Goodbye, Hearing - Hello, NYU

Life is insanely busy and I don't often update Nolan's blog - but here is my yearly post (ha). Nolan is now 9 years old. We have had an insanely cool summer, visiting Quebec City, Tadoussac to see beluga whales in the wild, and hiking the via ferrata in Ausable Chasm.

Last December, we went to Cleveland Clinic to evaluate Nolan's hearing. At the time, there were some small changes in his left ear (his good ear), but the right ear was largely stable, ranging from 60-90 dB (moderate to severe). His aided thresholds were in the mild-moderate range.

His speech perception using live voice was 80% in the "bad" ear and 100% in the good ear. We knew we would need to upgrade his hearing aids from Bolero Q SP's if his hearing degenerated anymore, but also knew that if his right ear lost more, he might be in the range for a cochlear implant.

Over the summer, we were getting more "whats" and non-responses from Nolan. If he was looking at you, he could understand you. If he wasn't looking at you, he sometimes wouldn't detect that you had spoken. The left side still seemed to be getting sound, but the right ear appeared to have great difficulty. I did the Ling sounds for just the right ear, and the only sound he picked up was "ah."

I knew this meant he had lost additional hearing, and made the call to NYU's cochlear implant program. I wanted an evaluation to get him into the system just in case the right ear had dropped. If he didn't qualify, that would be fine - but I had suspicions that his right ear was losing residual hearing quickly.

They reviewed his audiogram from last December and said he wouldn't be a candidate with that audiogram, but considering his history we should bring him in for an evaluation. We had hotels booked and made the 7 hour drive to New York City (this drive takes longer than 7 hours with traffic, but is still well worth the trip).

NYU performed a full cochlear implant evaluation for Nolan. We first met with the LSLS (Listening and Spoken Language Specialist) and the audiologist who would be testing Nolan's hearing. We explained that we knew he was not a likely candidate, but preferred to err on the side of caution since he had been having difficulty lately and is in the fourth grade - we don't want his academics to suffer if the left ear decides to take a sudden dive and we lose his "good" ear.

The testing was broken up into three days. Each day, Nolan sat in the booth for 90 minutes and performed various listening tasks. Day 1 was the unaided audiogram. I don't have a copy of the audiogram yet, but my suspicions were confirmed. The left ear is largely where it was at Cleveland Clinic (though his speech reception has declined slightly), but the right ear is now profoundly deaf. His best threshold was at 90 dB in the low frequencies, dropping to over 100 dB in the highs (to no response at 8000 Hz). Nolan's speech reception was 48% in the good ear with speech at 85 dB, and was very poor in the right ear (24% at 95 dB).

Suddenly we were no longer "getting into the system," but entering true cochlear implant candidacy evaluations. Cochlear implant candidacy requires a lot more than unaided testing, so we would return the following day for testing in the aided condition.

Nolan really wanted to see the Statue of Liberty while we were in NYC, so we left the clinic to explore Manhattan.

 Taking a cruise to see Lady Liberty

At the World Trade Center on September 12 

We returned to the cochlear implant clinic the following day to repeat a lot of the previous testing, this time with Nolan's hearing aids on. The audiologist said words and sentences, but this time the volume was at 60 dB instead of 95 dB, since he had hearing aids on. His left (good) ear was fantastic - he was able to get a score of 84% in that ear. The right ear, unfortunately, only scored 36% for words and 27% for phonemes, even with a hearing aid on. His right ear, even in the perfect silence of the sound booth, just wasn't really hearing clear speech. His candidacy looked like a surer thing, but they wanted to try one more thing first: more  powerful hearing aids.

Nolan has super power aids which are supposed to accommodate a loss of up to 110 dB in the high frequencies, but he was at or beyond that level unaided. We needed to determine if the Naida UP (the most powerful hearing aid on the market) would bring his aided hearing into the desired range. 

We left the clinic to explore more of New York City, including the Natural History Museum. 

Dinosaurs!

Checking out Times Square

The third day of testing would be the determining factor for whether or not Nolan would qualify for an implant. Nolan had language testing performed (his language skills are insanely high, due to very early intervention and a mother that never shuts up   extensive exposure in the home environment.

He was brought back into the booth, this time with the Naida UP's. The UP hearing aid brought his left ear into the mild range for hearing levels and he obtained 100% speech recognition with it. We were thrilled! The right ear, however, did not fare as well. He was aided to the mild/moderate range with the Naida UP in the right ear. He did improve his speech understanding with the Naida UP, but was still missing half of the speech signal, at 60 dB in quiet (live voice).

This is a tricky situation - as he might do well with the Naida UP hearing aids, but his hearing loss is progressive, the right ear is already profound, and if we continue to wait the left ear will likely drop - leaving him with very poor hearing while trying to navigate the fourth grade. It is also likely the right ear will continue to drop, so we would be spending a significant amount of money (near $8000) for a very brief period of time. There is no telling when the left ear will drop, but it always trails the right ear by a few months to a year. We decided that if he was a candidate, we would proceed with implantation of the right ear. This will give him a "stable" ear (once rehabilitated) in case the left ear decides to take a dive on him in the future.

It was decided that Nolan would be a candidate for a cochlear implant in the right ear, and we were able to look at the three major brands who manufacture the device. Each brand is slightly different, but all serve the same function and operate in the same manner. It is a bit like buying a car - all are reliable and will get you to your destination, but the features vary from model to model. We took home a ton of literature from that appointment and returned to our home in Western NY to figure out which brand we want our son to have - for the rest of his life. While we know they all work just fine (cochlear implant centers wouldn't use a brand that didn't work), we need to determine what the best brand would be for Nolan.

