I am asking about my father, an 87-year old man in otherwise decent
health for his age, who about a year ago, developed a condition in which he
begins uncontrollably to "spit up" saliva as he begins to eat dinner.
Sometimes this happens when he sits down at the table, even before he has
taken a bite of food, and the fluid comes up, clear but viscous, like a
fountain.
This will sometimes occur for days in a row and then not happen at all for a
period of time. Or on single, randomly occurring days.
His general practitioner and an otolaryngologist he consulted both say it is
a malfunction of the salivary glands and nothing can be done about it. Is this
the only possible diagnosis and is there no treatment? Is it possibly a
problem with his esophagus, since a short time before the behavior began,
he was hospitalized for another medical condition, during which time a
tube was inserted into his throat.
Reply -------------------------->
The symptoms described can be caused either by salivary hypersecretion or by a swallowing disorder in which normal salivary flow exceeds the physical capacity to swallow the secretion. In either case, the clinical observation will be drooling.
Swallowing dysfunction that can result in drooling can occur with emotional or psychogenic disorders, or chronic neurologic conditions such as Parkinson's, cerebral palsy, mental retardation, amyotrophic lateral sclerosis, as well as any neurologic condition that affects muscular control.
Actual salivary hypersecretion may be associated with rabies, mercury poisoning, tetanus, esophageal reflux, or inflammatory conditions affecting the lining of the mouth. Pregnancy can be associated with hypersecretion. Finally, certain medications, for example anticholinesterases, may be associated with increased salivary flow.
In most cases, drooling is associated with a neuromuscular condition. If drooling is severe and a health hazard, aggressive surgical interventions are occasionally recommended including repositioning of the tubes that drain saliva and/or removal of certain saliva glands.
Some medications are capable of causing decreased salivary flow and might be considered in certain cases of severe hypersecretion, if not contraindicated, including various anti-nauseant medications (phenothiazines), antihistamines, or certain anti-cholinergics frequently used as pre-anesthesia medications.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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