Then we did or OAE testing and what we're looking at with OAE is some different tones, different pitches, or frequencies going into the ear. It travels down into the inner ear and that inner ear has little hair cells in it, now when those are functioning normally sound is going to come in and those little hair cells will send back an echo it's very tiny. There are a lot of things that could block that response from being gained and I did not get a normal response in either ear. The ear canals have no blockage and they aren't inflamed, the ear drum is fine. The organ called the Cochlea has thousands of tiny hair cells which change the vibrations into electrical signals that are sent to the brain through the hearing nerve. The brain tells you that you are hearing sound and what the sound is. So in the test given we found that the little hair cells in the Cochlea did not respond to the tones telling us that more likely than not the origin starts here (the cochlea). There are three nerves going to the brain, one is for balance, one is a facial nerve and the other is the hearing nerve. Are finding are that the damage is starting at the Cochlea
It sounds to me like with the tests that we both did. We are both definitely seeing damage start at the origin of the cochlea. That's the beginning of that neural response. We did not see any kind of issues that would relate this to any type of allergy or ear infection.
An Explanation of the Graph Below
This is an audiogram. This is a graph of the softest sounds that he's hearing. What we are looking at are the softest sounds you can hear. Across the top of the graph we've got base sounds, the boomy low sounds all the way to high pitch, high squeaky sounds. These are the sounds that are important for speech and language. Down the side we've got really soft quiet sounds all the way to very loud sounds. So, basically the farther down the graph you go the louder I had to turn the beep for Z to hear it so he would raise his hand. The red is for the right ear and the blue is for the left ear so you can see they kind of match up they have that same pattern, which is good. If there were a huge difference we might be concerned about other things, so it's good that they are matching up. the normal range of hearing is going to be 20 and above. So you can see that some of those responses come up to that normal range but for the most part they are below the normal. I had to turn up the beeps so they were a little louder for him to hear them. Now that is just hearing the sound. Is the sound there? or not there? That's the first part of hearing so we've got from a ..., and I kind of jotted it down out here so you can remember it later when you take this home, but this is kind of a mild hearing loss in the low frequencies and then it slops down here to a moderately severe in the left and severe in the right. The other things that are on this graph are just everyday sounds anything below your lines you can hear it because it's loud enough, but anything above you either can't hear it at all or you have a really difficult time hearing it. You can tell that the low frequency sounds of speech like vowel sounds those are very loud and boomy they give the volume to speech. Those are audible so he can hear them when you're talking but sometimes understanding what you say id hard because look at all these consonant sounds that give the clarity to speech. Those are above that line so Z can't hear them. He's not hearing a lot of those sounds at all. So that means that his hearing is very muffled, it's distorted and he's not understanding much of what is said in conversation.
The next part of the testing that we did is involving speech because we want to know how soft does he understand speech and then if speech is loud enough it should be clear enough to hear. How well does he repeat back? That's where he started having some trouble. When we did the speech testing a lot of interesting things happened. Now, we know he's going to miss some things because we now know he is missing all those consonant sounds but I also noticed ... it was a little out of the ordinary not just missing those sounds. You know missing the /p/ sound at the end or the /s/ on the end of the word. It's hard to describe this but it's like he would say a completely different word or just say something that was not your typical response you would see. It was really out of the ordinary. Another observation he kind of twitchy or moving a little bit. The scores were stable from last time to this time which is a very good thing that his understanding of speech did not drop between the two test times. He is understanding speech better on his right side than on his left. Another interesting thing is when we turned up the volume. I went ahead and repeated the right ear I didn't do the left ear because, I mean, the right ear did the same thing where when we turn it up a little bit louder you should still be fine. You should hear it even better, it wasn't to an uncomfortable degree I just turned it up a little bit extra, so you would think, that's easier to hear that word. No, he actually did slightly worse. So he didn't do as well as we thought he would when we turned up the volume, that's out of the ordinary, not something we come across very often. Again goes along with damager in the cochlea or the inner ear. How is he doing in school?
"He's an A,B student and the teachers haven't noticed anything".
