A Year in Hearing

Happy New Year to My Peeps!

It has been almost a year since Nolan received his hearing aids. So, here is a snapshot of his past year with full access to the world of sound!

January 9, 2008: A mild-moderate loss won't hinder this little guy. Nolan's first-ever hearing aid fitting! Sounds previously unheard by him (such as "p," "g," and "z") are now audible.

February 2008: Pilot caps discovered. These would prove highly useful in the not-so distant future.


April 2008: Babble. Never has "mamama" or "bababa" sounded so wonderful!


May 2008: Due to chronic fluid, we had the first set of PE tubes placed.

June 2008: Nolan stops pulling out his hearing aids. The pilot cap is GONE! Or so we thought!

July 2008: We discover the painful results of another toddler's curiosity. OUCH.

October 2008: The pilot cap returns, to thwart hearing aid removal attempts.

November 2008: A nasty virus necessitates tube insertion number two. The right ear takes a plunge into the severe range, fortunately a temporary loss.



December 2008: The most recent audiogram shows a bit of a drop from the initial ABR. His aids are more than capable of handling his level of loss, and his speech is taking off!

The blue line is Nolan's initial "eHL" from his ABR. The green lines are his current hearing level- his left ear being the better of the two.

Of course, the last day of the year doesn't lack for excitement in the hearing aid department. Nolan's left aid has ceased making the high-pitched sound of feedback. While no one really welcomes feedback, a lack of it hints at some sort of a problem. The batteries are fine, but the aid doesn't appear to be working well. Nolan won't leave it in and thus we are aid-less today.

I look forward to 2009- life with a toddler rather than a baby, a language explosion, and hopefully more compliance with leaving those hearing aids in!

Merry Christmas!

OK, this blog post is a little late. We've been having far too much fun with all of the new toys and enjoying Daddy's time off from work.

The boys were up early on Christmas and Matthew really enjoyed tearing into the presents. Nolan was far more interested in a measuring cup that I received, and loved playing with the bows as a typical one year old is wont to do. Last year we were concerned with getting toys which stimulated language and auditory pathways, but this year we have relaxed and realized all toys present the opportunity for language growth. The language is not in the toy, but in how you play with it.

Of course, perhaps we should have invested in more pilot caps and fewer toys. The longest we managed to keep his aids in on Christmas was a 30 minute span of time. Plus, a pilot cap would help control static-hair in the ball pit.

Nolan is sixteen months old today, and I am looking forward to the language spurt that occurs somewhere around the age of eighteen months. We never had this with Matthew, but Nolan has normal language development. This time last year, I would never have guessed that my hard of hearing baby would have outstripped his brother in the language department! Three days ago he imitated the word "down" with a resonant "dau!" He has lacked the long "O" sound (pronouncing it as a long E instead), but with intense focus on that sound over the past few weeks, I am proud to announce that "uh-ee" is becomming "uh-oh." Watch out, /p/. You're next on our list!

Another Great Use for Pilot Caps

When you need a full-body bib, nothing else will do!

Note to self: In the future, avoid cakes with black frosting at all costs!

Happy Birthday, Matthew- I can't believe you're THREE years old!

Back to Moderate

We took a trip to the audiologist to re-check that right ear now that the fluid is gone. Good news- he's back to his August levels in that ear! I don't have the report yet, but I think he was 60dB at 500Hz and 1000Hz, 40dB at 2000Hz, and 50dB at 4000Hz. They tested his left ear again, too, and it was about 5-10dB better than the right ear. He does appear to have some fluctuation at the high frequencies, but at least he's staying in the moderate range.

I am very grateful that we listened to the audiologist and ENT, because with a blocked tube he had thresholds of 80dB in that ear! There is a HUGE difference between a 50dB threshold and an 80dB threshold (remember that decibels are logarithmic).

We are free from doctor appointments until January, when a trip to pick up earmolds is scheduled. Ahhh... blessed freedom!

15 Month Well Baby Visit

We took a little trip to the pediatrician for Nolan's 15 month well-baby visit today. I went in with a few concerns, including his persistent head lag, anemia, and low weight. The visit was a good one, and I walked out with one less worry!

Nolan's anemia is NOT iron deficient anemia. When they ran his CBC during the last bout of illness, the blood count showed a normal MCV (mean corpuscular volume) and a low hemoglobin count. This means there was anemia, but not due to iron deficiency. The pediatrician re-checked his blood counts today and everything was normal. The running theory is that the virus he had caused some acute anemia, which has since resolved. This is great, because we can stop the iron supplementation. No more rusty-nail flavored vitamins!

He still has the head lag, but the pediatrician isn't worried since he is walking, running, and doing everything else a 15 month old boy should be doing. I'll mention it to the ENT when we see her on the 14th, just to see what she thinks. It still bothers me a little, because it is something that shouldn't be there. It's probably just a quirk of Nolan's, but I want to make sure.

He's 31 inches long, which is great! He's growing well (in height) and his head circumference is fine. He is still below the 3rd percentile for weight, at 19 pounds, 5 ounces. He's almost sixteen months old, so he's a little guy! The lack of catch-up growth is also attributed to the recent virus.

