[Treatment of sialorrhea in patients under long-term ventilation]

Sialorrhea (drooling or excessive salivation) is a common problem in patients with progressive neurolomuscular diseases and bulbar palsy. Contributing factors are hypersecretion of saliva induced by cholinergic drugs and poor dental status. Non-invasive ventilation is often severely impaired in these patients. Treatment should be initiated with a thorough evaluation of the medication and of the oral status by an otorhinolaryngologist. As drooling is commonly caused by poor oral or pharyngeal neuromuscular control, swallowing therapy should be initiated by a speech therapist. Further treatment options are anticholinergic medications, botulinum toxin injections into the salivary gland, radiation and and surgical procedures. Whereas systemic anticholinergic medications lead often to side effects, the (ultrasound-guided) injection of botulinum toxin into the parotid and submandibular gland is a safe and effective method for controlling drooling for at least 2 months.