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March 22, 2015

How Often Does Tongue Tie Release Improve Breastfeeding? What about Speech?

In the last blog article, we discussed the controversy around tongue tie release that exists from ancient to modern times. According to modern research, cautious support exists for tongue tie release regarding breastfeeding but not speech difficulties. So what did the research actually show?

Statistically, tongue tie release improves/resolves breastfeeding problems ~80% of the time within 4 weeks, often within 48 hours. The percentage is lower if birth defects are present. Summary of the data out there are as follows. Please note that case reports are NOT included given they are considered the lowest quality form of research.

Amir, et al (N=35)
  • 6 (17%) no difference
  • 29 (83%) improved breastfeeding (mean 26 weeks, range 12–46)
  • 18 (51%) better attachment to breast
  • 20 (57%) improved sucking
  • 9 (26%) less pain
  • 6 (17%) improved weight
  • 2 (6%) "other differences"
  • 3 (9%) not breastfeeding
Argiris, et al (N=46)
  • 32 (70%) immediate improvement in breastfeeding
  • 40 (87%) improvement in breastfeeding at 6 weeks
  • 36 (78%) improved latch
  • 19 (40%) reduced nipple pain
  • 30 (64%) improved suck
Berry, et al (N=57)
  • 21 of 27 (78%) in the study group had immediate improvement in breastfeeding
  • 14 of 30 (47%) in the control group had immediate improvement in breastfeeding
Griffiths, et al (N=215)
  • Immediate assessment
  • 123 (57%) improvement in breastfeeding; 92 (43%) no difference
  • At 24h post-treatment
  • 173 (80%) improved breastfeeding at 24h post-treatment; 40 (19%) unchanged;
  • 2 increased difficulties
Hogan, et al (N=57)
  • Study group (frenotomy, n = 28)
  • 27 (96%) improved (85% immediately and 15% within 48 h)
  • 1 remained on a nipple shield with continuous feeds
  • Control group (supportive, n = 29)
  • 1 (3%) improved
  • Frenotomy offered at 48 h (27/28 improved, 77% immediately and 19% within 48 h)
Khoo, et al (N=62)
  • Likert scale from 0 to 10 (0-no difficulty; 10-maximum difficulty)
  • Pre-treatment: 6.1 2.7
  • Post-treatment: 1.9 2.6
  • Lalakea, et al (N=6)
  • 100% reported subjective gains in at least 3 or 6 categories of mechanical tongue function
Lalakea, et al (N=6)
  • 100% reported subjective gaines in at least 3 or 6 categories of mechanical tongue function
Marmet, et al (N=29)
  • 71% reported completely improved breastfeeding (improved latch, suck, nipple soreness,
  • breast soreness, slow weight gain, milk supply)
  • 29% non-responders had ‘‘severe birth defects’’
Masaitis, et al (N=36)
  • 1 week post-treatment
  • 89% breastfeeding; 11% bottle feeding
  • 75% problem resolved completely; 19% partially; 6% no
  • 94% appropriate infant growth rate; 6% slow growth
  • 100% would choose frenotomy again
Miranda and Milroy (N=51)
  • Within 2 weeks of treatment
  • 63% improved breastfeeding
  • 89% improved latch
  • 100% improved nipple pain
  • 100% improved nipple cracking and bleeding
Steehler, et al (N=82)
  • Retrospective report (unspecified time between treatment and interview)
  • 80.4% thought frenotomy was beneficial (86% frenotomy done during first week;
  • 74.3% frenotomy done later; 82.9% continued to breastfeed long-term (mean 7.09 months)
Wallace, et al (N=10)
  • 40% immediate improvement
  • 30% improvement within 2 weeks
  • 30% no improvement
  • 60% breastfed for at least 4 months


What about speech? Here, the research is sparse and the quality of research not as good. It should also be noted that children with tongue tie will often have normal speech as alternative tongue positions can mimic the sounds that traditionally required the most tongue tip movement (/th/, /l/, /s/, and /z/).  For example, the /l/ and /th/ can be produced with the tongue tip pressed down instead of up towards the alveolar ridge (/l/), or protruding out (/th/). Similarly, /s/ and /z/ can also be produced effectively with the tongue tip down.

  • Study group (underwent frenotomy during infancy, n=8)
  • Comparison group (non-treated frenotomy during infancy, n=7)
  • Control group (no history of ankyloglossia, n=8)
  • Outcome measures utilized standardized articulation test assessed by two speech pathologists. Most articulation errors in the comparison group, followed by the study and then control groups, but no significant difference between the groups in articulation errors and speech intelligibility
Heller, et al (N=16)
  • Study group (underwent 4-flap z-frenuloplasty); Comparison group (underwent horizontal-to-vertical frenuloplasty)
  • Outcomes based on tongue measurements and articulation testing by two speech pathologists (10 months post-treatment)
  • Results showed greater gain in frenulum length and tongue protrusion for the study group and better articulation improvements in the study group (no statistical analysis)
Lalakea, et al (N=6)
  • 2 reported subjective improvement in speech
  • 4 did not report any change
Messner and Lalkea (N=15)
  • 4 had normal speech pre-treatment (no change post-treatment)
  • 11 had abnormal speech pre-treatment. Of these, 9 (82%) judged to have improvement; 2 had persistent articulation problems. However, parents reported improved subjective speech intelligibility
Regardless of what the research shows, there is tremendous anecdotal evidence that support tongue tie release not only in infants, but also adults to help resolve symptoms that are secondary to a tongue with limited mobility.


References:
The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol. 2013 May;77(5):635-46. doi: 10.1016/j.ijporl.2013.03.008. Epub 2013 Mar 26.

Does frenotomy help infants with tongue-tie overcome breastfeeding difficulties? J Fam Pract. 2015 February;64(2):126-127.

Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie. Comparative Effectiveness Review Number 149

Ankyloglossia: to clip or not to clip? That’s the question, The ASHA Leader (2005), December 27.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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