Speech Sample: 17 Months

I try to get occasional speech samples of Nolan to compare with later. We've been working on "up" and "down" lately. He is missing some consonants lately, which always puts me on alert. We've lost /d/ lately, but have maintained /p/ so I'm not too worried. We also have an ending sound to "down" now (he says something like "downg," but close enough for now)!

Wah!

Nolan came up to me this morning and pulled at my hand. "Wa!" he told me. I had no idea what "wa!" meant, but it sounded close to his word for wet (weh). I grabbed a diaper and went to change him, impressed that he came up to me and indicated he was wet. Nolan, however, backed away and shook his head. "Wah!" he implored. Great... he's telling me something and I have no clue what he's saying.

Finally, I said, "show me, Nolan. Show Mommy what you want." Nolan took hold of my finger, led me to the rocking chair, and pointed at it. "Wah!"

Rock! He came to me, out of the blue, and told me he wanted to rock! We get lots of word imitation and even spontaneous word usage when looking at pictures in a book, but this is the first time he's come up to me to indicate a need.

Rock on, Nolan. Rock on!

On Being Hard of Hearing

Can he hear anything at all?

We get this question quite frequently, and it serves as a constant reminder that most people don’t really “get” hearing loss. One glimpse of those blue and white earmolds in our son’s ears shows the presuppositions of those who believe that hearing is all or nothing. A “Mr. Holland’s Opus” scenario of clanging pots behind a child’s head and observing no response. There are certainly many children who are deaf, those who (without amplification) would not startle at pots clanging or hands clapping. There are also many children who can easily hear these sorts of sounds, but struggle to hear the softer sounds of human speech.

The difference between being deaf and hard of hearing is not a black and white line, as shown on an audiogram. It is a continuum of gray, and a single child may well be deaf in one frequency and have normal hearing in another. And a severe/profoundly deaf child can have access to the auditory world through the use of a cochlear implant. The guesses of those random people we meet in the store, or at the park, can lead to rather humorous episodes. We see lots of wildly gesticulating hands and over-exaggerated smiles directed at our boy.

People assume he cannot hear them at all, and if we use the word “hard of hearing,” we get blank stares. Apparently, the general public only associates that term with an aged grandfather cupping his hand to an ear. On the flip side of this equation, when people notice he can “hear” without his hearing aids, they believe the diagnosis of hearing loss is hugely exaggerated. So, what does it mean to be hard of hearing?

Hard of hearing children are sometimes on the “borderline.” Some are on the borderline of requiring hearing aids with a slight/mild loss and some are on the borderline of needing a cochlear implant with a moderate to severe hearing loss. Being stuck on the borderline (in either scenario) is quite stressful, as knowing the most appropriate course of action is not clear. We are quite fortunate and are not close to any borderline- stuck squarely in the middle of hearing aid territory with a pure-tone average in the moderate range. Hearing aids help our son quite a lot, though don’t give him “normal” hearing.

Hearing aids only amplify the sounds and cannot improve on sound distortion. The cochlea has “inner” and “outer” hair cells. Mild to moderate losses typically have intact inner hair cells and damaged outer hair cells. As losses approach 50-60dB, the inner hair cells are affected and significant distortion of sound signals can occur. The greater the hearing loss, the greater the distortion becomes. Audible is not necessarily intelligible.

Hearing aids also amplify EVERYTHING. This means the squeaking chairs in my son’s future classroom, the pile of Legos being dumped on the floor, and the hum of the air conditioner vent above his head. Background noise is our greatest challenge, as Nolan goes from hearing us quite well in the quiet of our living room to not hearing us at all (simulation here) in a busy restaurant.

I suppose the greatest danger of the idea that hearing is “all-or-nothing” lies not with the reactions we get from the public, but with the reactions of pediatricians and parents who have a child that has “referred” on the newborn hearing screen. There is a huge lack of follow-up to failed screens, most likely caused by pediatricians who are eager to reassure the parents that the cause is probably fluid in the ears. We received this thought from several medical professionals. These opinions, coupled with the observation that a baby startles at loud environmental noises lead many parents to assume the child’s hearing is normal. We had this scenario with Nolan- failed referred hearing screens and an obvious response to loud noises. Parents might not want to risk sedation for an ABR test when the pediatrician is fairly confident there is nothing to be worried about. To any wavering parents out there, early identification of any level of hearing loss is key!

Still Stuck Inside

The weather is quite cold this week (the windchill is -23F today), so we are all confined to the great indoors. Our speech therapist is off for a minimum of three weeks, and I'm not quite sure what to do with all the free time!

Nolan is really charging ahead with language, imitating 2-3 new words every day. Few of them "stick" and they aren't used spontaneously, but imitation of sounds is still important. We picked up new earmolds and he has been leaving his aids alone. We also saw the ENT and his ears look beautiful- no fluid, no excessive wax, no infection.

Everything is looking so good that we don't need to return to the ENT until May, and I'll simply give the audiologist a call when his earmolds are outgrown. I do need to decide if I want to venture up to Buffalo once per month for their new parent/infant program at the oral deaf school. They have a program the fourth Wednesday of every month for 15 month-2 year olds. Since we don't have local oral deaf education opportunities, I might take advantage of this. Everything hinges on the weather and whether or not my older son will be allowed to come with us.

