The Tongue Was Involved, But What Was the Trouble? The search for the cause of a preschooler’s difficult behavior leads to a surprising discovery. Case Puzzler
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Case Puzzler  |   September 01, 2015
The Tongue Was Involved, But What Was the Trouble?
Author Notes
  • Nicole Archambault Besson, EdS, MS, CCC-SLP, is founder and executive director of Minds in Motion, a speech-language pathology, orofacial myofunctional therapy and sleep literacy clinic in Santa Monica, California. She is a faculty member at the Academy of Orofacial Myofunctional Therapy. nicole@mindsinmotiontherapy.com
    Nicole Archambault Besson, EdS, MS, CCC-SLP, is founder and executive director of Minds in Motion, a speech-language pathology, orofacial myofunctional therapy and sleep literacy clinic in Santa Monica, California. She is a faculty member at the Academy of Orofacial Myofunctional Therapy. nicole@mindsinmotiontherapy.com×
Article Information
Development / Speech, Voice & Prosodic Disorders / Swallowing, Dysphagia & Feeding Disorders / Professional Issues & Training / Attention, Memory & Executive Functions / Case Puzzler
Case Puzzler   |   September 01, 2015
The Tongue Was Involved, But What Was the Trouble?
The ASHA Leader, September 2015, Vol. 20, online only. doi:10.1044/leader.CP.20092015.np
The ASHA Leader, September 2015, Vol. 20, online only. doi:10.1044/leader.CP.20092015.np
Aiden, almost 5, is the brightest child in his pre-kindergarten class, but his teachers and parents are struggling to understand his behavior.
Aiden is constantly in motion, purposefully crashing into objects around him with little, if any, sense of caution. He avoids social interaction and doesn’t understand how to take turns in a conversation. Easily frustrated, Aiden tantrums and acts out, does not like to follow directions, and forgets basic instructions and routine tasks, like brushing his teeth after breakfast and putting empty juice boxes in the trash can.
Aiden’s parents turned to his pediatrician, who was concerned enough about issues of attention, hyperactivity and dysregulation to send the family to a neuropsychologist for testing.
Although Aiden had a prior history of receiving speech-language treatment for articulation, the neuropsychologist sent him to me because I am trained in orofacial myofunctional therapy. To check for an altered lingual frenulum (tongue-tie), I scheduled Aiden for an orofacial myofunctional assessment, which looks at oral and muscle functions related to proper oral rest postures, speaking, chewing, swallowing and nasal breathing support. I indeed discovered a tongue-tie, and given Aiden’s history and reported concerns, suspected his difficulties could be related to a little-known disorder.
Comprehensive intake
Part of my assessment involved collecting information from Aiden’s teachers, caregivers and health care providers, in addition to parent reports.

Anything that affects a child’s ability to breathe through the nose during the day—such as allergies—raises a red flag, as that same issue may affect nighttime sleep breathing.

Aiden’s history included premature birth, jaundice, frequent ear infections, sinus infections and environmental allergies. Ear infections are not uncommon in children with lingual frenulum restrictions, as tongue-ties can result in swallow patterns that don’t adequately ventilate eustachian tubes to support optimal middle ear functioning. And anything that affects a child’s ability to breathe through the nose during the day—such as allergies—raises a red flag, as that same issue may affect nighttime sleep breathing.
The parents also indicated that Aiden is a picky eater, sitting at the table for an average of two minutes during meals and often leaving his plate untouched.
Aiden spoke at a very low volume, mumbling and running words together, with unfamiliar listeners understanding his connected speech less than 50 percent of the time. Aiden became frustrated when he wasn’t understood.
In addition to atypical and age-appropriate articulation errors, Aiden had an interdentalized lisp for phonemes /s/, /z/, /t/, /n/ and /l/. This tongue thrust also resulted in an abnormal swallow pattern (tongue-thrust swallow) for liquids and solids. Many instances of tongue thrust in speaking and swallowing are rooted in airway obstructions: For example, if the airway is obstructed during nighttime sleep breathing, the tongue will clear the oral cavity with a constant tongue-thrust pattern to maintain the airway, a behavior that is then generalized to the daytime.
Therefore, tongue thrusts may be more than just a speech issue in need of remediation—they often are indicators of an underlying airway issue.
Airway issues, in turn, can wreak havoc on learning and academics, behaviors and mood, attention and memory, abstract thinking, problem solving, and speech and language—secondary to reduced oxygen to the brain.
Aiden’s speech and swallowing issues—in addition to his altered lingual frenulum—raised the possibility that his daily struggles were related to a more pervasive and life-altering issue than initially suspected.
Mouth and face tell all
As speech-language pathologists know, one of the tongue’s biggest roles—and the most essential to human life—is maintaining the airway for breathing. A lingual frenulum restriction affects the genioglossus muscle (a known upper-airway dilator) because the frenulum fibers don’t stretch. This aspect of a speech-language assessment, however, can easily be overlooked in the midst of so much ground to cover in a limited amount of time.
Aiden’s orofacial myofunctional exam revealed additional factors that pointed to a potentially compromised airway: a low forward tongue posture at rest (further visible by protrusion of the tongue through the teeth and lips), open lips at rest, a high narrow palate, wear patterns on the teeth (sign of possible nocturnal teeth grinding), enlarged tonsils and a convex facial profile (a pronounced head and recessed chin). Studies from the Journal of Craniofacial Surgery (see sources) show that a child with enlarged tonsils, malocclusion and convex facial profile has a two-to-three times greater risk for sleep-disordered breathing.
And at night?
Aiden’s sleep-quality screening questionnaire further revealed the telltale signs and symptoms of nighttime breathing difficulties:
  • Snoring nightly.

