Adenoids, tonsils, middle ear, dysfunctional breathing, and the tongue tie....

The purpose of this article is to explore how tongue tie affects the functioning of the entire face, mouth, and head physiology. In my experience as a pediatric chiropractor and craniosacral therapist, these issues translate into recurring infections of the tonsils, adenoids, and ears.

This issue is not widely discussed and is exacerbated by mainstream medicine's microscopic view of looking at one symptom - whether it be tonsil infection, adenoid infection, ear infection, chronic sinus infections, dysfunctional breathing - and addressing that sole body part versus looking at the root cause. Making corrections with the root cause provides a holistic solution that improves posture, sleep, digestion, immune system, nervous system, and many other critical bodily functions

I share my research below to get you started on your own inquiry. An educated, informed person is empowered to make more conscious choices and live a healthier, empowered, and more fulfilling life.

Example of mouth-breathing.

In my practice, as an alternative medicine provider, I am often the 3rd, 4th, or 5th opinion people seek after mainstream Western medical care has not provided effective relief. It's very common that I see children put on repeated cycles of antibiotics; and then when that doesn't stop the recurring infections, they remove the body part (tonsil or adenoid) or insert tubes to correct the dysfunction. The result is that while the child may stop having infections in those areas, they still get sick because the dysfunction caused by the root issue has not been addressed. This leaves the child in pain, and the parents feeling frustrated, helpless, and searching for answers.

Most parents don't know that there is another way that might support their child's holistic health more effectively and for the long term. This past school year, I had an influx of young children (2 years) through adolescence (14) that had chronic colds and sickness; more so than in all my 13 years of practice. Because there were so many, I started to notice a pattern - they all had a history of back to back rounds of antibiotics and when that didn't solve the issue, tonsillectomies, adenoidectomies, and ear tubes were administered. Yet even after these interventions they were still getting sick! This got my attention.

I'm not saying that my findings below are the answer to all adenoid and tonsil dysfunction and susceptibility; but I am sharing my experience and research into this question:

If the treatment of the disease is to remove these body parts in service to greater health, then why are kids who've had these treatments still constantly getting sick (e.g., every 3-4 weeks)?

As a parent of four kids, I understand that when our kids are sick we just want them to get better...yesterday. No more appointments, no more doctor visits and definitely no more meds - all while navigating health insurance hell. We feel helpless and scared and just do the thing that the expert says will fix it, because they are the authority, right? Well, I for one truly appreciate that, and this article is a means for parents to feel more confident exploring deeper, and seeing the incredible human body from a higher altitude, not just as a collection of separate organs, but a symphony of functions. It offers suggestions of alternative medicines and providers that will be supportive in exploring your child's case from a different lens.

Tonsillectomies are a result of repeated illnesses of infected tonsils. Just as adenoidectomies are the surgical removal of adenoids intended to improve breathing. Enlarged adenoids can affect the tubes that connect the middle ears and the back of the nose, so when adenoids are infected and become enlarged, they can impact ear drainage. This is why an adenoidectomy can be performed to decrease ear infections. It is quite often now that doctors recommend putting ear tubes in and taking adenoids out while the child is under anesthesia, a 2 for 1 if you will. But the question remains:  why are the adenoids getting so enlarged that they are impacting breathing and ear drainage? And why are the tonsils getting infected? What are they a symptom of? What is the dysfunction that is causing these organs to become so infected and are not healing, so that they impact normal physiological activity?

Ok, so I am going to back up a little bit and show you how I came to some conclusions. In my practice, I support many families who are challenged with nursing. It is a very common experience early on, as the learning is happening for both mother and baby. When a baby is brought in, there is consideration of why the baby is holding tension and where they are holding it in their body. The most common reason is the baby's experience in the womb and their birth. Often times I will see a baby with a tight jaw. This is a great example of residue from the birth process. However, if the baby's function improves only temporarily, the tension is typically coming from an internal pull and one common possibility is due to a tight tongue frenulum. I wrote an article about tongue ties  here -https://www.rosewoodhealing.com/blog/the-growing-trend-of-frenectomy - within the article are a lot of links for some fantastic resources.

