5 year old with tongue tie and difficultly with /l/ production

5 year old with tongue tie and difficultly with /l/ production

Q:

I have a 5 yr  old patient who has an obvious lingual tongue tie. He had a posterior cut when he was an infant but cannot elevate tongue tip to spot and cannot suction. He cannot produce /L/. I referred him to an ENT who said he doesn’t recommend cutting the tie, but rather he suggested the pt needs to have aggressive speech therapy to increase function and movement of the tongue.  I was quite baffled by this response, especially since this is one of the top Ped ENTs in San Diego. How do you recommend proceeding with this pt?

A:  By posterior “cut” do you mean he had a “posterior tie” released as an infant?  With your more current evaluation, what are your findings related to the lingual frenum? I’ll detail this a bit more at the end.  You didn’t include that information, and it is crucial to understanding his function.

You stated that he cannot produce /l/ but did not tell me how he attempts to produce it.  Is it the common “dark L” that is found in many who are ankyloglottic?  Or is it otherwise?

Using a mouth prop, how far up can he elevate this tongue tip?

Regarding the ENT to whom you referred, is that ENT savvy about tongue tie?  Stating that the pt needs aggressive speech therapy to increase function and movement of the tongue does not make sense to me.  Perhaps he meant an SLP who is also an orofacial myologist?

You asked how to proceed:

First you must carefully evaluate the tongue as discussed in class:  MOmax; MOWS (which he cannot do); and MOtts but since he can’t make the /L/, that is why I asked how he makes it.  With the jaw stabilized you might be able to obtain the MOtts enough to compare it with the MOmax.  With his mouth open, see where the attachment is to the floor of the mouth….well behind the lower alv ridge?  on the alveolus?  Is the frenum thick, thin, flexible?  Is it short?  Where does it enter the tongue itself?  How did he perform on each of the pre proficiency sections for lingual movements?

If he is restricted, then you might have to be the person to say so rather than send to someone else to make the determination unless this ENT is a specialist with ankyloglossia, which many are NOT.  Just because someone is an ENT does not mean they specialize in tongue tie.

You didn’t say why you are seeing this young man.  If, for example, he is being seen for some type of articulation disorder, the restriction will likely interfere with your ability to get him to habituate.  That’s why you must determine the function of the tongue and the frenum restriction as a possible barrier to success.

I hope this helps.  Let me know what you find and if I can offer any further advice.