If secretions are distressing a patient or stopping cuff deflation, then there are various options to reduce them to a more manageable level. Remember that by improving the laryngeal function, secretion management is also improved. It is always a balance between secretion production and clearance.

Simple measures to combat excessive secretions include good oral hygiene and regular oral suctioning. Encouraging the patient to manage their own secretions can help motivation. Good posture and reviewing the general mouth and teeth hygiene can improve salivation. If the patient is eating, review the type of foods with a dietician.

Question: What do you think are the main aims for managing excessive secretions?

If secretions are distressing a patient or stopping cuff deflation, then there are various options to reduce them to a more manageable level. Remember that by improving the laryngeal function, secretion management is also improved. It is always a balance between secretion production and clearance.

Simple measures to combat excessive secretions include good oral hygiene and regular oral suctioning. Encouraging the patient to manage their own secretions can help motivation. Good posture and reviewing the general mouth and teeth hygiene can improve salivation. If the patient is eating, review the type of foods with a dietician.

Question: What do you think are the main aims for managing excessive secretions?

If secretions are distressing a patient or stopping cuff deflation, then there are various options to reduce them to a more manageable level. Remember that by improving the laryngeal function, secretion management is also improved. It is always a balance between secretion production and clearance.

Simple measures to combat excessive secretions include good oral hygiene and regular oral suctioning. Encouraging the patient to manage their own secretions can help motivation. Good posture and reviewing the general mouth and teeth hygiene can improve salivation. If the patient is eating, review the type of foods with a dietician.

Question: What do you think are the main aims for managing excessive secretions?

If secretions are distressing a patient or stopping cuff deflation, then there are various options to reduce them to a more manageable level. Remember that by improving the laryngeal function, secretion management is also improved. It is always a balance between secretion production and clearance.

Simple measures to combat excessive secretions include good oral hygiene and regular oral suctioning. Encouraging the patient to manage their own secretions can help motivation. Good posture and reviewing the general mouth and teeth hygiene can improve salivation. If the patient is eating, review the type of foods with a dietician.

Question: What do you think are the main aims for managing excessive secretions?

Question: Secretions can also be controlled by medications. Before we review these, can you think of any down sides to drying the secretions?

Answer: Systemic drying agents will dry all secretions, including respiratory secretions. This can make chest clearance a lot more difficult. Anticholinergic agents such as hyoscine or glycopyrrolate should be used carefully.

Sometimes it is better to use targeted local therapy. Atropine is another anticholinergic but in the 1% eye drop form, can be administered topically into the buccal mucosa or sub lingually (under the tongue). This can have a local effect on secretions, and although there is some systemic absorption, this isn’t significant.

Amitriptyline is a tricyclic antidepressant but has anticholinergic side effects – most notably a dry mouth.

A more targeted approach involves the use of Botulinum toxin, exerting its effect through the blocking of acetylcholine (Ach) release at the neuromuscular /neuroglandular junction. Different sub-types vary in exact mechanism of action. Small doses of Bo-tox are injected into the salivary glands under ultrasound control. This is a specialist procedure but is effective in controlling saliva production.

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