Has anyone tried Botox for Excessive Drooling (Sialorrhea)?

My father had a severe stroke in 2022 and has moderate to severe dysphagia resulting in excessive drooling or he has hypersalivation (it’s hard to tell). It’s really affecting his quality of life because he can’t manage his saliva, which results in the sensation of choking and he coughs and coughs.

He’s had speech therapy and does the exercises, but it’s still more than he can manage and he keeps getting discharged because of Medicare’s requirements to demonstrate “significant progress.”

We are considering Botox injections to the parotid glands to temporarily paralyze some of the nerves that cause salivation. I’m wondering if anyone has experience with this or other treatments, and how did it work for you? Did your insurance cover it?

We’re not happy with the other medication options. My dad is 74 years old and extremely sensitive to medication. All the medications available are either older antidepressants that cause dry mouth as a side effect (but have other side effects) or anti-cholinergics not recommended for people over age 65. For example, his neurologist prescribed a scopolamine patch, but it specifically states to prescribe with caution in older adults because it can cause confusion, dementia-like symptoms, and even hallucinations in older adults. This has happened to him with Judd Zyrtec (a mild anti-cholinergic), so we don’t want to risk this again. His prescription drug plan won’t cover it anyway for this reason.

Botox is looking like the best thing to try, but we’re curious to hear if anyone else has tried it?