As Nolan doesn't tolerate illnesses well (Matthew's cold was severe bronchitis to Nolan), we opted for the flu shot. If we can head off any more infections, I'm all for it. He also got his scheduled chicken pox injection and MMR. Our little guy has two sore arms and one sore leg today!

We don't see the pediatrician again until March, so pending illness our doctor visits should decrease over the winter. That makes me one happy mama!

I Love Libraries

No, Nolan isn't really blue. I just need to adjust the camera settings.

I was at our local library and found they have entire activity packets available for check-out. The activities are rated by age, so I checked out a packet for the 1-2 year old age group and one for the 3-5 year old age group.

Nolan's packet came with the book "Ride, Baby, Ride" (he didn't care for it) and a felt board (which he likes- a little too much)! Matt's came with with the book "One Red Sun" and several laminated suns to count out while reading the book.. These things are great because:

1. They come with instructions. People like me need instructions to get by in life.
2. They tell you what your kid is learning.
3. They come with all needed materials.
4. They are totally free. I'm cheap. It's a match made in heaven.

I guess I could come up with some brilliant ideas on my own, but let's face it- I'm lazy. Letting the library do the work for me is worth the $0.50 the parking meter eats. I highly suggest investigating the children's room at your local library.

Twas Brillig and the Slithy Toves...

We have a new development on the speech front- Nolan has finally developed "jargon!" This is a variegated form of babbling which resembles the intonation and inflection of adult speech. Since we never had this with Matt (he said almost nothing until he hit 2 1/2), it is really neat to watch. Last night Nolan came up to me and informed me, "Ba! Dabawa! Inda!"

I'm fairly sure he was "tattling" on his brother.

This is cool.

IEP Meeting

We had our IEP meeting for Matthew today, which I considered great practice for when we have Nolan's in a year and a half or so. Matt only qualifies on the basis of articulation at this point in time, so we weren't too worried about the quantity of therapy sessions when we went in. On the other hand, we wanted to see exactly what we could get, since we'll be going through this again in a while and will be requesting expensive equipment (no, a sound field is not enough. We want that expensive FM system, thank you very much)!

IEP meetings are quite different than the cozy IFSP meetings we've had through early intervention. First off, the meeting is held at the middle school of our school district. Walking through the cafeteria-scented hallways with my little ones gave me a glimpse of our future- slouching adolescent boys with mullets. Yes, mullets. Have those become cool again? I shudder to think so.

There were about seven people in the room, including the school secretary. Everything was recorded and there were several forms to fill out. They had all of Matt's paperwork and his cognitive evaluation set out on the table. They say he has "superior" intelligence. Really? I mean, he does this and this . I'm just sayin'.

After talking about his history and test results, we had to come up with therapy recommendations. Once children transition to the school district, they typically get less speech therapy time (the typical is 30 minutes per week). We asked for 2 days per week, 45 minutes per session. They didn't blink an eye and granted our request- I think Nolan's recently soiled diaper may have persuaded them to make a quick decision.

He will stay in EI until December 31, then transition to the school district for services. We will have a lapse in service because the school board doesn't meet until January 13, but a 2 week break will be good for all of us. Except our wonderful speech therapist, of course- who doesn't get paid when she's not working.

Most things will stay the same as when we were in EI, but there are some important differences:

• Matt now follows the school calendar. That means if therapy falls on a holiday, he gets no services. This also means no services over the summer, during winter break, or spring break.
• Our speech therapist now gets paid less, even though she's doing the same thing.
• We have annual reviews rather than semi-annual.

Matt will probably graduate from CPSE services in the spring, just in time for us to start the process with Nolan.

10 Books Per Day

Reading is important for all kids, and is absolutely vital for hearing impaired kids. We have a goal of ten books per day for Nolan (this is a self set goal- sometimes we meet it, sometimes we don't)!

Finding books that keep an active 15 month old engaged isn't always easy, so we read during lunch, we read during breakfast, we read before nap, in the car.. everywhere! Since Nolan is hard of hearing and can hear in close range when his aids are off, I even read to him in the bathtub. Here's a selection of ten of our favorite books in the 12-18 month range:

Five Little Monkeys by Eileen Christelow. Why we like it? Counting, repetition, the ability to do an accompanying finger play, and the inclusion of words we don't encounter every day (picnic, snooze, river, scold). Nolan would like to add that his favorite part is the "SNAP" when the crocodile goes after the monkeys.

That's Not My Kitten by Fiona Watt and Rachel Wells. Why we like it? It is touch-and-feel and gives descriptions of fuzzy, smooth, shiny, rough, and fluffy. There is a repeating mouse character on each page. Nolan likes this one because he has a thing for cats.

Hug by Jez Alborough. Why we like it? While there are few words (primarly "hug") the pictures offer many discussion points for emotions. The baby monkey watches mother/baby pairs throughout the jungle exchanging hugs and longs for his own love. We use words like sad, lonely, friend, help, kindness, happy, and grateful when talking about the baby and mommy monkey.

Good Night Gorilla by Peggy Rathmann. Why we like it? There are many zoo animals, with the recurring theme of "good night (animal)." It is short enough to hold Nolan's attention, and has an element of humor as all the animals end up in the zookeeper's bedroom. This book also has a recurring mouse with a banana on each page.

