Can’t see uvula or tonsils upon phonation
I started working with a client who has:
· an anterior and posterior crossbite,
· an everted lip,
· jaw sliding when talking
· high narrow palate
· mouth breather
· rests tongue on bottom of mouth
I now know to take her through phases I, II and III. But the one thing I am not sure what to do with is that I could not see her uvula/tonsil upon phonation of ah. Should I recommend a visit to an ENT?
I am out of state giving our course this week, so I will give you my quick thoughts, but please do present it also to our private Facebook Group as I know you will also receive wonderful suggestions from your “fellow and sister” graduates around the globe!
Here are my thoughts:
Referral? Who sent her and for what purpose? You didn’t say and that is critical since an orthodontic referral might have different answers than a child you see for speech in a school setting when taking into consideration all of the symptoms you listed.
With regard to the uvula/tonsils, that would depend upon your case history in part. Does she have symptoms of sleep apnea, for example? There are some therapists who send everyone who comes to their office for ENT exams. I never did that and most people do not, but when in doubt it is best to err in favor of referring out to be certain. I might also consider the age of the client with regard to sleep apnea, provide one of screening tests we discussed in class, etc. Is the tongue scalloped? Do they report snoring?
These are the questions, directions of probing that come to mind to me in this situation. I hope this is helpful. Please keep me updated.
Sandra R. Holtzman
MS, CCC/SLP, COM, QOM
Director Neo-Health Services
954 461 1114