The management of drooling in adults with neurological conditions

Curr Opin Otolaryngol Head Neck Surg. 2012 Jun;20(3):171-6. doi: 10.1097/MOO.0b013e32835328ec.


Purpose of review: Drooling is a distressing symptom for adults with neurological conditions and can be challenging for health professionals. This review will consider the physical and psychosocial impact of drooling and will discuss the current management options including behavioural, pharmacological and surgical approaches.

Recent findings: A number of studies describe the use of botulinum toxin injections and irradiation of the salivary glands but no conclusive guidelines exist to recommend the most efficient dose or technique. The majority of saliva management studies focus on children with physical and/or cognitive disabilities and this evidence cannot be generalized to adults. There are relatively few studies that focus on saliva management in the adult neurological population.

Summary: Drooling is distressing for patients and their families. Ideally an individual would have easy access to the most efficient treatment with the fewest side effects. More evidence is now available but a lack of consensus on management approach, treatment dose and administration technique still exists. The symptom of drooling is best managed by a multidisciplinary team, starting with a conservative approach and then leading to more invasive procedures as appropriate.

Publication types

  • Review

MeSH terms

  • Administration, Cutaneous
  • Adult
  • Amitriptyline / administration & dosage
  • Amitriptyline / adverse effects
  • Atropine / administration & dosage
  • Atropine / adverse effects
  • Behavior Therapy / methods
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / adverse effects
  • Cerebral Palsy / rehabilitation
  • Child
  • Cholinergic Antagonists / administration & dosage
  • Cholinergic Antagonists / adverse effects
  • Cooperative Behavior
  • Deglutition Disorders / complications
  • Deglutition Disorders / etiology
  • Deglutition Disorders / rehabilitation
  • Glycopyrrolate / administration & dosage
  • Glycopyrrolate / adverse effects
  • Humans
  • Interdisciplinary Communication
  • Motor Neuron Disease / complications
  • Motor Neuron Disease / rehabilitation
  • Nervous System Diseases / complications*
  • Nervous System Diseases / rehabilitation*
  • Parkinson Disease / complications
  • Parkinson Disease / rehabilitation
  • Patient Care Team
  • Salivary Glands / surgery
  • Scopolamine / administration & dosage
  • Scopolamine / adverse effects
  • Sialorrhea / complications
  • Sialorrhea / etiology*
  • Sialorrhea / rehabilitation*


  • Cholinergic Antagonists
  • Amitriptyline
  • Atropine
  • Scopolamine
  • Botulinum Toxins, Type A
  • Glycopyrrolate