True or False: Can Tongue Tie Affect Speech?

Tongue-tie, also known as ankyloglossia, is a congenital anomaly present at birth that restricts tongue mobility.

What is she talking about? Ok, let’s try this, place yourself in front of a mirror, open your mouth, and try to touch the roof of your mouth with the tip of your tongue. Do you see that band tissue right underneath your tongue? That small membrane that goes from the floor of your mouth, all the way to the midline portion of your tongue. This is known as lingual frenulum. Most likely yours is long and stretchy enough to let you move your tongue all the way up, and side to side. However, some people are born with a short lingual frenulum which ends up bringing the tongue (including its mid and anterior portion) closer to the floor of the mouth.

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Tongue-tie has been associated with some of the following difficulties:

• Feeding problems (e.g., Mothers breastfeeding infants with tongue-tie have more nipple pain than mothers feeding normal infants)
• Dentition Issues
• Cosmetics and Personal Interactions
• Speech Production

Noala has taken a step further to investigate what the scientific literature tells us regarding the link between tongue-tie and speech difficulties. But first, let us look at the prevalence of tongue-tie in infants, how it can be diagnosed, and the typical treatment plan.

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How widespread is tongue-tie?

Definition of Prevalence: Prevalence is the proportion of a population who have a specific characteristic in a given time period.

A systematic review and meta-analysis conducted by Hill et al (2021) identified that the overall prevalence of tongue-tie in children aged <1 year (N=24,536 infants) was 8%. Prevalence was 7% in males and 4% in females. Prevalence was 10% when using standardised assessment tool compared to 7% when using visual examination alone.

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How do you know if tongue-tie is affecting your speech?

According to Segal et al (2007) methodological review, there is no accepted standard test to diagnose tongue-tie. In fact, different criteria can be used to diagnose tongue-tie including:

• Physical characteristics of infant’s oral anatomy
• Frenulum being abnormally short and thick causing the tongue to become heart-shaped upon protrusion
• Signs of functional impairment such as inability to stick out the tongue past the gum line
• Effects on breastfeeding causing maternal nipple pain and nipple trauma
• Other indications of decreased tongue mobility.

There is also another tool called the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) that has been developed to give a quantitative assessment of the tongue-tie. According to a study (Amir, James & Donath, 2006), published in the International Breastfeeding Journal, it was determined that the HATLFF has a high reliability in a study of infants with tongue-tie and control infants. However, this assessment if often “lengthy, and complex for use in busy clinic” (Segal et al, 2007)

Given the variability of these diagnostic tools and observations, none of these criteria have been validated.

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‍Treatment for tongue-tie

The most common treatment for ankyloglossia is something called frenotomy. This procedure is brief and usually bloodless. According to an informative flyer published by the American Academy of Pediatrics (AAP) in 2004, “a simple 'nip' with a blunt ended scissors is usually all that is needed, and bleeding is minimal. It's less traumatic than an ear piercing and much less invasive and painful than circumcision. Complications are minimal” (Coryllos, Genna & Salloum, 2004).

However, as nice, and simple as this procedure sounds, there is a huge controversy around this topic. In fact, concerns have been raised about the increase in diagnosis and possible complications after frenotomy. A more recent survey completed by pediatricians in the AAP section of breastfeeding (SOBr) revealed the following (Gilliland, Bunik & O’Connor, 2020):

• Pediatricians are performing frenotomies largely by clipping
• Complications of frenotomies do occur
• Oral aversion and scarring seem to be associated with frenotomy performed by laser, electrosurgery/bovie or a combination of procedures
• Pediatricians reported concerns about overdiagnosis of tongue-tie, parental anxiety, and dentists performing the procedure with laser leading to increased cost and complications.

Now that we know a little bit more about tongue-tie, let’s see what the scientific literature tells us regarding its connection with speech problems.

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How much does tongue-tie affect speech and what speech problems can tongue-tie cause??

Messner and Lalakea (2000), found that 60% of otolaryngologists, 50% of speech and language pathologists, and only 23% of paediatricians believe tongue-tie is at least sometimes associated with speech difficulties.

A recent study conducted by Melong, Bezuhly, and Hong (2021) investigated a group of paediatric patients being referred for speech concerns due to tongue-tie. Patients underwent a tongue-tie release procedure, and after 1 month, speech articulation was reassessed using a standardised assessment tool called the GFTA-2 (This is an assessment that speech and language pathologists use to determine the severity of a child’s speech difficulties).

This investigation revealed: “The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility.” (Melong, Bezuhly &Hong, 2021)

According to Ann W Kummer,  senior director, Speech Pathology Department at the  Cincinnati Children’s Hospital Medical Center, and professor of clinical paediatrics at the University of Cincinnati Medical Center, sounds that require tongue tip movement /t, d, n/, slight elevation of the of the tip of the tongue /s, z/, complete tongue tip elevation to the alveolar ridge /l/, posterior tongue elevation /r/, and tongue protrusion to the maxillary incisors /th/ can still be produced with the tongue tip pressed down resulting in little if any distortions (Kummer, 2005)

It is recommended therefore to evaluate the effect of tongue-tie on lingual-alveolar sounds (such as /l/) and interdental sounds /th/ to determine if tongue tie is affecting speech or speech development.

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So, does tongue-tie affect speech?

It’s hard to come out with a definite answer to this question, however, our review of the literature has shown us that there is still inconclusive data. In most cases, it DOES NOT affect speech development. However, Noala always recommends following up with a certified speech and language pathologist to complete an appropriate assessment and determine the best course of treatment.

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References

1. Alison M. Gilliland, Maya Bunik, Mary E. O'Connor; Pediatricians' Concerns about Ankyloglossia and Breastfeeding. Pediatrics July 2020; 146 (1_MeetingAbstract): 124–125. 10.1542/peds.146.1MA2.124
2. Amir, L. H., James, J. P., & Donath, S. M. (2006). Reliability of the hazelbaker assessment tool for lingual frenulum function. International Breastfeeding Journal, 1(1), 3.
3. Ankyloglossia (Tongue-tie)—Stanford medicine children’s health. (s. f.). Recuperado 24 de agosto de 2022, de.
4. Becker, S., & Mendez, M. D. (2022). Ankyloglossia. En StatPearls. StatPearls Publishing.
5. Coryllos, E. & Genna, Catherine & Salloum, A.C. (2004). Congenital tongue-tie and its impact on breastfeeding. American Academy of Pediatrics Section on Breastfeeding. 1-6.
6. Hill, R. R., Lee, C. S., & Pados, B. F. (2021). The prevalence of ankyloglossia in children aged <1 year: A systematic review and meta-analysis. Pediatric Research, 90(2), 259-266.
7. Kummer, A. W. (2005). Ankyloglossia: To clip or not to clip? That’s the question. [Review-article]. The ASHA Leader.
8. Messner, A. H., & Lalakea, M. L. (2000). Ankyloglossia: Controversies in management. International Journal of Pediatric Otorhinolaryngology, 54(2), 123-131.
9. Segal, L. M., Stephenson, R., Dawes, M., & Feldman, P. (2007). Prevalence, diagnosis, and treatment of ankyloglossia. Canadian Family Physician, 53(6), 1027-1033.