Sialorrhea ICD-10, Definition, Symptoms, Causes, Treatment


Sialorrhea, consisting of the involuntary release of passive saliva from the mouth due to the inability to deal with oral secretions, is often a finding of ALS patients and an important source of social stress. This is not caused by an increase in saliva production that has actually decreased, but due to gradual paralysis and lack of coordination of the muscles related to orofacial and palatolingual area during saliva production.

Sialorrhea is normal in infants and young children. Mild to moderate drooling may continue in infancy and have been reported in children up to 5 years of age. Hyper-salivation or sialorrhea  that goes beyond this period is usually considered pathological and is most common in patients with neurological disorders.

Drooling is often sharpened by a dental malocclusion, poor oral closure or psychogenic control of oral cavity and limited head or trunk control connected with neurological malfunctioning. For example, hyper-salivation is reported in 10% to 37% of children with cerebral palsy. Sialorrhea management is recommended when it represents some kind of clinical implications in a patient.

Sialorrhea or hypersalivation can be part of many diseases. Sialorrheais often a part of parkinson disease, as it has an excessive production of saliva in combination with a reduction in swallowing. Other neurological conditions may also produce hypersalivation such as cerebral palsy, stroke conditions, traumatic brain injuries or neurodegenerative diseases such as ALS.

Sialorrhea ICD-10, Definition, Symptoms, Causes, Treatment

Symptoms of sialorrhea

Some commonly observed symptoms of sialorrhea are

  • Nausea
  • vomiting
  • Dysphagia
  • change in taste
  • Pooling of saliva in mouth
  • Drooling

Sialorrhea Causes

Mild to moderate kind of sialorrhea might be associated with minor irritation orally or denture  or braces fitting problems. Episodic sialorrhoea can be a treacherous manifestation of a gastroesophageal reflex (GERD). Increased salivation is produced as a protective mechanism for buffering in patients with GERD. This is called  water brash.

A similar saliva state whose underlying cause is unknown called idiopathic paroxysmal salivation. Increased salivary flow consists of episodes occurring 1 or 2 times per week for 2-5 minutes in duration. Episodes are preceded by a multi symptomatic response consisting of nausea or pain in the epigastrium, but without progressing vomiting. These might be variants of the same clinical problem. Hypersalivation may also be associated with obstruction of the esophagus (foreign body, cancer and strictures), infection and nasogastric intubation.

Sialorrhea Treatment

Sialoreia is socially uncomfortable and can interfere with oral hygiene and is a risk factor for bronchial aspiration. Increased saliva management might be done with gum or hard candy to induce swallowing. If this is not enough then injections of toxins like botulinum helps to improve this socially uncomfortable condition. Botulinum toxin injections are considered only effective in the treatment of Parkinson related sialorrhea or hypersalivation.

Sialorrhea ICD-10

ICD-10   H15         Disorders of sclera                      Billable
ICD-10   H15.8      Other disorders of sclera            Billable
ICD-10   H15.89    Other disorders of sclera            Billable
ICD-10   H15.9      Unspecified disorder of sclera    Billable
ICD-10   Q13.5      Blue sclera                                    Billable

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