Tuesday, January 12, 2010

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!

19 comments:

The Brights said...

Well, probably not the most desired news, but glad Nolan was cooperative today so you have a better idea of his needs.

Since you have a plan, you can just sit back and relax, right?!

Keep us posted!

Miss Kat's Parents said...

I'm sorry things are proving so odd. Progressive losses are the worst!

So, at 60 db, Nolan will now be considered "severe", right? At what point would you start looking into a CI? We did ours when Miss Kat was 65 sloping to 80. I know the criteria for over 2 is severe (or greater) loss and less than 40% on a speech test...

Anyway, I hope you get it figured out!

Drew's Mom said...

Interesting in deed! I'm glad that you found some answers to your questions. (Good Job Nolan!)

It sounds like you and your team have a good plan of attack. We'll pray that his hearing is restored with a simple PE tube!

leah said...

He's not a candidate for a CI- his worst hearing is at 60dB and CI candidates usually have a pure-tone average of 70dB or worse. I think 60dB is technically considered "moderately severe," though there are two different scales (one calls "severe" 70-90dB and the other calls "severe 60-90dB).

The other big thing is that it is a mixed loss. Even if it were found to be permanent and he was a mixed 90dB loss, he wouldn't be a CI candidate because they won't count a conductive component into the Pure Tone Average for considering candidacy.

We know the conductive component is more than just needing a PE tube, because he has NO fluid. There is a very tiny perforation (our ENT couldn't even see it under the microscope when we were there last). We only know it is there because of the tympanogram. Unfortunately, it is unlikely that the perf. is causing a 30dB drop. But who knows? If the perforation is causing it, we'll need to have the eardrum patched. Though I don't know how they'll do that if they can't even find the hole!

We'll take things one appointment at a time, I suppose. We'll get through the sleep study next, then focus on getting into the ENT ASAP.

Pattie said...

I am confused. I was never good at the whole dB thing. But it sounds like you have a plan in place (as always).

I will keep you guys in my thoughts.

BTW...love the cowlick!

Julia said...

Well, I'm glad he was cooperative -- and hopefully that bodes well for future tests, too. But I'm sorry for the additional loss, especially the conductive element, just because it's so confusing and leaves you limbo -- although I hope it can be corrected. I forget -- have you had an MRI? What do they know about his inner ear anatomy?

ST playgroup was small today (after a huge crowd last week). I taught them the Beatles song "Birthday". Good luck with the sleep test next week, and I hope you can join us sometime thereafter.

Herding Grasshoppers said...

Wow.

Glad he was so cooperative... he's getting to be such a big boy!

Praying the new loss is NOT permanent, but don't be too discouraged. Tate's loss is far worse and his speech is great. No one would know, from his speech, how abysmal his hearing is.

Nolan is a plucky and persistent little guy... not to mention his parents :0) You guys will make it.

Julie

Jenny- Sienna's mom said...

Very excited to hear that you had a successfull soundproof booth test. Good luck with all your appointments, hope you sort this out as soon as you possible can!!

tammy said...

Leah I think you've had a busy spring, busy summer, busy fall, so why not end it all with a busy winter? Just seems par right? : )

That's great Nolan sat in there without you and the necessary testing done - at least you know the results are good, per se, and have a plan of action in place. You amaze me.

I had to laugh at the picture because as soon as I saw it (without reading your caption) I thought "him and Aiden ARE SO alike" - Aiden has crazy uncontrollable hair because of all his cowlicks. LOL The boys are destined to know each other one day!

leah said...

Tammy, Nolan's cowlicks are hilarious. There's always one, and it is always in a different place! He really needs a haircut, but he doesn't cooperate well for those (surprise, surprise). I'd cut it at home, but I'm afraid it would end up looking stranger than the cowlicks, lol!

Julie, the audiologists were amazed that his speech is so good with his level of loss, especially since he's generally under-amplified (he has had a conductive component due to fluid or wax - and now an unknown cause for so long, that his aids probably have rarely been set high enough). He misses sounds here and there, but you wouldn't know he had a hearing loss by just listening to him. I was quite proud when they praised his speech abilities, though it has little to do with me (if it had been Matt with a hearing loss, he STILL wouldn't be speaking- he isn't as wired for verbal skills as Nolan is).

Herding Grasshoppers said...

Well, Leah, I think it is a LOT to do with you, as well as Nolan. You're both working hard at it... and keeping it fun :0)

Krystal said...

you are such a great mom leah!! I am so encouraged by each post from you to press on and never give up. Let me encourage you by reminding you that God has given Nolan the perfect mom for him! You are doing everything you can to prepare him to do whatever God has and will call him to do! Thank you for being a Godly example to me!!

Blessings!

Kimmy K said...

Oh, my, LOVE the hair. I know what you mean about not cooperating with the hair cuts. I think they get tired of people always coming at their head with various equipment! We solved the problem by cutting it ourselves at home in the tub in a series of about 7 nights, a little here, a little there. Might not look that fashionable, but it keeps his ears on and his vision clear!

rouchi said...

I can feel all your anxiety and stress in this post. I really pray all is well and his hearing is steady and does not have a progressive loss. Take care and God has plans for him, he would be alright .

Green Bus said...

You are an excellent teacher. I have learned more about Josh's hearing issues from reading your post than from our doctor and audiologists' explanations. Strangely, this post has helped me to understand the further testing that Josh is scheduled for this coming Monday.

I will pray for Nolan. What a brave guy to go through all of this testing and to do the last one without his mom present. He is learning independence and self-reliance (and resilience!) at an early age.

Heidi (motherimperfect--I guess I have to post comments from my empty blogger account)

Megan said...

Leah-Since Nolan are so close in age and similar with their hearing loss, it makes me wander if we should get Luca retested like you did. We are working with him on touching his nose when he hears a sound, so I think we may be able to get a more accurate hearing test like you did.

Oh, our little boys...

AimeeTheSuperMom said...

That's fantastic that he's learning to cooperate for a sound booth test!!

I'm sorry those results are so frustrating. Seeing his audiogram, though, leaves me fairly hopeful that he will get those missing sounds back. There are a lot of visual ways you can compensate for the underamplification for him. Be sure to ask his AVT or SLP about those because they can really help.

We're always thinking of you guys!!!

Chris'n'Deb said...

Thanks for dropping by my blog last week (Little Dumer News)and commenting, it is always nice to hear from other parents of children with hearing loss. I hope that a resolution to the conductive loss clears things up greatly for Nolan! Keeping my fingers crossed for ya!

Hetha said...

Good grief but that cutie keeps everyone on their toes! Whenever your posts go into detail on the audiograms I end up learning a lot. Ultimately, I retained very little of what I learned about hearing loss since Ethan's was totally profound in both ears. We just didn't have these experiences stacking up and informing us, so I learn so much about it from you. I'm glad you were able to get a good session in the sound booth and it does seem like you'll have your plates full this winter, as always. We've also taken advantage of a procedure requiring anesthesia and have coordinated multiple people to do tests while he's knocked out. That in and of itself is a logistical nightmare. Best wishes to you guys. xoxo