Goodnight Moon by Margaret Wise Brown. Why we like it? Oh, come on. What kid DOESN'T like this book? There are a ton of household objects named, it rhymes, it has repetition, yadda yadda yadda. I think I can recite this one from memory.

Good Night Baby , a DK book. Why we like it? Real life photographs of the evening routine. I like this one because this time of day is frequently one where Nolan has no aids in. While he can hear without his aids within close range, he is probably not hearing everything correctly. Reviewing this language in a book is a good way for him to acquire words for things like towel, bubbles, bath, soap, undress, pajamas, etc.

Moo, Baa, Lalala by Sandra Boynton. Why we like it? Farm animals and their accompanying sounds, it is short, funny, and you can really ham it up. We have several Boynton books and enjoy all of them, but this one in particular is great for the 12-18 month age range.

Brown Bear, Brown Bear, What Do You See? by Eric Carle. Why we like it? Colors, animals, repetition, the last set of pictures on the last page reinforces left-to-right labeling (for future reading), etc. All of Eric Carle's books are great.

Winter Friends by Carl R. Sams II and Jean Stoick. Why we like it? Real life photographs of a winter woodland, similar to our own backyard. The snowman provides food for several woodland animals. This is a shorter board book version of Stranger in the Woods.

B is for Bear by Roger Priddy. Why we like it? The alphabet, touch-and-feel, rhymes, and real-life photographs of 26 objects.

I'd also like to mention Matthew Van Fleet and his books. We used to have "Tails" and "Dogs" and loved both of them. They're touch and feel/lift the flap and have several interactive elements. Unfortunately, ours have been loved to death and we have to repurchase Tails.

Tubular Day

I really, really hope this is the last sedation for a long time. Nolan is quite perky and happy now, but the food deprivation separation from mommy was not a recipe for toddler happiness.

We were up at 4:00am to load the car and get everything ready for our trip up to Buffalo Children's. The car ride takes about two hours and we had a 7:00am registration time, so a pre-dawn departure was necessary.

Nolan didn't mind the early trip, but once up on the 9th floor for the same-day surgery, he started to get uneasy. He's been there before, and I don't know if he remembers it or not. He definitely was less playful the second the nurse came to get us. They had to return the toddler sized gown they brought out and find an infant sized one (at 19 pounds, he's very small for a 15 month old). Normally PE tubes are done in the special procedures unit on the fourth floor, but since he was squeezed in as an "emergency" case, it had to be done in the main operating room.

The nurse took him from me and he screamed from that point until they knocked him out with gas. When he woke up, he screamed until we were finally released and opened the door to leave the hospital. This was definitely stressful for him- not so much for the procedure, but for the separation from mommy.

The real negative of all the ear infections and Dr. visits is that he is becoming very shy about his ears. Any time an otoscope comes within 3 feet of him, he totally wigs out. I feel sorry for our audiologist at his next appointment for impressions...

I have my fingers crossed that this set of tubes will remain in place and functional for as long as possible!

Going Under

There are times I really, really wish our ENT was a little closer to our house. We were sent to the office in Depew yesterday to discuss the whole 80dB mixed hearing loss in the right ear thing. I learned some really valuable lessons on the way:

1. Transit Road in Buffalo is NOT the same as Transit Road in Depew.
2. My GPS system is out to get me.
3. Calling 411 for the phone number to the ENT will not help you when the ENT's office dumps you into their voicemail system.
4. You will need a pen to write down alternative phone numbers offered by the voicemail system, and there will be none in the car.
5. Mobile gas stations do not carry pens.
6. Three hours in a car does not make 1 and 3 year old boys happy.

We did eventually make it to the ENT, which was good considering the looming lake effect snow warning. She looked in Nolan's ears and made the proclamation that he had lots of middle ear fluid in his right ear. She scheduled us for a replacement PE tube this Thursday, and will check the positioning of the left PE tube at the same time. She also considered taking his adenoids, but then relented and said that the adenoids will come out with the third set of tubes.

I'm really hoping that we can avoid a third set of tubes, but having 2 sets in his tender 15 months of life doesn't set a very promising record. Off we go for sedation number 4!

Mr. One Ear

Nolan is finally feeling better. His fever broke Sunday afternoon, so it looks like he is finally on the mend. His ear looks great, though we're not quite done with the antibiotics. Thank goodness the boy likes Yoplait!

I've been keeping his right aid out for most of the day, worried that trapped moisture might reignite the infection. We see the pediatrician today and I should get the all-clear to keep both aids all day. Since his eardrum is healing, his hearing levels in the right ear *should* return to normal (well, his normal). We see the ENT on December 1st to get the all-clear to finish audiological testing.

Our SLP wanted to increase his service times to three times per week. I was worried we wouldn't be allowed to increase times since one ear fluctuated back up to mild/moderate in the high frequencies. Luckily, the service coordinator agreed to the increase in speech services over the next few months to make sure he stays on track. The frequent middle ear problems and fluctuating loss complicate things a bit, because getting him properly amplified is difficult! He is either over or under amplified, depending on the current state of hearing. Hopefully we'll get reliable, stable hearing levels soon!