  • Mouth breathing or open lips position.

  • Grinding teeth (a micro-arousal that alerts the body to breathe).

  • Restless sleep.

  • Waking multiple times (from snoring, grinding teeth or body movement to open the airway).

  • Enuresis (often from a diuretic hormone produced by an overworked heart).

  • Waking in the morning feeling tired, even after ample sleep.

  • Complaining of being or appearing tired during the day.

An interdisciplinary solution
Aiden’s assessment warranted immediate referral to the appropriate medical professionals. At the top of this list was consultation from an airway-centric orthodontist to weigh in on the position of the facial and cranial bones in relation to the airway, and an otolaryngologist to assess nasal openings and to address potential signs of sleep-disordered breathing and/or airway obstructions. Enlarged tonsils, for example, can be accompanied by enlarged adenoids that further restrict the airway—Aiden’s adenoids were obstructing 80 percent of his airway.
  • The collaborative team recommended the otolaryngologist release Aiden’s restricted frenulum when removing Aiden’s adenoids and tonsils.

  • I planned orofacial myofunctional therapy to begin a couple weeks before surgery to address jaw stabilization.

  • I also planned post-surgical orofacial myofunctional treatment to re-educate the oral and facial muscles to support proper oral rest postures, speaking, swallowing and chewing, as well as to retrain nasal breathing. Studies show that this follow-up treatment improves outcomes for children whose tonsils and adenoids are removed.

  • The neuropsychologist, informed of Aiden’s physiological issues that resulted in sleep-disordered breathing—and possibly his behavior issues—decided to wait on Aiden’s response to the medical and rehabilitative services before reaching a diagnosis.

Improved outlook
From participation in an orofacial myofunctional program, Aiden has improved oral rest postures, tongue-tip elevation for some lingual alveolar sounds, improved speech intelligibility, increased talking and increased confidence speaking. He also is beginning to normalize his swallow pattern.
He sleeps through the night at least three nights per week, which his mother says is an enormous improvement for all of them. He also moves less in bed when sleeping.
People can no longer hear him breathing through the daytime. And in treatment he shows improved focus, participation and ability to follow directions. He now has a foundation for airway health and quality sleep—the fuel that drives children’s health, growth and development, and learning. Aiden—and his parents—are now resting easy.
A Hidden Epidemic of Lost Sleep

Sleep problems affect up to 45 percent of the world’s population, according to the World Association of Sleep Medicine. They affect males and females from all walks of life and of all ages.

Quality sleep is the foundation of every human function, and compromised sleep can affect health, physical growth, learning and academics, socialization, emotional well-being, swallowing, communication, and executive-function skills, particularly in a developing child. Its manifestations are easily overlooked or mistaken for something else, yet 25 to 50 percent of preschoolers have sleep problems. Most parents do not realize that nighttime sleep breathing should be quiet, with the lips together at rest.

Sleep-disordered breathing alone can increase a child’s risk for a special educational need by 40 percent, according to sleep researcher Karen Bonuck. Children can be moved off that track through the efforts of an interdisciplinary team and appropriate interventions.

Do you have an unusual diagnosis or treatment story to share in “Case Puzzler”? We’d like to know about it. Send your ideas to leader@asha.org.

