L and R with Tonsils/Adenoids Problems

By Pam Marshalla

Q: I am seeing two elementary age brothers with a history of enlarged tonsils and adenoids that are not significant enough to warrant surgery according to the ENT. Both are difficult to understand because of their resonance issues. We are working on R and L with limited progress. I don’t know where to go with them. Speech is starting to impact reading and writing.

A child with mild-to-moderate upper respiratory problems and minor articulation errors is one of the most irksome situations we face. We know that the tonsil/adenoid problem is contributing to the speech problems, but the doctors say there is nothing to be done.

What did Charles Van Riper say we should do when faced with structural/medical problems that cannot be remediated? He said we should teach compensatory speech movements. We have to help them sound the best they can given their medical problems.

Begin with the vowels because they are probably the main root of the unintelligibility, and they may be the reason reading is being effected. Help the kids make round and resonant vowels with the mouth more open. Speaking a little louder usually makes them sound better. Sing the vowels with prolongation so they have time to process what they are hearing.  Help the client develop the image of the opera star and new auditory images of what their vowels should sound like.

Once the vowels begin to sound better, use the wide open “Ah” sound to teach R and L. In other words, teach the client to prolong/maintain his vowel sound as he moves his tongue into and out of position for L and R. Start with L: Ahhh-LLL-Ahhh-LLL-Ahhh-LLL… Teach these sounds more as if they were part of the vowel family.

The key here is that you have to teach the boys’ ears to recognize when they are being more oral and more nasal. Use a tube stretched from their mouths to their ears, and from their noses to their ears in order to teach them about their own resonance. These kids have their own internal image of what they sound like (as we all do), and this is what you are trying to re-shape. This is more akin to vocal training than it is to articulation therapy.

See the resonance keyword on this blog for more ideas.

Also, did you know that books of elocution that were published in the 19th century concerned both speech and voice for singing? Much can be gained from these early works. As a modern alternative, set yourself up to observe an excellent professional choir director or opera teacher at work with students. This is probably not your local church choir director, but a real professional who makes their living teaching the art of singing to people serious about the craft. Watch how they teach voice. You will learn far more about teaching voice and vowels than you ever will from the speech pathology community. These professionals know how to teach the voice and the vowels to be strong, round, and fully resonant.

2 thoughts on “L and R with Tonsils/Adenoids Problems”

  1. I was unable to pronounce L & R (they came out as W) until I had my adenoids removed at age 5 – I could then speak perfectly. My tongue twister was “a round biscuit wrapped in red paper” which came out as ” a wound biscuit wapped in wed paper”. I also stopped being sick every morning as soon as I got up from bed! Get those adenoids removed!

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