Tongue Tie: Is tongue tie causing speech problems in your child?

Tongue tie can lead to difficulty in coordinating tongue movements. This can reduce the clarity in speech and make it difficult for children to put words together in a sentence. Parents who have children with difficulty in speech, should have their kids evaluated for a tongue tie as it may be one of the causes. The ENT Clinic in Singapore is an ear, nose and throat medical practice that evaluates both children and adults for any ear, nose and throat disorders. Tongue tie is a condition that can be addressed by the otolaryngologists here.

What is tongue tie?

Medically referred to as ankyloglossia, tongue tie restricts the movement of the tongue. Tongue tie occurs due to the ‘lingual frenulum’ being very short and thick.  The lingual frenulum is the tight band of tissue holding the tongue to the tip of the floor of the mouth. Individuals who have tongue-tie have difficulty in sticking out their tongue. A very strong tongue tie can affect breast feeding in an infant. Moderate tongue tie can affect a child’s ability to eat, swallow and speak. 

What are the symptoms of a tongue-tie?

If your child has trouble performing any of the tasks below, then it may be due to a tongue tie.

  • Having the tongue heart shaped when sticking out
  • Facing difficulty in lifting the tongue up to teeth and moving the tongue side to side
  • Difficulty in sticking the tongue to reach the lower set of teeth

What causes tongue tie?

Generally, the part of tissue called the lingual frenulum has to separate prior to birth. If it is separated, it allows the tongue to move freely. However, individuals who have a tongue tie, have a tightly held lingual frenulum attached to the bottom of the tongue. The reason why it happens is not known; it is believed that there is a genetic association.

Are there risk factors for tongue tie?

Due to its genetic predisposition, it can run in families. It is also more prevalent in boys than in girls. Tongue tie can however affect anyone too.

Can tongue tie cause complications?

The most important complication which tongue tie can affect is an infant’s oral development. Complications include:

Problems in breast-feeding: During breastfeeding, babies need to keep the tongue over the lower gum for sucking. However, if a baby is not able to position the tongue correctly, then the baby is not able to suck, instead the baby would chew. It will cause injury to the mother and affect the feeding ability of the child, leading to low nutrition levels in the infant.

Difficulty in communicating: Having a tongue tie can interfere in making certain sounds like ‘t’, ‘d’, ‘z’, ‘r’ and ‘I’. There is however no direct correlation between speech difficulty and severity of tongue tie.

Reduced hygiene in oral cavity: In older children, if the tongue tie is not corrected, then it is difficult to remove any food debris from teeth, by rotating the tongue. It can cause tooth cavities, leading to tooth decay and gum inflammation called gingivitis. Tongue tie can also form a gap at the bottom of the front teeth.

Difficulty doing oral activities: Individuals who have tongue tie have difficulty in carrying out normal activities like licking an ice cream or playing a wind instrument.

When should you see a doctor?

As a parent, if you observe any of the signs below, then it is recommended to visit an ENT practice.

  •  An infant who has trouble with breast-feeding
  •  Difficulty in eating and swallowing in older children
  •  Difficulty in communication and pronunciation of certain words
  • An older child complaining of tongue tie problems which interferes with eating and speaking

How is a tongue-tie diagnosed?

A tongue tie is diagnosed through a physical examination. An ENT doctor will be able to use a screening tool to examine the appearance of the tongue and its ability to move.

What are the treatment methods which can be adopted to treat a tongue tie?

The approach adopted varies from physician to physician. Some doctors may want to have a tongue tie correction done even as a newborn within the first 24 hours. While some other doctors may want to observe for some time to see if it resolves by itself.

It is believed that the lingual frenulum may loosen over time resolving the tongue tie on its own. Tongue ties which are present without any problems may be monitored by an ENT doctor. Lactation specialists and speech therapists may intervene to help any problem due to a tongue tie. However, surgical treatment of tongue tie is needed if the problems persist. The common procedures are frenotomy and frenuloplasty.

What is frenotomy?

This is a simple surgical intervention where the ENT doctor, after a physical examination, uses a sterile pair of scissors to cut the frenulum free. It may be done with or without anaesthesia in a hospital or at an ENT practice. Being a quick procedure, there is minimum discomfort caused, as the area has very less nerve endings or blood vessels. In case, if there is any bleeding, it is just a drop or two of blood. Following this procedure, an infant can immediately breastfeed. It is very rare that complications occur. Any complications can include damage to the salivary glands or the tongue. Scarring may be present and the frenulum too may reattach to the tongue’s base at times.

What is frenuloplasty?

This procedure is more extensive than the former one. It is done if additional repair is needed. It may also be done if the frenulum is too thick to perform a frenotomy. This procedure is performed under general anaesthesia using surgical tools to release the frenulum. It may leave a small wound, which is closed using sutures which may absorb on its own, when the tongue heals.

Complications are generally rare and are similar to frenotomy. Following frenuloplasty tongue exercises may be recommended to help with tongue movements to reduce scarring.

The ENT clinic has specialist ENT paediatric surgeons who are well versed in performing this procedure. Located conveniently at Gleneagles hospital and Mt Elizabeth Novena Center, in the heart of Singapore, this  award-winning practice is  a recommended option for a consultation.


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