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!