People at the extremes of age, the chronically debilitated, or those in chronic care facilities, especially when associated with cerebrovascular events and oesophageal cancer, are especially affected by drooling. True sialorrhoea is rare.
Drooling is a problem for many children with cerebral palsy, intellectual disability and other neurological conditions, and in adults who have Parkinson disease or have cerebral palsy, intellectual disability, or have had a stroke (cerebrovascular event; CVE), pseudobulbar palsy, or bulbar palsy.
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).
|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
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)
Clinically: drooling persons are at increased risk of skin maceration, infection periorally and on the neck, chest, and hands and aspiration-related respiratory infections. Pulmonary complications are greatest in those with a diminished sensation of salivary flow and hypopharyngeal retention.
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:
|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