Virginia, 

Thank you for highlighting this very important fact. I became aware of this because my client population involves two languages- English and Spanish. R's are more difficult to pronounce in Spanish with tongue mobility restriction.  A few months ago an relative accompanied a mother to see me. The baby had some tongue mobility restriction that was part of the breastfeeding problem. The relative was very interested and started asking me a lot of questions, convinced that her oldest son was tongue-tied. She shared that he prefers to speak English even though they speak Spanish at home, and that he has difficulty with his Rs.  When I asked about breastfeeding, she told me that she breastfed him for a year, but that it hurt every day of that year.  She brought this now 13 yo boy to meet me. He did not seem aware of that he had any issues. Apparently his mother had him examined at school, where they found no problems-- in English. As I continued to converse with him, talking about how a person with problems may do okay if they are concentrating but start to deteriorate when excited, intoxicated or tired, he at one point spoke rapidly and surely enough, even his English started to deteriorate. I looked at his lingual frenulum- there was a definite string; it was not super tight, it had some flexibility, and he was able to mimic movements for me. But clearly there were some subtle issues going on that I could validate for the mother. 



In examining siblings who also caused their mothers difficulty, sometimes I see obvious problems, sometimes I am not sure. I have learned that structures grow out and become less obvious over time; my own nephew is a case in point. He caused my sister pain for at least 6 months, and he has a bit of lisp. He is now in 2nd grade and when he was referred last year to get his lip tie clipped (not on my radar 7 years ago- it was now separating his front teeth), I suggested they get his tongue done at the same time. Much to my dismay, the practitioner told my sister it was not necessary and would not help. I have monitored his frenulum over the years, noting that at 3 he could not elevate his tongue, and only in the past 1-2 years has he been able to do so better. He still has some speech problems. What was more obvious as an infant is not obvious now, making his chances of getting this taken care of much lower. How many kids like him are running around?



When I have a baby with apparent tongue mobility restriction, I ask about siblings and relatives. It is amazing how often I get a positive answer of speech issues, and most of the time they have not been tied to any particular cause. I once asked my local elementary school's speech pathologist how often she sees speech issues caused by tongue-tie, and she answered, "never."  It was then that I came to recognize that tongue-tie has not been a part of SP training; they learn how to work with what is there,  not how to identify anatomical problems contributing to the issue. To most, everything they see is a variation of "normal."  And thus does the myth that tongue-tie rarely affects speech perpetuate.



Below are three citations, all from other countries that have noted problems. There are also two Japanese articles, but I don't have a translation of the abstracts.



~Lisa Marasco



Dollberg, S. and E. Botzer (2011). "Neonatal tongue-tie: myths and science]." Harefuah 150(1): 46.

	Anatomical restraining of tongue movement (tongue-tie, ankyloglossia) has been known for centuries and the subject of dozens of articles. The heated debate persists on its clinical significance and indications for treatment. Most authorities in the field of infant feeding and Lactation agree that breastfeeding problems, such as nipple pain and latching difficulties, are common signs of clinicaLly significant tongue-tie and indications for performing a frenotomy, while the sole presence of a visible lingual frenulum is not. In contrast, the lack of a visible frenulum does not rule out the diagnosis of clinically significant tongue-tie since submucosal ties, also called "posterior tongue-tie", may interfere with efficient breastfeeding. Whether tongue-tie interferes with speech articulation to a significant extent is currently unknown. Theoretically, articulation of some consonants (e.g., /s/, /th/, /r/) would be affected by impeded tongue movement. These articulation problems are, however, Less common than tongue-tie itself, and children and adults characteristically use various compensatory techniques of mouth opening and tongue movements. When it is indicated, frenotomy is performed by lifting the tongue and snipping the frenulum with scissors. Complications of frenotomy are rare and consist mainly of self-limited minor bleeding. The significance of posterior tongue tie and the long-term effects of frenotomy performed during early infancy are unresolved issues.



Ostapiuk, B. (2006). "[Tongue mobility in ankyloglossia with regard to articulation]." Ann Acad Med Stetin 52 Suppl 3: 37-47.

	A sound is created as a result of several breathing, phonetic and articulation positions and movements which take place in the articulation system consisting of both mobile and immobile elements. The tongue is one of the mobile elements of the articulation system. Full range of tongue mobility is required to form sounds correctly. If mobility of the tongue is reduced, sounds may slightly, moderately or highly deviate from proper ones. Serious deviations in articulate structure of sounds (such as non-vibrating front part of the tongue in the /r/ phoneme) are easy to notice since they change phoneme structure of the sound. Slight deviations (e.g. non-vibrational or non-mediumistic action of the tongue) may be unnoticed because speech is still comprehensible although it is formed with compensatory positions and movements of breathing, phonetic and articulation apparatus. There are some phonemes that require a wide range of tongue mobility to be formed correctly, while others require less tongue mobility. In the Polish language, phonemes that require the most mobile tongue are: trembling /r/, lateral /l/, humming /sz, z, cz, dz/, and soft /i, j, s, z, c, dz/. In order to diagnose abnormalities, organs of speech need to be observed directly (photographs, films) or indirectly (videoradiography). One of the factors that restrict (to a slight, average or high degree) tongue mobility is the short frenulum. According to the general opinion "the tongue frenulum has no influence on tongue mobility". However, persons with ankyloglossia form at least one of the above-mentioned phonemes incorrectly to a slight, medium or high degree and frenotomy is required to make improvement of speech by a speech therapist effective. In opinion of many physicians and speech therapists " frenotomy is usually pointless because a new scar is formed that makes the frenulum even shorter than before". I have found in my research that tongue mobility improves after each frenotomy and no adhesions are formed after simple horizontal cutting of the frenulum with scissors (local anesthesia) if the wound is not sutured. It is often necessary to carry out several frenotomies to achieve full articulating mobility of the tongue.



Lee, H. J., et al. (2010). "The Improvement of Tongue Mobility and Articulation after Frenotomy in Patient with Ankyloglossia." Korean Journal of Otorhinolaryngology-Head and Neck Surgery 53(8): 491-496.

             Background and Objectives. Ankyloglossia, manifested by the short and lingual frenulum, can affect tongue mobility and articulation. The purpose of this study is to evaluate the improvement of tongue mobility and articulation in patients with akyloglossia, which is treated by frenotomy. Subjects and Method A prospective study was done for 81 patients with ankyloglossia undergoing frenotomy, and who were aged between 2 to 10 years old. Outcomes were assessed by measuring tongue mobility, analyzing the articulatory evaluation and reviewing patient questionnaires. Results The mean length of tongue elevation improved from 7.4 mm preoperatively to 16.3 mm postoperatively (p<0.05). Similarly, the mean length of tongue protrusion improved from 15.0 mm to 26.0 mm (p<0.05). The mean articulation score improved from 8.5 to 9.9 (p<0.05). Parents' subjective satisfaction scores improved from 2.3 to 3.2 (p<0.05). Conclusion Tongue mobility and articulation improved after frenotomy in patients with ankyloglossia.







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