Response to Letter Regarding Cordray et al. (2023) and Brief Commentary on the Ankyloglossia Debate

Ankyloglossia (tongue tie) is common, and its clinical relevance is hotly debated among multidisciplinary health care providers including pediatricians, lactation consultants, otolaryngologists, and speech-language pathologists. The literature focuses on breastfeeding symptoms; less evidence exists to clarify the spectrum of possible symptoms after infancy. We conducted a scoping review of potentially related symptoms in pediatric patients who presented for clinical evaluation of untreated ankyloglossia, with the aim of mapping symptoms that providers may want to evaluate and identifying targets for further research. Kummer (2025) has alleged "erroneous statements without evidence" about "the effect of ankyloglossia on speech," "inaccurate citations," and "errors of omission" in our scoping review (pp. 982, 983). This letter provides a rebuttal of her statements.

Based on results from 20 primary studies, our review drew a provisional conclusion that ankyloglossia may be associated with speech difficulty in a subset of patients; we did not assert any causal relationship. Kummer took issue with a citation in one sentence of our review; we note that some of her concerns were inaccurate, though we appreciate her clinical expertise on speech sound production. The omissions she perceived were in fact present in our original review article.

Kummer's letter does not warrant an erratum to our scoping review. However, her letter prompts us to urge the multidisciplinary community of providers involved in studying and caring for patients with ankyloglossia to engage in a collaborative and open-minded discussion. We must reduce professional antagonism around this controversy and work together on patient-centered research to support children whose experiences may not fit the typical clinical picture.