And so another chapter begins. As the year came to an end, I could do nothing but look forward to learning more things in 2013. More things about hearing in particular. So, let’s get acquainted with The Ear:
We went for Addie’s 2nd audiology test, and got the same results as the first. Moderate hearing loss.
While this does not mean that she is deaf, it does mean that when I say mother’s intuition, it doesn’t mean “tell me your opinion about how I’m paranoid”. It means, I’m THE Mom. When I know that my baby can’t hear me from across the room, I know.
Hearing loss is typical in children with achondroplasia due to the mid-face often times being small with a flat nose and narrow nasal passages. The inner-workings of the “drainage system” are also flat, not angled. This feature retains fluid, often behind the eardrum and can cause hearing loss with or without infection. This seems to be Addie’s issue (sans infection, Amen!), however, we will know more after our appointment with ENT in a few weeks. The most common solution is putting tubes in the ears. I am concerned because children with dwarfism have different spines, and any procedure requires someone familiar with their body-type, but I know that Dr. Bober would never let us do something he felt unsafe, so we will be consulting him before anything procedural happens.
As it turns out, Addie’s ear drum is not vibrating. After a physical examination of her ear, confirming no visible fluid or wax, the testing went on as it had before. We started with the tympanogram.
At Hasboro Audiology
A small ear bud attached to a wire is inserted in the ear, one side tested at a time. The ear bud changes the pressure in the ear. In the grid-area, a line comes up (almost like a bleep on a heart monitor). It should be flat and then raised then flat. For example:
Tympanogram example
Addie’s results were flat. Completely flat. Like this:
EXAMPLE ONLY
This reading indicates there is final fluid in the middle ear, also known as serous otitis media. Not the best way to start out, but we moved on, because she mimics and babbles, the doctor knows she can hear.
All the fancy wires in the sound-proof room
The machine that tells what frequency Addie is responding
We sat in a sound-proof room where Addie turned her head toward sounds, more loud than soft, and was rewarded with flashing lights and a puppy or frog dancing for her. Her response was better this time verses last, but was still not great. Because of this, the doctor used a bone oscillator headphone test. The bone oscillator transmits sound through bone vibration to the inner ear (cochlea), bypassing the middle and outer ear. The test is placed against the bone behind each ear (mastoid bone) to test bone conduction. This test helps determine if your hearing loss is due to the middle ear issues, inner ear issues, or another problem altogether. (P.S. Thank you ONE semester of nursing school for giving me the knowledge to understand everything the doctor was telling me!)
Headphones for bone test
Addie heard much better with this test, but the doctor was unable to give me much beyond that , in terms of a fluid behind her eardrum or whether the bones in the middle ear are possibly fused (not common to children with achondroplasia).
A last ditch attempt to graph what she can hear
So far we know Addie’s eardrums are not moving efficiently and she has conductive hearing loss. Conductive loss means it lies in the middle ear. Whether the loss is from fluids (not permanent) and can be corrected with tubes, possibly needed her whole life, or if it’s from the ossicles of the middle ear being fused (permanent), resulting in hearing aides, remains to be seen… or heard, as the case may be. Fluid seems to be the general consensus in the audiology department, as it’s very common in children with achondroplasia, but the ENT doctor will be able to tell us more, and possibly a trip to Delaware.
I am glad to know the she tested better. Where she was in the 55-65 dB range before, she’s now in 40-45 range. What the doctor is looking for is 15 or better. Confused? The graph below breaks down the severity of hearing loss, decibels (dB) by hertz (Hz), and the one below gives examples of what are considered common sounds in that range (lawn mower, dog, etc.):
Hearing Range, dB x Hz
Audiogram range examples
Finally, you’re now an expert on hearing! Just kidding… but I think I will be soon. I hope that this issue gets resolved soon to avoid speech delays and issues in the future, but only time will tell. For now, I will continue to sing to my sweet girl and talk to her as I always do. I’m a loud person, in general, so I’m sure that helps! I know that she hears some of what I say and knows mama, dada, baba and something that sounds like “I did it”. She may not know what she did, but I do… she stole my heart!