I am really pining for spring and warm weather. Hopefully this cold front will leave us soon!

Snow Day

Slacking after "school"

New earmolds will have to wait, as Mother Nature has descended upon us in all her white and frigid glory. With 8-10 inches expected in our area today, I decided not to risk the drive. This turned out to be a great thing, as our speech therapy session could go forward as planned. And Nolan had an amazing "skyrocket" day.

While playing with the Aquadoodle, Nolan heard and said the word "wet." It was more of a "weh," but he said it over and over again. Then came "hop hop" when we were looking at a bunny picture, /p/ and /h/ sounds included. Goodness gracious, this kid is starting to imitate like crazy! He has also picked up some signs (banana and a few more I can't think of off the bat), but his word acquisition rate is now faster than his sign acquisition rate. I swear the kid said "dah go mmmmmm" (cow go moo) the other day, though I might be imagining it. Are two and three word sentences even possible at sixteen months of age?

Today rocks.

Dry and Store

We received a little canister with silica dessicant when we purchased Nolan's hearing aids, but had heard about a better drying system through the Dry and Store company. They have a system which gently warms and dries the hearing aids to remove all traces of moisture, so we thought it might be worth our while to purchase one.

I'm $120 poorer today (even after putting in the HLAA code for 10% off), but if the system allows Nolan's aids to last a little longer the cost is justified. Let's face it: kids are rough on hearing equipment. Nolan plays in the snow, we dash through the rain, and summer is coming with its accompanying high humidity and dratted misters at the zoo.

The company has three models: the Professional, the Global, and the Zephyr. The Professional seemed like overkill with the size, and it would be hard to travel with. The Zephyr lacks the disinfecting capability, so I opted to forgo that option. Nolan has frequent ear infections (he's on cold number 2 from the date of his last set of tubes) and the disinfection might help keep his ears clear. The Global has the disinfecting quality I like and is still small enough to take on vacation.

Here's to having a long, long life for our beloved little Unitrons!

Frustration

Nolan has been wearing his hearing aids for a full 12 months, so one would expect that he would be quite used to them and would leave them in his ears for more than 20 minutes at a time. The pilot cap has lost its power to keep the aids in, because Nolan can rip it off in 3 seconds flat. If it is triple knotted, he will pull his ears out from behind the edges of the cap and rip his aids out.

I've thought about trying these caps, but they are $30 per hat and I have a feeling they would be no match for Nolan's excellent fine motor skills. So we are now at an impasse: Nolan pulls his aids out, we replace them, he pulls them out... repeat ad infinitum.

Some might suggest we get to the bottom of why he is pulling them out. We simply have no clue, as we know his hearing level has recently returned to previous levels and the aids are properly set. Perhaps the constant noise level provided by our three year old bothers him? Or he hears "well enough" (from his point of view) without them?

We are getting new earmolds on Thursday, so perhaps that will help keep those aids snugly in his ears. In the meantime, his time spent in aids is decreasing as we fervently try to keep them in as long as possible. At least he keeps them in during speech therapy.

Aside from super glue or some other permanent measure of adhesion, any suggestions are welcome (and don't think I haven't thought about the super glue)!

The Wonderful Sound of Feedback

Nolan's left hearing aid hasn't been producing the right level of feedback. Instead of a highly annoying shrill, it was a barely audible warble, indicating something was a tad off. I did a listening check, changed the batteries, and cleaned the earmolds completely. The hearing aid was still not functioning properly, causing my heart to sink as we approach the end of the one-year warranty.

I finally tried replacing the microphone filter, and voila! Feeback is restored. Big relief on this end, because I wasn't looking forward to repair costs or replacement costs when the aid is only one year old. For future reference, here is "Hearing Aid Diagnostics, 101."

If you notice a reduced volume during a listening check or a reduction in feedback noise, check the following:

• Batteries. Sometimes the battery is a dud and the fix is as simple as replacing it with a new one. Checking battery strength on a battery monitor will verify it has enough charge to power the aid.
• Earmolds. Any occlusion of wax or debris will affect the aid. If necessary, the earmold may have to be removed and washed with a warm, soapy liquid. Ensure the mold has been dried thoroughly before reattaching it to the aid.
• Tubing. If the tubing is occluded by wax, the aid may not work. If the tubing is cracked or not sealed properly, it may need to be replaced. Check the tubing for moisture, as this can also cause hearing aid dysfunction.
• Moisture. If the hearing aid has been exposed to a humid environment, such as the interior of your child's mouth, the aid may malfunction. Placing the aid into a drying canister or a Dry and Store overnight may solve the problem.
• Microphone. If the filter is blocked by debris, the aid may not function properly. Replacing the filter or cleaning the filter will allow for proper amplification. If the said debris is playdough and some other unidentifiable blue material, skip the cleaning and go right to replacing.

If the aid is still not functioning properly, a trip to the audiologist is in order. We see the audiologist on the 8th for replacement earmolds, and I'll probably have her check the aid just to verify it is still amplifying to the pre-set levels.