Our weekly schedule is going to soon involve:

Monday: Speech therapy x 2 boys

Tuesday: Preschool (Matt) and Library Story Hour

Wednesday: Speech therapy x 2 boys

Thursday: MOPS and speech therapy x 1 boy

Friday: No scheduled activities- woo hoo!

Still Sick

Nolan's ear is looking better, but his fever keeps going up. It was being kept down to 102 on Tylenol, but he's been on strong antibiotics since Tuesday and this bug keeps getting worse instead of better!

Our pediatrician's office is open on Saturday mornings, so I took him in for a check to make sure nothing more serious is going on with the little fellow. His fever was 102.5, so they gave him some Motrin on top of the Tylenol to see if it would come down. They also took some blood to make sure it wasn't a bacterial infection that the antibiotic wasn't fighting.

The good news is that he doesn't have a serious bacterial infection, but there is a very nasty virus at play. He still has bronchitis and his fever is difficult to manage. We just have to wait a few days until his body fights off the infection. We also need to finish the antibiotic (which was prescribed for the ear infection). His ear is clear now and the rupture is healing, which is good news. We have an appointment with the ENT on December 1 to get the all-clear to finish his audiological testing.

The bad news? He's severely anemic. This was surprising since his CBC at his one year old checkup showed no anemia. He's far below the normal weight curve (18 pounds, 15 ounces at 15 months of age). He only eats a small amount of food, and is rather picky at the same time. We were sent off to get some liquid vitamins with iron to help him build up his red blood cell count.

Our current medical arsenal now includes amoxicillin, Tylenol/Motrin alternating every four hours, Ciprodex (eardrops), and now liquid vitamins that smell like rusty nails. His fever is back up to 102 F even with the Motrin, so I really hope he beats this thing soon!

The Good, The Bad, and The Ugly

Ah, the joys of the soundbooth! We were not able to get a full test in due to the squirming nature of the little guy. We have some good news and some bad, though not entirely unexpected, news.

The Good

Looks like the left ear has fluctuated upwards! Nolan had a 35dB threshold at 2kHz and was 40dB at 4kHz. This is 10dB and 15dB BETTER than our results in August at those frequencies, respectively. We didn't really get responses to the 500Hz and 1000Hz points, because Nolan decided he was done testing. His speech detection threshold was 55dB (borderline moderately severe), which indicates that his low and mid frequency hearing thresholds are not quite as good as his high frequency.

The Bad

We knew the right ear had a ruptured eardrum, but weren't sure of the effect this would have on his hearing level. It turns out a conductive problem can be devastating to a kid with a moderate sensorineural loss. Nolan is testing at about 80dB across the board, with speech reception thresholds at 80dB. This is severe, and his hearing aid is pretty much useless for that ear at this point. We did do an unmasked bone conduction on that side and got speech thresholds of 45dB, so we are fairly positive the results are due to the hole in the eardrum. On the other hand, it was unmasked and any vibration from the bone oscillator could also have been picked up by the left cochlea.

The Ugly

Nolan's right ear is just nasty. The drainage has slowed considerably, but we are under orders to contact the ENT ASAP to treat the rupture. With such a drastic threshold shift, our audiologist wants it treated before we attempt to complete the audiological testing.

Take Home Lesson

Kids with sensorineural hearing loss who develop middle ear issues need to be monitored and treated promptly! Problems with the conductive system can seriously compromise hearing ability in a kid who has an underlying, permanent hearing loss.

Just Not Our Day

One sick little dude

Things aren't looking very good for our hearing test on Thursday. I took Nolan to the pediatrician because of his persistant cough and the fluid coming out of his ear. It is never good when the doctor looks in your child's ear and says, "oh, this is bad. This is very, very bad."

Not only does he have bronchitis, an ear infection, and a low grade fever, but he's ruptured his right eardrum despite having a PE tube in that ear. When I mentioned the PE tube, the pediatrician took a closer look and said that the hole was quite large and the PE tube is gone. Luckily the tube in his left ear is functioning well.

Nolan got a lovely injection of high-dose antibiotic to stem the rapid infection in that ear, to be followed with antibiotic ear drops and oral antibiotics. Time to stock up on the yogurt!

We're also missing the tone hook on his left hearing aid. We have the loose earmold and the hearing aid, but no tone hook. I don't want to blame anyone, but I have a suspect in mind:

Sure, he looks innocent...

I gave the audiologist a call to see if she wanted to call off his hearing test. She wants to take a look at his ruptured eardrum and to get soundbooth results anyway, though she warned us his test results will probably be poor in that right ear. The hole should heal on its own, but it has to be monitored because sometimes a minor surgery is required to patch the hole. We'll probably end up with a hearing test about a month after this one, just to watch the hearing in that ear.

I am counting the days until cold and flu season is over!

Early Intervention WORKS

Yesterday morning our speech language pathologist arrived with a box full of blocks, toy utensils, a teddy bear, and a testing manual. After having Nolan take a block off the box, put the block in the box, and select various objects, he received a receptive language score of 124%. That score is ABOVE the level of his normal-hearing peers. His expressive ranked at 108%.

