MENC: The National Association for Music Education

Teaching Tongue-Tied Students: Ankyloglossia in the Instrumental Classroom

Author(s): Jason Dovel
Source: Music Educators Journal, Vol. 96, No. 4 (June 2010), pp. 49-52
Published by: Sage Publications, Inc. on behalf of MENC: The National Association for
Music Education
Stable URL: https://www.jstor.org/stable/40666429
Accessed: 22-09-2019 01:53 UTC

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 by Jason Dovel

Teaching Tongue-Tied
Students
Ankyloglossia in the
Instrumental Classroom
A nkyloglossia is a significant medi- ankyloglossia vary greatly in severity. The
condition that has not been ade- lingual frenulum is the medical term for the
quately addressed in music educationsmall fold of tissue that secures the tongue
to the floor of the mouth (see Figure 1). The
literature. While practically every in-
Hazelbaker assessment tool for lingual frenu-
structor will have students who struggle with
lum function (HATLFF), which evaluates
ankyloglossia, many teachers are entirely un-
seven function and five appearance criteria,
aware of this condition's various symptoms
and treatments. Ankyloglossia, more com- is perhaps the most comprehensive means of
monly known as tongue-tie, is a congenital evaluating the tongue's mobility.5 The length,
oral anomaly in which the small fold of tis- location, and overall elasticity of this band of
tissue greatly affect the tongue's mobility. As
sue that secures the tongue to the floor of the
a general rule, the shorter the frenulum, theHow
mouth is abnormally short and restricts the can you assist
more mobility is limited.
mobility of the tongue.1 Recent studies show
students who have
that as much as 5 percent of the population While tongue-tie is defined by the length
of the frenulum, its location is also important.the
suffers from tongue-tie.2 The condition dispro- medical condition
portionately affects males, who account for Inas general, the closer the frenulum is to the tip
much as 86 percent of cases of tongue-tie.3 of the tongue, the greater the restriction it will called tongue-tie?
While medical journals cite a number of impose. A frenulum connected to the very tip This article offers
symptoms of tongue-tie, including difficul- of the tongue will create tremendous limita-
ties with speech, intraoral hygiene, and infant some useful initial
tions on the tongue's mobility. (Compare Fig-
breastfeeding, none addresses the manage- ures 2 through 4.) Such restriction will make
ment of this condition among musicians.4 The
responses and
articulating on a wind instrument particularly
tongue plays an important role in the perfor-
difficult. suggestions for the
mance of wind instruments, and students with
The most severe cases of tongue-tie will classroom.
tongue-tie may encounter numerous difficul-
likely include a frenulum that is short and
ties as a result of their tongue's limited mobil-
located near the tip of the tongue. This oral
ity. Because most music teachers will have
configuration will impose a great deal of
students who struggle with tongue-tie, it is
restriction on the tongue's mobility. For exam-
important that they understand how to assess
ple, clarinetists may be incapable of bringing
and accommodate students who have this
the tip of the tongue to the tip of the reed,
condition.
the conventional manner of articulation on

Assessing Ankyloglossia that instrument. Similarly, trumpeters may be

unable to bring the tongue to the intersection
When assessing tongue-tie in the music class-
of the upper front teeth (incisors) and the hard
room, teachers must first know that cases of
palate. Musicians with more severe limitations
Copyright © 2010 MENC: The National
Association for Music Education
Jason Dovel is an assistant professor of trumpet at Northeastern State University in Tahlequah, Oklahoma. He can be contacted
DOI: 10.1177/0027432110368478
atdovel@nsuok.edu. http://mej.sagepub.com

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 gu, etc.). Because ankyloglossia primarily
FIGURE 1
affects the mobility of the tongue's tip, it
should not interfere with the ku articula-
The Lingual Frenulum
tion in the back of the mouth. Moreover,
a music teacher should not interpret a stu-
dent's difficulty with multiple tonguing as
a possible sign of ankyloglossia.
One articulation that is virtually impos-
sible for musicians with ankyloglossia is
the flutter tongue. In the flutter tongue,
one performs an alveolar trill while blow-
ing a steady stream of air into a wind
instrument, just as if rolling the letter R in
Spanish. The limited mobility imposed by
tongue-tie makes this rapid oscillation of
the tongue practically impossible. How-
ever, it should be noted that an inability to
flutter tongue does not necessarily mean
that a performer has ankyloglossia. Many
conceptual and cultural factors also affect
one's ability to flutter tongue.