We are returning to NYU tomorrow to meet with Nolan's surgeon. We are bringing Nolan's CT scan and MRI from when he was a baby so we won't have to repeat those tests. The process is long and involved, and we have to get insurance approval, the surgery scheduled, turn on the device, program the device, and do a lot of auditory-verbal-therapy to help his brain learn to use the signal generated by the implant. While it will take some time for him to adjust to it, his hearing will be better with the cochlear implant than it will be with his hearing aid. 

It's Been a Long Time

I haven't updated Nolan's blog in a long time. Primarily because I now work outside the home (and have little time for writing), and also because things have been going "hunky-dory." There is some exciting news on the home front: Nolan is growing on his own and we will be able to remove his feeding tube later this month. This is a wonderful development and we are absolutely thrilled. He'll never be a giant, but he is growing and otherwise thriving.

He plays soccer and loves it. He plays the piano and is flying through his lesson books - he has a natural talent and his fingers fly over the keyboard. He does wonderfully in the academic arena and is excelling in his third grade class.

His hearing, however, continues to deteriorate. This past spring, we had his PE tubes (grommets) removed and paper patches applied to try to heal his eardrums. Unfortunately, the right ear is stubborn with its infections and he had an infection in the recovery period. The paper patch didn't "take" in that ear.

The ear infections continue in that ear. It is a catch-22: they won't do a tympanoplasty in that ear until it is "dry," but the infections are not likely to stop, particularly since he has such a large hole in that eardrum. The nurse practitioner estimated about 15%-20% of his eardrum is missing. We had a hearing test done in an infection-free time and found the following:

The right ear is now in the severe range from 1000 Hz-8000 Hz. He does hit moderate at 500 Hz in that ear, but all other frequencies are in the severe range. The left ear is doing better, at a moderate-moderately severe level across the board. The conductive component is still there. The ENT does not believe it is due to the hole in his eardrum, though we cannot be sure. Our current ENT has decided to ignore the right ear and simply focus on the better ear. His better ear (the left one) is aiding to 25-35 dB (the "As" on the audiogram above). Our current audiology practice does not test the aided ears separately, so the worse ear is not evaluated.

Unfortunately, we are seeing some signs of speech "slippage" from Nolan. His high frequency sounds are less clear. Words like "kits" are becoming "kiss." He currently has (yet another) ear infection in the right ear. Buffalo cultures it each time, delaying the treatment time and causing that ear to continue to degenerate.

Since the audiology practices locally don't test the aided ears individually, it is hard to tell what, if anything, the right ear is perceiving. When we do the Ling 6 test with the right ear aided (taking out the left hearing aid), he only detects the "AH" sound.


I am concerned about the right ear "dropping off the map," so I contacted Cleveland Clinic for a second opinion. The audiology practices in Buffalo are not practicing according to the current best practice guidelines for pediatric audiology, and Nolan is not aided as well as he should be.

Cleveland Clinic is amazingly responsive and have a plan in place. We have an appointment for December 21 with audiology and the ENT surgeon there: we will see if there is anything that can be done for the right ear (since there is a perforation in the eardrum) and we will see what can be done with his aided hearing results in the sound booth. Cleveland does real-ear testing (Nolan has never had real-ear testing) and will test each aided ear individually. There are several options available to us, and the ultimate goal is to allow Nolan to hear better. It is possible his hearing aids can be cranked up to allow him to access more sound, or we may need a technology change.

In any case, there is our update (hey, it's only been nearly two years)!

Still Here, Just Incredibly Busy!

We have been so busy in the past 2 months. Some of the "busy" has come from medical appointments, but baseball/tee ball games, Piano Guild, and simply playing outside in the good weather has kept us hopping over the past few weeks.

On the "medical" side of life, Nolan's stridor has already returned post-surgery. Some nights he is quiet, and on other nights he is noisy. We have no idea if there is apnea associated with the "noise." Stridor is fine as long as he isn't dropping oxygen saturation numbers. Nolan will have a sleep study on June 23 to determine how he is faring.


Nolan had a vision appointment, and that went very well. His vision is now correcting to 20/20 in both eyes! When we first started treatment, his vision was 20/80 in the poorer eye (corrected vision - this means his vision was 20/80 when he was wearing glasses). Some people have asked if Nolan will continue to have to wear glasses, and the answer is "yes." He must wear them full time, or else the eyes may "separate" again (he could lose vision in the amblyopic eye). He is also nearsighted, and nearsightedness does not improve in children. The typical course for myopia in childhood is for it to worsen, as the eye lengthens as the child grows.

He has had to come home once from school, and was ill at school twice over the past month. This was not due to a virus, but caused by his gastroparesis. His stomach was bloated and he didn't tolerate his night feeds. This is a problem that we are monitoring, but he is growing and managing to do well overall. We take the bad days in stride and carry on.

We also had Nolan's IEP meeting, which will have its own post (because this one is getting too long)!

On the hearing front, things are looking good. He's only had one infection in the right ear since he had his fifth set of tubes placed in October 2012. His hearing levels were stable, with some improvement in the low frequencies (he had been testing at 75dB in the low frequencies, and he has returned to 60-65dB). We still cannot get aided testing performed, and have had no luck in finding an audiology location that will do real-ear measurements or aided testing. Nolan has some articulation errors due to this issue (he cannot discriminate "sh" from "ch," for example) - the articulation errors are minor and most people can understand him most of the time. He does quite well, despite being aided to only 40-45dB in the high frequencies (aided testing was performed at Buffalo Children's, but they cannot adjust his hearing aids).

