Traditional chinese medicine (tongue acupuncture) in children with drooling problems

This article was presented in the National Child Neurology meeting in Wan Zhou, People’s Republic of China (May 1999) and at the 3rd Meeting of European Child Neurology Society (Nice, France, November 1999).
https://doi.org/10.1016/S0887-8994(01)00292-2Get rights and content

Abstract

Tongue acupuncture is an innovative technique in traditional Chinese medicine. We have demonstrated that specific tongue acupoints are related to various functional domains. This study aimed to assess the efficacy of tongue acupuncture in children with neurologic disability who had severe drooling problems. We conducted an intent-to-treat study in a cohort of 10 children. A continuous course of tongue acupuncture was performed daily to five acupoints in the tongue for a total of 30 sessions. Standardized outcome measures of drooling were evaluated by a blinded assessor to study the efficacy at baseline and after a course of treatment. Statistically significant improvement was noted in the following outcome measures: (1) mean visual analog scale (VAS) decreased from 6.6 (pre-TAC) to 4.67 (post-TAC) (P = 0.002); (2) mean drooling quotient (DQ) decreased from 14.016% (pre-TAC) to 8.335% (post-TAC) (P = 0.0078); and (3) mean drooling score (DS) decreased from 7.4 (pre-TAC) to 4.4 (post-TAC) (P = 0.002). This study demonstrated the efficacy of tongue acupuncture as an adjunctive or alternative treatment for patients with drooling problems and can be integrated as part of the oromotor stimulation program, drooling program, and behavioral modification program before subjecting the patient to invasive surgical procedures on the salivary glands.

Introduction

Drooling (siglorrhea) is normal in young infants; it usually subsides by 18 months a as result of physiologic maturity of the oromotor function [1]. Drooling beyond 4 years of age is considered abnormal. Persistent drooling is socially stigmatizing and may affect interpersonal relationship because of bad odors and unhygienic appearance. Persistent drooling may be due to infrequent swallowing, inadequate lip closure, or poor head posture [2]. Drooling primarily results from an overflow of saliva from the mouth because of dysfunctional voluntary oral motor activity, improper swallowing, or oral sphincter deficits, but rarely because of hypersalivation.

Children with neurologic disorders, such as cerebral palsy, neuromuscular disease, autism, language disorders, or mental retardation have drooling problems. It is estimated that 10% of children with cerebral palsy have drooling problems [1], [3], [4], [5], [6].

For a drooling-management program to be successful, a multidisciplinary drooling team is essential for assessment and management of drooling [7], [8], [9], [10], [11]. Many methods, singly or in combination, have been used for treating the problem of drooling. However, none have been successful universally. Methods for treating drooling problems include the following: (1) oral motor stimulation program, which involves the stimulation of oral motor coordination and proprioception; (2) behavioral modification program, which uses a conditioning technique with auditory or visual signals as cues to prompt swallowing [12], [13], [14]; (3) medication, such as anticholinergic drugs [15], [16]; and (4) surgical removal of salivary glands or salivary duct relocation for patients with severe oromotor dysfunction or cognitive deficits [17].

Oral motor and/or behavioral intervention depends on the intellectual ability and motivation of the child and is quite time consuming. Chronic use of anticholinergic drugs have side effects, such as constipation, bradycardia, reduced bronchial secretions, urinary urgency and retention, dilatation of pupils, loss of accommodation, photophobia, dry mouth, and flushing and dryness of skin [18]. Postoperative results of salivary duct ligation or relocation may lead to dryness of the mouth and an increase in the incidence of dental decay [19], [20].

Quantitative measurement of drooling in children is difficult. Drooling frequency and severity varies daily and is influenced by hunger, hydration, emotional state, level of wakefulness, and other concurrent medication being given. Investigations into the mechanism of drooling are available [21], [22], [23], [24], [25], [26].

In traditional Chinese acupuncture, which has been practiced in China for over two millennia, 400 acupoints on the body surface are interrelated to various functions. The surface acupoints are linked through 14 meridians to various organs and viscera of the human body. The approach in traditional Chinese medicine, in sharp contrast to western medical concept, is a “holistic” approach with a more philosophical background of balancing the “yin” and “yang.” The physiologic basis of traditional Chinese medicine is aimed to improve “energy” or “body-flow” (so-called de-qui in Chinese). Even a normal human subject will respond to acupuncture resulting from the flow of energy. The effect of acupuncture was hypothesized and proven in animal and human studies to result from direct neural stimulation; changes in neurotransmitters, such as endorphin; immunologic markers; or endocrinologic signals. Thus acupuncture is especially effective in chronic disorders, especially in brain disorders [27].

Tongue acupuncture (TAC) is an innovative acupuncture technique invented by Dr. Sun, who practiced this technique in Peoples’ Republic of China. After over 20 years of clinical experience, he discovered that there are at least 40 acupoints on the tongue, which are linked through 14 meridians to various organs and viscera, according to traditional Chinese medicine concept. Specific acupoints subserve various functional domains of the human body, similar to “the little man in the motor and sensory cortex.” Clinical efficacy of acupuncturing the surface or base of the tongue in specific acupoints has proved the efficacy in improving various functional modalities for patients with chronic neurologic disorders. Our clinical experience with TAC, using objective outcome measures, has demonstrated functional improvement in pseudobulbar palsy and motor function in adults with stroke and children with cerebral palsy [28], [29], [30], [31], [32], [33], [34].

This study aimed to assess the efficacy of TAC as an adjunctive treatment in children with severe drooling problems who failed conservative treatment.

Section snippets

Materials and methods

A total of 10 children (five males and five females) with persistent drooling were recruited into the study as an intention-to-treat category. These children had been actively followed up in the multidisciplinary drooling clinic of the Children’s Habilitation Institute of the Duchess of Kent Children’s Hospital. Normal children, or those who drooled for unknown reasons other than physical or cognitive disability, were excluded. Children with bleeding disorders were excluded.

The children had

Results

The drooling database consisted of 10 children (five males and five females). The mean age of the cohort is 7.3 years old (median = 5.5; S.D. = 4.762; range = 2–18 years of age).

Discussion

We have demonstrated the efficacy and safety of tongue acupuncture as an adjunctive treatment in children with severe drooling. Our cohort was unable to comply with oral-motor stimulation or behavior modification program. Surgical treatment for drooling problem was not easily accepted in this Chinese community. Thus TAC may be an alternative option for children with intractable drooling problem.

The tongue is a very important organ within the oral cavity. It facilitates biting, swallowing,

Acknowledgments

This project is supported by the Jockey Club MRI Engineering Centre of the Department of Electrical and Electronic Engineering, The University of Hong Kong (through the support of Dr Ma Q.Y. and Professor Edward Yang); and with seed funding from the University of Hong Kong for research in tongue acupuncture. The authors thank the nursing staff of Children’s Habilitation Institute of the Duchess of Kent Children’s Hospital. This research was conducted in the Duchess of Kent Children’s Hospital.

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