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Hypersalivation: update of the German S2k guideline (AWMF) in short form

  • Neurology and Preclinical Neurological Studies - Review Article
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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.

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Authors and Affiliations

  1. Department for Otorhinolaryngology, University of Luebeck, Ratzeburger Allee 120, 23538, Lübeck, Germany

    Armin Steffen

  2. Parkinson-Klinik Ortenau, Wolfach, Germany

    Wolfgang Jost

  3. Paediatric and Adult Movement Disorders and Neuropsychiatry Group, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany

    Tobias Bäumer

  4. Department for Otorhinolaryngology, University of Göttingen, Göttingen, Germany

    Dirk Beutner & Rainer Laskawi

  5. Faculty for medicine, speech therapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany

    Sabine Degenkolb-Weyers

  6. Department for Neurointensive care and early phase rehabilitation, Evang. Hospital Oldenburg, Oldenburg, Germany

    Martin Groß

  7. Department for Otorhinolaryngology, University of Cologne, Cologne, Germany

    Maria Grosheva

  8. Department for Maxillofacial surgery, University of Lübeck, Lübeck, Germany

    Samer Hakim

  9. Department for Psychiatry and Social psychiatry, University of Hannover, Hanover, Germany

    Kai G. Kahl

  10. Department for Psychiatry and Psychotherapy, University of Münster, Münster, Germany

    Rebekka Lencer

  11. Academic Institute for applied Otorhinolaryngology, Bad Bramstedt, Germany

    Jan Löhler

  12. Curavid, Office for radiotherapy, Lübeck, Germany

    Thekla Meyners

  13. Evang. College Berlin, Nursing and Healthcare, Berlin, Germany

    Saskia Rohrbach-Volland

  14. Department for Otorhinolaryngoloy/Phoniatry and pediatric audiology, University of Lübeck, Lübeck, Germany

    Rainer Schönweiler

  15. Office Internal Medicine Rosenplatz, Reinbek, Germany

    Sara-Christina Schröder

  16. Dr. von Haunersches Children´s Hospital, Ludwig-Maximilians University Munich, Munich, Germany

    Sebastian Schröder

  17. Faculty for Medicine, Institute for Phonetics and speech processing, Ludwig-Maximilians University Munich, Munich, Germany

    Heidrun Schröter-Morasch

  18. Department for Otorhinolaryngology, Technical University Munich, Munich, Germany

    Maria Schuster

  19. Department for psychiatry and psychosomatic, HELIOS Hospital, Schleswig, Germany

    Susanne Steinlechner

  20. Office for Neurology and psychiatry, Berlin, Germany

    Roland Urban

  21. Department for Otorhinolaryngology, University of Jena, Jena, Germany

    Orlando Guntinas-Lichius

Authors
  1. Armin Steffen
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  2. Wolfgang Jost
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  3. Tobias Bäumer
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  4. Dirk Beutner
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  6. Martin Groß
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  12. Jan Löhler
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  15. Rainer Schönweiler
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  16. Sara-Christina Schröder
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  17. Sebastian Schröder
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  18. Heidrun Schröter-Morasch
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  19. Maria Schuster
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  20. Susanne Steinlechner
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  21. Roland Urban
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  22. Orlando Guntinas-Lichius
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Corresponding author

Correspondence to Armin Steffen.

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Steffen, A., Jost, W., Bäumer, T. et al. Hypersalivation: update of the German S2k guideline (AWMF) in short form. J Neural Transm 126, 853–862 (2019). https://doi.org/10.1007/s00702-019-02000-4

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  • DOI: https://doi.org/10.1007/s00702-019-02000-4

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