 Nolan's right ear improved from 75dB at 500-1000 Hz to 60dB. His left ear, however, decreased from 45-50dB at 2,000-4,000 Hz to 55dB. His right ear drops to severe (70dB) at this level. His ears tend to "catch up" to each other over time. 

Nolan is able to detect spoken sound when it is at a volume of 50-55dB. He cannot comprehend words until they are between 85-96dB in volume. His aided hearing was not evaluated.

We have an appointment with the pediatric specialist in Buffalo on May 22. I am anxious to have the doctor take a good look at Nolan and determine what is causing his leg pain (and hopefully put some of the puzzle pieces together to figure out what is going on with our boys)!

Matthew is still having difficulty with his sleep apnea, and we will see the ENT for his tonsillectomy/adenoidectomy follow-up on June 3. He is on Prilosec and hopefully that will help with the inflammation in his esophagus/airway. Matthew still struggles with severe constipation and we saw a GI doctor in Rochester to try and sort the problem out. They believe he struggles with motility issues (in the same way Nolan does, but lower down in the GI tract). He is on an aggressive medication regime in the attempt to get the problem under control. There is some concern that he might have eosinophilic esophagitis (the concern is there with Nolan, too). This is an allergic condition where white blood cells called eosinophils attack the esophagus. This would explain Nolan's weird "exudate" during his last procedure, and we know that Nolan has a high eosinophil level from his biopsy. The high levels were blamed on reflux, but we may have to revisit the issue since Matthew also struggles with reflux and inflammation with motility problems. We won't deal with this potential issue until we get Matt's sleep apnea under control.

The appointments should slow down as summer approaches, and we are looking forward to having things quiet down for a few months! Matthew will require another sleep study, and there is a good likelihood that he will need a supraglottoplasty to trim away the floppy airway that prevents him from breathing well at night. Hopefully this will be the LAST procedure this year!

ENT Appointment, Part 1: Audiogram and Aided Testing

We had a trip to the boys' ENT on Monday, and discussed several issues. I am going to break the appointment up into three posts (by topic) to help keep things short and sweet.

First, I managed to get a copy of Nolan's actual audiogram.

The audiogram has Nolan's bone conduction scores (the brackets), his unaided responses to sound (the x's and o's), and his aided responses (the B's). He has had some fluctuation in his unaided test results, which is typical for Nolan.

The biggest concern is Nolan's aided levels, which are only achieving a mild-moderate level of hearing loss. We have friends with similar levels of loss who are obtaining 20-25 dB aided levels, so this is clearly unacceptable. Nolan is only able to detect the presence of a voice when it louder than 30 dB (with aids on).

In any case, our ENT was not happy with the lack of aided testing and real-ear verification. She also thinks he probably needs power aids, since he has a mixed loss and the conductive component requires more power than a purely sensorineural hearing loss.We have some leads on different audiology centers that may offer better aided testing. I have to make a few phone calls, but it will have to wait until after the boys' surgeries (see parts 2 and 3).

Hearing Test and Audiogram

Yesterday, Nolan had a hearing test at Buffalo Children's. His hearing has been hit-or-miss, and his speech has shown some regression. Nothing serious, mind you, but I still don't like the disappearance of our friends /s/, /j/, /ch/, and /z/,

I don't have his official audiogram in the mail right now, but his unaided test scores are fairly consistent with the October results. His left ear has dropped by about 20 dB at 2,000 Hz, in typical Nolan fashion.

For those who are unfamiliar with audiograms, Nolan cannot hear the sounds above the lines without his hearing aids. Basically, he can't hear any speech sounds at normal conversational volumes. If you shout at him or talk directly into his ear, he can hear enough to make out what you are saying. This is a moderately severe to severe hearing loss.

The reason for his "slushy" speech is more likely due to his aided hearing levels. Obtaining a pure-tone aided audiogram is a tricky business, because digital hearing aids suppress pure-tones as "background noise," which can make the audiogram a bit tricky to interpret. A child may show hearing thresholds of 30 dB across the board, for instance, but really be able to pick up voices at 20 dB.

With that said, Nolan's aided audiogram is terrible. The suppression effect should affect all frequencies equally, and Nolan's results are showing a significant drop-off in the high frequencies. His higher frequencies are not set appropriately for his hearing loss. His aided results are:

Hearing with both ears, Nolan can't really detect f, th, or s with his hearing aids. Z and V are also above the 35 dB line, which explains why he's having difficulty with those sounds. The audiologist noted he couldn't detect her voice until it was at 30 dB with his hearing aids on - essentially, Nolan has a mild-moderate hearing loss even with his hearing aids on.

I did ask about his bone conduction results and whether the BAHA could be an option for him (to eliminate some fluctuation and to give him better hearing). The audiologist stated that the sensorineural component of his hearing loss is too severe for a BAHA, so he is not a candidate for that technology.

His hearing loss isn't severe enough for a cochlear implant, so he doesn't qualify for that technology, either.

Since Buffalo Children's does not have a hearing aid program, they can't adjust Nolan's hearing aids. Since Nolan's current audiologist does not believe in aided testing, she won't adjust Nolan's hearing aids.