Sources
Bonuck, K., Trupti, R., & Linzhi, X. (2012). Pediatric sleep disorders and special educational need at 8 years: A population-based cohort study. Pediatrics, 130(4), 634–642. [Article] [PubMed]
Bonuck, K., Trupti, R., & Linzhi, X. (2012). Pediatric sleep disorders and special educational need at 8 years: A population-based cohort study. Pediatrics, 130(4), 634–642. [Article] [PubMed]×
Choi, Y. S., Lim, J. S., Han, K. T., Lee, W. S., Kim, M. C. (2011). Ankyloglossia correction: Z-plasty combined with genioglossus myotomy. Journal of Craniofacial Surgery, 22(6): 2238–2240. [Article] [PubMed]
Choi, Y. S., Lim, J. S., Han, K. T., Lee, W. S., Kim, M. C. (2011). Ankyloglossia correction: Z-plasty combined with genioglossus myotomy. Journal of Craniofacial Surgery, 22(6): 2238–2240. [Article] [PubMed]×
Ikavalko, T., Tuomilehto, H., Pahkala, R., Tompuri, T., Laitinen, T., Myllykangas, R., Vierola, A., Lindi, V., Narhi, M., & Lakka, T. A. (2012). Craniofacial morphology but not excess body fat is associated with risk of having sleep-disordered breathing—The PANIC Study (a questionnaire-based inquiry in 6-8-year-olds). European Journal of Pediatrics, 171(12), 1747–1752. [Article] [PubMed]
Ikavalko, T., Tuomilehto, H., Pahkala, R., Tompuri, T., Laitinen, T., Myllykangas, R., Vierola, A., Lindi, V., Narhi, M., & Lakka, T. A. (2012). Craniofacial morphology but not excess body fat is associated with risk of having sleep-disordered breathing—The PANIC Study (a questionnaire-based inquiry in 6-8-year-olds). European Journal of Pediatrics, 171(12), 1747–1752. [Article] [PubMed]×
Lavigne, J. V., Kiplewicz, H. S., Abikoff, H., & Foley, C. (1999). Sleep and behavior problems among pre-schoolers. Journal of Developmental and Behavioral Pediatrics, 20, 164–170. [Article] [PubMed]
Lavigne, J. V., Kiplewicz, H. S., Abikoff, H., & Foley, C. (1999). Sleep and behavior problems among pre-schoolers. Journal of Developmental and Behavioral Pediatrics, 20, 164–170. [Article] [PubMed]×
Lee, S. Y., Guilleminault, C., Chiu, H. Y., & Sullivan, S. (2015). Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep and Breathing, epub ahead of print (www.ncbi.nlm.nih.gov/pubmed/25877805).
Lee, S. Y., Guilleminault, C., Chiu, H. Y., & Sullivan, S. (2015). Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep and Breathing, epub ahead of print (www.ncbi.nlm.nih.gov/pubmed/25877805).×
Owens, J. A. (2009). Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatric Pulmonology, 44(5), 417–422. [Article] [PubMed]
Owens, J. A. (2009). Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatric Pulmonology, 44(5), 417–422. [Article] [PubMed]×
Takashi, O. (2012). Tongue and upper airway function in subjects with and without obstructive sleep apnea. Japanese Dental Science Review, 48(2), 71–80. [Article]
Takashi, O. (2012). Tongue and upper airway function in subjects with and without obstructive sleep apnea. Japanese Dental Science Review, 48(2), 71–80. [Article] ×
10 Comments
September 2, 2015
Laurie Amador
So interesting!
I cannot say how many times we have seen cases like these in our practice. Nicole's case study really ties together all the pieces of the puzzle, with current research to substantiate it. I will give this article to parents and school staff to educate them and increase awareness about Orofacial Myofunctional Therapy/frenum restriction/sleep disordered breathing. Thank you!
September 2, 2015
Julia Leadford
Great .article!
I have a client who fits this description to a T. The only difference is I started working with him when he was 3. Printing it for his parents. Thanks so much!
September 8, 2015
Ann Kummer
Concern about tongue-tie comments
The author describes a relatively common condition of hypertrophic tonsils and adenoids, resulting in upper airway obstruction and probable obstructive sleep apnea. Enlarged tonsils can cause pharyngeal cul-de-sac resonance (where the sound resonates in the pharynx due to the blockage of the tonsils to the entrance of the oral cavity). This also causes low volume and a muffled quality. Large tonsils can also cause an open mouth posture and anterior tongue position. Finally, swallowing a large bolus can be difficult with large tonsils, which narrow the opening between the oral and pharyngeal cavities. I question the author’s conclusion that the child had both tongue thrust and tongue-tie (ankyloglossia), which would be mutually exclusive. More than likely, the anterior tongue position was due to obstruction and not a myofunctional disorder. Also, there is NO EVIDENCE that tongue tie affects production of English sounds (maybe the Spanish /r/). The most you have to elevate the tongue is for an /l/ and the most you have to protrude the tongue is for a /th/. Both phonemes can be produced even with severe restriction of the tongue tip. See the recent AHRQ meta-analysis report: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=2073. In addition, there is no evidence that ankyloglossia affects swallowing or Eustachian tube function. Therefore, frenulectomy would NOT be indicated in this case or in MOST cases because it is unlikely to improve speech or swallowing. We need to be sure that our recommendations, especially when it comes to surgery (even minor surgery), are evidence-based. Ann W. Kummer
