The Results Are In, And They're... Interesting

No one gets cowlicks like Nolan does. No one.

After two abysmal attempts at getting hearing test results, we decided to change things up a bit by:

• Changing the time of day (doing a morning test instead of an afternoon test).
• Kicking Mommy (that would be me) out of the testing booth.
• Changing audiologists (unintended, but our audi called off unexpectedly).
  

These changes (plus the random good-will of a certain two year old) made all the difference in the world. Nolan marched into the sound booth, I told him I was going to "get some coffee," and left as they were checking his ears with an otoscope.

I sat outside for what seemed an eternity. Since sound proof booths are, well, sound proof, I couldn't hear what was going on inside. I always get nervous during these things, more for Nolan's cooperation and getting accurate results than for anything else. The long span of time was reassuring, because it meant that they were getting results from the little guy.

The audiologist came out and we sat down to discuss the results. My heart dropped a little when I saw this:

The red line is what his hearing was at birth. He even had present OAE (indicating healthy outer hair cells in the cochlea) in his right ear at birth. The purple line is from his left (good) ear in June 2009. A small drop from his levels at birth, but nothing drastic. The "X" line on the bottom is his left ear today. A flat line at 60dB. Definitely a big change! The "O" line is his right ear, and it is pretty consistent with what it has been since August 2008, so it is holding fairly steady.

His speech recognition thresholds were 50dB for his left ear, and 55dB for his right ear (a drop for both ears).

His tympanogram shows no fluid, meaning that middle ear fluid is not the cause for this most recent drop. His left ear does still have a tiny perforation that has not healed over yet from his PE tube that fell out in December. His right ear has some negative pressure. Keeping that in mind, the audiologist then showed me his bone conduction results:

These are the results from today's testing. The red line above shows his bone conduction results. The bone conduction testing bypasses the middle ear entirely, and tests the cochlea. Nolan is too young to test each ear independently, so the bone conduction results show the hearing ability of his better ear, when the middle ear is bypassed. Essentially, his better ear (probably his left ear) looks stable when you look at the sensorineural loss. The overall picture, however, shows that he has a deterioration of hearing. He has a mixed hearing loss now.

The good news is that the conductive component of these hearing losses is typically correctable. If the source of the conductive component can be isolated, then it can usually be corrected. There are a few possibilities for Mr. Nolan:

• The tiny perforation and negative pressure are causing that much of a hearing loss. This would be strange, since PE tubes cause small perforations and are not typically associated with a drop in hearing. Still, it is a possibility. If Nolan's perforation doesn't heal up on its own, surgery may be needed to patch his eardrum. Also, negative pressure might be affecting his hearing. So another set of PE tubes might be needed.
  
• Something else is going on with his middle ear. Something that we haven't previously detected, that is progressive and/or permanent. This may need exploration in the future, if his ears don't clear up after the typical PE tube treatment.

The problem with this type of loss is that we will not increase his amplification unless the conductive component proves permanent. Obviously, we don't want to increase the volume on his hearing aids, have his hearing improve from surgical means, and then have him blasted with too much sound. On the other hand, this means that he is underamplified and will remain underamplified for the near future. This kills me from a speech-development standpoint, because Nolan has recently lost the /K/ and /F/ sounds in his speech. We'll get them back eventually, but it is hard to know that he isn't amplified appropriately and there's not a darned thing we can do about it for the time being.

The plan of action is currently:

• Get the sleep study done and over with (January 20).
• See the ENT, probably sooner than March 1. I will call and set up an earlier appointment as soon as the sleep study is completed.
• If necessary, do a tonsillectomy and adenoidectomy. At the same time (if necessary), patch up his left eardrum. And possibly add PE tubes into the mix. Truly, our insurance company must hate us.
• Go back to Buffalo Speech and Hearing Center on April 12 for another hearing test. We need to get his ears cleared up, then check his hearing levels to see if the conductive component has disappeared or not. If it hasn't, his amplification will be increased and more exploration as to why it hasn't disappeared will be considered.

I'm a little worried about his under-amplified status, but thrilled at the prospect at correcting the conductive component to his hearing loss. We are going to have a busy winter, sorting this all out!