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.

Exactly One Month And Counting...

We are officially in "countdown mode" for our John Tracy Clinic session. In exactly one month, we will board our plane and fly off to sunny Southern California for three weeks of education and fun!

I am still waiting for our audiology report from Nolan's most recent hearing test, and for the rest of the audiological information requested by the John Tracy Clinic staff. Our audiologist has been on vacation, and I am sure the requested materials will arrive soon.

We are still sorting out the logistics of our stay. Matthew is too young to attend the sibling program offered by John Tracy, so he will stay with his grandparents. Fortunately for us, both sets of grandparents live within two hours of the John Tracy Clinic! Matt is only four, though, and we felt three weeks would be too long for him to go without a parent present. Dennis will stay part-time with Matt, and part-time with Nolan and me in the apartments near John Tracy.

I will not have a rental car for the three weeks, so I won't be able to drive anywhere during the week. With family so close, however, I am sure people will come to visit over the course of the session. We also get out at noon every Friday, so we are plotting many fun adventures for the weekends!

Our three weeks will be very full of experiences. We fly out on Dennis's birthday, so that Saturday will be filled with travel, checking into the Annenberg Apartments near John Tracy, and a birthday dinner. Our general plan for Sunday includes leaving Matt with my parents (if they are free, of course) and having Dennis drive Nolan and me down to the John Tracy orientation. We can both attend the orientation, and then Dennis can drive back "home" to stay with Matt and his parents overnight. Nolan and I will be on our own throughout the first week, but family will come and pick us up on Friday.

The next weekend (July 16-18) is "Disney Delight," and I plan on booking a hotel through hotwire or priceline. We want to do Disneyland and California Adventure, and I am sure extended family will join us on our outing. I can't wait to see Nolan's face when he sees his beloved "Mitty Mouse."

The toughest part of the trip will be the separation of our family unit over the three weeks. The opportunity is priceless, however, and I cannot wait until we embark on our learning adventure!

General Update, Or In Which Nolan's Tonsillectomy Has Amazing Benefits

People have been asking if Nolan is three lately. This wouldn't normally be a striking question, since he will be three in a little over two months. Earlier this winter, however, we had been asked how many months remained until he turned two.

Nolan isn't really very short, but his "toddle" run and low weight made him look a tad younger than his true age. He was also tired much of the time, so we had to carry him a lot- adding to the age confusion.

Three months ago, we couldn't walk the length of the mall without Nolan crying and falling to the ground, too tired to go on. I actually had visions of carrying a five-year-old Nolan on my hip to the bus stop, because he literally couldn't walk more than 100 feet without collapsing in exhaustion.

Then he had his tonsillectomy and adenoidectomy this April. I expected a reduction in snoring and better breathing. We had hoped for better sleeping. We did not expect the sudden burst of energy and general health following the procedure. Nolan's post-tonsillectomy health improvements include:

Weight: While we were at the vet's office, I decided to throw the boy on the scale. It was accurate for our cat, so I'm pretty sure it was accurate for Nolan. The reading? Twenty eight pounds. Twenty eight pounds. Less than a year ago, he was nineteen pounds. This is some major weight gain, folks. If the vet's scale was accurate, he's now in the 20% range for weight. Much of this improvement was made with the Nexium, but the tonsillectomy seems to have added some benefit to his appetite. We have discontinued the DuoCal, and he is eating food without calorie supplementation.

Energy: Nolan has become, frankly, a bit of a terror with his energy level. Running laps around the house, running ahead of us in the mall, racing his brother in the driveway... doing what a typical two year old should do.

Height: Nolan's height was never much of a concern, but it had stalled out and dropped from the 80% to the 10% mark. He is growing again, and is now almost 36" tall. We're happy to see him climbing the charts and outgrowing his size 24 month shirts!

Happiness: While his screaming/crying episodes are not completely gone, they are greatly diminished. It is a rare morning that we have an hour of "inconsolable Nolan." His general happiness is improved.

Sturdiness: Perhaps because he is running more, his legs seem a bit more sturdy. He doesn't fall as often when he runs, and he seems less "loose" in his stride. This is probably a result of better muscle tone, since he is running around a lot more with his increased energy.

We are absolutely thrilled that Nolan is doing so amazingly well. You may have noticed that I didn't include "sleep" in the benefits- "sleep" seems to be a mixed bag. Since the tonsillectomy (2 months ago), Nolan has slept through the night six times. This is good, because it is approximately six times the number of nights he has slept through since birth. It is not, however, the improvement we had hoped for.

He also still snores, and has some noisy daytime breathing. We're not sure what to make of that, but the sleep study in August will give us more information on whether he is having any apnea. Judging by his increased energy levels, his quality of sleep must be improved (even if the quantity is not greatly improved). His nighttime wakings may also be a product of his severe reflux, so we're trying not to read too much into his nighttime capers.

If we had known a simple tonsillectomy/adenoidectomy would have had this much effect on Nolan's well-being, we would have been much less worried about having the surgery done. Here's to more energy and more growth from this point forward!

Nature Books

Summer is in full reign here, with preschool ending this week and more free time on our hands. With everything in full bloom and green plants growing everywhere, I decided to take the boys on a nature walk. I figured we could make our experience books, and learn about local plants along the way. Buckets in hand, we headed down the street to the empty lot "Magic Forest."

I let the boys select whatever struck their fancy- keeping a careful eye out for poison ivy. They gathered rocks, flowers, leaves, grass, and sticks. We headed home, and used crayons to make impressions of our materials. The flowers were too three-dimensional to do impressions, so we painted them and pressed them to paper.

I cut out the impressions, and we made our nature books.

Nolan was able to do some of this project (collecting the items, gluing, and painting). I had to do the cutting for him, though Matt was able to make his book with almost no help from Mom.

There was a lot of language learned today: various flower names (we actually found Forget-Me-Nots and Chickory in the empty lot), tree types (pine vs. deciduous), and rock characteristics (color, and whether it was shiny or dull).

The kids always want to keep things they find on our nature walks, and this way, they can!

Speech Sample, 33 Months: In the (Play) Kitchen

Nolan spent much of today making me "coffee" in his play kitchen. His imaginative play has really blossomed lately!

Starting the Process for Obtaining a FM Sytem

Hearing in a noisy environment

Background noise is a real difficulty for children with hearing loss. The average background noise level in a classroom is somewhere in the neighborhood of 50-60dB. Considering Nolan's average hearing ability is at this level, picking the teacher's voice out amongst the din can be a difficult chore. Essentially, the signal-to-noise ratio is not high enough for Nolan to hear the teacher above the background noise.

For children with normal hearing, background noise is a problem. Many schools have placed sound field systems in classrooms to help raise the teacher's voice above the general noise level. For children with pre-existing hearing losses, a personal FM system is more appropriate. The FM system works with Nolan's hearing aids to give a much better signal-to-noise ratio. The teacher wears a wireless mic, which sends her voice directly into Nolan's hearing aids- it is as if she were only inches from his ears, rather than across the room.

Originally, we had planned on waiting until universal pre-kindergarten to request the FM system. Watching Nolan in his preschool classroom, however, shows that he is not hearing well in a group setting. He is disinterested in the stories during circle time, and wanders randomly. When a visiting youth pastor came to read a story, his loud, booming voice kept Nolan's attention. For the first time since starting preschool, Nolan was on the edge of his seat, listening to the story. For the first time, he could hear the story.

We decided to lobby for the FM system for next year. It won't be easy- it can be hard to convince school personnel with budget constraints that this equipment is necessary for Nolan to have equal access to the curriculum.

Our speech therapist wrote about background noise issues in her recent report on Nolan's language scores. I spoke to our audiologist, and she sent us a letter in support of the Phonak Inspiro FM System (which works with Nolan's brand of hearing aids).

We have our first CPSE meeting in two months, and we are hopeful the documentation trail will support our request for the FM system!

Preparation Pays Off

All of our activities related to our Pittsburgh mini-vacation definitely paid off- Nolan was highly interested in the sights and sounds of the city.

The actual Duquesne Incline turned out to be far more exciting than the chalk version, to Nolan's great delight.
If Pittsburgh rocked his little world, I can only imagine what California is going to do for him!

Countdown to John Tracy: 1 month, 9 days