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@LRSx2 - sorry, this is long
Hi there - I saw some answers that you gave ladies earlier this year and was hoping to get your opinion. My son will be 3 next month and has articulation issues with his speech.
We took him to a speech pathologist to get him tested and she said he was severly impaired and would need and benefit from therapy, because he just doesn't have the "rules" down. As part of the process, she suggested that we take him to an audiologist to get him checked. He failed the OAE's as an infant in the hospital because he had fluid in his ears. He passed the follow-ups and we have never had a concern, except when he had ear infections, his hearing was impacted.
So we took him last week, and after about 40 mins of testing, the audiologist (who was noticeably nervous with a red neck, etc.) told us that he had mild-moderate hearing loss in both ears and that it was permanent and he would need hearing aides. We were floored to say the least. We took him to the appt to "check the box", but had no expectations of what we heard. He referred on some of the OAE tests (which he was really uncomfortable and talked the whole time) and she used that information, along with the behavioral testing (which he performed well) and his speech issues to tell us that she was completely confident of a loss and that he was probably reading our lips already, etc. to learn new speech and carry on day-to-day. She told us to plug our ears and that is what he heard...I felt HORRIBLE...how could I miss something like that with my baby...?! So, we have been testing him on our own and he hears us...(behind him, whispers, covering our mouth and monitoring him when he looks at us to see if he is reading our lips - he is not)...now, he does have some "selective hearing" when he is playing or watching a show, but I will test him by saying something like, "okay, fine, no candy then" or something and he will respond with "candy!"...so he could hear me, he just didn't answer. He even holds his hands over his ears and says "that hurts my ears" if something is loud...?
I took him to the pediatrician to check his ears before having him tested again because it just doesn't FEEL right in my gut. I want whatever is the best for my LO, so that is my only concern is making sure that the diagnosis is correct. My pediatrician said that his throat/tonsils were red and swollen, so he needed to be on Claritin for 2 weeks before being tested again. We are going to follow those instructions and go back to the same place, but a different audiologist (the one we saw sees patients 1 day/week and does research 4 days/week). My friend went through the same experience at this place and had a sleep ABR performed that said her son actually had good or even better than "average" hearing...and she had already ordered the hearing aides. I guess I am just looking for your opinion on if the OAE can be affected that way with fluid or if we can seriously have never had a concern with our son's hearing and it turns out that he has to have aides?
Are there questions that I should be asking the audiologist? Would a sleep ABR be the best way to find out for sure? (My friend that had the misdiagnosis from this place recommended me go straight to that, since her son had to do everything else first.) They looked in his ears before starting and saw wax (which he normally has a lot of), but she didn't say anything else really and I didn't think to ask about fluid, etc. Could possible allergies (he has always had dark circles) cause fluid in the ears for an extended period of time or a cold, which he did have over the last 2 weeks, cause issues with the OAE and speech? I just didn't feel right about the experience at all and I sit here now and question is the feeling my intuition as a mom or possible guilt for missing something so big?
Thank you so much.
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Re: @LRSx2 - sorry, this is long
What she said.
I am another hearing aid mommy. It would probably be good to get your second opinion from someone who can look at the big picture. A pediatric ear, nose and throat doctor (otolaryngologist) can look at the tonsils, adonoids and the possibility for getting ear tubes to deal with the fluid. They will also advise you regarding an ABR vs further booth testing.
Nate had gunky fluid in his left ear that was dealt with by tubes in August. I believe he had the fluid from birth since his original (and only) ABR showed a marked difference between the two ears. He had what is known at OME (otitis media effusive) which is fluid that is present in the ear canal but not causing ear infections. However this fluid does cause damage. The only reason why we knew about it was because he had an MRI and CT scan for other reasons. As soon as I read the CT scan report I was on the phone with the ENT and requesting tubes. I feel some guilt since I didn't pursue the one sentence in the ABR report about the possibility of the left ear having some conductive loss. What is a mother to do? We can't know everything. Just be glad that your are addressing the situation now and getting a second opinion before you plunk down 3 grand for hearing aids. Good Luck and let us know how it goes!
