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!