About Heru H, M.D., DSTHT,M.S., CCC-SLP Expertise I can almost answer any question related to my profession as an otolaryngologist (ear nose and throat, head and neck surgeon) and speech language pathologist. I`m a faculty member and a surgeon from Indonesia and I`d love to help if I can.
Question I have a six year old son with a very severe speech problem. He has been in speech therapy since he was 2 1/2 years old. Today his new speech teacher said she thinks he is "tounge tied", meaning that the skin below the tounge, connecting to the base of the mouth was the problem and that it should be "clipped". Have you heard of this? I can see that it does appear to pull the underside tip of his tounge into a dimple when he sticks it out. How common is it to clip that skin, & how risky is this proceedure?
What is the success rate for this? My son's problem is difficulty making sounds/words that involve putting his tounge to the top of his mouth or the top teeth (t's, l's). She also mentioned having the tonsils and adnoids removed to make the letters that involve the back of the tounge (g's) as she says they appear to be a little large (and he has frequent throat infections). She says there isnt enough room in the back of his mouth to make these sounds with the tonsils in the way. Please advise?
Answer Hi there
The tongue is generally considered the most important articulator for speech production. Tongue movements during speech production include tip elevation, grooving, and protrusion. The tongue is relatively short at birth, grow-ing longer and thinner at the tip with age.
Fairbanks in the 50's investigated differences in tongue character-istics between 30 individuals with superior articulation and 30 with inferior articulation. They found no significant differences between the two groups on measurements of maximum length of protrusion length of the tip, maximum amount of tongue face, or in the percentage of errors in duplicating tongue position.
Ankyloglossy, or "tongue-tied," are terms used to describe a restricted lingual frenum. At one time (many many years ago), it was commonly assumed that an infant or child with ankyloglossia should have his or her frenum clipped to allow greater freedom of tongue movement and better articulation of tongue tip sounds and frenectomies (clipping of the frenum of the tongue) were performed relatively frequently (Some old speech pathologist still follow this old guidelines).
However, a researcher by the name of McEnery and Gaines (1941) examined 1,000 patients with speech disorders and identified only 4 individuals with abnormally short frenums. Their most extreme case of a short frenum was a 10-year-old boy, whose only articulation error was a /w/ for /r/ substitution; the error was corrected following speech instruction. The authors recommended against surgery for ankyloglossia because of the possibility of hemorrhages, infections, and scar tissue (this may even causes the frenum even getting shorter than before surgery). It can be inferred from these data that a short frenum is only rarely the cause of an articulation problem.
Another researcher, Fletcher in 1968 (I knew him personally) examined the relationship between length of the lingual frenum and articulation. They compared two groups of sixth-grade students, 20 with limited lingual movement and 20 with greater lingual movement, and reported that subjects with restricted lingual movement scored within normal limits on a measure of articulation but tended to have more articulation errors than the group with greater lingual movement.
A short lingual frenum can restrict movement of the tongue tip. Most in-dividuals, however, acquire normal speech in spite of a short lingual frenum. If your son can touch the alveolar ridge (this is the part behind the base of the front upper incisive teeth) with the tongue tip, the length of the frenum is adequate for speech purposes AND DOES NOT REQUIRES ANY SURGERY. In the rare instance where this is not possible, surgical intervention may be necessary.
Hyertrophy of the tonsils and adenoid need special precautions. The only indications to remove this structure is medical, such as if your child had frequent throat infections and infected by streptococcus Beta Haemolyticus
with certain type.
The reason is if the soft palate is short, after surgery it will ended up with hypernasality sound post surgery because of the gap that creates after the surgery, the short soft palate cannot compensate to close it down (after tonsiloadenoidectomy there will bw a big gap in the back of the throat). These requires an endoscopic nasal evaluation befoe surgery by an ENT that specialized in voice production because of hypernasality still persist, it may lead to more and more reconstructive surgery such as pharyngoplasty etc.
Another thing is the tongue for most of the case is very flexible and is suitable for the production of proper articulation.
I believe a more conservative approach is needed before applying surgical intervention because in my experience, in most cases (almost 92% of it) can be treated with the proper phonological interventions and most of the using the Klein methode developped at the late of the 90's.
Please consider this before planning any surgical intervention, I am an ENT surgeon and I never recomend any surgery unless is realy realy needed.