It's very subtle, because he has that drop where he's got a mild loss and then he slopes down in those high frequencies and you can kind of see on this graph. If the lines above that sound, that's typically that you should be able to hear those sounds pretty well so these consonant sounds he's going to struggle here because his line drops below, but the vowel sounds he should hear pretty well. But you can see where it's borderline right here. I think he's getting by on having a little bit better hearing in the low so when you talk about amplification or hearing aids. It kind of helps span that gap and gives you a little bit of a boost where you need it and a lot more boost where you need it there. Unlike testing under headphones or listening to TV or something like that. He may turn the TV up here to try and grab these. Well it going to be way to loud for right there. (The Dr. is pointing at the above chart as she describes this to us). So if he's listening to the TV or to music or something like he may really try to jack it up so he's catching those consonant sounds, but when he does that it over corrects on those low sounds and could cause further damage.
"How would hearing aids fix that"?
Hearing aids? We can't say that they totally correct your hearing like a pair of glasses corrects your vision. It's not quiet the same but hearing aids amplify or give us a chance at being able to modify so that ..., basically where he doesn't need as much power we don't give him as much and where he needs more we can give him more. A basic hearing aid even the good basic you may only have four sections where we can actually make changes to it. So, it gets kind of dicey where he goes from a mild and slopes pretty quickly to a severe to moderately severe level. Thats one reason why I would plan on the total cost being in that 4 - 5 thousand dollar price point. I can extend a little bit of a discount and we will work with your insurance on that, but you should plan on there being some out of pocket expense. We will try to get the best basic aide that we can but its going to be a lot harder to fit his hearing loss and also get a hearing aid that will function well in the school type setting. You really want something now that manages that speech and noise.
You can compare the different levels of hearing aids to cells phones take technology for instance you take like an old basic cell phone vs. a smart phone. It's a computer chip on the inside that's what we're dealing with and so the smart phone computer chip and the processing is happening quickly it can do a bunch of things automatically running the background. Whereas the other one you literally have to push buttons each time to do what you want it to do. So, hearing aids are based on a computer chip and so when you go top of the line everything is more automatic, it's a faster processing it a more sophisticated of a noise manager so someone who has a more active life style if you think about it he will be going into different environments, for example he will be going into this noisy classroom, and then into a cafeteria where it's this big open space with a lot of noise and then he will be going home where it's very quiet and he will be focusing on mom or a TV.
"So the hearing aid automatically adjusts the volume"
Yes, exactly! It's automatically going to detect noisy rooms from quiet ones. Let's say I'm in a coffee shop and there's a guy talking over there while I'm trying to listen to my mom the hearing aide is going to alleviate that noise so that I can hear my mom or it will lower the range of where you are listening. With a basic hearing aid you have to physically look at the person you're talking to and it's only going to lower the volume from the back or behind you, so it's just very basic. And then you have technologies that are between there.
So a top tier, it used to eliminate back noise or it would minimize or eliminate what was going on behind you. Now it actually will kind of zoom back if like someone was behind you telling you to do something it would recognize that there is a prominent noise from behind and it would zoom to the back, whereas before you would have to turn so you could see who was talking to you. They are always going to work better with anything within 6 feet and more face to face but that's just an example of the newest offering in the high or top tier level. The other thing I would consider for Zachary is doing the water proof or water resistant it's a little bit bigger casing but its going to be a little more durable for a child. Given to how we are uncertain to how this will progress I would put him in a Rick that way we have a lot of flexibility for the life expectancy of that hearing aide. If we start seeing his hearing change then we're not coming back in a couple of years and saying we need to get a different hearing aide. If his hearing progresses to where it is off this graph then we would be talking about cochlear implants. Hopefully we wont see it progress rapidly like that, but it is something we will want to watch for. I would recommend we have him tested every 6 months for the first couple of years and if it remains stable then we can see him once a year.
Essentially Zachary is going to need some support in the classroom. Being moved to the front of the classroom and the FM System we discussed last time we met and possibly a note taker as he gets older if he needs it.
Zachary do you have ringing in your ears? yes
Are you in any pain today? No
I just wanted to be sure pain wasn't a factor as sometimes if a child is in pain they won't be as focused during the testing.
"Does the constant tone in his ear have any affect in him hearing some of the higher pitched sounds?"
No it will not create a problem for our testing, but it can be a little disruptive throughout the day. Sometimes it can have an impact on sleeping, getting to sleep at night, because its kind of annoying. We look at that too when we're managing that hearing loss.
No comments:
Post a Comment