drugs and poisons parathion, strychnine, (Table 54.6) |
Oropharyngeal infections and obstruction | Macroglossia or tongue thrusting Surgical defects following major head and neck surgery |
Parkinson disease, cerebral palsy, intellectual impairment, stroke, pseudobulbar palsy, bulbar palsy, anterior opercular syndrome (Foix–Chavany–Marie syndrome, Ch. 56) Rabies |
CLINICAL FEATURES
Drooling (Fig. 7.1) impacts on patients, families, and/or caregivers:
DIAGNOSIS
History helps assess the severity and frequency of drooling, and the effect on the quality of life of patient and family. Quantitative measurements can be helpful for guiding treatment decisions (Table 7.2): counting the number of bibs or items of clothing soiled each day provides a subjective estimate. Examination should include:
Table 7.2
| Condition | Description |
| Dry | Never drools |
| Mild | Only lips wet Occasional drooling – not every day |
| Moderate frequent drooling | Lips and chin wet – every day |
| Constant drooling | Severe – clothing soiled Profuse – hands moist and wet |
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