Tuesday, November 24, 2009

Audiological Russian Roulette

Nolan had another hearing test yesterday. It went in a similar manner to his other hearing tests (to recap: we've never had two audiograms in a row that look the same). Every time we step into the sound booth, it's like playing audiological Russian Roulette. Which frequency will change this time, by how much, and will it be a loss or a gain? In the past, we've actually had an increase in hearing ability for the left ear after it had dropped. For a sensorineural loss, this is pretty rare. But obviously, it can happen. Nolan is proof of that.

Anyhow, Nolan's audiologist wanted to try and train him to do "play audiometry" rather than the "visual reinforcement audiometry (VRA)." In the VRA scenario, tones are played and the little guys are rewarded with a dancing puppet when a tone sounds. They quickly associate the beep and the dancing koala (or puppy, or rabbit, or whatever other stuffed animal can be shoved into a lighted box and animated). In play audiometry, the child is trained to drop a block into a bucket when they hear a sound.

The thing is, Nolan's on the young end for this task. He gets bored quickly and wants nothing to do with it. We did manage to get his 500Hz mark using this method, but most of the time he was just dropping the little bears on the floor and wouldn't cooperate. So we moved onto the VRA method to get some accurate readings.

Nolan's pure tone audiogram has taken yet another little dip. Of course, it isn't a HUGE dip, but typical Nolan-style, he's losing a tad at each hearing test. We only had fair reliability. His audiologist isn't very sure of his reading at 2000Hz in the right ear, because he wasn't really responding very well. she thinks he might have a worse threshold than what she plotted, and in her graph she placed a question mark beside it. The left ear's dropped a tad, too, but only in the low frequencies. We couldn't get the 4000Hz point, because Nolan was fed up by the time we finished with the 2000Hz point. I plotted out some of his hearing levels so you can see the progression. Not a lot at any one test, but a lot over time:

Anyhow, she did speech detection thresholds as well. This is where the biggest change was observed. Nolan was really playing along with this one, so we know they're pretty accurate. She placed several flashcards out in front of him, and had him point to the snowman, airplane, hot dog, popcorn, or toothbrush.

At our last hearing test, Nolan's speech detection was at 40dB in the right ear. Yesterday, he couldn't detect speech until it was at 65dB. That's a 25dB drop in his ability to pick up speech in that ear.

The left ear had a similar drop. In June, his detection was at 35dB. Yesterday, it was at 45dB- only a 10dB drop, but a significant decrease nonetheless.

We did a tympanogram, and his left ear is fine: the PE tube is patent and there is no fluid or wax. The right ear had a lot of wax and a flat tympanogram. We're hoping the wax and possible fluid (she couldn't see the eardrum) are behind some of yesterday's change. To that end, we now get to see the ENT in December. The possibilities after the ENT appointment are:

1. The extra loss in the right ear is caused by wax. This is easily remedied- the most hoped for scenario.

2. The extra loss in the right ear is caused by fluid. Not my favorite scenario, because this will require a third set of PE tubes. Which might come with an adenoidectomy. We'll take it as it comes.

3. The extra loss in the right ear is permanent. Which means we need to adjust his hearing aids, and review his CT scan and MRI again to make sure we didn't miss something like enlarged vestibular aqueducts. Again, we'll take it as it comes.

There is a lot of good news in all of this, though. For one thing, Nolan's hearing aids are still helpful to him. Also, his speech and language is developing despite any fluctuations he is experiencing. And these recent results might explain why he's shouting all the time and not responding as well as he used to.

Of course, I was really hoping for a long period of time without doctor appointments, but it looks like we're going to have a replay of last year's "Medical December." I managed to secure an ENT appointment on the 7th, we have a GI doctor appointment on the 8th. And we'll have a repeat hearing test shortly thereafter. Also, if there is fluid at the ENT appointment, we'll have another surgery to place a PE tube in the right ear again. We're going to be a little busy this Advent season.

They should really give us frequent flier mileage for all of our trips to Buffalo!


rouchi said...

Phew that is a lot of detection and lots of pros and cons. He is doing well with his picking up of language and i am sure things would look up soon as he grows up. His awareness of sound too would improve and you would have better looking graphs.

Bright Family said...

Well, Merry Christams to you! Sounds like no fun.

We got Tayten to use play audiometry by "racing". Whoever dropped the block first, after hearing the sound, "won"...of course, he always won because we could only began the race after we knew he heard it. This detoured him from dropping the item at any random moment. Tayten is more competitive then most, so it may or may not work for others.

I'll keep my fingers crossed that drops are due to fluid/wax in his ear, fluid clears on it's own, and that you aren't scheduling surgery anytime in the near future.

Lots of luck!

terena said...

Queen Teen also has sensorineural hearing loss, so I know the fluctuating results you're talking about. She HATES the drop the block in the box game. Talk about boring. She's 14, so it's pretty annoying, but she won't focus enough to get a reading without a task, so she gets to do the blocks. You fly to your appointments? Wow, and I thought a three hour drive was tough.

leah said...

Oh, no- we drive to our appointments! I was joking with the "frequent flier" mileage comment- if we had airline miles for all the road trips we take to Buffalo, though, it would be nice!

I'm not looking forward to seeing the ENT. I really don't want to go through another set of tubes, but we'll do what needs to be done.

tammy said...

Any drop, big or small, is always hard, but it's good that Nolan is continuing in his speech and language development. Hopefully you get the answers you're looking for at the ENT and it sounds like whatever is causing the drop, you're ready to take head on! We'll be thinking of you guys!

tammy said...

Oh ... and we practice "play audiometry" at AVT every week and sometimes at home when we do our ling checks. Right now Aiden will hold a cheerio (or other cereal) to his ear, listen for the ling, drop it in the bowl when he hears it, then he gets to eat them all up at the end! Sometimes he's all for it, other days he's like "whatever mom, I'm just eating the cereal!" LOL!

JoeyRes said...

We've been having fluctuations ourselves - 5 to 10 dB over just a few frequencies. Our audiologist thinks it's because Julia insists on wearing headphones rather than the in the ear plug type things. We're retesting in 6 months with the hated ear plugs to try and start getting consistent readings.

It seems amazing to me that they can get reliable results from such little kids.

I'll keep my fingers crossed for ear wax for you guys. Good luck!

leah said...

We're really betting on the ear wax thing. We've always managed to get insert ear thingie results (I'm pretty sure that's the technical term) because Nolan isn't bothered by them. We're thankful for that, lol!

Have they tried using her earmolds as the "inserts?" They did that with Nolan for a few tests- just tucked the wires in behind his earmolds. Now they use the regular inserts without his earmolds, but it was a good way to transition him to doing the test this way.

Kristen@nosmallthing said...

I think it's really really tough to know if you're getting accurate read with little ones. Now that Henry is nearly six, we are pretty confident in what we get. Hang in there...this too shall pass. :)

Good luck at the ENT...have my fingers crossed for you that it is just wax. :)