Adaptation

One method students may use to accom-

on the tongue's mobility may elect to have
a surgical procedure to correct this prob-
lem. (This type of surgery is discussed
later in this article.)
Mild to moderate cases of ankyloglos-
sia cause less severe limitations on the
modate tongue-tie in instrumental music
performance is adaptation. Adaptation
Ankyloglossia in Instrumental
is appropriate for musicians with mild
Performance
to moderate cases of tongue-tie. These
Several nontraditional articulation loca- individuals may successfully adapt their
tions (of varying degrees of acceptance)tongue placement to accommodate their
exist. For example, trumpet players withlimited tongue mobility. Dorsal tonguing,

tongue's mobility. Musicians with a moder- tongue-tie may elect to use a less com- mentioned earlier, is one example of an
mon type of articulation known as dorsalalternate tongue placement for students
ate case of tongue-tie may have sufficient
tonguing. With this method, sometimes with ankyloglossia.
tongue mobility to perform basic articu-
called "anchor tonguing," the tongue
lations correctly, but may encounter diffi-
When working with students with
culties with more advanced articulations. is placed against the back of the lower tongue-tie, it is important to remember
Because the connective tissue secures the front teeth, instead of the traditional loca-the relationship between articulation and

tongue closer to its tip, elevation of the tion behind the top teeth.6 While thespeech. Articulation for a wind player is
tip of the tongue will pose a great chal- overwhelming consensus among trum-
like diction for a singer. Many studies have

lenge and may require an alternate tongue pet teachers is to tongue behind the top documented the effects of ankyloglos-
placement. For example, trumpet players teeth, some performers and teachers have sia on speech, and one practical way of
commonly lower their jaw when produc- used dorsal tonguing with a great deal ofaddressing the tongue's limited mobility is

ing pitches in the lower register. Because success, most notably, the famous cornetthrough attention to the student's speech.
soloist Herbert L. Clarke.7 For example, instead of providing elabo-
they generally tongue at the intersection
of the top teeth and the hard palate, trum- It should be noted that ankyloglossia rate instructions on the placement of the
should not interfere with a student's abil- tongue within the mouth, a teacher can
pet players with tongue-tie will likely
have a great deal of difficulty raising the ity to multiple tongue. Many students withfocus on the syllables involved in the con-
tongue from this lowered jaw position to tongue-tie learn to multiple tongue with ceptual aspect of articulation. A teacher
the roof of the mouth. Such an individual great success. Multiple tonguing, such asshould have the student speak the syl-
has a variety of options for coping with using tu-ku to double-tongue on a brass lables appropriate for articulation on their
instrument, involves one articulation in respective instrument, such as a tu, ta, du,
tongue-tie, including raising the jaw dur-
the front of the mouth (tu, du, etc.) andda, and so on. Until the student can accu-
ing articulation or tonguing in a nontradi-
tional location. one closer to the back of the mouth (ku, rately reproduce these syllables in speech,

50 Music Educators Journal June 2010

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 FIGURE 2 FIGURE 3 FIGURE 4

Severe Tongue-Tie: Moderate Tongue-Tie: No Tongue-Tie (Normal

Short Frenulum Near Tip Frenulum Closer to Tip of Tongue Configuration):
of Tongue Tongue than Desirable Frenulum Attached Far
from the Tip of the Tongue

