Saliva Management

Saliva Management #

• Sialorrhea is a common and frustrating symptom in ALS.
• Poor saliva management can be caused by various factors, including impaired swallowing, reduced orofacial muscle control/weakness, pharyngeal weakness, and open mouth breathing, among others.
• In addition to sialorrhea, patients may present with thick or sticky mucous (often combined with weak cough, making it difficult to expel) and/or xerostomia.
• In addressing poor saliva management, consider the following:
  • Presentation (thin saliva, thick mucous, and/or dry mouth)
  • Effect of and/or impact on swallowing and speech
  • Severity – see table below from Garuti et al (2019)
  • Behavioural interventions – refer to Saliva Management handout
  • Pharmacalogical intervention – refer to MD (GP or neurologist)
  • Respiratory devices (suction machine, cough assist) – refer to respirologist/respiratory therapist