Comparative Efficacy and Side Effect Profiles of Interventions for Pediatric Saliva Control: A Cohort Study

Abstract

To compare efficacy and side effect profile data on conservative, behavioral, pharmacological, and surgical treatments used for pediatric saliva control. A cohort study of children (n=483) referred to a specialty Saliva Control service between May 2014 and November 2019 was performed, using quantitative data from pretreatment and post-treatment questionnaires (the Drooling Impact Scale [DIS], Drooling Rating Scale [DRS]) and recording of side effects. Overall, 483 children were included; treatment choices were based on published international guidelines. The greatest improvement was seen after intraglandular botulinum toxin A (BTX-A) injections (n=207; 551 courses; mean DIS change, 34.7; 95% CI=29.2-35.7) or duct transpositional surgery (n=31; mean change in DIS, 29.0; 95% CI,22.3-35.7). Oral anticholinergics were associated with good outcomes, with no significant statistical difference between glycopyrronium bromide (n=150; mean DIS change, 21.5; 95% CI,19.1-24.0) or trihexyphenidyl (n=87; mean DIS change, 22.4; 95% CI,18.9-25.8). Inhaled ipratropium bromide was not as efficacious (n=80; mean DIS change, 11.1; 95% CI,8.9-13.3). Oromotor programs were used in a selected group with reliable outcomes (n=9; mean DIS change, 13.0). Side effects were consistent with previous studies. Overall, in cases of milder severity, enterally administered therapies provided a good first-line option. With more severe problems, BTX-A injections or saliva duct transpositional surgery were more effective and well tolerated. We describe a large, single-center pediatric saliva control cohort, providing direct comparison of the efficacy and side effect profiles for all available interventions and inform clinical practice for specialists when considering different options. BTX-A injections or saliva duct transpositional surgery seem to be more effective for saliva control that is more severe.