Tongue-tie (or ankyloglossia) is a ‘congenital condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short frenulum’ (Wallace, 1963). Tongue-ties can cause problems with feeding and oral hygiene. Some health professionals – including some speech-language pathologists – believe tongue-ties cause problems with speech.
Surgery to “release” tongue-ties – known as a frenulectomy – is controversial. For speech problems alone, there is little evidence to support surgery in most cases. However, a 2004 study showed that up to 65% of Australian surgeons regard poor speech as an indication for surgery; and almost 20% of these referrals are made by speech pathologists (Brinkman, Reilly & Meara, 2004).
For a balanced overview of the issue, we recommend Dr Caroline Bowen’s “Information for Families: Tongue-Tie“. Dr Bowen highlights the lack of evidence about whether tongue-ties cause speech problems. She also links to an article by a highly respected clinician, Professor Ann Kummer, who concludes:
“There is virtually no evidence in the literature to establish a definite causal relationship between ankyloglossia and speech disorders. In fact, there is very little in the literature that addresses ankyloglossia and speech at all. This is probably because a causal relationship is not what is typically seen clinically. Therefore, it can be assumed that ankyloglossia is unlikely to cause speech problems in most cases.
Most experienced speech-language pathologists would conclude that frenulectomy is rarely indicated for speech reasons unless it is very severe or there are concomitant oral-motor problems. It may, however, be warranted for problems with early feeding, bolus manipulation [ed note: moving the food and liquid around the mouth in preparation for swallowing], dentition, or aesthetics. Although frenulectomy is a minor procedure with a low risk of morbidity, the true danger is the disappointment that can result when parents are led to believe that this will correct speech problems that are actually due to other causes.”
So don’t believe everything you read!
Understandably, parents of a child with speech disorders and a tongue-tie are often keen to research the pros and cons of surgery. The experts are divided, however, and there is a lot of conflicting, sometimes poor quality information, on the Internet.
Parents should take extreme care when Googling for information on tongue-ties and speech. In particular, be wary of websites marketed by professionals and organisations who make money from the surgery or who claim that the surgery will magically “cure” speech problems. To help parents sort the wheat from the chaff, we link below to some practical information about how to evaluate the quality of health web-pages.
References
Kummer, A.W. (2005). To clip or not to clip: that is the question. AHSA Leader, retrieved from here.
Speech Pathology Australia Tongue Tie Fact Sheet.
Dr Caroline Bowen’s information sheet.
UC Berkeley. (2012). Evaluating Web Pages: Techniques to Apply & Questions to Ask.
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.
Leave a Reply