This is the kid who couldn't understand simple words like "kitty," "truck," or "cup" two months ago. One month ago, something clicked and he has never looked back! We did identify some language holes (he can only identify one body part and should be able to label four), but overall he is thriving in his language rich environment!

We are sans hearing aids today until we visit the pediatrician. Nolan has a nasty cold with drainage out of one ear which makes me leery of inserting the earmolds. With his hearing test only 2 days away, I want to make sure his PE tubes are open and any infection is addressed!

Yesterday evening the "lady game" (Matthew's term) came to our house to evaluate Matthew. He has already been evaluated for speech and language, so we know he still qualifies for services based on articulation. This testing was a formality to assess his general cognitive skills. We won't have the results back for a week or two, but the psychologist did tell me she's confident he's performing at age level.

The testing was interesting. There were puzzles to put together (Matt got to the five-piece puzzles and was stymied after that). Blocks to build in patterns that matched a template set up by the psychologist (he could do anything with three blocks, but four blocks were a little difficult). Lots of questions for information (he couldn't name the colors in a rainbow, for instance). There were also a lot of receptive language questions. He missed two that I thought he would get- one of a lamp (we don't have bedside lamps, so he isn't familiar with the term) and one of an iron (embarrassing, but I don't iron our clothes very often).

Matt's responses to some of the questions were rather interesting. A selection of his answers are below:

Lady Game: Matthew, can you name some animals?

Matt: Animals live at the zoo.

Lady Game: Can you name some of them?

Matt: My mommy drive me there.

Lady Game: Matt, can you name two items that have wheels?

Matt: A choo choo train!

Lady Game: Can you name a second one?

Matt: Another choo choo!

Lady Game: Matt, what is this picture?

Matt: A banana!

Lady Game: Matt, can you tell me what this is (picture of an iron).

Matt: That a plug on it.

Lady Game: Yes, but what is the whole thing called?

Matt: I go eat banana now.

Testing almost-3 year olds is a job reserved for saints!

Testing, Testing

We have a very busy week ahead of us. In addition to Nolan's hearing test on Thursday (my inward mantra is "please be stable, please be stable") he has his annual EI evaluation today. I thought those two tests would be it for the week. Silly me.

I forgot about Matt! He's transitioning from EI to the school district, so he has to have a full psychological evaluation (translate this as IQ, not "my parents traumatized me as a child" psychology). The center called today and they're going to test him tonight.

Hey, at least we have a few hours between tests!

Review of Our Goals

I've been reviewing Nolan's goals, which were set six months ago. Our overriding goal is for him to maintain both expressive and receptive language milestones on par with his hearing pears, and I would venture a guess that he is at least at peer level. As he is approaching his annual testing date, I thought I'd look over his goals again. The goals we set last May (for a 15 month old child) were:

• Respond to name on a consistent basis and turn to parent's names on a consistent basis.

He doesn't turn to his name on a consistent basis, but this could be due to his age. He gets engrossed in things that are far more interesting than turning to his name. A hearing test in one week will verify that this is an attention issue vs. hearing issue.

• Respond to basic questions (i.e. "where is the ball?") with a sign or gesture.

Check! He will find anything with a known vocabulary and will point to it or bring it to us.

• Identify at least 30 nouns and 10 verbs by choosing picture.

Hmmm... He'll probably get 30 nouns, but he hasn't figured out the verb thing yet. Maybe we'll work on "jumping" and "sitting" next week!

• Identify 5 body parts on himself or a doll.

He can identify his nose, but that is it at this point in time. If you ask him where his mouth is, he'll point to his nose. If you ask him where is ears are, he'll point to his nose... another thing we're working on.

• Respond to "no."

Check! Though his response is usually to laugh and continue doing what he wants to do! Sigh...

• Engage in social games (i.e. Pat-a-Cake)

Check! He loves "ring around the rosie" and other games we play at home. He doesn't quite get the turn-taking idea of Pat-a-Cake.

• Follow simple routine directions (i.e. put ball in box).

Check! He likes to put things IN other items, so he understands that concept. He may or may not understand "on top" or "beside," but he's a little young for that.

• Use three words in addition to mommy and daddy

Check! Well, sort of. There is no "mommy," but we have daddy, light, doggie, meow, roar, ball, and uh-oh.

• Attempt verbal imitation

Check! He will imitate when he feels like it.

• Imitate bilabial p, b, and m in 2/3 of prompts.

Hmmm... He doesn't do /p/ yet, and /b/ is just emerging. He does say "mamama" in babble but doesn't consistently imitate 2/3 of the time.

• Imitate vowel/consonant combinations with t, p, and n (at, up, and on) in 3/4 of opportunities.

Not so much. He has no /t/ or /p/, so those are missing entirely. He does have /n/, but when he imitates "on" it just sounds like "aw."

• Imitate consonant/vowel combinations (t, d, m, n, p, and b) at 75% of opportunities.

Another one he won't do. He sometimes will imitate "mamama," but none of the others. We have no /t/ or /p/. We are just starting to get a /b/.