Buffalo Children's was very surprised that our current audiologist does not do real-ear measurements, as this may be part of the problem. The DSL program that sets hearing aid amplification levels is based on a set of averages, but is not specific to an individual child's ear canal size and hearing loss type. With a mixed loss, Nolan likely needs more amplification than a child with a purely sensorineural loss.

And then there is the problem of  recruitment and a narrow dynamic range. Recruitment is a problem for people with severe losses. All of the outer hair cells are damaged, so only the inner hair cells remain to transmit sound in the cochlea. There is no gradual increase in the perception of volume - a sound goes from being inaudible to being WAY TOO LOUD very quickly. This makes setting hearing aids particularly difficult, as the level of amplification needed to make a sound audible is very close to the level which causes pain.

So the hearing aid program must be compressed to fit into this narrow range of hearing - the range between audibility and pain. We may not be able to increase his amplification by much, because it would cause him discomfort with sounds that are too loud.

Rock, meet hard place.

Other than the slushy speech sounds, however, Nolan is doing well - so we'll just repeat ourselves more often, use the FM more consistently, and monitor his hearing to see if (when) he qualifies for different hearing technology.

July 2012 Audiogram

I got Nolan's report in the mail. Most of the frequencies were fairly stable, though he lost a considerable amount of hearing at 4,000 Hz in the right ear. His hearing at 8,000Hz also dropped by 10dB in that ear (I'm less concerned about that frequency because it isn't really in the main speech frequencies).

Here is his latest audiogram:

He can't hear anything above the red and black lines (without hearing aids). This basically means he cannot hear any speech sounds without aids (this is the same situation as his last audiogram - kids who hit the moderately severe level are usually completely below the coveted "speech banana").

His speech discrimination (closed-set, WIPI) dropped from 100% at 80dB to 80% at 80dB. I managed to get aided discrimination at 50dB with the same WIPI cards and he scored 96% using both ears in a soundfield (while wearing hearing aids).

His bone conduction scores are showing less of a gap than they used to show - a 15dB gap between his better-hearing ear and the bone conduction values. His loss is predominantly sensorineural, though there is obviously some small conductive component at play. The bone conduction at 250Hz is generally disregarded because it is vibrotactile - kids feel rather than hear bone-conduction tones at this frequency.

His hearing has been slowly progressive. I put all of his audiograms together and made a short video out of them, to show the progression over time. There is a significant change from birth, but the progression is very slow.



You can see the amount of lost hearing (summary) in the audiogram below. The blue line is from his first behavioral test at the age of 8 months, and the red/black lines are from his test last week. The lost sounds are highlighted in pink - he has a very slowly progressive hearing loss, but the sounds he has lost are significant (they include ch/sh, r, and k).

Visit to Seneca Lake and a Hearing Test

Dennis's parents visited this week and we took a trip to Seneca Lake (one of the Finger Lakes). It was so beautiful, and the boys really loved playing on the playgrounds, hiking through Watkin's Glen, and driving the pontoon boat. Nolan's most favorite activity was driving around the lake.

We loved our vacation, though once it ended the spate of July medical appointments began. Nolan had a hearing test on Friday, July 6. He had been stable for a year, so I was hopeful we'd see the same audiogram we saw in December. If he was still stable, then we would be able to go to once-per-year hearing tests.

Unfortunately, his right ear decided to drop down to 70dB at 4,000Hz. This explains where his /s/ detection went! I can't remember his actual new audiogram, so the picture below is just an estimation. I'll post the "real" audiogram once I get it in the mail. His right ear used to be the "better" ear, but is now the "worse" ear. The black line is what he was able to hear in December, the red line is his approximate new hearing level:

This is a 15dB drop at that particular frequency, which is where f, s, th, and the softer sounds of speech are found. This is typical for Nolan, and usually the other ear drops to match the worse ear in a matter of months. His unaided speech discrimination dropped from 96% to 80% in that same ear, at a 90dB volume. His left ear is currently unchanged.

This was a bit of a bummer, but his hearing aids have been reprogrammed to match his current level of loss. I did manage to convince his audiologist to do aided speech discrimination. The current recommendation is to do aided discrimination at 55dB and at 35dB, as children won't "overhear" incidental language if they can't perceive soft speech. I didn't get any data at 35dB, but our audiologist did do aided discrimination at 55dB. With both hearing aids, Nolan has a wonderful 96% discrimination at 55dB (via sound field, using both hearing aids).

On the bright side, his "dead" hearing aid slowly came back to life. I simply kept running it through the Dry and Store, changing out dry bricks, and it began to give its feedback whistle again. For the first few days, it would cut out after an hour or two, but after about four days in the Dry and Store, it was "back to normal." Our audiologist checked it and it was right as rain, so that is a HUGE relief. We have been using Ear Gear ever since, just to protect them from humidity and sweat.

Since Nolan has decided to show some progression in his hearing level, another hearing test has been scheduled three months out from this one: he'll go back into the booth on October 8 to determine if his right ear is going to stay at 70dB and to watch his left ear - since it is likely to drop to the level of the right ear, too.

We also discussed new hearing aids. Nolan's Unitron Element 8's are still working, though we are having more frequent maintenance issues with them. They are also not as "up to date" as other hearing aids. I would really like to get Phonaks for him, because I am in love with his FM system. Phonak also makes water-resistant hearing aids that have sound-recover technology.