September 10, 2015
Jennifer Maietta
Thank you, Ann Kummer!
I echo Ms. Kummer's sentiments exactly. I am in complete awe that the ASHA Leader would publish this article.
September 18, 2015
April Johnson
Peer Review?
I am also disappointed by the many false statements in this article. Who is editing and reviewing for our national publication?
September 18, 2015
Nicole Goldfarb
A response to anyone questioning this article
I am responding to the posts from and anyone who is doubting the information in this wonderful article. It is import to be up-to-date on the current research on the role of the lingual and maxillary frenum as well as pediatric sleep disordered breathing before passing incorrect judgments on such an amazing, relevant, and true article. THE TONSILS- The tonsils and adenoids are never a large from birth, but rather hypertrophy in response to irritants and inflammation. It is important to look at the cause of why the tonsils and adenoids did overgrow. THE FRENUM- A restricted lingual frenum is the most significant contributing factor for tongue dysfunction resulting in myofunctional disorders. Whether in a child, adolescent, or adult, the restricted lingual frenum interferes with the tongue’s ability to perform 3 important functional tasks: 1. It limits the tongue’s ability to rest and swallow up on the palate. 2. It limits the tongue’s ability to sweep the front of the tongue to the back molars to position food during chewing or to remove food from the teeth or the cheeks. 3. It limits the tongue’s ability to lift up and/or curl back for specific speech sounds or to move quickly and effortlessly to produce the various consonant sounds. The lingual frenum is a non-elastic tissue which is attached from the floor of the mouth and inserts into the underside of the tongue. With regards to the lingual frenum, a restriction can be in the length only, the placement only or in both the length and the placement, making it difficult for the tongue to function correctly. The frenum develops in utero, so if there is any restriction, it is present from birth. This non-elastic tissue, has the potential to hold the tongue in an abnormal position at rest, for swallowing, and even for speech sounds thus causing an individual to utilize compensatory movements and positioning. THE FRENUM: A LITTLE HISTORY- Before formula and bottles were invented, an infant’s ability to nurse effectively was the determining factor on whether that infant would survive. Midwives used to have a long fingernail and release the lingual frenum at birth if an infant was unable to breastfeed effectively. Historically, it was a matter of life or death for infants. However, once formula and bottles were invented (as well as mothers began working more and separating more from their infants throughout the day), breastfeeding decreased and infants were able to survive even though they may have had a restriction in the frenum tissue that made effective nursing difficult or impossible. A frenum restriction in the lingual, maxillary, or mandibular areas can cause nursing issues. Some specialists now call frenum restrictions “Tethered Oral Tissues”. THE FRENUM: IS IT REALLY “RESTRICTED”?- It is important to note that there is a gradient of "restriction", meaning that determining if there is a restriction is not black and white and also depends on other symptoms that are present. Before I got my degree as a myofunctional therapist, my training as a speech language pathologist taught me to examine the lingual frenum to determine if it was completely ankylossed to the floor of the mouth. I was taught that the tongue does not need to move very much to produce speech sounds. An ankylossed frenum is a very obvious restriction. However, observing the degrees of restrictions, and knowing that they can interfere with correct infant feeding and also oral and facial development is important. The lingual frenum can also affect speech sound production, perhaps not always from an acoustic perspective, but from a functional/movement perspective. THE FRENUM: SPEECH PRODUCTION- If there is a frenum restriction, an individual will likely compensate by producing speech sounds differently. This may not affect the acoustic perception of each specific sound, however the tongue may have a different placement and movement when producing certain sounds. Of course, this depends on the degree of the restriction. The movement of the tongue is determined by its resting position. If a tongue is resting low in the mouth because of a restricted lingual frenum, that individual is more likely to produce the alveolar sounds like the S/Z sounds with the tongue tip down or sounds like the L/N with the tongue forward, as opposed to up by the alveolar ridge. This usually does not negatively impact speech intelligibility, but it is an important factor to take into account when there are other issues that may cause the therapist to investigate the lingual frenum. The frenum