No problem. First off, fluid or negative middle ear pressure (retraction of the eardrum due to congestion) can cause a refer on an OAE. It can also lead to an abnormal ABR. This has to be addressed prior to any testing. A tympanogram (pressure test) can help determine if the middle ear is working as it should.
With the behavioral testing, there are two types...air conduction (speakers or earphones) and bone conduction. If the loss is due to fluid, then air conduction would be down while bone conduction would be normal. If the loss is due to a problem with the cochlea(hearing organ) or hearing nerve, air conduction and bone conduction should be relatively equal.
I would consult a pediatric ENT and pediatric Audiologist. The ABR is typically needed if accurate behavioral information cannot be obtained. But before any testing is done I would make sure those ears are healthy and clear of congestion of any kind.
Hope this helps!
Thank you. I am taking him to the ENT today...but apparently the tympanogram was normal on both ears and the bone conduction was in line with the OAE test results (I called the audiologist yesterday for more clarification).
We are having him re-tested either way, just to be sure that we are doing the best for him and his hearing. I am not 100% sold on the behavioral portion because he was uncomfortable and watched her the whole time (so he would look at her when he heard the beep, but wouldn't always throw the toy in the bucket); however, I think his ears were clear if he tested normal, so we will see. Whatever is best for him.
Thanks again.
We are going to the PEDIATRIC ENT today and will talk to him about the ABR as well.
Thank you for all of your responses:-)!
Throw a toy in the bucket???? What ever happend to looking in the direction of the sound? That seems whacked to me. Especially if they are tesing a child with any sort of motor planning issues. My kid could never do something like that!
Good Luck today!
Throwing a toy in a bucket, completing a puzzle, etc is called Conditioned Play Audiometry. It is typically used in children 3 and up to get an audiogram and is a completely valid way of testing. Some kids are shy or reluctant and will look for confirmation before doing the task. This can also be correlated with a speech threshold (softest level the child can accurately point to body part or picture) for confirmation of results.
VRA, or visual reinforcement audiometry is typically used in children younger than 3 years and involves playing a sound and localizing the direction and getting a reward (toy lit up, movie clip, etc). If a child cannot be accurately conditioned to do play audiometry, then VRA may be used on an older child as well.
Test selection is done based on the capabilities of a child. Typically auditory based intervention will work on conditioned responses as well which helps get more accurate behavioral results over time.
When in doubt an ABR(accurate performed by someone well trained) is the way to go.
LRSx2 - Good to know about the different options for testing. We do VRA. I would love to do another ABR now that we have dealt with Nate's fluid issues, but since he does pretty well on the VRA, our ENT thinks we shouldn't bother putting him under.
Since he does have a processing delay, which I have mentioned to all three audiologists who have been testing him, I always wonder if they are giving him enough time to respond to a sound before moving on to another....*shrugs*
They did the conditioned play and the speech threshold. The audiologists that we had for the 2nd appointment agree with the initial findings (mild-moderate sensorineural hearing loss in both ears), but they were much more thorough in their explanation to us (explaining certain behaviors that he could have - some of which he does have, but that can also be confused with toddler behaviors, etc.) I do think he has some loss and we just want to be sure that the levels are completely accurate for hearing aids (which he is going to be fit for next week-I just want my baby to hear everything and get caught up with his speech). I am still unsure on how the test results could be so inaccurate for my friend's LO (referred twice on the testing...passed 1 time with an independent audiologist and passed with the ABR). They tested his middle ear and he didn't have fluid...and they told her mild-moderate sensorineural hearing loss in both ears as well? Obviously, her situation was a fluke and ours was not.
Thank you! So far, it seems that he does have hearing loss, so we need to get him hearing aids and hopefully figure out what caused the loss.