At Swallow Science Melbourne, we provide specialised assessment and non-pharmacological management of saliva and upper airway secretions for people experiencing dry mouth, drooling, thick mucus, or difficulty clearing the throat.

 

Changes in saliva volume, thickness, or clearance can significantly affect swallowing, comfort, and respiratory health. Effective management can improve not only safety and hygiene but also communication and social confidence.

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Many people we support live with progressive neurological conditions such as motor neurone disease (MND), Parkinson’s disease, or progressive supranuclear palsy (PSP), but secretion management can also be relevant after head and neck surgery, radiation treatment, or respiratory disease.

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Problems may include:

• Excess saliva or drooling (sialorrhoea)

• Thick, sticky, or difficult-to-clear secretions

• Frequent throat clearing or “gurgly” voice

• Weak cough or ineffective airway clearance

• Recurrent chest infections or aspiration​​

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Assessment

Secretion management begins with a thorough clinical assessment and, where indicated, endoscopic evaluation with FEES. This allows direct observation of saliva accumulation, secretion movement, and clearance within the throat.

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Assessment helps determine whether the issue relates to one or more of:

• Reduced swallow frequency or reflex

• Poor oral or pharyngeal sensation

• Weak cough or respiratory coordination

• Changes in saliva production or viscosity

• Medication side effects or dehydration

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Findings guide a tailored management plan that addresses both the source and the symptom of secretion difficulties.

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Management Approaches

Secretion management is highly individualised and may include adjunctive and supportive strategies such as:

• Adjusting posture, hydration, and positioning

• Exploring use of tools such as oral suctioning or nebuliser use 

• Increasing swallow frequency through cueing

• Mucolytic agents for thick or tenacious saliva

• Moisturising agents to soothe dry mouths and enhance comfort / oral care

• Humidification

• Expiratory Muscle Strength Training (EMST) to support cough strength and secretion clearance.

• Collaboration with medical teams to explore pharmacological options

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Each plan is developed in close consultation with care teams and family or support staff to ensure consistency and safety across settings.

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Ongoing Support

Secretion patterns often change over time, especially in progressive conditions. Regular review helps maintain comfort and reduce respiratory complications.
We work alongside patients and their care teams to adapt management as needs evolve - balancing comfort, safety, and quality of life at every stage.