Do Tonsils and Adenoids Play a Role in Stuttering?

doctor checking the mouth of a child

Some infants with speech and sound disorders (SSDs) also have a problem with their tonsils and adenoids. In some instances, speech, adenoid and tonsil issues are often related, but sometimes, they are not. A common speech issue is stuttering. Research on whether tonsils and adenoids play a role in stuttering may be on top of your to-do list.

This article has you covered. It highlights vital information about the connection of speech issues with tonsils and adenoids, and the solution, which is usually their removal. Upon reading this article, you will understand whether tonsils and adenoids affect stuttering in kids.

What Are Tonsils and Adenoids?

Tonsils and Adenoids

tonsils

TONSILS

Tonsils are usually visible and are located at the back of your throat on both sides and are mainly responsible for producing antibodies that are useful in helping you fight throat and nose infections, and preventing them from spreading to other areas, including your bloodstream and neck. Tonsils act as a germ filtration system.

ADENOIDS

On the other hand, the adenoid is a tissue mass that is situated at the mysterious meeting point between your throat and your nasal passageway. You cannot see your adenoid by just opening your mouth. Both the adenoid and the tonsils are useful in improving your immune system so that it can fight germs.

Children usually have larger tonsils and adenoids, which is because children are mostly exposed to many new germs in their first few years of life, and it the job of the adenoids and tonsils to process and fight these viruses and germs. By the time you become an adult, your body encounters viruses and get accustomed to them, and the adenoids and tonsils do not have to take note of them.

adenoids diagram

What Causes Enlarged Tonsils and Adenoids?

Sometimes, they may become inflamed or enlarged when fighting the pathogens. Some children have enlarged tonsils and adenoids with no underlying cause. In most instances, experts cannot explain why, but link this to genetics.

When the adenoids and tonsils are enlarged, you may have other symptoms, which include:

  • A runny nose
  • Trouble sleeping
  • Loud snoring or breathing
  • Trouble when breathing through the noose
  • Voice changes and alterations
  • Middle ear infections
  • Reduced ability to smell and taste
  • Auditory tube dysfunction
  • Changes in facial growth and behavioral development
  • Open mouth breathing and hyponasality

Underlying infections that can contribute to enlarged adenoids and tonsils are:

  • Viral infections, for example, flu or mononucleosis
  • Bacterial infections, for example, strep throat

Peritonsillar abscesses and tonsillitis can also be caused by these infections. In addition, non-infectious things can also irritate your tonsils and adenoids, which may cause them to enlarge, including:

  • Gastroesophageal reflux disease
  • Allergies
  • Tonsil cancer
  • Tonsil stones

What Do They Do?

Both the adenoids and tonsils are vital in trapping pathogens, which is why they are seen to constitute a germ-filtering system. These pathogens include viruses and bacteria that enter your nose or mouth. They usually constitute immune cells that are responsible for the production of antibodies that are capable of killing the pathogens before they spread to the other parts of the body.

The adenoids are covered with a mucus layer that has hair-like structures that are referred to as cilia. These structures are important in fighting germs as they push nasal mucus down the throat and into your stomach where they are eliminated. Your tonsils and adenoids continue to grow until you are aged between 3 and 7. After that, they begin shrinking as one approaches the teenage years. Sometimes, they may completely disappear.

While the primary role of tonsils and adenoids in infection protection, adenoids are also important for the development of normal speech in children. They are situated behind the soft palate behind your nose. Before puberty, when children say oral speech sound, such as a voiced oral consonant or vowels (for example /d/,/l/,/v/, or /g/), the soft palate rises and consequently touches the adenoids, which creates a seal that stops air from coming through the nose whenever children speak these sounds.

The seal is vital for intelligible speech among children. The soft palate is also vital as once it lowers, it allows air to come up through the nose when children produce a nasal speech (for example /n/, /m/ or “ng”).