it is not likely that they will achieve sat- loplasty includes not only the release of all medical professionals have adequate
isfactory results in their articulation on a the frenulum but also plastic surgery to training to treat ankyloglossia; as few as
wind instrument. more completely correct the problem.11 10 percent of pediatricians report that
It is important to note that teachers The procedure takes only a few minutes they were taught how to surgically repair
working with students who struggle with to perform, and bleeding is minimal.12 tongue-tie in their residency.15 This means
ankyloglossia should avoid overly techni- While medical research shows that that tongue-tie may be overlooked and not
cal explanations of the physiology of the discovered until a young person encoun-
these two surgical procedures are highly
tongue, as these students will likely dif- ters a difficulty on a wind instrument.
successful, musicians should be aware
fer in the exact location and execution of
of their possible risks. While no exten-
tonguing patterns. Additionally, specific Be Prepared
sive study of tongue-tie release on musi-
technical instructions, such as "Place your cians has yet been conducted, there areMusic educators need to be aware of the
tongue behind your top front teeth," may numerous studies that examine its effects
symptoms and treatments of ankyloglos-
actually be impossible to follow for stu- on speech. In one recent study, 7 per-sia. If a teacher notices a student is having
dents with more severe cases of tongue- cent of speech pathologists report that difficulties in articulation, it is possible to
tie. Instead, teachers should focus on the surgical correction of tongue-tie results
quickly determine if tongue-tie is likely.
sound that is desired, with frequent mod- in additional speech problems.13 MusicThere are at least three quick methods
eling and demonstration. They should fre- teachers should be aware that these pro-of evaluating the tongue's mobility: (1)
quently model the sounds of consonants, cedures may force students to relearnCan the student extend his or her tongue
such as D and T, and have the student rep- the fundamentals of articulation on their
beyond the threshold of the lower lip?
licate the sound as best he or she can. The instrument. While the ultimate result is
(2) Can the student curl the tongue into
focus should be on the product, not the greater freedom and function, learning to
a U shape? (3) Can the student flutter the
process. play (and speak) with a different degree tongue (rolling the consonant /?)? If the
of tongue mobility can be both challeng- answer to one or more of these questions
Medical Treatment ing and frustrating. Nevertheless, in cases
is no, the teacher should refer the student
Moderate to severe cases of tongue-tie of severe tongue-tie, surgery may be the to a medical professional who can pro-
may necessitate surgery. Two surgical only solution. vide a proper evaluation and suggest a
procedures are commonly performed: In some cases, medical professionals method of treatment.
frenotomy and frenuloplasty. Frenotomy, diagnose and treat severe cases of anky- This article is not intended as a com-
commonly known as "clipping," is a sim- loglossia when the patient is very young, prehensive guide to the diagnosis and
ple procedure that releases the tongue before a student learns to play a wind treatment of tongue-tie in the music class-
and can be performed with or without instrument. Recent medical literature cer- room. Further research in many different
anesthesia.8 While this is a straightfor- tainly addresses the need to treat tongue- areas of ankyloglossia is still needed. Pos-
ward, relatively painless procedure, it is tie. Authors of 179 articles written between sible future studies include the incidence
generally recommended only for infants.9 1968 and 2003 share an overwhelming of tongue-tie among wind players, the
For older children and adults, the pre- consensus that surgery is necessary to variation in articulation patterns of stu-
ferred procedure is frenuloplasty.10 Frenu- release the tongue-tie.14 However, not dents with tongue-tie, alternatives to sur-

www.menc.org 51

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gery, and the effects of various surgical
treatments on the articulation of perform-
ers of wind instruments.
While only a medical professional
can properly diagnose and treat a patient
with tongue-tie, music educators must be
prepared to appropriately respond to its
occurrence in the classroom. With proper
... and know you're giving your
diagnosis and management, music teach- students a sound environment.
ers and students alike can easily conquer
ankyloglossia.

Notes

1. Lisa Helen Amir, Jennifer P. James, and

Joanne Beatty, "Review of Tongue-tie
Release at a Tertiary Maternity Hospital,"
Journal of Paediatrics and Child Health
41 (2005), 243.
2. Craig McBride, "Tongue-tie," Journal of
Paediatrics and Child Health 41 (2005),
242.

3. Tuomas Klockars, "Familial Ankyloglossia

(Tongue-tie)," International Journal of
Pédiatrie Otorhinolaryngologyll (2007),
1323.

4. M. Lauren Lalakea and Anna H. Messner,

"Ankyloglossia: Does It Matter?"
Pédiatrie Clinics of North America 50
(2003): 383-85.

5. Amir et al., "Review," 243.

6. David Hickman, Trumpet Pedagogy:
A Compendium of Modern Teaching
Techniques (Chandler, AZ: Hickman
Music Editions, 2006), 135-37.
7. Ibid.

8. Lalakea and Messner, "Ankyloglossia:

Does It Matter?" 391-94.

Better Planet Better Strings

9. Ibid.

10. Ibid.

11. Ibid.

12. M. Lauren Lalakea and Anna H.

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Messner, "Ankyloglossia: Controversies in ■ ^ß^ H| common packaging. Our sealed
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14. S. Brinkman, S. Reilly, and J. G. Meara, ^BS&Ep^^B H that every Red Label string you open
"Management of Tongue-tie in Children:
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15. Lalakea and Messner, "Ankyloglossia:
Controversies," 128. www.SuperSensitive.com
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