Nolan's audiogram is below (copied onto a larger graph for photographic purposes). The "teaching audiogram" used below has different categories of hearing loss than typically used, so disregard those levels. Nolan's hearing loss is not in the "severe" category, but "moderately severe rising to moderate." For reference, normal hearing in children is above the 15dB line. Nolan cannot hear any sound above the lines on the graph (unaided). Basically, with his hearing aids off, he can hear dogs barking and babies crying, but none of the sounds of speech.
Over time, Nolan's hearing loss has fluctuated a great deal. When he was born, he had a 40dB loss rising to borderline normal hearing (with present OAE in his right ear). Obviously, this is no longer the case. Still, we've had improvements and decreases in hearing over time- I created a table to show his hearing levels, with the total change from May 2008 (first booth test) through May 2010. The first two dates are estimated hearing levels from ABR testing.
There is a net loss at each frequency, going from a mild/moderate loss to a moderately severe rising to moderate loss. I am interested in obtaining more bone conduction testing to determine how much of Nolan's hearing is conductive vs. sensorineural. For amplification purposes, it doesn't matter: even if there is a conductive component, it is permanent and his hearing aids had to be increased. On the other hand, it would be nice to know if there is a conductive component to gauge how "progressive" his loss might be. John Tracy will perform a full battery of tests when Nolan is at the clinic, so I am hopeful that a bone conduction test will be included.
16 comments:
I am so excited for you guys to take part in what this awesome clinic has to offer! What an amazing experience this is going to be for you! And I can only imagine the wealth in information you will be bringing back with you!
Thanks for the report and explanation. I am so grateful that Nolan is born in a time when help is available. You are a great Mom.
So, will you start looking into a CI if he becomes severe,(70-90 db) or will you wait until profound (greater than 90)?
I hope some of these mysteries are solved when you go to JTC! It sounds like a fantastic experience. I don't know much about conductive hearing loss (this is the first I've heard of a mixed hearing loss, for that matter), but I was under the impression that depending on the cause, it may be able to be surgically fixed. Also, conductive hearing losses often times have less distortion of speech than sensorineural, so he just may be getting better speech understanding than expected. Then again, you don't know if it's definitely conductive, but it's an interesting thing to think about.
Melissa, we'll have to see what would happen with Nolan's hearing. He gets tremendous benefits from his hearing aids right now (as long as they're turned up). We would start pursuing a CI as soon as his hearing aids seemed to be giving him little use, though we're still a ways from that decision... and if part of his loss is conductive, then he probably wouldn't be a candidate (though I think the conductive portion is only about 10dB).
PinkLAM, it is an interesting scenario with Nolan. Generally, conductive losses ARE correctable. If you can find the source of the conductive loss, that is. That's the problem with Nolan- if he has a conductive component, it is from an unknown source and can't be fixed! His middle ear bones are normal, his ear canals are normal, and he has no fluid in his ears. Go figure.
It does make me wonder, because there are some hearing loss conditions (like LVAS) that will sometimes show an air-bone gap when there is no true conductive component. Nolan doesn't have LVAS (according to our ENT), but it makes me wonder...
The other possibility is that he has permanent scarring and thickening on his eardrum, and there isn't a darned thing they can do about that. If they replace the eardrum, the replacement material causes a similar conductive loss.
The "good" thing about his conductive component (if he has one) is that there is a maximum point of progression (it could take him to the severe mixed loss level, but no further).
The "bad" thing about his conductive component is that he has a sensorineural loss, too, so he gets the distortion from that and the volume reduction from the conductive component (this is why he hears "king" as "cane")...
I'm not a fan of mixed losses, especially as they approach the severe level. They prevent you from being a CI candidate, but throw you into the "difficult to aid" category....
LOL that's where I'm at right now though even I got a 64% without the FM
I have asked several audiologists, and they all say that you can get a CI with a mixed loss, if they aren't getting the benefit from the aids (ie scoring less than 50% on the sentence test).
How is his speech discrim? Have you looked at the Listening room's "Clix for Kids"? It has a discrim test you can do right on the computer and it will save the results for you and everything. I just found out about it at a conference, it is sooooo cool!
I haven't heard about the speech discrim online! I have to check that out!
His ability to hear the single words (snowman, baseball, bathtub, etc) is at 45dB for his left ear and 55dB for his right ear- we haven't done any of the percentile tests because of his age. He's still pretty far off from CI candidacy, though- he'd have to drop another 20dB across all frequencies to be a "borderline" candidate, I think... (going from 60-65dB to about 80dB).
I should think he could still be a CI candidate with a mixed or conductive loss, depending on the source. All they have to do is get the electrode array successfully into his cochlea, and if so then the conductive obstruction is immaterial, because it isn't necessary for sound to travel through the outer or middle ear anymore. It goes straight from microphone to processor to auditory nerve. Unless the obstruction prevents insertion, I don't see why he wouldn't be a candidate.
But hopefully that decision is a long way off, if it comes at all. (We're having CI equipment trouble right now, so I'm not wishing that more intense level of technology on you any time soon.)
I guess the most galling thing about Nolan's mixed loss is that there are so many open questions, so it's hard to aid him or make predictions.
Julia, from what I understand (and that is rather limited), they're reluctant to do CI's on kiddos with significant conductive components because technically, a conductive component should be correctable. Nolan's conductive component isn't very great, however (I think his air bone gap is only around 10dB from the last testing in February), so I don't think that would affect him if he should ever drop down to that level.
It is all very hypothetical, and we would certainly choose the hearing aid route for as long as those worked for him. Even if he continued to deteriorate at his current rate, it would be a matter of several years before he was anywhere near the candidacy range.
You're right: my interest in knowing whether it is conductive or not is because it would be nice to know if he has a truly progressive loss, or a stable sensorineural loss with a conductive component. We know he's lost some sensorineural-type hearing (after all, he had present OAE's at one point), but I would like to know how much. I really can't wait to get to John Tracy to get the full picture (they have three uninterrupted weeks to get the information, so we'll definitely get a full hearing picture)!
Thanks for the explanation on the mixed loss. I can definitely now see how frustrating it is, especially since there's so much you don't know about the cause. I can totally relate to what you said about wondering if his loss was caused by LVAS. I know multiple people who have had patterns of hearing loss nearly the exact same as mine (moderate/severe as a toddler, progresses, usually gets CI by preteen/teen years) and they all have LVAS. Yet, my top-notch ENT did not find that on my CT scan. Go figure.
Hope you get a very informative audiogram when you go to John Tracey!! When will you know if it is conductive? When it goes?
pinkLAM-do you have LVAS? I don't think I've been checked for LVAS, they wanted to do an MRI/CT scan on me, but of course it was after my implant so could not be done. Always makes me wonder though, although doctors say my hearing loss is caused by medication, but it does not add up because of my sister. The same doctor on the same day stated I have a genetic hearing loss....huh???
I really hope he doesn't get into the "difficult to aid" category. I think it's really scary that the loss can progress and no one can tell you how much or give any sort of prognosis.
Hopefully JTC will shed more light on the conductive aspect - they're a fabulous organization!
There is a lot you are going through and will have all your doubts sorted out and come out more educated on the subject.I am glad as I am looking forward to loads of input from you.
It's always interesting to see people's audiograms. I met a cool lady last fall who had a t-shirt with her daughter's audiogram results (post cochlear implant) printed on it. She was just so supportive of her daughter.
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