can also affect an individual’s ability to easily produce an R sound, as the tongue must elevate in the back for a bunched R or the tip must be able to curl back for a retroflex R. Moreover, the frenum can interfere with the rapid production of speech, as it can negatively impact an individual’s ability to smoothly and precisely move between consonants in on-going speech. This may be of importance for those speech therapy referrals in which the parents or the patient reports “lazy speech”, “unclear”, “mumbling”, or “decrease in speech intelligibility towards the end of the day when tired”, and the person correctly produces all speech sounds. These referral are common not only in children but in adolescents or adults. I am not referring to an apraxia situation or any other neurological issue. Do not be misled to considering the role of the frenum in speech sound production. Not always does it cause a speech issue that needs to be treated, but it is important to take into account, especially when other symptoms are present or when speech therapy is just not working. THE FRENUM: ORAL/FACIAL DEVELOPMENT, SLEEP, AND GENERAL HEALTH- The tongue needs to rest on the palate to maintain the width of the arch. When the tongue rests low in the mouth for any reason, most often due to restrictions in the lingual frenum, the palate can become narrow. The palate is connected to the nasal cavity, and when the palate is narrow, the nasal cavity will decrease in size. Also, a low tongue positioning means the mandible will be lower/drops and therefore recesses back, which can cause a Class II malocclusion (upper jaw forward in relation to lower jaw). The lower jaw is connected to the posterior airway, meaning if the mandible is retruded, the posterior airway can decrease in size. Also, when a person rests with an open mouth position, that person is more likely to become a mouth breather. It is important to breathe through the nose throughout the day and when sleeping, as the nose helps us fight germs/allergens and breakdown oxygen more effectively via a chemical released by the nasal turbinates called nitric oxide. Furthermore, with an open mouth posture, not only is mouth breathing more likely, but all of the oral muscles will weaken (lip muscles, tongue muscles, cheeks, etc.), which will cause the facial structure to develop differently. Also, a person with weak oral muscles is more prone to sleep-disordered breathing, snoring, and sleep apnea. Humans are the only species on the planet where the tongue is connected into the airway. Thus, if the tongue does not maintain adequate resting tone when a person is sleeping, the tongue has the ability to fall back into the airway and cause sleep breathing issues. A restricted frenum can undoubtedly cause the tongue to rest low and therefore fall back into the airway when a person is sleeping. 90% of growth hormone is released when a person is sleeping, so if a person is not sleeping deep enough for a long enough period of time, and if that person is also receiving less oxygen when sleeping due to restricted airway (such as, from the tongue falling back into the airway), this has profound life effects on an infants, children, and adults. Based on a study by the American Journal of Pediatrics, 50% of children no longer met the diagnosis for ADHD once their tonsils and adenoids were removed, thus showing that sleep-disordered breathing can have significant behavioral effects on children that may cause them to be misdiagnosed as having ADHD. Plus, brain development can be significantly impacted in children and adults due to sleep-disordered breathing, and research shows that these individuals are more likely to be diagnosed with learning disabilities, sensory processing issues, cognitive and memory impairments, and even Alzheimer’s disease. The role of the frenum in facial, dental, sleep, and brain development should not be overlooked. THE FRENUM: A SUMMARY- A restricted lingual, maxillary, and even mandibular frenum can have a cascade of negative effects on the infant from day #1, which can lead to a multitude of negative consequences throughout development from childhood through adulthood. The role of the frenum should not be overlooked at birth. If there are ANY feeding issues, breastfeeding difficulties, issues with infant growth, and nasal breathing/congestion in the infant, the frenum should be one of the first things that is investigated. It is important to be up to date on current research, as imposing an opinion based on out-dated information can really set back the medical profession and the health and well-being children. Importantly, there are now mandatory “Fenum Inspection Laws” in at least eight different countries in the world, meaning that all infants in these countries must have their frenums inspected within 48 hours after birth (reminiscent of newborn hearing screenings)! Our team of myofunctional therapists in California is trying to push for this in United States as well. Having a child that went through these issues makes this not only a career goal but a personal passion. I have seen first hand these