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Laryngorhinootologie 2019; 98(06): 388-397
DOI: 10.1055/a-0874-2406
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© Georg Thieme Verlag KG Stuttgart · New York

Hypersalivation – Aktualisierung der S2k-Leitlinie (AWMF) in gekürzter Darstellung

Hypersalivation – Update of the S2k guideline (AWMF) in short form
Armin Steffen
1   Universität zu Lübeck HNO-Klinik
,
Wolfgang Jost
2   Universitätsmedizin Göttingen, HNO-Klinik
,
Tobias Bäumer
3   Universitätsklinikum Münster Klinik für Psychiatrie und Psychotherapie
,
Dirk Beutner
4   Wissenschaftliches Institut für angewandte HNO-Heilkunde HNO-Praxis Bad Bramstedt
,
Sabine Degenkolb-Weyers
5   Curavid Praxis für Strahlentherapie Radiologie
,
Martin Groß
6   Evangelische Hochschule Berlin Pflege- und Gesundheitswissenschaften
,
Maria Grosheva
7   Phoniatrie Universitätsklinikum Schleswig-Holstein
,
Samer Hakim
8   Gemeinschaftspraxis Am Rosenplatz
,
Kai G. Kahl
9   Dr. von Haunersches Kinderspital Ludwig-Maximilians-Universität München Pädiatrische Neurologie und Entwicklungsneurologie
,
Rainer Laskawi
10   Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für Phonetik und Sprachverarbeitung
,
Rebekka Lencer
11   Klinikum der Universität München, Klinik für Hals-, Nasen- und Ohrenheilkunde
,
Jan Löhler
12   Parkinson-Klinik Ortenau GmbH & Co. KG
,
Thekla Meyners
13   HELIOS Fachklinik Schleswig, Psychiatry and Psychosomatik Medicine
,
Saskia Rohrbach-Volland
14   Praxis für Neurologie, Psychiatrie, Psychotherapie und Nervenheilkunde
,
Rainer Schönweiler
15   Universitätsklinikum der FSU Jena HNO
,
Sara-Christina Schröder
16   Universität zu Lübeck, Institut für Neurogenetik
,
Sebastian Schröder
17   Georg-August-Universität Göttingen, Universitätsmedizin Klinik für Hals-Nasen-Ohrenheilkunde
,
Heidrun Schröter-Morasch
18   Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Fakultät, Studiengang B. Sc. Logopädie
,
Maria Schuster
19   Evangelisches Krankenhaus Oldenburg Klinik für Neurologische Intensivmedizin und Frührehabilitation
,
Susanne Steinlechner
20   Uniklinik Köln Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie Köln
,
Roland Urban
21   Universität zu Lübeck, Klinik für Kiefer- und Gesichtschirurgie
,
Orlando Guntinas-Lichius
22   Medizinische Hochschule Hannover, Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie
› Author Affiliations
Further Information

Publication History

Publication Date:
05 June 2019 (online)

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Zusammenfassung

Hypersalivation bezeichnet einen übermäßigen Speichelfluss, der durch insuffiziente orofaziale Fähigkeiten, verminderte zentralnervöse Kontrolle und Koordination oder gestörte Schluckabläufe entstehen kann. Die Aktualisierung der S2k-Leitlinie soll den neuen diagnostischen und therapeutischen Kenntnisstand berücksichtigen.

Die Diagnostik- und Therapiemaßnahmen sollten multidisziplinär erfolgen. Schwerpunkte sind die Abklärung von Schluckstörungen mit Speichelaspiration. Hier sind klinische Screeninguntersuchungen und die fiberendoskopische Schluckuntersuchung (FEES) hervorzuheben.

Bei fast allen Ursachen sind die schlucktherapeutischen Übungsmaßnahmen zur Aktivierung und zum Erlernen von Kompensationsmechanismen unverzichtbar. Insbesondere bei Kindern mit hypotoner orofazialer Muskulatur sind myofunktionelle Therapiekonzepte indiziert, allerdings ist die Kompetenz zur Mitarbeit entscheidend. Zusätzlich können orale Stimulationsplatten durch die Veränderung der Zungenpositionierung zu einer Symptomreduktion führen. Sinnvolle medikamentöse Therapien sind insbesondere die verschiedenen Applikationsformen von Glycopyrrolat, von denen Sialanar® (Glycopyrronium) als Saft eine Genehmigung zur Behandlung bei Kindern ab 3 Jahren und Jugendlichen erhalten hat. Die Injektion von Botulinumtoxin in die Kopfspeicheldrüsen hat sich als effektive und sichere Behandlungsform mit einer langanhaltenden Speichelreduktion erwiesen. Für Incobotulinumtoxin A ist die Phase III-Studie bei Erwachsenen aktuell abgeschlossen und führte in den USA bereits zur Zulassungserweiterung bei Hypersalivation. Chirurgische Eingriffe der Speicheldrüsen bleiben Einzelfällen vorbehalten. Die Bestrahlung der Speicheldrüsen ist, insbesondere wenn sie in moderner 3-D-konformaler Technik zur Gewebeschonung durchgeführt wird, eine sichere und effektive Therapie. In einer regelhaften Nachsorge sind Therapieeffekte und mögliche Nebenwirkungen zu erfassen; insbesondere bei neurodegenerativen Erkrankungen ist die individuelle Dynamik der Symptomverschlechterung zu berücksichtigen.

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 in order to activate compensation mechanisms as long compliances is 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 E. U. 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 U. S., 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 3 D techniques to minimize tissue damage. Therapy effects and symptom severity has to be followed, especially in cases with underlying neurodegenerative disease.

Schlüsselwörter

Hypersalivation - Drooling - Schluckstörung - Botulinumtoxin - Sialorrhoe - Glycopyrrolat - Übungstherapie

Key words

hypersalivation - drooling - dysphagia - glycopyrrolate - botulinum toxin - sialorrhea

Zusatzmaterial

    Tabellarische Zusammenfassung der Interessenerklärungen
  • Zusatzmaterial
 

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