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.
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.
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.
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.