This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Q: How can you tell if a client’s tongue is too big?
Usually a tongue that looks too big actually is a tongue that is low in tone. These clients usually have an unstable jaw and an unstable tongue. I.e., the jaw is low and the tongue is low and forward. The client also may have upper respiratory problems that are forcing him to keep the mouth open and carry the tongue forward in order to create a bigger oro-pharyngeal air space.
The only way to know for sure that the tongue is too big is to send him to an ENT/oral surgeon who can measure it and give an opinion. A large tongue characterizes certain syndromes; so additional chromosome tests may be required. The ENT also can give you an opinion regarding the potential upper respiratory issues.
Without a definitive structural diagnosis, I would assume that the tongue is low in tone and simply hanging forward.
When I have a client whose tongue is hanging forward and out, I teach him:
To pull the jaw in an upward stabile position for increasing lengths of time and during speech, by using a jaw stabilizer and by developing the masseters and internal pterygoid muscles.
To and keep the tongue back in for increasing lengths of time and during speech, by developing stability at the shoulders of the tongue using the Butterfly Position.