We have testing in a week or two and a hearing test next Thursday. Then we'll be ready to set goals for a (gasp) 21 month old!

Happy Surprises

You never know when your kid is going to surpise you with something they learned. Nolan isn't always very verbal, but he's obviously taking it all in. Today he surprised us with.... animal sounds! He will accurately make the sounds of a cat and tiger, and sometimes will make a whimpering dog sound. I managed to get "tiger" and "cat" on video before he tired of the game.



You can also see his "selective hearing" here- this is when we're not sure if he is not quite hearing us or just ignoring us!

Babble Game

I first heard of the "babble game" over on the Cochlear Kids blog, as a good way to practice hearing and repeating different sounds. This is good for speech development, and also for tracking hearing levels with which sounds the kids are able to reproduce correctly. Obviously Nolan is just learning the idea of this game, so he generally doesn't imitate. He is starting to catch on, though, and will occasionally repeat the babble. Here is a sample of us learning to play the babble game:



Gage and Brook use beads to make bracelets, but that won't work with a 14 month old. I used raisins instead. I also used Matt as a model- he has a speech delay so he says many of the babble words incorrectly. This game is rather good for him, too! We don't have true AVT in this area, so I am sort of "winging it" with the help of other parents on the internet.

We also have Nolan's IFSP review coming up soon. We will have to make goals for an age level of 21 months. I am waiting to see the results of his annual testing through EI, as I am sure that will yield some goals. We are continuing with sign language as well as with the auditory/oral part of his therapy. Nolan will imitate many signs and often will attempt to verbalize the words he signs. The combination seems to work for him, so we will continue with this method.

Halloween

Turns out almost-three-year old boys are not very good helpers with scooping out pumpkin guts. Let's just say that the words "ew" and "you do it" came out nice and clear from my firstborn. Nolan, however, was extremely enthusiastic and literally dived right in. Note the lack of hearing aids, because we really didn't feel like exercising the warranty at this point in time.

Even though we had removed his aids, we continued to talk up the experience. He mostly gets vowels with his aids off, so I was bummed that his pilot cap was in the wash! I will make an experience book for all of our recent events to go over the language in a cleaner environment.

Luckily, the pilot cap was nice and clean by the time it was time to go trick-or-treating! Hopefully that kid will stop pulling his aids out soon- sheesh!

I Expect a Full Book Report in the Morning

We received Val's book in the mail a little while back and we have all thoroughly enjoyed it. What is I'm All Ears about? The initial fears and anxiety of a new diagnosis, the thrill of watching your children thrive despite challenges that life throws at them, and perseverence.

Plus, the book contains many therapy ideas, including 101 uses for a laundry basket. With the recent snow, we found just one more thing laundry baskets are good for: impromptu sleds!

We got IN the basket, went DOWN the hill, then PULLED the sled UP the hill. Who knew laundry baskets were so good for language?

Don't Make Me Get the Hat Out, Boy!

And I thought our pilot cap days were over- ha!

Nolan won't leave his right aid in his ear. He constantly pulls it out, hands it to me, and then walks away to continue playing. A few minutes later the left one will come out, but he really doesn't want the right one put back in. I did a listening check and the aids are OK, so I can only hope its a phase he's going through. I really hope he isn't losing more hearing! I doubt it, since he can still hear us with his aids off (we're still audible, but not really intelligible to him with his aids off). He does have a cold, so that could be part of his problem.

Receptive Language Explosion

We've been a little worried about Nolan's receptive language because he hasn't really demonstrated an ability to listen to a word and associate it with an object. For example, if you asked him to get his cup, he might come back with a book or a toy truck. He would only obtain the right object if he had a visual cue- i.e., pointing to the desired object.

This past week has shown us that talking, talking, and more talking has started to work some magic. He was grumpy this morning and I asked him if he wanted his milk. Without any visual cues, he wandered over and picked up his cup. It might sound like a small thing, but in our world it is huge!

To further wow all of us, he correctly identified the cow, sheep, and rooster during his speech therapy session this morning. The pig seemed to confuse him a little, though. Perhaps he simply doesn't like pigs! I am over the moon. Things are really starting to click in his auditory world.

A Wasted Language Opportunity

I'd love to say that I used this moment to use words like "magnificent" and "black bear" and "powerful." Instead I mostly said "EEEEEEEK!" and got the kids inside the house.

Yogi finally wandered off and we are able to venture outside again.

We also found Nolan's earmold by a bookcase, so it turns out I don't get to win Worst Mother of the Year Award for letting him ingest a choking hazard this time around.

Man, This Gum Tastes Like Rubber!

Notice anything missing? Sigh....

We were on our way to a Mothers of Preschoolers meeting and I clipped the hearing aids to Nolan's shirt to save some time. By the time we arrived at the preschool, this was the configuration I found them in. I can only hope that earmolds are non-toxic!

Toddlerhood can be so much "fun!"

Pumpkin Patch Language

My parents visited for a week and it was so nice to have the extra pair of hands to help out with the boys! Extra adults means extra language and more one-on-one attention, so we had a week packed with activities while they were here.

