Working With Tongue Tie (Ankyloglossia) and Lip Tie Patients as a Speech-Language Pathologist

Ankyloglossia is a congenital oral anomaly found in 4 percent to 10 percent of newborns, describing an unusually thick, short oral frenulum (the membrane attaching the underside of the tongue to the floor of the mouth). That very broad estimate of the numbers is only a preview of the wider disagreements surrounding the condition. The fact is that there is no well-validated clinical method for making a diagnosis of the ankyloglossia, and even more controversy over how those cases should be handled.

Lip tie describes tissue attaching lips to gums, and may be just as controversial, but has engendered far less open debate. Both conditions are thought to primarily impact breast-feeding, so are usually encountered in the context of working with infants.

Speech-language therapists are frequently drawn into issues surrounding tongue tie (the colloquial name for ankyloglossia) and lip tie, however. They are often the primary professional responsible for making the initial diagnosis for either condition. They may be asked to assess the impact those conditions may have on feeding, speech, or swallowing for affected patients. In circumstances where they find speech or feeding to be affected, they may be the primary non-surgical treatment option for correcting those issues. Where a surgical approach is taken, they can be involved in therapy to retrain the patient afterward.

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To Clip or Not to Clip is The Question in Ankyloglossia Cases

A 2005 survey of 299 SLPs found that slightly more than half of them were responsible for the initial diagnosis of ankyloglossia. In about 20 percent of cases, they recommended no action be taken, as no observable difficulties with speech or feeding could be found. In about 11 percent of cases, patients were referred to a surgeon for a frenulectomy, a procedure clipping the frenulum to free tongue movement.

Most of the remainder of those cases were addressed strictly through oral motor or feeding/swallowing therapies.

Most formal studies, however, have called into question the relationship between tongue or lip tie and most speech and language problems. A host of studies, dating back to 1963 and including one as recent as 2003, have shown no causal connection between tongue tie and speech impediments. A 2015 ASHA review of trials and case reports found no evidence to assess non-surgical treatments in patients with ankyloglossia or ankyloglossia with concomitant lip tie.

Impacts on feeding are more widely agreed upon, but even there, there is wide disagreement between SLPs, physicians, and otolaryngologists about just how much effect they have and what the appropriate treatment should be. For frenulectomies that may induce complications inherent in any surgery, surgeons are beginning to demand more evidence of a genuine problem before breaking out the scissors.

The official ASHA (American Speech-Language-Hearing Association) position on frenulectomies is that the decision is outside the scope of practice of SLPs and is a medical question that must be left to physicians. But many SLPs are still involved in making those recommendations… and doing so without real guidance from their own standards body.

SLPs Provide Non-Surgical Interventions for Tongue Tie and Lip Tie Patients

Extreme cases of ankyloglossia or lip tie may still required treatment, even if a surgical intervention is ruled out. Although speech impediments may not often be related to tongue tie, many other functional limitations are:

  • Orthodontic problems
  • Functional limitations in breastfeeding
  • Swallowing
  • Articulation
  • Limited oral clearance
  • Psychological issues

Unfortunately, SLPs are also on thin ground when it comes to the most effective treatments they can offer to ankyloglossia patients. Few studies have been performed to gain a better understanding of how speech-language therapy affects tongue and lip tie cases, and the ones that have been done are generally thought to be of low quality and not necessarily indicative of clinical effectiveness.

Nonetheless, the social stigma of tongue tie remains one of the most significant impacts on patients, and therapy provided by SLPs can have psychological as well as clinical implications. The studies reporting positive outcomes to speech therapy in tongue tie patients were not comparative in nature and therefore can’t provide a conclusive claim for how effective they may or may not be. Still, there’s no reason to doubt that  both therapists and patients observed and appreciated the improvements that were reported.

As long as a lack of evidence persists in the treatment modalities for tongue and lip tie, speech-language therapists will have to continue to use their own judgment and experience as the primary yardstick for recommending and treating the conditions.