The hearing aids we're thinking of getting are the Phonak Nios S H2O, though I'm a bit nervous about selecting these because they have a maximum fitting range of 70-75dB hearing loss in the low frequencies. Since Nolan is already sitting at 65dB there, there is a great likelihood that he will "outgrow" the ability of these hearing aids to amplify his loss. When Nolan loses hearing, it tends to be 15-20dB in a single frequency, and the affected frequency is unpredictable. The Nios S can handle the high frequencies well (up to 90dB HL). I'm just a tad concerned about the low frequencies - I'd hate to get this hearing aid and then wind up needing a Naida (power aid) 2 years later. We'll see what his hearing does over the next few months and make our decision from there, I suppose!

The Phonak Nios S H2O 

July 2011 Audiogram

Sailing was a success - we went out on the lake and had a great time. Nolan's hearing aids stayed at home, but he did fairly well on the boat. We explained that he had to sit tight on the boat (we don't have a motor, so we use the sail as our sole means of power). If you have never sailed, it requires a bit of activity when tacking (going back and forth) - the occupants have to switch sides so that the person in control of the main sheet can control the sail. Fortunately, neither boy weighs enough to affect the balance of the boat - they were able to sit tight while Dennis and I darted back and forth across the boat. The wind did die down, unfortunately, which meant we had to drop sail and row back to the dock (the lake looked like a sheet of glass - never a good thing in a sail boat)!

I did get Nolan's most recent audiogram in the mail. His bone conduction is still slightly better than his air conduction, but there is no chance that his loss is conductive. His best bone conduction scores were at 40dB at 500Hz (this means the sensorineural portion of his loss is moderate). His actual hearing level is moderate severe, with his hearing at 55-65dB in all frequencies.

His (unaided) speech detection thresholds are 45dB for the right ear, and 50dB for the left ear (this is the level that he can detect speech is present).

They also performed a word recognition task: Nolan was able to identify 88% of the words in his right ear when the speech was presented at 85dB volume. He was able to identify 92% of words in his left ear when the speech was presented at 90dB volume. This testing is done using Nu-CHIPS, a word recognition hearing test designed for preschoolers. Basically, about 40dB of volume is added to the child's speech awareness thresholds, and words are presented at that level.

Nolan's word recognition is pretty good at the 85-90dB presentation level. Remember, of course, that 85-90dB is MUCH louder than typical conversation: he can't even detect speech is present at normal conversational volumes. Essentially, he can understand words without his aids when you bellow at him. That residual hearing is useful for sailing and other water sports, however, when he doesn't have his aids in!

His audiogram looks identical to the one in June. He can't hear the sounds above the line (unaided), he can hear everything below the line. Both ears are identical in hearing level.

Newest Audiogram

I received the report from Nolan's most recent hearing test in the mail today. The results look remarkably similar to the test results from Buffalo Children's last November, but they are still a change from the last hearing test at our normal audiologist's office (particularly for the left ear). The low frequencies are still a mixed loss, but everything above 1000Hz is sensorineural. His bone conduction scores have dropped by about the same amount that the air conduction scores have dropped, which indicates that the small new loss is sensorineural (inner ear loss) in nature.

For those who aren't familiar with audiograms, Nolan can't hear anything above the plotted lines when his hearing aids are off. Basically, he can't hear any speech at normal conversational levels with his aids off, though he can hear things like rock music, lawn mowers, and other loud things. With his hearing aids on, he gets most of what lies in the middle frequencies, but still misses out on the high and low frequencies (hearing aid adjustment issues).

Thankfully, the worst hearing is at 65dB (I thought I had seen a 70dB mark on the audiogram in the office, but he is still just moderately severe in the low frequencies).

His speech reception thresholds changed from 40dB in each ear to 45dB (right ear) and 50dB (left ear). His hearing aids are still set for a mild loss in the high frequencies, which explains why John Tracy was showing under-amplification in those frequencies. He has lost a bit in the low frequencies, too - he seems to lose a bit at one frequency (or in one ear), and the rest follow suit shortly thereafter. Fortunately, it is a very slow loss - it has taken almost four years to go from mild/moderate to moderately severe.

We will return on July 5 to confirm the level of loss and (finally) adjust his hearing aids to match the loss.

Audiology Report from Buffalo Children's

I received the official audiology report from Buffalo Children's audiology department. I am impressed it arrived so quickly! It states that Nolan has a moderately severe mixed hearing loss, has patent PE tubes (i.e. his middle ear ventilation tubes are working very well), and that he is an absolutely amazing kiddo. But we already knew that.

Since my friends/family are probably addled by all the charts, I'm going to explain Nolan's results- so my hearing loss bloggy friends can stop reading now. I'm pretty sure all of you are all too familiar with audiograms! Also, this will be boring. Fair warning.

For those not as familiar with an audiogram, it is a graph displaying "frequency" across the top. Frequency is pitch- it is like a piano keyboard rolled out in front of you. Middle C is at 250Hz, which is the lowest useful frequency used for human speech. 8000Hz is very high pitched- think of a shrill whistle (or the higher pitched sounds like "s" and "th").

The volume is placed down the side of the audiogram. It is recorded in decibels (dB)- children with normal hearing can hear from 0-15dB (adults with normal hearing can detect sounds from 0-25dB). A whisper is at about 30dB, conversational speech is at 55-60dB, and jackhammers are around 100dB.

I have placed Nolan's hearing levels onto an audiogram which has the sounds of speech placed onto it. Nolan's right ear is red, and his left ear is blue. He cannot hear any sounds above the lines. In other words, he hears almost no speech sounds without his hearing aids. He can hear shouting, dogs barking, and other loud sounds.


