The Dramatic Rise in Tongue Tie and Lip Tie Treatment

by Nikki Kean •

ENTtoday: How common are speech-related issues among children with tongue ties?

Johnson: This is a difficult question to answer because there is a lack of comparative data on this subject. Studies show great variability in speech disorder prevalence among children, and the American Speech and Hearing Association has reported that 2.3% to 24.6% of school-aged children were estimated to have speech delay or speech sound disorders. Of the children diagnosed with a speech sound disorder, there are no data on the prevalence of AG within this population.

There are a few studies that claim that tongue tie release improved articulation in patients with AG. Because there are no standardized measures to evaluate the need for release, many practitioners, including physicians and speech language pathologists, look at lingual mobility tasks, such as lingual protrusion, as well as parent report of a speech disorder, to make a decision regarding release. However, there is no evidence that reduced ability to protrude the tongue and to lateralize the tongue tip to the molars will affect a patient’s ability to produce consonants.

ENTtoday: When would you recommend treatment?

Johnson: I look at tongue mobility for functional tasks, such as clearing food residue from the cheeks and teeth. For speech, I use standardized testing with an articulation test as well as informal measures to test overall speech intelligibility in conversation. I look for the child’s ability to produce alveolar consonants, which are produced with the anterior portion of the tongue. Even in cases of AG, most children I’ve seen do not have difficulty producing these sounds.

It’s important to provide a differential diagnosis because there are many reasons why a speech sound disorder may exist, including a motor speech disorder, an articulation delay, or a phonological processing delay. These diagnoses require different treatment methods, and I would always start with speech therapy targeting the sound errors and the child’s ability to produce accurate productions prior to recommending a surgery to release the frenulum, if that is a concern. Ultimately, the decision to perform a surgical release is based on the physician’s recommendation.

Pearls & Pitfalls for In-Office Frenotomy

John Carter, MD, section head of pediatric otolaryngology–head and neck surgery at Ochsner Health Systems in New Orleans, recommends the following for releasing a tongue tie:

  • You can typically perform in-office frenotomy until an infant is old enough to bite your finger (approximately six months of age).
  • Don’t do the procedure in the office on:
    • infants on anticoagulants or aspirin;
    • infants who can’t tolerate anemia (i.e. congenital heart defects, BPD); or
    • infants who have difficulty managing their secretions.
  • Hemostatic gauze is a good way to stop bleeding that oxymetazoline or neosynephrine will not.
  • Silver nitrate is not good solution to stop bleeding, as it will often burn the infant’s upper aerodigestive tract.
  • Oral sucrose is sufficient for perioperative anesthesia.
  • It is OK to let the infant breastfeed right after the procedure, and helps to calm her down, which slows bleeding.

Items in operative set-up:

  • Iris scissor
  • Groove director
  • Sucrose vial
  • Hemostatic gauze
  • Oxymetazoline
  • Gauze