♥♥♥ !♥♥♥ !!!
Thanks for such a detailed description of the testing. We go back next month for a follow up ( he tested borderline last year). Two of the tests you wrote about sound familiar. I hope you get more answers from the ENT soon.
I’m glad to hear that you’re in good hands on this — we have been going through hearing tests for my little girl because of fluid buildup, and the tubes and adenoids words have been thrown around. It’s scary to think about but at the same time if that simple procedure can help them to hear and stay healthy…. being a parent is hard stuff 😉 Thank you for sharing the information!
Thanks so this post! We don’t have to deal with this but my friend does so this is great information. Thanks so much for sharing!
This was so interesting. I had no idea about any of this. Thank you for sharing.
That was truly very interesting to read. I’m glad to hear that there is a good plan of action in place for her. I’m sure over time you’ll be doing duets together. xo
Thank you so much for detailing what you all are going through. You explained it in a way I could understand even though this topic is new to me. Best of luck with future tests for your beautiful little girl.
Wow- this was really interesting and informative. I’m glad Addie has made progress and I’m sure she is in great hands. Thanks so much for sharing your story with us and I hope you get more answers soon!
Hi,
Firstly, I am sorry you are having to do this. My daughter with HCH is having her second sets of ear tubes tomorrow, she is 20 months.
It looks like Addie basically flat-lined her tympanometry. It means that she has Eustachian tube dysfunction, did the audiologist not say that? http://www.dilworth.co.nz/clinical-information-articles/guide-to-tympanometry-1
It is VERY common with ACH/HCH for the reasons you explain. The good news is that they are more than likely going to outgrow it by around 8 years of age when the Eustachian tube becomes large enough to take care of the ventilation If her hearing is at 45 dB I would really push to have ear tubes ASAP. Check out this really cool simulator which shows you how one hears with different levels of hearing loss: http://www.betterhearing.org/hearing_loss/hearing_loss_simulator/index.cfm.
THANK YOU!!!!!!!!!!!! I hope she out grows it. The audiologist said they could not conclude if it was fluid or bone issues 🙁
That is pretty weird.. Check out the link I sent you… A flat line like that should be pretty easy to analyze with the moderate hearing loss she has… I am sure Dr Bober will be able to review and explain… Best of luck with it all.
Wow, it’s really amazing that they can track all of that to at least *try* to understand what a baby can and can’t hear. It’s great that you can be armed with the information you need going forward. One thing’s for sure – that little girl knows how much she’s loved! 🙂
I am sorry your little one has to go through this (and you too!) Wow! Lots of great info and details! Thanks for sharing!
Wow, super interesting to read about! I hope your precious girl continues to show improvment.
As a mom you always know. Glad to hear she improved.
What a detailed description of a hearing test, thanks for sharing. My daughter is going for a hearing test next week due to her ear infection history. I actually remember getting hearing tests as a toddler (I had hearing loss due to ear infections and didn’t talk to 2 years old– then they couldn’t shut me up!!) Best of luck, keep us posted!
this information is really interesting. i had no idea there were so many ways to test a baby’s hearing! good luck with everything! it seems like Addie is in good hands!
Wow, this post has so much great information…thank you for sharing! Your little girl is lucky to have such a strong mama advocating for her. xo!
Great post Chelley! Declan just had a follow up hearing test a few weeks ago. I find it all very fascinating. For him.. on the tympanogram test, one ear had a ‘typical’ response and one ear had a flat line, like Addie’s. Interestingly…when she looked in his ears, the ear that ‘flat lined’ looked completely clear, whereas the ear that responded better is the one that had a nasty infection last fall and still isn’t 100% clear (though not infected). However, he did well with the sound room tests with the beeps/lights/toys, so they’re not concerned at the moment with any hearing issues (thankfully). Hoping your ENT is helpful and able to get the ball rolling. It seems to me that it’s best (with this ‘achon issue’) to be proactive with the whole tubes things (since it seems inevitable for most young achon kids), rather than trying to play catch up after their speech development has suffered. Good luck, keep us updated!