issues and the misdiagnosis my son having a restricted maxillary and lingual frenum from a handful of medical professionals, which led to a tonsil and adenoidectomy at the age of 2:11 because his tonsils and adenoids hypertrophied and caused obstructive sleep apnea, all were initially due to infant reflux which was caused by a restricted frenum and swallowing issues from birth. There was also an array of other issues or “symptoms” from birth throughout his 3 years of development that seemed non-significant or unrelated at the time, all of which were described to me as “common”/”normal” by medical professionals, but were related to the frenum. At the time, I did not even notice that his frenum was restricted, and I had already been a SLP for nearly 15 years. This is because I was unaware that what appeared to be “slight” restrictions could have such negative impacts. As an SLP, I was not taught how to accurately diagnose frenum restrictions and the impact even slight restrictions can have on the health and well being of an infant, child, or adult. Importantly, current research has now provided clear evidence that myofunctional therapy is necessary to rehabilitate the oral muscles (lips and tongue) post tonsillectomy/adenoidectomy if there was a sleep-related breathing issue present, otherwise the sleep-breathing issue will most likely come back in three months or more. I am experiencing this with my son right now, about 3 months post-surgery, and he will begin his myofunctional therapy program this week. Lastly, if an individual has had a frenectomy, myofunctional exercises are necessary so the tissues do not scar back down again. A myofunctional therapist can determine whether there is a frenum restriction contributing to any myofunctional issues if a frenum restriction was not noticed by the lactation consultant, pediatrician, ENT, dentist, orthodontist, SLP, or any other specialist. Please read up on the current research. I can guide anyone to a list of resources if you are interested. Nicole Goldfarb, M.A., CCC-SLP, COM Speech-Language Pathologist Certified Orofacial Myologist
September 19, 2015
Linda D'Onofrio
Restricted lingual frenulum & Tongue Thrust Swallow
In a previous post, it was stated that tongue thrust and a restricted lingual frenulum are mutually exclusive. This is incorrect. They are seen together frequently. The restriction contributes to the horizontal oral seal. When the tongue tip cannot elevate easily to the alveolar ridge and the blade cannot create a lingual-palatal suction, the suction is then made against the back of the incisors or between them if an open bite is emerging. All lactations consultants and pediatric feeding specialists should be aware of the negative impact of restricted oral frenula for nursing and for clearing milk and food debris in infants and small children. Unnecessary dental and orthodontic problems arise when not caught early. SLPs are often the first line of professionals that see these issues. Pediatric sleep apnea is a growing epidemic – this should be a question on every intake form. I am so excited to hear Nicole Besson’s presentation at ASHA this year highlighting all the new research in this field and how SLPs are uniquely suited to help these patients in early intervention, the school years, and as adults. Great article and about time! PS – As a matter of online courtesy, please refrain from using all capitals for emphasis. It is considered shouting and impolite.
September 22, 2015
Linda D'Onofrio
From the Dept of Health & Human Services
Updated info from the US Dept of Health & Human Services. The evidence for supporting lingual frenuectomy for speech improvement alone is insufficient due to poor and limited studies. However, evidence is much stronger regarding oral function and eating. As always, more data is needed. More studies should be done. Consider the whole client and normal oral functioning. http://www.effectivehealthcare.ahrq.gov/ehc/products/558/2073/ankyloglossia-executive-150504.pdf http://www.effectivehealthcare.ahrq.gov/ehc/products/558/2074/ankyloglossia-report-150504.pdf —LD' ---------------------- Linda D'Onofrio, MS, CCC-SLP D'Onofrio Speech & Language 1827 NE 44th Avenue #120 Portland OR 97213 503.808.9919 office www.donofrioslp.com
October 25, 2015
Dawn Moore
THANK YOU!
This article could not have been printed at a better time! It is time for our field to rise up and join the dentists, orofacial myologists, ENT's, SLP's, and lactation consultants who are pushing for this birth defect to be corrected AT birth. I applaud Nicole Goldfarb and Linda Onofrio's responses and couldn't agree more! It's time to put some real time and research into this ignored midline defect and help all those affected by this potential life altering condition!
August 23, 2017
Janet Coe Hammond
duel tongues
The strangest oral structure I have seen was a young child with two tongues. It actually took some research for me to convince myself that I was seeing what I was seeing. It was an absorbed twin.
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FROM THIS ISSUE
September 2015
Volume 20, Issue 9