However, adenoids become less important for speech purposes as you grow older. Essentially, after puberty, when you are aged about 15, the adenoids shrink. The wall located at the back of your throat becomes more vertical. This implies that the soft palate can touch the back of the throat and maintain a good seal when producing vowels and oral voiced consonants. Tonsils which are more precisely referred to as “palatine tonsils,” do not affect resonance or articulation.

Do They Effect Stuttering?

talking to a child

What Is Stuttering?

Stuttering is labeled as a disturbance in the rhythm or flow of speech, which is categorized by syllable repetitions, prolongation of certain sounds, and sporadic cessation of airflow. The latter is attributed to when air stops flowing through the vocal folds that stop to vibrate leading to no sound. Other characteristics include word prolongations, sound repetitions, interjections, and struggling to get words out.

When stuttering, phenomena that occur concurrently include tongue musculature tension and folding of the vocals, which makes the face and lips struggle, as evidenced by head jerks, tics, or grimaces. This is why most stutterers have the fear of articulating some specific words and sentence structures or speaking in some situations.

How Enlarged Adenoids and Their Removal Affect Speech

The most common cause of nasal obstruction among children is adenoid hypertrophy, and you should consult ENT experts as it can be caused by other conditions, such as septal deviation, nasal polyps, or rhinitis. In some instances, removing them can relieve instances of hyponasality, which is also referred to as blocked-nose resonance. Sometimes the soft plate can be in a position that it cannot seal against the back of the throat immediately after it operates, which causes temporary hypernasality.

Hypernasality usually occurs when the speech sounds are incorrectly transmitted via the nose when a child produces vowels or oral voiced consonants. It reduces significantly within 3 months after the adenoids are removed.

However, the adenoid removal can have long-term adverse effects on speech, especially if the kid has a short soft plate, a submucous cleft palate, a large nasopharynx, or if the soft palate does not work properly.  If the hypernasality does not heal after 3 months after adenoid removal, an ENT should perform a reassessment and refer to a speech-language pathologist.

How Enlarged Adenoids and Their Removal Affect Speech

On the other hand, enlarged tonsils can “nestle” between the soft palate and the back of the throat which causes a gap between both nostrils. Enlarged tonsils can also cause a “potato-in-the-mouth” effect, which is referred to as “cul-de-sac resonance,” which causes air to get trapped in a blind pouch with only one exit.

It also causes a tongue fronting pattern where /k/, /g/, and ‘ng” are pronounced as /t/, /d/ and /n/. In some other occasions, the enlarged tonsils and adenoids cause a tongue thrust swallow. This is because the space that is occupied by the back of the tongue during the production of “back” speech sounds is taken up by the enlarged tonsils, that forces the tongue to move in a forward direction.

The hypernasality that is attributed to enlarged tonsils is usually eliminated by the removal of the tonsils. The soft palate seal problems after the removal of tonsils are, but they can still occur.

The Bottom Line

Adenoids play a vital role in children’s speech development until puberty. Enlarged adenoids can affect stuttering since it causes resonance issues that affect the intelligibility of a child. On removal, adenoids can cause temporary resonance issues that can disappear in a few months. It is rare that the removal will cause a permanent speech issue, but if a problem arises, ENT/speech pathologist is required for assessment and treatment.

Tonsils do not affect resonance or speech. However, enlarged tonsils can cause speech and resonance issues, and thus stuttering. Removing the tonsils resolves the issue, but if the child develops speech and sound errors due to the enlarged tonsils, which do not self-correct speech pathologist for assessment and treatment are required, particularly if the infant is 3 years or older and unintelligible to strangers.

Conclusion

Although the main significance of tonsils and adenoids is for protecting children against infections, they are also vital for speech development. Both are vital for articulation and resonance which is greatly hampered if they are enlarged. Enlarged adenoids can affect the intelligibility of a child as the resonance issues can cause stuttering. Enlarged tonsils can also affect resonance and speech, such as stuttering, but removal usually resolves the problem.

We have established that tonsils and adenoids can indeed affect stuttering in children, but in most instances, it is temporary. If removed, the problem is solved but in case the issue persists, we recommend assessment and treatment by ENT and speech pathology specialists.

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