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Hypersalivation: update of the German S2k guideline (AWMF) in short form.
J Neural Transm (Vienna) 2019; 126(7):853-862JN

Abstract

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This update presents recent changes and innovation in the treatment of hypersalivation. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, saliva aspiration, and oro-motor deficiencies. Clinical screening tools and diagnostics such as fiberoptic endoscopic evaluation of swallowing generate important data on therapy selection and control. Many cases profit from swallowing therapy programmes to activate compensation mechanisms as long compliances are given. In children with hypotonic oral muscles, oral stimulation plates can induce a relevant symptom release because of the improved lip closure. The pharmacologic treatment improved for pediatric cases as glycopyrrolate fluid solution (Sialanar®) is now indicated for hypersalivation within the EU. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long-lasting saliva reduction. Here, a phase III trial is completed for incobotulinum toxin A and, in the US, is indicated for the treatment of adult patients with chronic hypersalivation. Surgical treatment should be reserved for isolated cases. External radiation is judged as a safe and effective therapy when using modern 3D techniques to minimize tissue damage. Therapy effects and symptom severity have to be followed, especially in cases with underlying neurodegenerative disease.

Authors+Show Affiliations

Department for Otorhinolaryngology, University of Luebeck, Ratzeburger Allee 120, 23538, Lübeck, Germany. armin.steffen@uksh.de.Parkinson-Klinik Ortenau, Wolfach, Germany.Paediatric and Adult Movement Disorders and Neuropsychiatry Group, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.Department for Otorhinolaryngology, University of Göttingen, Göttingen, Germany.Faculty for medicine, speech therapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.Department for Neurointensive care and early phase rehabilitation, Evang. Hospital Oldenburg, Oldenburg, Germany.Department for Otorhinolaryngology, University of Cologne, Cologne, Germany.Department for Maxillofacial surgery, University of Lübeck, Lübeck, Germany.Department for Psychiatry and Social psychiatry, University of Hannover, Hanover, Germany.Department for Otorhinolaryngology, University of Göttingen, Göttingen, Germany.Department for Psychiatry and Psychotherapy, University of Münster, Münster, Germany.Academic Institute for applied Otorhinolaryngology, Bad Bramstedt, Germany.Curavid, Office for radiotherapy, Lübeck, Germany.Evang. College Berlin, Nursing and Healthcare, Berlin, Germany.Department for Otorhinolaryngoloy/Phoniatry and pediatric audiology, University of Lübeck, Lübeck, Germany.Office Internal Medicine Rosenplatz, Reinbek, Germany.Dr. von Haunersches Children´s Hospital, Ludwig-Maximilians University Munich, Munich, Germany.Faculty for Medicine, Institute for Phonetics and speech processing, Ludwig-Maximilians University Munich, Munich, Germany.Department for Otorhinolaryngology, Technical University Munich, Munich, Germany.Department for psychiatry and psychosomatic, HELIOS Hospital, Schleswig, Germany.Office for Neurology and psychiatry, Berlin, Germany.Department for Otorhinolaryngology, University of Jena, Jena, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30972507

Citation

Steffen, Armin, et al. "Hypersalivation: Update of the German S2k Guideline (AWMF) in Short Form." Journal of Neural Transmission (Vienna, Austria : 1996), vol. 126, no. 7, 2019, pp. 853-862.
Steffen A, Jost W, Bäumer T, et al. Hypersalivation: update of the German S2k guideline (AWMF) in short form. J Neural Transm (Vienna). 2019;126(7):853-862.
Steffen, A., Jost, W., Bäumer, T., Beutner, D., Degenkolb-Weyers, S., Groβ, M., ... Guntinas-Lichius, O. (2019). Hypersalivation: update of the German S2k guideline (AWMF) in short form. Journal of Neural Transmission (Vienna, Austria : 1996), 126(7), pp. 853-862. doi:10.1007/s00702-019-02000-4.
Steffen A, et al. Hypersalivation: Update of the German S2k Guideline (AWMF) in Short Form. J Neural Transm (Vienna). 2019;126(7):853-862. PubMed PMID: 30972507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypersalivation: update of the German S2k guideline (AWMF) in short form. AU - Steffen,Armin, AU - Jost,Wolfgang, AU - Bäumer,Tobias, AU - Beutner,Dirk, AU - Degenkolb-Weyers,Sabine, AU - Groβ,Martin, AU - Grosheva,Maria, AU - Hakim,Samer, AU - Kahl,Kai G, AU - Laskawi,Rainer, AU - Lencer,Rebekka, AU - Löhler,Jan, AU - Meyners,Thekla, AU - Rohrbach-Volland,Saskia, AU - Schönweiler,Rainer, AU - Schröder,Sara-Christina, AU - Schröder,Sebastian, AU - Schröter-Morasch,Heidrun, AU - Schuster,Maria, AU - Steinlechner,Susanne, AU - Urban,Roland, AU - Guntinas-Lichius,Orlando, Y1 - 2019/04/10/ PY - 2018/12/27/received PY - 2019/03/27/accepted PY - 2019/4/12/pubmed PY - 2019/4/12/medline PY - 2019/4/12/entrez KW - Botulinum toxin KW - Drooling KW - Dysphagia KW - Glycopyrrolate KW - Hypersalivation KW - Oro-motor and oro-sensory therapy KW - Sialorrhea SP - 853 EP - 862 JF - Journal of neural transmission (Vienna, Austria : 1996) JO - J Neural Transm (Vienna) VL - 126 IS - 7 N2 - Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This update presents recent changes and innovation in the treatment of hypersalivation. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, saliva aspiration, and oro-motor deficiencies. Clinical screening tools and diagnostics such as fiberoptic endoscopic evaluation of swallowing generate important data on therapy selection and control. Many cases profit from swallowing therapy programmes to activate compensation mechanisms as long compliances are given. In children with hypotonic oral muscles, oral stimulation plates can induce a relevant symptom release because of the improved lip closure. The pharmacologic treatment improved for pediatric cases as glycopyrrolate fluid solution (Sialanar®) is now indicated for hypersalivation within the EU. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long-lasting saliva reduction. Here, a phase III trial is completed for incobotulinum toxin A and, in the US, is indicated for the treatment of adult patients with chronic hypersalivation. Surgical treatment should be reserved for isolated cases. External radiation is judged as a safe and effective therapy when using modern 3D techniques to minimize tissue damage. Therapy effects and symptom severity have to be followed, especially in cases with underlying neurodegenerative disease. SN - 1435-1463 UR - https://www.unboundmedicine.com/medline/citation/30972507/Hypersalivation:_update_of_the_German_S2k_guideline_(AWMF)_in_short_form L2 - https://dx.doi.org/10.1007/s00702-019-02000-4 DB - PRIME DP - Unbound Medicine ER -