OBJECTIVE: To report a case of late development of oral communication in a patient with West syndrome and tuberous sclerosis from the point of view of speech therapy. CASE REPORT: Female patient, 2 years and 11 months, with a history of delayed development of oral communication delay associated with other milestones of global development. Diagnosed as having West syndrome and tuberous sclerosis (hypsarrhythmia in the electroencephalogram and hamartomas to cranial tomography computed). In the assessment phoniatric proved delayed acquisition of developmental milestones in oral communication for age, despite an initial audiological assessment compatible with present and normal hearing thresholds. It was noted the influence of co-morbidities in the context described. We carried out periodic monitoring of the lowest in the otolaryngology speech therapy for the coordination and guidance of the best therapy for the patient's progress. CONCLUSIONS: Emphasize the need to heed the otolaryngologists for the early diagnosis and to guide patient management of patients with oral communication difficulties, as well as understand their aggravating factors as a means of minimizing the deleterious effects of the condition.