Audiologists like to know what is causing the hearing loss, so they test both the inner ear (how well the delicate hair cells in the cochlea are working) and the middle ear (the mechanical portion of hearing). The middle ear bones vibrate and transmit sound to the inner ear, and the inner ear hair cells move and transmit the sound information to the auditory nerve. If either system is "broken," sound will not get through to the brain. Problems with the middle ear are generally correctable, if the problem is caused by middle ear fluid or a malformed middle ear bone. Problems with the inner ear are not correctable.

A problem with the mechanical, middle ear function is called a "conductive hearing loss." A problem with the inner ear is called a "sensorineural hearing loss." Conductive hearing losses are treated with surgery to correct the problem, or hearing aids if the problem is not correctable. Sensorineural hearing losses can only be treated with hearing aids (or cochlear implants for severe-profound levels of hearing loss).

They test the "middle ear system" by placing a vibrating sound system on the head, called a bone oscillator. This sends sound directly to the inner ear (cochlea) and bypasses the middle ear. If there is a problem in the middle ear, this type of testing will show the true hearing ability of the inner ear.

They tested Nolan's middle and inner ear systems, and found the following:

The black line shows that when they bypass Nolan's middle ear system, he hears better than when they play sounds through headphones. This means that a portion of his hearing loss is due to a mechanical problem with his middle ear bones. The other part is due to inner ear hair cell damage.


This type of hearing loss is termed a "mixed hearing loss." In Nolan's case, nothing can be done to fix the conductive portion, since we don't have a cause for it. His mechanical problems are not caused by fluid, since he has functional tubes in his eardrums. It is likely that his mechanical sound transmission problems are caused by stiffened middle ear bones- the result of chronic infection. This is why ENT's are very aggressive in treating middle ear infections in children with pre-existing hearing loss. Even though our ENT has been right on top of Nolan's hearing loss and ear infections, damage has been incurred. Hopefully the new, spiffy "permanent" tubes will prevent further damage to his middle ear system.

In the meantime, Nolan has yet another cold with a fever- hopefully this will disappear in time for his pH probe on Monday. I am ready for summer to arrive and these nasty germs to disappear!

And We Have a Consensus

With Nolan in a cooperative mood, we set out for Buffalo Children's this morning. With the sun shining, a good night's rest, and some blatant bribery, he made it through an entire hearing test. The audiologists at WCHOB were very impressed with his skills in the booth- I don't think they see a lot of kids who have an auditory-verbal background, since listening and hearing test skills are integrated into the therapy we do with Nolan. While we are not a true AVT family (there is no actual AVT center around here), we incorporate as many of the "learning to listen" skills as we can into our therapy.

The result of the testing indicates that Nolan does NOT have a purely conductive loss. His hearing levels are currently a mixed, flat moderately-severe loss. This is fairly consistent with the most recent audiogram obtained at Buffalo Hearing and Speech Center.

Guesstimate Audiogram-
I don't really have a photographic memory.

This is good news, because it means that the sensorineural portion of his hearing loss is stable. This also means that the hearing loss detected at birth was sensorineural or mixed in nature, and not conductive. A bone anchored hearing aid is not appropriate or advisable in Nolan's case, so we can wipe that option off the table.

Unfortunately, he has lost hearing since birth. As it stands now, he cannot hear sounds softer than 60dB. All of the additional loss, however, is of a conductive nature. This means that there is a maximal point of progression, since conductive losses can only add so much to a sensorineural hearing loss.

There is a good chance that Nolan's low frequencies were a mixed hearing loss at birth (he had a 50dB loss in this region, even before he had any ear infections). The current theory is that his loss has progressed due to tympanosclerosis (thickening of the ear drum) and some stiffened middle ear bones from chronic ear infections.

We do need to get a "tune up" on his hearing aids, since they are programmed for a 30dB loss in the high frequencies and he currently has a 60dB loss in this region. The conductive portion of his hearing loss is not "fixable," since it is not due to fluid build-up or other reversible causes. Hopefully the new permanent tubes will prevent further infection and damage to his middle ear system!

Getting Ducks in a Row

Nolan's "third site" hearing test is scheduled at Buffalo Children's (WCHOB) on Wednesday. People often ask why Nolan is underamplified, and there are a few reasons for his amplification difficulties. One reason is that his hearing levels fluctuate- his high frequencies have been anywhere from mild to moderately severe (currently at moderately severe). When his hearing dips, the amplification is insufficient to get him above the speech banana in the high frequency ranges. This is the reason that he has completely lost his high frequency sounds, and can only hear them with an FM system (his aided thresholds are in the moderate range in the high frequencies).

The other reason is that part of his hearing loss may be an idiopathic conductive hearing loss. Conductive hearing losses often take more power than a sensorineural hearing loss, and the DSL programs for programming hearing aids are based on sensorineural hearing loss parameters. In other words, Nolan's hearing aids aren't programmed appropriately due to the recently discovered nature of his loss. Without aided audiograms (our current audiology clinic refuses to do them), we are not able to get his low frequencies set to the right levels.

As a recap, we have had several different results for Nolan's hearing levels. We obtained Nolan's first bone conduction scores back in May of this year (this should have been performed with his newborn ABR testing). At the age of two-and-a-half, this is what his audiogram looked like:

His air conduction scores were in the moderately-severe rising to mild category. His left ear was the better ear. His bone conduction score was a rising configuration, indicating that his cochlear (or sensorineural) loss was consistant with his newborn ABR testing.

