"Tongue Tied"

We have probably heard of someone being “tongue tied”. What this really means is the tongue is fused to the floor of the mouth. The lingual frenulum is a mucous membrane that usually recedes after birth. 

With ankyloglossia, the medical term for “tongue tie”, the lingual frenulum stays attached to the tip of the tongue. This can cause restricted tongue movement. It appears that if we had restricted tongue movement, we would not be able to produce a number of our speech sounds; however, there has been no empirical research to indicate that “tongue tie” causes a speech delay/disorder. Wait, I just said it can cause restricted movement, how will one be able to protrude their tongue between their teeth for the productions of “th” and /l/. The “th” production can accurately be produced with limited tongue protrusion. The /l/ can be produced inside the mouth, with the tongue touching the alveolar ridge, decreasing the tongue extension. How is one going to make lingual-alveolar sounds such as /t, d, n, s, z/? In reality, we use such limited movement/elevation of our tongue during these sounds. These sound productions can be produced using compensatory strategies, such as slightly changing the position of the tongue (e.g. moving the tongue tip down instead of elevating it). With practice, little to no distortion should be heard, just practice!

According to the ASHA Leader, the oral cavity changes significantly in size and shape during the first 4 to 5 years of life. In return, the significance of ankyloglossia tends to decrease with oral growth. For example, with time the lingual frenulum can recede, stretch and at times rupture.

Being “tongue tied” can cause other functional difficulties, such as latching, sucking, and feeding. Literature primarily deals with potential difficulty with breast feeding (Nicholson, 1991; Jain, 1995; Fitz-Desorgher, 2003; Ricke et al., 2003). It was reported, that the majority of newborns with ankyloglossia do not have feeding difficulties.

To clip or not clip? The clipping of the lingual frenulum is called a frenulectomy. It is a decision solely left up to the parent. If there are feeding concerns, clipping of the tongue can be done. Most speech-language pathologists would rarely recommend a frenulectomy to increase correct sound productions, unless the child presents with a severe articulation or phonological disorder.

In conclusion, many physicians continue to think that ankyloglossia will cause a speech delay, regardless of no evidence found in literature. In the words of Agarwal and Raina (2003): "…there is enough evidence that good speech is still possible with significant tongue-tie and speech problems can be overcome without frenulectomy with speech therapy."

References:

Kummer, A. W. (2005, December 27). Ankyloglossia: To Clip or Not to Clip? That's the Question.. The ASHA Leader.

~Written by Angie