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Vocal quality of children with altered frenulum in the tongue


Lingual frenulum
Voice quality
Auditory perception

How to Cite

Camargo Z, Canton P da C. Vocal quality of children with altered frenulum in the tongue. J. of Speech Sci. [Internet]. 2020 Aug. 3 [cited 2024 Mar. 1];8(1):15-26. Available from:


Children with a disordered lingual frenulum are said to be more prone to various difficulties in the development process. Although these children tend to present changes in chewing, swallowing and speech, it can be assumed that the voice is practically not focused, with few studies concerned on vocal function (Camargo et al, 2017, 2017a). With the aim of investigating voice quality in children with and without lingual frenulum disorder, 61 children were clinically evaluated regarding the characteristics of the lingual frenulum (Marchesan, 2012) and the perceptual judgments of voice quality in semi-spontaneous (audio) speech samples. Video samples of orofacial clinical examinations and semi-spontaneous (audio) speech samples were recorded in a soundproof room. 28 children presented altered lingual frenulum (19 boys and 09 girls) and 33 frenulum without alterations (20 boys and 13 girls). We adopted the phonetic description of voice quality model as the theoretical background (Laver, 1980) and the Vocal Profile Analysis Scheme – VPAS (Laver et al, 1981; adapted for brazilian portuguese: Camargo, Madureira, 2008) for perceptual data analysis. Voice quality settings regarding the position of lips, tongue (tip and body), jaw, pharyngeal cavity configuration and vocal tract muscle tension occurred in a greater proportion (in terms of number of the occurrences and the degree of manifestation) in children with lingual frenulum disorded. When observing the data differently by male and female subgroups, we estimate that the former accounted for most of the occurrences related to labiodentalization, retracted and lowered tongue body and pharyngeal constriction. In the girls' subgroup, pharyngeal constriction was also recurrent. With regard to our previous explorations on the topic (Camargo et al, 2017, 2017a), we were able to advance in terms of a broader understanding of children's voice quality profiles and, particularly, those related to congenital orofacial motricity limitations. The relationships between size and position of the hyoid bone in children with an altered frenulum of the tongue (Ardekani et al, 2016), especially the raised and posterior position of the hyoid bone and the posteriorization of the jaw compared to children without frenulum disorerss, seem to influence the voice quality findings reported in this study. The high incidence rates of dysphonia in childhood tend to make it difficult to associate the alterations of the lingual frenulum to phonatory settings, although they may, hypothetically, appear as aggravating factors for dysphonia.


Angelillo N et al. Epidemiological study on vocal disorders in paediatric age. J Prev Med Hyg. 2008;49(1):1-5.

Batista GKS. Avaliação de risco de disfonia em crianças com e sem alterações vocais. Monografia. Fonoaudiologia- USP, 2018.

Ardekani MD, Tabatabaee Z, Halvani N, Tabatabaee H, Yasaee S. Evaluation of Hyoid Position in Children of 7-11 Years Old with Ankyloglossia in Lateral Cephalometic Radiographs. MAEDICA. 2016;11(3):198-202.

Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. The Laryngoscope. 2015;125(3):746-750.

Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breast Med. 2012;7(3):189-193.

Camargo Z, Madureira S. Material instrutivo para o uso do roteiro Vocal Profile Analysis Scheme para o português brasileiro (VPAS-PB). In: CAMARGO, Z. (Org). Fonética Clínica: 20 anos de LIAAC. 1 ed. São José dos Campos: Pulso, 2016;1:225-234. Disponível em:

Camargo ZA, Marchesan IQ, Oliveira LR, Svicero MAF, Pereira LCK, Madureira S. Lingual frenectomy and alveolar tap production: An acoustic and perceptual study. Logopedics Phoniatrics Vocology. 2013;38(4):157-166.

Camargo Z, Oliveira LR, Canton PC, Rusilo L, Marchesan IQ. Frenulum disorders and voice quality: a possible relationship? Proceedings IAOM Annual International Convention of 2017, San Diego, 2017; v.1.

Carding PN et al. The prevalence of childhood dysphonia: a cross-sectional study. Journal of Voice. 2006;20(4):623-630.