Then we went to John Tracy, and the testing there resulted in this audiogram:

The testing obtained at John Tracy indicated a conductive loss for all frequencies below 2000Hz, and a sensorineural loss 2000Hz-4000Hz. In other words, his cochlear hearing loss is in a traditional sloping pattern. The conductive hearing loss in the low frequencies will require more power to obtain access to the speech banana. It is interesting to note that the left ear (which was mild in May) shows a moderately severe air conduction threshold, with no appreciable air-bone gap. In other words- his high frequencies have a fluctuating sensorineural hearing loss. We have seen his hearing levels go up and down in this frequency range over the past two years. His low frequencies are conductive, but relatively stable.

With such different test results, we returned to our current audiologist in Buffalo to repeat the bone conduction testing. We achieved these results:

I used the air conduction thresholds obtained in May, since we didn't get any air conduction testing run. The bone conduction testing in August demonstrated a conductive loss at 500Hz (consistent with John Tracy), and a mixed loss at the other frequencies.

With three different bone conduction results, we need to get a "referee" test to determine which is the most accurate. The audiology department at WCHOB will be running bone conduction, air conduction, and hopefully aided testing.

Hopefully, with a proper hearing loss diagnosis, we will be able to manage his amplification better and will have a clearer picture of how his hearing loss fits in with his other medical issues. Unless, of course, we get yet another "different" hearing loss picture- hopefully the WCHOB results will match the John Tracy results or the original Buffalo results. Then we can find someone to take Nolan's declining articulation scores seriously and get his amplification set to appropriate levels.

We really want to get his plurals back!

On Conductive Hearing Losses

In many cases, conductive hearing losses are caused by earwax or fluid in the ears. This condition is both temporary and easily remedied (with wax removal or pressure-equalization tubes to allow the fluid to drain).

Since Nolan was discovered to have a large conductive component to his hearing loss (the frequencies from 250Hz-1000Hz have a large air-bone gap), I have been trying to figure out what could cause this component. It is not caused by fluid, infection, or any other temporary situation. It has been there since birth, and has not improved with the insertion of PE tubes. In fact, it has only gotten worse or fluctuated over time. In addition, he has had several hearing tests with type A tympanograms (no fluid), which demonstrate a hearing loss with a clear middle ear space.

With some research via Dr. Google, I have found a few causes for air-bone gaps (conductive hearing losses) in children. They include:

• Ossicular malformations (the middle ear bones are malformed). Nolan's CT scan at the age of six months states: "Bony ossicles are well formed. Middle ear cavities and mastoid air cells are clear." The CT scan rules out any malformation of the middle ear bones.
• Atresia. This means the external ear canal is not formed and prevents the transmission of sound to the eardrum. Nolan does not have atresia.
• Congenital cholesteatoma. The MRI and the CT scan did not indicate any cholesteatomas present.
• Fixed stapes or malleus (middle ear bones). Usually identified on CT scan- Nolan's CT scan was unremarkable.
  

Of course, Nolan doesn't just have a conductive loss. He has a moderate sensorineural hearing loss from 2000-4000Hz. So, what could cause a congenital hearing loss consisting of both sensorineural and conductive components, which fluctuates over time?

• Enlarged vestibular aqueducts: there is often a low frequency air-bone gap in children with EVA. Nolan's CT scan report states, however: "Vestibular aqueducts are unremarkable." So it is probably not that.
• X-Linked Stapes with Perilymphatic Gusher. This occurs only in boys and causes a fixed stapes, which cannot be repaired because a "stapes gusher" will occur and the ear will lose all hearing. This is a mixed hearing loss profile, but is typically severe-profound (Nolan is moderately severe).
• Otosclerosis. This is rarely encountered in children, and is extremely rare in congenital form. This is also visible on CT scan, and Nolan's CT scan was normal.
  

I can't really find anything else that would cause Nolan's hearing loss profile. In any case, we either have an idiopathic conductive hearing loss and an idiopathic sensorineural hearing loss, or the two are related and Nolan's CT scan or MRI failed to show the problem.

I plotted his thresholds over time, excluding any tests with middle ear pathology (all scores below are with either type A tympanograms or patent PE tubes). Anyhow, you can see the fluctuation in his air conduction scores over time- something our ENT and audiologist have never really paid attention to:

Left Ear

Right Ear

Audiograms

Here is Nolan's aided audiogram from John Tracy, transposed onto an audiogram with a speech banana. We sort of wondered where /f/ went- I suppose it disappeared because he can't hear it. The magic box shows that the aids aren't meeting DSL targets, either.

Here is his unaided audiogram, with bone conduction scores. Currently, his right ear is testing better than his left. The shaded yellow area represents the air-bone gap, indicating a conductive component to his loss. The frequencies above 2000Hz do not show an air-bone gap, indicating the loss in that region is purely sensorineural.

Official Audiogram and Information for John Tracy

I received the packet of Nolan's hearing tests/hearing aid settings in the mail today. This is the last documentation required for John Tracy's Summer Session, so I am pleased to have it! I am going to make a photocopy on Monday (so that we have a copy in case the other one gets lost) and then mail it to the Clinic.

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.

Pump Up The Volume

The boys at the Buffalo Zoo

We had a successful hearing test today, which was nothing short of a miracle considering Nolan's recent state of mind (hint: it is not "cooperative"). Many things that could have gone wrong DID go wrong on this trip, but we still pulled off a good hearing test.

