Ask a Doctor: Sialorrhea

Introducing: Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, our pediatric team discusses sialorrhea.
Prepared by: Govind Bindra, M1 class of 2025
Reviewed by: Dr. Anthony Sheyn, Pediatric ENT specialist

First, what is sialorrhea?

Sialorrhea is a condition of increased saliva production or excessive drooling.

Though drooling is common in normally developed babies, it is considered uncommon after age four. This condition can be uncomfortable, can lead to anxiety in social situations, and cause problems with self-esteem. In severe cases, it can lead to coughing and can impede chewing or speech.

Most often, it is associated with neurological disorders.

What are the causes of sialorrhea?

The major salivary glands (parotid, submandibular, and sublingual glands) normally secrete saliva which plays major roles in lubrication, digestion, immunity, and maintaining body homeostasis. Sialorrhea can either be due to increased production of saliva or decreased clearance of produced saliva from the oral cavity.

The most common causes of sialorrhea in children are neurologic, including (but not limited to):

• Cerebral palsy among children
• Parkinson’s Disease or amyotrophic lateral sclerosis (ALS) among adults
• Facial paralysis
• Loss of sensation in the lips
• Dental problems
• Nasal blockages
• A mix of these factors

What are the symptoms?

Sialorrhea’s severity can vary depending on its etiology. It can present as either an increase in normal saliva production, or as a continuous production of saliva.

In either case, you may have difficulty keeping excess saliva in your mouth or you may have difficulty swallowing. In children with neurologic problems, uncontrolled salivary production can lead to pneumonia and extended hospitalization.

How can I prevent sialorrhea?

For cases unrelated to neurological conditions, dietary management may be sufficient to prevent excess saliva production.

• Eating sugary foods such as candies, sweet drinks, or desserts tends to increase saliva production; avoiding these foods may help reduce this production.
• Sour foods can also stimulate production of saliva. You may try avoiding eating citrus fruits, pickles, or foods with vinegar.
• For excessive drooling at night, try sleeping on your back to prevent pooling in the mouth.

When should I call my doctor?

You should reach out to your doctor if you or your child have been unable to control excess drooling via dietary changes.

Also, contact your physician if you have concerns about coughing or choking on excess saliva secretions, or if you have begun to hold your head in abnormal positions to control for increases in saliva production.

What are the current treatment options for sialorrhea?

Treatment options include 1) pharmacological therapies, 2) surgical interventions, 3) behavioral and speech therapy, and 4) biofeedback. Of course, a multidisciplinary approach integrating multiple treatments has been found to be most successful.

1) Pharmacological therapies involve a) Botulinum toxin (Botox) injection or the b) anticholinergic drugs.

• Botox use currently stands as the most effective known treatment for sialorrhea, showing minimal side effects in both pediatric and adult populations. This treatment involves injection of Botox A or B into the parotid and submandibular glands, directly leading to decreased saliva production. Here, it’s necessary that the patient hasn’t had Botox injections in the six months before the procedure.
• Anticholinergic drugs include oral formulations of glycopyrrolate, benztropine, scopolamine, and tropicamide. Though these medications contribute to positive outcomes in many patients, they also may present with side effects including headaches, constipation, dry mouth, and urine retention.

2) Surgical therapies are currently being examined as treatment options for more severe cases.

• These involve denervation (removal of the nerves) of submandibular glands and complete removal of the sublingual glands.
• They are usually reserved for more severe cases of sialorrhea, are generally much more invasive, and may involve significantly more side effects than conventional behavioral or medical treatment strategies.
• Consult your doctor to determine if your case necessitates an interventional strategy as involved as salivary gland surgery.

How can our Dream Team help?

Our pediatric specialist, Dr. Anthony Sheyn, has wide-ranging expertise in treating children with ear, nose, and throat issues. If you have concerns about your child’s salivary glands, please contact our office to schedule an evaluation: 901-287-7337