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Special Needs
carissa_danielle
member
Lurker with another hearing question....
carissa_danielle
member
Hi ladies!
I have been lurking here for a while now, and after reading some of your hearing posts, questions, and comments, I really want to ask another hearing question of you wonderful ladies!
DD#1 will be 4 in May. Her communication skills are that of a two year old. She is just now barely talking in full sentences, still babbles, and her pronounciation of many words are way off. She had tubes put in her ears last fall after a failed ABR. After the tubes were put in, she passed the ABR (she had to be sedated to have it done). After over 6 months, she still doesn't act like she's hearing. She is in a special education preschool, and even they are concerned. They say that she plays well with others and her gross motor skills are up to par with kids her age, but her communication skills are lacking. They can't figure out why. They think it may be something to do with the 8th nerve, but there's nothing to test that until she gets older.
I hope I got this across OK.... I'm worried that there's something that we're missing. Or does it just take a long time for kids who haven't heard very well for the first three years of their lives a long time to catch up? What also worries me is that even the special education preschool is stumped..... Anyone else have a similar situation? TIA!
This discussion has been closed.
Re: Lurker with another hearing question....
The one thing that I have learned is that you have to calibrate your expectations for speech development based upon the time when you know that your LO had complete or good access to sound.
For example, Nate got hearing aids at 3 months and we know they were "working" due to follow-up testing while aided. So now, for all my speech concerns I adjust my expectations by 3-4 months. At one year old I only expected 8-9 month old levels for outcomes. You may need to adjust you expectations in a similar way.
Your DD is old enough now to be booth or even earphone trained for testing. It takes a few tries to get the child to learn to respond. I would followup with a pediatric ENT and get her tested again. Actually, you should be doing follow-up testing to make sure the tubes are still doing their jobs. I believe the ears grow enough and into the correct drainage position by age 7 so you should be following up until that time especially since you and others have concerns.
Just as an FYI, you can check the 8th nerve at any age. The ABR is essentially measure neural firing of the 8th nerve to estimate hearing thresholds. What they must be referring to is a condition called auditory neuropathy in which the cochlea/ outer hair cells are functioning, but the inner hair cells are not. In these kids you can have hearing that is anywhere from normal to profound, but their ABRs are abnormal in all cases. You may think you are seeing a nerve response when it is actually a hair cell response. The only way to check that this is the case is to do an ABR using a stimulus called a click. You then change the polarity of the stimulus and compare. If the response reverses (mirror images) you have auditory neuropathy.
Wow! Thank you!
Another question... Is the ABR 100% accurate? She had to be sedated, so I'm just assuming that everything went well and there was no questionable results. Are there instances of ABRs not being accurate? I just worry that if it's not a hearing problem she has, is it an expressive/speech/learning problem of some kind?
ABRs can be inaccurate. Usually it is rare and due to a poorly trained/experienced audiologist. You want a good pediatric audiologist to perform the test who uses proper recording protocols and techniques. I have been the second opinion in many cases where the first ABR was very wrong. In cases of auditory neuropathy you may think you are seeing a response and take it as normal. However, if you were to change the stimulus and look for that mirror image then you would know that the response you thought you were getting was not real. These cases are rare, however they do happen.
I would suggest asking if a polarity reversal was done to rule out auditory neuropathy and go from there. Also, booth testing can be helpful to determine where behavioral thresholds are.
Hope this helps.
Thank you so much! You have helped quite a bit. I took DD to a pediatric audiologist who read the ABR results (he wasn't affliated with the hospital who originally did the test) and the results were read completely wrong! I was shocked! DD failed the ABR! The pediatric audiologist showed me the results, and what they look for in them, and the ABR showed a significant hearing loss in both ears. He also did another OAE today, which she failed miserably. He recommended hearing aids immediately, to help get DD caught up and hearing better, of course. I feel like such a terrible mom for letting go on like this!
If hearing aids were suggested I would make sure that you also obtain behavioral information regarding hearing sensitivity in addition to the ABR. Your child would noee to be able to be conditioned to respond to a sound and look for it (visual reinforcement audiometry) or complete a task in response to a sound (conditioned play audiometry) to do this. There are cases where you cannot obtain the information, but it is always best to attempt it because it solidifies the hearing aid prescription and confirms the results from the ABR.
Also if you child has PE tubes, then OAEs are absent 30% of the time. This depends on location and how vibration of the eardrum is affected. So in cases of absent OAEs and present PE tubes you cannot determine clinical significance.
You are not a bad mother at all. You are actively seeking answers and looking for solutions. In cases with many factors (history of ear infections, tubes, etc) it often takes a while to get the complete picture.
PM if you have any specific questions.