Case Puzzler In the article “The Tongue Was Involved, But What Was the Trouble?” in the September 2015 issue, Nicole Archambault Besson failed to provide any research supporting her overarching belief that a tongue-tie was a major player for this “case puzzler.” Although it is well-known that underlying respiratory issues can wreak ... Inbox
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Inbox  |   December 01, 2015
Case Puzzler
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Development / Swallowing, Dysphagia & Feeding Disorders / Professional Issues & Training / ASHA News & Member Stories / Inbox
Inbox   |   December 01, 2015
Case Puzzler
The ASHA Leader, December 2015, Vol. 20, 4. doi:10.1044/leader.IN1.20122015.4
The ASHA Leader, December 2015, Vol. 20, 4. doi:10.1044/leader.IN1.20122015.4
In the article “The Tongue Was Involved, But What Was the Trouble?” in the September 2015 issue, Nicole Archambault Besson failed to provide any research supporting her overarching belief that a tongue-tie was a major player for this “case puzzler.” Although it is well-known that underlying respiratory issues can wreak havoc on attention, learning, behavior, sleep and other issues, the author makes a strong case for how a tongue-tie can result in atypical swallowing patterns, negatively affecting sleep; that these nighttime patterns are “generalized to the daytime”; and how her treatment positively affects jaw stabilization and “re-educate[s] the oral and facial muscles to support proper oral rest postures, speaking, swallowing, and chewing, as well as to retrain nasal breathing.”
Although interdisciplinary work is mandated for this type of case, the author’s strong statements related to our field backed by weak or nonexistent evidence for this case is a case puzzler!
Craig Selinger, Brooklyn, New York
Author’s response:
I really appreciate your passion and commitment to our shared profession. Engaging in a considerate and respectful dialogue moves our profession and patient care forward. ASHA has often cited an article from the British Journal of Medicine, which comments on evidence-based practice: “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”
The evidence to support various applications of orofacial myofunctional therapy (OMT) is constantly growing. Relevant studies pertaining to the orofacial functions are available in many disciplines. I can share only a few here. In 2015, Stanford University reported in the International Journal of Pediatric Research that restricted lingual frenula are implicated in pediatric obstructive sleep apnea.
Numerous other studies on sleep-disordered breathing (SDB), specifically the 2009 Penn State Child Cohort Study and the 2011 Avon Cohort Study have highlighted significant risk factors—identifiable by SLPs—for SDB. A 2015 Stanford University Study found new evidence on the development of pediatric SDB.
Unfortunately, enlarged tonsils and adenoids can affect breathing at any time. Hypertrophic lymphatic tissue obstructs the airway day and night, affecting the physiology of tongue and orofacial muscles. A 2014 meta-analysis demonstrates that myofunctional therapy decreases the Apnea-Hypopnea Index (AHI) by approximately 62 percent in children and 50 percent in adults. For additional references, please refer to on.asha.org/tongue-puzzler.
Nicole Archambault Besson, Santa Monica, California

We appreciate the constructive dialogue on this interesting case. Read more about ankyloglossia, or tongue-tie, in an ASHA Leader article by Ann Kummer.

1 Comment
December 3, 2015
Linda D'Onofrio
OMDs
Thank you for the opportunity to highlight the research again!
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FROM THIS ISSUE
December 2015
Volume 20, Issue 12