Since I have seen many babies go through the frenectomy procedure, I have seen just as many families decide that the frenectomy route was not the right choice for them. I am blessed to have had long-term care with both groups, and I've seen the difference between babies who had the frenectomy compared to those that did not.

The babies who have worked with significant tongue ties and not had the frenectomy, switched to bottles, received regular chiropractic and craniosacral care, stayed with pureed food for a long time, did speech therapy, etc. I've seen how even with long-term work, the fascial pulls are present, albeit there are less symptoms in that original area. The pulls often shift direction as the cranium, throat and thoracic cavity expand as the child grows, causing the symptoms to shift slightly. Sure the child does not gag every time something is placed in their mouth, but now we see teeth grinding or cavities along the gum line or chronic congestion...catch my drift?

Let's start with the basics.

Fact #1:  We don't grow out of things, we grow into them.

Fact #2:  Everything is connected.

Not only in the body, but the emotions, spirit, and thoughts as well (but this is for another article all together). So, the baseline is - the tongue is connected to other parts of the body and when a baby or child is diagnosed with a tie, it doesn't just go away. The fascial pull or tension symptoms can be found elsewhere in the body and these lead to compensatory movement patterns.

The tongue is the only muscle(s) in the body that has one end that is unattached and freely movable while the other end has attachments on the hyoid bone, mandible, temporal bones, and other parts of the cranium. When the tongue is "tied" it means that the frenulum (which is designed to be reabsorbed at 7 weeks prenatally) limits the full range of motion and function that the tongue is designed to have. And let's be clear, there are 4 levels of the tie so it is quite common, and the tighter the tie, the greater the inhibition/dysfunction. This article is geared towards the higher levels of the untreated tie in the pediatric population. The tongue tie will pull on the fascia associated with it and will often pull the hyoid bone up higher under the mandible. This can pull on the trachea and esophagus as well. By producing so much tension in the front of the body, it often pulls the body downs to a kyphotic posture, pulling the shoulders forward. In a baby, this is demonstrated as stiffer torsos with extending their necks back, lots of arching of the back and neck. As a grown up, it looks like forward neck carriage (poor posture) that is difficult to correct. It is difficult because of the tight fascial pull that they have grown into since they were babies. As a chiropractor, I know that there are MANY reasons for this posture for an adult, but for a young child, this is definitely something that needs to be checked out by a pediatric body worker. https://www.daniellopezdo.com/assess-impact-tongue-tie-patients-osteopathic-considerations/ **Fun fact, most of the babies that I see with torticollis that doesn't resolve within a couple of sessions have a tongue tie. This is because the pull is coming from an internal structural source that pulls the neck back into the torticollis.

What I find to be particularly incredible about the human design is that the positioning of the tongue at rest in the mouth affects the shape of the maxilla (upper jaw). A well-developed upper jaw has a broad palate and low arch. The tongue’s natural resting place is up against the palate, where the tip of the tongue rests behind the front teeth. The teeth develop around the tongue and the upper jaw develops to the front and sides, stimulated by the tongue’s position behind the teeth and against the upper palate.

When a mouth has a "tight" frenulum, often only the tip of the tongue will rest on the palate (behind the upper teeth).  On the picture to the left, below, the solid blue bar represents the frenulum; the red arrow represents the pull of the frenulum; the yellow vectors represent the resultant pull of the frenulum in the horizontal and vertical planes; the blue arrow is one of the eventual effects where the posterior tongue sits low and back, which produces an array of sucking, breathing, speech and TMJ difficulties. At rest, the middle and back parts of the tongue should nestle up against the back of the hard palate." http://www.paragonhealth.net.au/blog/tongue-tie-in-adults

When the tongue is tethered to the bottom jaw, children suck on pacifiers, fingers or other things in order to stimulate the release of endorphins, which should happen during proper tongue rest posture and proper swallowing. (I highlight children, because as babies they typically can't hold the pacifier in their mouths, they don't like it because they can't create a vacuum with the back of their tongues to hold it in.) In the absence of correct tongue posture and swallowing, habits like finger-sucking meet the need for the pressure on the roof of the mouth. Studies also show that when the palate does not get pressure from the tongue, there is an increase in adrenaline in their systems.  Mukai, Mukai & Asaoka (1993) It is very common for these kids to have a harder time regulating their behavior and have more challenges with maintaining attention.