We visited the local pumpkin patch "Pumpkinville," which is a great example of capitalism at its best (or worst, depending on who is shelling out the money for the games)! We had a lot of new words this time around, including: water pump, turkey, cannon, pumpkins, cider, maze, and hay.

I'm not sure how many of those words Nolan remembers, but all these new concepts and words will work its way into his brain over time. We're still seeing a receptive language lag, but he did retrieve a book the other day with no visual cues. We'll get there in time!

Our speech language pathologist wants to increase Nolan's therapy time to work on his receptive language, and I hope that increase in time goes through. He's due for his annual evaluation in November, so any time increase will take place after that evaluation. We're also concerned that he is "humming" again and is becoming more inconsistent with response to sound. He still responds on occasion, so we're not sure if he's demonstrating another drop in hearing or if he is just showing the selective hearing that his brother displays. Our next hearing test will be at the same time of year as his EI evaluation, so we'll have a busy November/December.

In the mean time, we are reading, talking, signing, and singing!

AVT is NOT good for the waistline!

We've been working with an apple theme today, so I made some mini candied apples (WAY easy to make and wonderfully delicious). We got in some wonderful language: apple, dip, sprinkles, twirl, sticky, green, sweet, sour, thick, cover, harden, tummyache.

I think I have about 10 of these puppies left, and let's just say that the kids didn't eat that many. I'm staying away from all scales until further notice!

Mini Candied Apple Recipe:

Materials:

Apples (I used Granny Smith)

Candy Chips (I used butterscotch)

Sprinkles and/or chopped nuts

Melon baller

Lollipop sticks or toothpicks

Method:

Using the mellon baller, scoop out several "mini" apples from the big apple. Make sure some peel is left on each mini-apple.

Cut lollipop sticks in half at an angle (for easier insertion). Stick the pointed end of the stick into the mini-apple.

Melt candy chips in the microwave (I melted a cup of chips by nuking them for 45 seconds).

Dip each mini-apple in the melted candy chips, then roll in sprinkles. Set on wax paper to harden, then refrigerate until eaten.

Working on Receptive Language

Nolan's expressive language is coming along swimmingly, but everyone has noticed an obvious lag in his receptive language. This is definitely new territory for me, since my speech-delayed child always had above average receptive language. While Nolan understands most of what he says (doggie being the exception- he can say it but might bring you a truck if you ask for one), he is far below the average 50-100 words that most 1 year olds understand. The word "mama" even eludes him- a "where is mama" yields a blank stare or a confused looking about for a random toy.

Sometimes I feel a little guilty that we don't live in an area with dedicated oral-deaf schools or even licensed auditory-verbal therapists, but I can't dwell on what isn't. So our solution is to increase the amount that we talk and read to him. Its really time to get working on those experience books!

I found a yahoo group called learn2hear and have been stealing language exercises from the wonderful parents there. The current theme is autumn, so in addition to our speech therapy goals (working on "in" and "out"), we are working on the following words:

Acorn, leaf, tree, colors, falling, spider, fog, frost, turkey, apple, spider web, pumpkin, squirrel.

I've adapted the words from the list on learn2hear for Nolan's age (photosynthesis is a bit beyond him at this point), so hopefully he'll pick up a few of them!

Wonderwoman (AKA our Speech Therapist)

Nolan had an absolutely amazing speech therapy session on Wednesday. We had lost the words "ball" (pronounced da) and "Uh-Oh" (pronounced uh), which was rather upsetting. We have been working very hard to get them back, and Nolan successfully uttered "Da!" for us several times during our session. Then, to further wow us with his unending potential, he proceded to imitate "eat" (eee!) and "Kitty" (not a consistent sound, but one that usually has a "kh" sound somewhere within the squeal). I'm not quite sure how Mrs. C. manages to get Nolan to become a literal chatterbox when she's here- maybe she secretly puts something in his goldfish crackers! It is interesting that most of his early words and word approximations are ones that he already has signs for. Is it normal to be in love with your kid's speech therapist?

We also discussed Nolan's minor head lag issue. She consulted with a physical therapist, and after talking to his pediatrician and the PT, we feel that it is not a pathological or neurological problem. He can hold his head up in a prone position and doesn't have low muscle tone in the rest of his body, so it is probably just one of those things where he is on the low end of normal for muscle strength in his neck. We'll keep an eye on him, but all the experts who deal with him are sure there is nothing to worry about. That's a big relief!

We had an ENT appointment that afternoon. I did ask about his MRI results and she confirmed they were totally normal. She is concerned about the drop in hearing level and wants another booth test before we see her again in January. We'll be monitoring his hearing levels every three months until he stabilizes. She does feel his loss is genetic due to the symmetry and odd configuration. She also said they used to see a lot of 2-3 year olds show up with severe/profound losses out of nowhere, and the number of these supposedly "acquired" cases of deafness have dropped substantially since the inception of the newborn hearing screening program. She said a lot of these losses were actually mild or moderate losses that progressed and were then found at the age of 2 or 3. Interesting to know, though we hope that Nolan's hearing won't deteriorate any more than it already has. His aids work really well for him right now, and we hope it stays that way. We're prepared for the alternative if it should continue to progress, and know that he'll be just fine no matter what.

