Drooling

• Infectious
  –Viral and bacterial rhinosinusitis: Nasal congestion and obstruction lead to chronic mouth opening and contribute to drooling
  –Adenotonsillar hypertrophy may cause drooling via nasal obstruction leading to persistent mouth opening to breathe
  –Severe pharyngotonsillitis/tonsillitis causes an obstruction of swallowing
  –Retropharyngeal or peritonsillar abscess similarly causes a physical obstruction of the swallowing mechanism
  –Epiglottitis: Severe, life-threatening illness caused by Haemophilus influenzae type B, which causes rapid enlargement of the epiglottis; classic symptoms include drooling, a “perched” posture, respiratory distress

• Inflammatory
  –Allergic rhinitis
  –Nasal polyposis
• Congenital lesions
  –Craniofacial syndromes
  –Midline nasal masses, e.g., encephalocele and glioma, may obstruct nasal breathing and require mouth breathing and therefore reduced swallowing
  • Neurologic
    –Cerebral palsy: Significant persistent drooling may occur secondary to impaired neuromotor control
    –Cricopharyngeal achalasia and esophageal dysmotility are conditions of neuromotor dysgenesis in the smooth muscle
  • Trauma
    –Caustic ingestion causes an increase in saliva production
    –Laryngeal trauma may damage the structures necessary for swallowing
  • Dental
    –Teething may cause an increase in drooling in an infant or a young child
    –Dental caries may cause drooling because of pain and local irritation
  • Foreign body

  Workup and Diagnosis

  • History
    –Severity (number of bibs or tissues saturated), onset, duration
    –Ability to eat and drink
    –Recent URI, sinusitis
    –Mouth breathing, snoring
    –Severe neuromotor delay, recurrent or chronic aspiration
    –Prior conservative therapy
    –Immunization history for HiB
  • Physical exam
    –Fever, general appearance
    –Head control (a child keeping head in continuous flexion may persist with drooling)
    –Stridor, nasal obstruction, tonsillar size
    –Tongue control, excoriations around the mouth
  • Studies
    –Lateral skull X-ray when adenoid hypertrophy is suspected
    –Flexible fiberoptic nasopharyngolaryngoscopy permits visualization of nasal cavity, adenoids, larynx
    –CT neck with contrast if abscess is suspected
    –Modified barium swallow if swallowing difficulty or chronic aspiration is suspected
    –Further testing for chronic sialorrhea is seldom necessary

  Treatment

  • Acute drooling with airway obstructive symptoms may require urgent or emergent airway management
    –Anesthesia and ENT evaluation to secure airway
  • No treatment
    –Age less than 2 years
    –Mild intermittent drooling
    –Medical contraindications
  • Medical treatment
    –Anticholinergics: Scopolamine, glycopyrrolate
    –Botulinum injections in the salivary gland
    –Speech pathology: Oral motor training to improve oromotor function
  • Biofeedback: Condition child to increase frequency of swallow based on noise stimulus
  • Surgery
    –Submandibular gland excision, submandibular duct relocation, parotid gland excision, tympanic neurectomy

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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