In medicine, “form follows function” is a basic premise where abnormal function leads to abnormal structural development. Therefore when the tongue position is tethered down and there is tongue thrusting, the upper jaw does not get the natural pressure and the arch becomes high and the face takes a longer shape. The teeth become cramped, the bite is not closed tightly when biting down, the sinuses become compressed and there is continuous congestion. Swallowing is affected and often times so is speech. When swallowing is dysfunctional, the ears become more susceptible to infection. Think about when you need to clear your ears while on a plane, you swallow (or yawn or chew). When you can't swallow correctly or your jaw is tight, your ear canals are not getting the regular massage that they should get each time one swallows.

In addition to all that has been mentioned, it is the mouth breathing that directly affects the child's immune system. There is often mouth breathing due to the tongue's resting position, which is tethered to the lower jaw. When people don't breathe through their nose, they miss out on the first filtration system that our body has in the design. During mouth breathing, it is the tonsils that get constant exposure to environmental viruses, bacteria, etc that would normally be filtered out by the nose. The constant exposure of these foreign substances to the tonsils leads to increased tonsil infections. Interestingly, nitric oxide, a gas needed for blood pressure regulation, fighting bacteria & viruses, immune health, pain reduction, energy production, and other beneficial functions, is produced in high amounts in the nose.  Therefore nose breathing increases available nitric oxide. Nose breathing supports immune function. Finally, it is shown that there is a correlation with mouth breathing and challenges with restful sleep, bed wetting and as mentioned earlier, the ability to regulate one's behavior.
https://www.newscientist.com/article/dn4001-bed-wetters-could-breathe-easier/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400898/

The upper palate is one part of the maxilla bone which runs from the teeth up to the eyes. The maxilla also holds 85% of the nasal sinuses. And here is the common slippery slope that I have been seeing - The restriction of the tongue impacts the growth of the face, creating compression in the sinuses, causing difficulty breathing through the nose, causing mouth breathing, causing the tonsils and adenoids to become the primary filter of toxins, causing them to be infected. Are you with me?

So even though the organs have been removed, the cause of why they were so infected was not addressed. So yes, no more tonsillitis, but if the breathing or swallowing haven't been corrected, the next level of symptoms get louder - snoring and poor sleep, behavioral disregulation, etc. Again, this is one scenario; allergies, obesity, orofacial genetic malformations are not considered with this trajectory. What I am trying to say is if your baby has a tongue tie, it's not just about breast feeding. You don't grow out of it. You grow into it.

Does that mean you must have a frenectomy? Well, that depends on who you ask. There is still quite a bit of controversy on this one in different fields. I personally have seen miraculous changes post-frenectomy and seen cases without much change  in the ability to nurse. However, the provider's skill level and amount of body work before and after has to be taken into consideration. https://www.atlantaperiodontics.com/frenectomy/tongue-tie-tied-children-sleep-apnea/

Here is an anatomical demonstration of how fascial tension in the tongue affects the kinemaic chain throughout the body.

​In addition to the dental challenges and mouth breathing patterns noted above, another clear indicator of myofunctional issues in the mouth and head with children (ages 2-5) is difficulties with food and eating. Children with ties often deal with symptoms directly related to eating, such as the inability to chew age-appropriate solid foods, gagging, choking or vomiting foods, slow weight gain, cavities at the the top of the front teeth, and persistence of drooling. Problems can also include the child gagging or even throwing up when eating, or being an extremely messy eater. If your child is sensitive to food texture, or seems to be a picky eater, this can indicate a problem with their swallowing. This occurs when the child cannot form a proper bolus with their tongue correctly to move the food to the center of the tongue and then push it back. In extreme cases, children may even choke on food if they cannot swallow correctly. Children may also store food in their cheeks and then spit it out, also demonstrating their challenge with coordinating swallowing.  https://tonguetie.net/consequences/

Another possible indicator of myofunctional issues is a delay in your child’s speech, or other speech problems. This article is not going to go into this, but luckily for Rosewood, our incredible craniosacral therapist, Sara Mangano, is also a speech pathologist. 

