JCPSLP Vol 23, Issue 1 2021

Speech pathology: An agile and responsive profession

Factors that influence the decision to have a tongue-tie released A preliminary study Anna-Maree Bennett, Grace E. Vincent, and Barbra Zupan

There is equivocal evidence regarding the impact of tongue-tie release on feeding or speech outcomes, but rates of release have risen dramatically. This preliminary study explored the decision-making process and experience of clients and caregivers who decide to have a tongue-tie release. This online survey yielded 41 respondents. Feeding was the primary reason identified for release in children under age 1, with speech and dental related issues cited for older children and adults. Dentists were most frequently identified as the health care professional who released the tongue-tie. Positive change was noted by most respondents. More than half the respondents indicated that they would approach their decision-making process similarly if faced with the decision again. This survey was limited by its small sample but provides insight into what is guiding the decision to have a tongue-tie released and potential gaps in the information people have when making this decision. T ongue-tie, also known as ankyloglossia, refers to the frenulum that attaches the tongue to the floor of the mouth, which limits functional movements of the tongue due to a tight or short frenulum and/or extended genioglossus muscles (Lalakea & Messner, 2003). The majority of the literature on the impact of tongue-tie has focused on infants, in particular, feeding issues (e.g., Francis et al., 2015; Power & Murphy, 2014). However, difficulties with oral-motor activities such as speech production, oral hygiene, and playing musical instruments have also been linked with tongue-tie for older children and adults (Lalakea & Messner, 2003). The reported prevalence of tongue-tie is variable, but is reported to impact between 2.1–10.7% of infants (Francis et al., 2015; Ricke et al., 2005). Tongue-tie release continues to be a topic of debate due to the differing classification systems of tongue- tie, variations in presentations and outcomes among individuals, and opposing opinions among health professionals as to client outcomes. Feeding difficulties

in infants is often cited as a primary reason for tongue- tie release. However, feeding is reported to be impacted in only a small number of infants, with maternal pain during breastfeeding the most commonly reported issue (Hall & Renfrew, 2005; Ricke et al., 2005). Breastfeeding outcomes following tongue-tie release vary widely with no consistent reports of improvement (Berry et al., 2012; Emond et al., 2014; Francis et al., 2015; O’Shea et al., 2017; Power & Murphy, 2014), leaving the efficacy of the procedure in question. Articulation errors are also professed to be associated with tongue-tie, but evidence indicating tongue-tie as the cause of speech difficulties is minimal and of low quality (Brookes & Bowley, 2014; Webb et al., 2013). Furthermore, a recent study comparing children with treated and untreated tongue-tie showed no statistically significant differences between these groups on speech production or tongue mobility indicating that there is no causative relationship between tongue-tie and articulation errors (Salt et al., 2020). Despite the lack of evidence regarding the impact of tongue-tie on feeding and/or speech, or the benefit of tongue-tie release, tongue-tie release rates have substantially increased. In Australia from 2006 to 2016, the rate of release increased by 420% (Kappoor et al., 2018). Further, tongue-tie release rates in the United States rose by 866% from 1997 to 2012 (Walsh et al., 2017). Therefore, there is a marked incongruence between the quality of the available research evidence for tongue-tie release and current rates of release. The conjecture surrounding tongue-tie release warrants preliminary investigation into the factors that influence the decision of having a tongue- tie released. The overall purpose of the current study was to explore the decision-making process and experience of clients and caregivers who decided to have a tongue-tie release. As a preliminary investigation, this study aims to provide a descriptive assessment of tongue-tie release to provide speech-language pathologists with some insight from the patient perspective, including information related to their knowledge of, and experience with, the procedure. Method This was a cross-sectional study conducted as an online questionnaire (Survey Monkey © ). The research was approved by the CQUniversity Human Research Ethics Committee (2018-076). Prior to developing the survey, the literature was reviewed to identify commonly reported concerns regarding presence of tongue-tie, information related to the tongue-tie release process (e.g., health professionals

KEYWORDS DECISION- MAKING TONGUE-TIE RELEASE

THIS ARTICLE HAS BEEN PEER- REVIEWED

Anna-Maree Bennett (top), Grace E. Vincent (centre) and Barbra Zupan

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology