Special Needs & Hearing Impairments

Hi all,

I'm new to the board. A bit of background. My 5-year-old daughter failed two newborn OAE hearing screenings, and then passed a diagnostic ABR at two months. At 10 months she failed a diagnostic OAE test and was found to have fluid in hers a few days later when we attempted another ABR. We went to a pediatric ENT and watched and waited for a few months. When she was 13 months old, we had another ABR, which showed moderate to severe bilateral conductive hearing loss due to fluid (OME diagnosis). She had PET tubes placed at 14 months, and then a behavioral hearing test and ABR one month post tube placement at 15 months, which both showed normal hearing in both ears. She has developed language normally, she passed her four-year-old hearing screening at the ped's office, and can say all of the sounds of the alphabet including /f/, /s/, /th/, /k/, /p/, and /sh/. No teacher in any of her classes from infant daycare to preschool, to pre-k, to kindergarten have ever asked me about her hearing, and they look at me like I'm crazy when I have asked them about it - and I always have because of our early experience with her. So, she has always done well in the classroom and continues to do so in kindergarten - she just mastered her first phonics lesson.

However, she failed her five-year-old hearing screening at her ped's office. I thought it was probably fluid given her history of OME, so I took her to her ped ENT for a hearing test a week after the screening. At that test, she presented with mild SNHL in both ears, although the bone conduction test had poor reliability and the audiologist at that test looked me in the eye and said the bone conduction could be wrong. I freaked and made myself sick for three weeks. I wanted to go straight to an ABR and scheduled one, but the pediatric audiologist at the Children's hospital encouraged us to do an extended booth test instead because our daughter was recovering from an ear infection. She had been diagnosed with an acute ear infection in her left ear the week before the most recent test, and her eardrum perforated and leaked quite a bit of fluid, wax, and debris. Anyway, we did the extended booth test, and she tested within the normal limits in her left ear (as low as 10db for each frequency). However, her right ear presented as a type B ear with a flat tympanogram, and showed slight to moderate - the lower frequencies had the most loss. We got mixed results from the bone conduction test on the right ear - the two lower frequencies tested within normal limits according to the bone conduction, and the two higher frequencies still showed a SNHL at around 35 db. However, the audiologist looked me in the eye and said she thought the results of the bone conduction were due to my daughter's waning attention at that point in the test. She said the bone conduction test had fair reliability. She told me she didn't think we had anything serious to worry about, especially given all of the normal bone conduction tests my daughter had in her previous ABRs, her history of OME and ear infections, and because her language was and pronunciation was age-appropriate. However, as any good audiologist would, she said she couldn't rule out SNHL on those two frequencies in her right ear. She said we should consult with our ENT about tube placements, and then get an ABR at the time of tube placement to either confirm the SNHL or rule it out.

We were very encouraged by this news, and went to the ENT to discuss scheduling surgery. He put the brakes on that, and said he didn't think tubes would necessarily help since he couldn't rule out SNHL in her right ear. He also said he had never seen hearing tests all over the map like our daughter's (not comforting). As a side note, our daughter has never produced OAEs - the audiologist who did her ABRs when she was a baby said she was probably one of the small percentage of people with normal hearing who don't produce OAEs - that audiologist said she was one herself. Anyway, the ENT thought we should do further testing, but wasn't in a hurry - he said we could come back in three months to do a booth test to see if her right ear cleared up, or we could do one in six weeks. He also said the ABR was an option as it was the most objective test, although it's not perfect. He said he wouldn't lose sleep over this if she were his child, but I am losing sleep over it!  She had a mild to severe cold during all of this testing, and she has complained of her ears being clogged, but that blowing her nose while holding it helps her hear better. He said that while he couldn't rule out SNHL in her right ear, he thought she probably had eustachian tube dysfunction.

I'm leaning toward having the ABR done - our daughter has been sedated numerous times and has done fine with it. And I feel that we will be able to get the most reliable bone conduction results given that during the two prior booth tests the bone conduction reliability was not good due to her attention waning and/or her pulling measuring instruments off her head. My husband doesn't want to sedate her though. What test would you do if it were your child, and if there are any audiologists in the group, I would love to hear from you too. On a side note, since my daughter's eardrum burst, she definitely seems to be

Many thanks,

Beck

Welcome!  First off I'm sorry your daughter is going through this right now, and that you are having difficulties getting answers!

"On a side note, since my daughter's eardrum burst, she definitely seems to be ..."  could you finish your sentence!  LOL

I am an audiologiest (just not working right now).  I empathise with you about getting answers.  Children don't always co-operate the way we want them to, especially when it's important!  I also understand your dh not wanting to sedate her.  Do you think she could lay still there for 30mins...maybe sleep?  If the answer is NO then an ABR is not a good choice right now.  I would urge you to get another audiological test done (make sure they are pediatric audiologists!!).  I would also ask  that they test her on 2 seperate days back to back.  This way they do impedance testing and air conduction testing on the first day, and then bone conduction testing on the second.  This would make it easier for your dd to sit still and not get too ansy because the test is taking so long.  Maybe even bribe her...offer her an ice cream (or something else that gets her to cooperate) after each test if she does well!

In the meantime, if she is suffering from nasal congestion give her some allergy meds or a nasal decongestant (from the pharmacy) to help dry out the nasal passages, and help dry out the middle ear. If she does have eustachian tube dysfunction, there's not much you can do.  What I have recommended in the past is to get your child to try and blow up a balloon.  I realise that it's hard, and you may have to start it, but the blowing action can open the eustachian tube and help introduce fresh air into the middle ear cavity, thus helping in draining and drying out. 

Hope this helps.  Keep us posted on the outcome.  If you have any more questions fell free to ask away!

Hi Maria,

Thanks for the welcome and the response!

Sorry about my unfinished sentence. What I meant to say is that since my daughter's left eardrum burst and drained so much fluid, she definitely seems to be hearing better. She's saying "what" a lot less (although she still says it some) and can watch the television at a lower volume without complaining. Still, I sense something is off since her right ear probably still has some issues (hopefully only temporary conductive issues, but you never know). She seems to have more problems when my husbands talks softly than when I talk softly, which doesn't make sense to me if her potential SNHL loss is on the two highest speech frequencies, but I'm not an expert.

There is no way she can lie still and sleep for 30 minutes without being sedated. I'm fine with her being sedated as she has been through three sedated ABRs and one tube surgery and done just fine with it. All of the audiologists who have tested her are pediatric audiologists working either for my city's children's hospital or her pediatric ENT and/or both - her pediatric ENT is part of a University hospital which partners with the Children's hospital here, so we're seeing the best people. I have been in discussions with the two audiologists who are following her case. One thinks we should do another booth tests beginning with the bone conduction test in the right ear, the other thinks a sedated ABR will provide the most reliable results for bone conduction and everything else. So, we have debating audiogists on our hands. I guess what I don't understand is if the ABR is used to either confirm or rule out a SNHL diagnosis, then why go through the booth testing if bone conduction results have been unreliable due to behavioral issues in two previous tests?

Anyway, my husband and the pediatric ENT want to try another booth test (nobody has mentioned doing them on back-to-back days though), and if anything is abnormal, then we go to an ABR to confirm or rule out SNHL. So, I guess that's what we'll do, despite the fact that it makes my stomach turn thinking of another booth test. I'm hoping her right ear failed the last test because she had a type B ear and nothing else, but it's a real possibility she has a mild loss on the two higher frequencies in her right ear.

Another question for you, would you typically aid with amplification a child who has a mild (35 db threshold) unilateral hearing loss on the two highest speech frequencies if the rest of the affected ear tested in the normal limits? Can hearing aids be programmed to aid on a frequency by frequency basis? Or would an FM system in school be the best option? Or just monitor as she's doing great in kindergarten right now and doesn't seem to be missing anything at least according to her kindergarten teacher. I know I'm getting ahead of myself, but I am just trying to get as much information as I can.

Thanks in advance for your response and also for the advice re: decongestants!

One more thing - there's no treatment for eustachian tube dysfunction? Our ped ENT that he has treated it successfully with tube placement.

Beck

Hey!  Aiding a unilateral loss is tricky.  When you say she doesn't hear in the 2 highest frequencies, do you mean at 2000Hz and 4000Hz, or 500Hz, and 250Hz?  If the loss is from 250-500Hz then this is probably due to the fluid. If the loss is at 2000-4000Hz then this is probably nerve damage, and won't get better with ear drainage!

As for hearing aids.  I think I would hold off on the hearing aid.  Although aids can be made to  only amplify certain ranges (they can be programmed that way) since she is doing well in school right now I don't see a need.  If she does start to complain she can't hear the teacher well, and/or is missing info, then an FM system would be a great option.  You can also check with the audiologist about trying an aid.  I think there are still hearing aid companies out there that have a 30-60day money back guarantee....sort of a trial period!  You just have to pay for the are mold and impression.  This way you could "see" if the aid is helping or not.

Good luck, and keep usposted!

Maria,

Thanks again for your responses. The last bone conduction test she had performed indicated that she had a mild SNHL loss in the 2000 - 4000 Hx frequencies in her right ear - the bone conduction marks on the audiogram were at 40 db on those two frequencies. However, the audiologist told me she didn't think that part of the test was reliable because my daughter had stopped cooperating/paying attention to the testing (e.g., attempting to pull the measuring instruments off her head). It was at the end of a two-hour booth test (we did have a few breaks during it). So, we really don't know at this point if she hears at those frequencies when her ear is clear - it had a flat tympanogram the day of the test.  That's why we need to do another test, and are trying to determine the most reliable test to conduct. From an anecdotal perspective, my daughter says she hears my watch ticking when I hold it up to her right ear, which from the speech banana looks to be about 30 db in the 2000 Hz range, and she said she couldn't hear that sound the day of the test, but I know that's not a reliable indicator either.

So, we're just going to test again. It seems like even if she does have mild SNHL on those two frequencies in one ear, it will be minor problem since she has normal hearing in her left ear, but I also know even mild unilateral loss can impact classroom performance, so it will be something we will need to monitor regularly if she does end up having SNHL in that ear.

I'll let you know when we have more test results. I do know that I will push for PE tubes if it all turns out to be conductive because there's no point in her suffering from hearing loss (even if it's mild and conductive) if she doesn't have to, especially given her history of OME.

Thanks again,

Rebecca