Please check this video on mouth breathing in children by Dr. German Ramirez. It brings everything all together and is a fantastic comprehensive short video that demonstrates the physiology of the mouth-  https://www.youtube.com/watch?v=3h0JgmmLj_Q

Treatment -When a fascial pull is coming from the base of the tongue, whichever way you slice it, the entire body, anatomically and physiologically will benefit tremendously from releasing the tension. And getting checked and cared for is ALWAYS better sooner than later. Getting a team of a providers that range from lactation consultants, chiropractic, craniosacral, myofunctional, occupational therapy and of course a holistic dentist or ENT rounds out the types of care one would explore.

Considering that a baby’s jaw is almost 50% of its adult size at birth, a child's bite position is apparent by about 18 months to 2 years. By 6 years old, jaws are almost 80% of their adult size, with most of the growth occurring in the first 4 years. https://www.todaysdental.net.au/importance-of-jaw-growth-and-develpment.

Ideally, if a family is considering getting a frenectomy, the sooner the better. Not only because of the opportunity to influence facial growth, but also the earlier it is performed the less synapses in their motor control have been developed using a dysfunctional movement pattern. Basically just because the frenulum has been released doesn't mean that the tongue now knows how to use all of the space that has been made. (Body work saves the day with this one.)  If you discover your child has tension in their mouth that is causing breathing, swallowing, posture, etc challenges - have no fear! Frenecomies are safely and effectively performed on kids and adults. Also, I see tremendous shifts from chiropractic and craniosacral therapy with these kids.  After the initial block of time that is focused on addressing their subluxations and releasing fascial pulls, coming in for regular maintenance care supports their body's nervous system during growth and developmental spurts. 

​If your doctor has recommended an adenoidectomy and/or tonsillectomy because of diseased tissue, it will make a difference in their breathing, sleeping, sinus cavity, hearing, and overall well-being to remove them. AND I want to be clear that this is addressing the SYMPTOM of the dysfunction. In fact, studies show that  the surgery's initial improvement with breathing efficacy, the structure, space to breathe is still constricted for 5-12 years. (Tasker, 2002) Body work is a necessity to release the root cause of the tension and pulling. The relapse rate for sleep apnea and airway constriction after tonsils and/or adenoids removal is greater than 50%, as immune tissue often regrows and airway becomes a problem again. I am going to be bold and make the assumption that the rate is so high because most parents aren't aware that the root cause has not been treated, thus the body is going to maintain it's dysfunctional pulls.

In conclusion, one of the easiest and most effective things we can do for our kids is have them checked for myofunctional issues as young as possible, so that therapy can begin before more serious problems develop. In many cases, chiropractic, craniosacral, and myofunctional therapy can be used to reverse hypertrophic tonsils and adenoids, as well as correcting issues that lead to chronic ear infections. This is also to say when dealing with facial ties, if the ties are not dealt with, when braces are removed, eventually teeth shift back, imbalanced bites return, mouth breathing and snoring return. Therefore, treating the symptom is never a long lasting option. Thankfully holistic dentistry now offers ALF pieces - widening the palate and airway, unlike traditional braces that only addressed the teeth.  http://www.kidstowndentist.com/myofunctional-issues-children-aged-2-5/. It has truly been amazing to work with kids pre- and post-ALF.

In conjunction with chiropractic and craniosacral care (ideally scheduled right after an adjustment to the appliance has been made), not only does the child's sleep and breathing and health improve, but behavior shifts due to deep and restful sleep and decreased adrenaline in their system. It's also been found that bed wetting stops and concentration improves. I am so excited that this type of care is out there for kids that are usually just dismissed with labeling the symptoms of ADD, dental ailments, picky eating, etc to have more support. Be sure to find yourself a holistic pediatric dentist! I hope this was helpful, my goal is to at least start the conversation of putting pieces together and addressing these pulls while they still have more growing to do.

​With all of my love and support,
Dr. Maura