We're still battling the weight issue, which hasn't been helped by a recent stomach bug. We are getting about 10 ounces of milk into him every day, but that is still far short of the recommended 24 ounces from the pediatrician. I think my son and I need to switch diet strategies!

Volume Control

I was cleaning the kitchen and came downstairs to a sleeping baby. I was surprised he was able to sleep amidst all the Matthew-created noise, but then saw that Nolan has figured out his own version of volume control. Being able to tune out can be a benefit sometimes!

1 Year Checkup and Mommy Worries

Nolan had his one year checkup, and our poor little pincushion is now blissfully asleep after having his iron count/lead test, Prevnar, and Hib shots. The vital stats are:

Height: 29 1/2 inches. That's about the 25th percentile and not too far off from his growth curve.

Weight: 17 pounds, 12 ounces. Uh-oh. That's below the 3rd percentile and he's not even on the charts. Plus, he's fallen off of his own growth curve here.

And so begins the "mommy-worry." This is exacerbated by the fact that we don't have a cause for his hearing loss, so my mind goes in all sorts of directions. I doubt the following are related to the hearing loss, but I'm a mother so I worry anyway:

• Weight: The pediatrician thinks he's losing weight because we give him too many snacks. And he's walking and was recently weaned. I'm sure that's most of it, but we have structured snacks and good meals. Nolan doesn't eat a lot. In fact, he eats hardly anything at all. He drank a grand total of 3 ounces of milk yesterday. And nothing I can do convinces him to eat more! Anyway, we're under orders to decrease snacking and increase amounts given at meals. No juice is to be given whatsoever, under the theory that he won't starve himself and will increase consumption of high calorie milk. He doesn't get much diluted juice anyway (maybe 4 ounces a day), so this won't be hard to cut out. We'll see how it goes.
• Head lag. Nolan's head flops back when you lean him backward. This means that when he falls backward, his head hits first because he can't tuck it in. The rest of his gross motor skills seem age appropriate, so we're not too worried. But a part of me wonders why he doesn't have better control over his neck at the age of one.
• We've lost our only two words. For the past two weeks, there has been nary a "da" (ball) or "uh." Not sure if this is hearing related or if Nolan is going to follow his older brother's speech development pattern. On the other hand, we seem to have gotten our "B" sound back. You win some, you lose some!

The pediatrician also asked me if I had the MRI report. Darn it! I was hoping SHE did! With the additional drop in hearing, all of us want to see the report. The unofficial lowdown from the office staff was "normal," but I do want to see the report for myself. We have an ENT appointment next Wednesday, so I'll bring up my concerns there and see what that doctor thinks.

Other than a mildly weak neck and being very light weight, Nolan is doing great. His fine motor, cognitive, and most of his gross motor are at or above age level. So I guess I shouldn't worry too much!

Ling Six Song and official audiology report

I found this on another website and thought it worth posting. Any parent of a deaf or hard of hearing child who is pursuing listening and speaking as a primary mode of communication will be familiar with the six ling sounds (mmm, oooo, aaahhh, eee, shhh, and sss) which cover the speech frequency range. Anyhow, I found a song which emphasises these sounds on the web:

The horn on the car goes beep beep beep

Beep beep beep, beep beep beep

The horn on the car goes beep beep beep

all through the town.

The people in the car eat mmm, mmm, mmm

Mmm, mmm, mmm, mmm, mmm, mmm

The people in the car eat mmm, mmm, mmm

all through the town.

The snake on the road says sss,sss,sss

Sss, sss, sss, sss, sss, sss

The snake on the road says sss, sss, sss

all through the town.

The monkey in the car goes ooo, ooo, ooo

Ooo, ooo, ooo, ooo, ooo, ooo,

The monkey in the car goes ooo, ooo, ooo,

all through the town.

The babies in the car sing laah laah laah,

Laah laah laah, laah laah laah

The babies in the car sing laah laah laah

all through the town.

The mommies in the car go shh, shh, shh

Shh, shh, shh, shh, shh, shh

The mommies in the car go shh, shh, shh

all through the town.

We also got the official report in the mail from the audiologist. No surprises here since I saw the audiogram in her office. We've lost 20dB at 4000Hz and 15dB at 1000Hz. The official report states:

“A second audiologist assisted in today’s testing. Insert earphones (Nolan’s earmolds) and visual reinforcement were used to elicit responses. Today’s test results revealed a moderately severe loss at 500 and 1000 Hz sloping up to moderate at 2000Hz then down to moderately severe at 4000Hz bilaterally. A decrease was noted in both ears at 4000Hz when compared to testing in May 2008. Tympanometry revealed flat curves with large ear canal volume indicating patent PE tubes. Adjustments were made to the hearing aid settings based on today’s test results and responses were checked on S-REM. Nolan was also fit with new earmolds.”

His hearing loss is very symmetric and the ears are:

Left ear:

500Hz: 55dB
1000Hz: 55dB
2000Hz: 40dB
4000Hz: 55dB

Right Ear:

500Hz: 60dB
1000Hz: 55dB
2000Hz: 45dB
4000Hz: 55dB

His left ear is currently marginally better than his right ear, but for all intents and purposes they’re the same.