Camargo Z, Oliveira LR, Canton PC, Reis N, Rusilo LC, Marchesan I. Alterações do Frênulo Lingual e Índices Acústicos de Qualidade Vocal. Revista Intercâmbio, Especial Expressividade, São Paulo: LAEL/PUCSP. 2017a; XXXVI: 52-65.

De Freitas MR, Weckx LLM, Pontes PAL. Disfonia na infância. Rev. bras. Otorrinolaringol. 2000;66(3),pt. 1,257-265.

Cutsforth-Huber B. Care of the Professional Voice: Chiari Malformation: What Singers Should Know. Journal of Singing-The Official Journal of the National Association of Teachers of Singing. 2009;65(5):567-571.

Laver J. The phonetic description of voice quality. Cambridge: Cambridge University Press. 1980; v.1. Reprinted, 2009.

Generoso R, Tavano O, Ribeiro A, Parreira MLJ. Estudo da correlação entre a idade cronológica e a maturação das vértebras cervicais em pacientes em fase de crescimento puberal. Revista Dental Press Ortodon Ortoped Facial, v. 8, n. 4, p. 19-36, 2003.

Kaplan H, Lloyd LL. Audiometric interpretation: a manual of basic audiometry. Baltimore: University Park Press, 1978.

Knox I. Tongue tie and frenotomy in the breastfeeding newborn. Neo Reviews. 2010;11(9):513-519.

Marchesan IQ. Lingual frenulum protocol. Int J Orofacial Myology. 2012;38,89-103.

Laver J, Wirz S, Mackenzie J, Hiller S. A perceptual protocol for the analysis of vocal profiles. Edinburgh University Department of Linguistics Work in Progress. 1981; v.14, p.139-155.

Martinelli R, Redher MIBC, Marchesan IQ, Oliveira LR, Araújo RLT, Costa MLVCM. Inter-relações entre qualidade vocal, alterações de fala e alterações de frênulo de língua em uma população de crianças de 1a. a 3a. Série do ensino fundamental. In: 16º Congresso de Fonoaudiologia, Campos do Jordão. Revista da Sociedade Brasileira de Fonoaudiologia - Suplemento Especial, 2008.

Melo E et al. Incidência de lesões laríngeas não neoplásicas em pacientes com queixas vocais. Revista Brasileira de Otorrinolaringologia. 2001,67(6),788-794.

Mornet E et al. Assessment of chronic childhood dysphonia. European annals of otorhinolaryngology, head and neck diseases. 2014;131(5):309-312.

Oliveira LR, Camargo Z. Análise acústica comparativa das vogais orais entre crianças respiradoras orais e nasais. In: Camargo Z. (Org). Fonética Clínica: 20 anos de LIAAC. 1 ed. São José dos Campos: Pulso. 2016;v.1,p225-234. Disponível em:

Peter CV, Williams AP, Korula A. Hoarseness of voice and skin lesions since childhood. J Assoc Physicians India. 2010; 58:384.

Ramos LA, Souza BO, Gama ACC. Análise vocal na infância: uma revisão integrativa. Distúrb. Comun, 2017;29(1):20-32.

Redher MIBC, Marchesan IQ, Martinelli RCL, Caltabellotta MRT, Oliveira LR, Costa MLVCM, Araujo RLT. Estudo epidemiológico de motricidade orofacial e voz em crianças de 1ª a 4ª série do ensino fundamental. In: 17o. Congresso Brasileiro de Fonoaudiologia; 1o. Congresso Ibero-Americano de Fonoaudiologia, Salvador. Revista Brasileira de Fonoaudiologia- Suplemento Especial. São Paulo: Sociedade Brasileira de Fonoaudiologia, 2009.

Shen T, Sie KCY. Surgical speech disorders. Facial plastic surgery clinics of North America. 2014;22(4):593-609.

Tavares EM, Brasolotto A, Santana MF, Padovan CA, Martins RHG. Epidemiological study of dysphonia in 4-12-year-old children. Braz J Otorhinolaryngol. 2011;77(6):736-46.

Tsai HH. The positional changes of hyoid bone in children. J Clin Pediatr Dent. 2002; 27:29-34.

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Copyright (c) 2020 Zuleica Camargo, Paula da Costa Canton


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