I showed up late for the appointment- for some reason I had written down the time as 10:00am, when the appointment was actually for 9:30am. Well, at least I had the right day this time! Of course, this gave Nolan less time to adjust after a two hour car ride. We all know how much he loves cars.

I was "in solo parentis" today, so I had both boys when I escorted Nolan to the audiology booth. Our wonderful audiologist reached over to remove Nolan's hearing aids, and he howled in indignation. I might have forgotten to note that Nolan has become a wee bit "attached" to his aids. In that no-one is allowed to touch them, or he goes berserk. He lets me remove them, of course, but he freaks out if anyone else gets near them.

Luckily we used his earmolds as the inserts for the hearing test, so he was happy once they were back in place. He wouldn't touch the picture cards for the speech reception threshold test, though. For those who aren't familiar with hearing tests, they use a certain set of words (snowman, bathtub, toothbrush) and present them at various levels. Nolan wasn't going to perform this task, so we invited Matt to the table to see who could "win" the pointing game. With a little competition spicing things up, Nolan decided to cooperate!

We were afraid to move once Nolan was happy, lest we set off the tear-fest again. Matt and I sat on the floor near the play table and I tried to keep Matt absolutely quiet. Those of you who have four-year-old boys know what a difficult task this is- let's just say there were many whispers of, "If you want to go to the zoo this afternoon, stay quiet!"

The testing was completed after about half an hour. We didn't get bone conduction testing done, but his tubes are patent and functioning. His hearing levels are a touch better than the last time we had testing performed, but worse than his levels in June 2009. I can't remember all of the numbers exactly, but his audiogram looks something like this:

His SRT's were 45dB and 50dB, slightly better than the January test, but worse than the June 2009 levels. Essentially, we've eliminated a slight amount of conductive loss, but the permanent loss has still progressed a little in a year. His permanent loss is now categorized as moderately severe rising to moderate (his better ear used to be moderate rising to mild based on the last bone-conduction test).

His audiologist turned up his hearing aids, especially in the high frequencies. They were set for a mild level of loss in the 2000-4000Hz range, and had to be adjusted for a moderate/moderately severe loss in that range, depending on the ear. He does squeal (feedback) a lot more, especially if you get too close to his aids. Knowing that our little guy has more access to sound is wonderful- maybe we'll get those /f/ /p/ and /s/ sounds back!

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!

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!

Official Audiology Report

I received the official audiology report in the mail from Nolan's latest hearing test. Everything looks great, we only had one significant drop in the last six months (at 500Hz for the left ear, by 10dB). Everything else was about the same, a 5dB loss for many frequencies, but this is considered simple variability and not a "true" loss.

They also took a reading at 1500Hz for the first time- 50dB for the left ear and 45dB for the right ear.

Because audiograms can vary by a slight amount, it is good to compare audiograms taken quite some distance apart. So, here is the left ear, with one year's difference:

His high frequencies have remained at the same mild level.

A fluctuation to 55dB at 4kHz was observed in Aug. 2008, but did not stay at that level!

And here is the right ear, with one year's difference:

The right ear has dropped a tad in all frequencies.

The shaded area are the sounds of speech that Nolan cannot hear unaided. Which is pretty much... all of them. He actually can't hear Dennis unaided at a short distance at all, though he can hear me fairly well. My voice must resonate at a fairly high frequency!

All in all, it is still good news because his hearing is helped greatly by his hearing aids. Since hearing ability is calculated by the "better ear," he is moderately severe rising to mild. Pay no attention to the categories on this teaching audiogram, because they have 55dB-80dB listed as "severe." Most terminology I have seen labels this hearing level as "moderately severe," and that is the terminology our audiologist uses.

A Year in Hearing

Happy New Year to My Peeps!

It has been almost a year since Nolan received his hearing aids. So, here is a snapshot of his past year with full access to the world of sound!

January 9, 2008: A mild-moderate loss won't hinder this little guy. Nolan's first-ever hearing aid fitting! Sounds previously unheard by him (such as "p," "g," and "z") are now audible.

February 2008: Pilot caps discovered. These would prove highly useful in the not-so distant future.


April 2008: Babble. Never has "mamama" or "bababa" sounded so wonderful!


May 2008: Due to chronic fluid, we had the first set of PE tubes placed.

June 2008: Nolan stops pulling out his hearing aids. The pilot cap is GONE! Or so we thought!

July 2008: We discover the painful results of another toddler's curiosity. OUCH.

October 2008: The pilot cap returns, to thwart hearing aid removal attempts.

November 2008: A nasty virus necessitates tube insertion number two. The right ear takes a plunge into the severe range, fortunately a temporary loss.



December 2008: The most recent audiogram shows a bit of a drop from the initial ABR. His aids are more than capable of handling his level of loss, and his speech is taking off!

The blue line is Nolan's initial "eHL" from his ABR. The green lines are his current hearing level- his left ear being the better of the two.

Of course, the last day of the year doesn't lack for excitement in the hearing aid department. Nolan's left aid has ceased making the high-pitched sound of feedback. While no one really welcomes feedback, a lack of it hints at some sort of a problem. The batteries are fine, but the aid doesn't appear to be working well. Nolan won't leave it in and thus we are aid-less today.

I look forward to 2009- life with a toddler rather than a baby, a language explosion, and hopefully more compliance with leaving those hearing aids in!