Thursday, November 13, 2008

Better Results in the Soundbooth ... AGAIN

I know this should be so exciting to me, and believe me, it is. We had a full day at Johns Hopkins today, starting with our psychological and ending with what I thought was just going to be a choose your implant device discussion. Well, they started with another sound booth ... which I'm always glad to walk into, but then threw our decision for "simultaneous bilateral implants before 12 months" off a bit.

Here is his audiogram and then next to that the speech banana, which I explained when Aiden got his first soundbooth test. At this time he was just over three months old and showed responses with his hearing aids at 75db and I was like my daughter in a candy store. I couldn't contain myself that my baby heard something! That was 5 months ago. So to think now that he is hearing sounds at 45 to 50 db and definitely hears some of what his mommy says to him is just UNBELIEVABLE! From 75db at 3 months to 45 db at 7 months. Actually, from being told he "probably wouldn't get any benefit from hearing aids" to learning to listen like no other!



Okay ... to explain his audiogram for family & friends ... the left side shows decibels (how loud something is ... a whisper is at around 20 db and normal conversation levels around 45 to 50 db). The bottom axis shows the frequency level ... the more energy it takes to make a sound, the higher the frequency ... with deaf/hard-of-hearing people it is typically harder to hear high frequency sounds than lower).

Okay ... so look at Aiden's audiogram, the "S"s show his "Binaural" responses - that is with both hearing aids on - he was hearing between 45db and 50 db from frequencies between 500 to 4,000. This includes normal conversational levels.

Then, the O's and X's show his responses without hearing aids ... O's show his right ear responses and the X's show his left ear responses ... which, as you can see, both ears are pretty much the same from 65-70 db at lower frequencies and then drops to 75 to 80db at the higher frequencies. So without his aids, he could possible hear a dog barking or lawn mover.

All of these responses are to sounds though that he would probably hear only about 50 percent of the time. Think about it, as normal hearing people, we can make out what we don't hear based on everything we do hear ... for hard of hearing/deaf people it is so much harder to do this ... it's harder to "fill in those blanks".

Now look at the speech banana next to his audiogram. This shows what a person can hear at different db's and frequencies. So you can see that even with Aiden hearing with aids at 45 to 50db, he's still missing out on hearing (and therefore speaking and responding to) the important sounds of speech, such as the /p/, /k/, /h/, /g/, /th/, /s/, /f/, /z/, /b/, /d/, etc.

So, is he hearing somethings? Definitely. Is he hearing all he needs to acquire ALL sounds of speech? NO. Is he hearing enough to only need one implant or maybe, just possibly maybe, only hearing aids ... still checking this out. My gut still wants at least one cochlear implant. My big question now truly is will he be just as successful with one than he would be with two?

Honestly, truly, I wish he was just deaf OR could hear enough to know he just needed hearing aids. Seriously, wouldn't it just make it all that much easier?!? Don't get me wrong, I'm on cloud nine that my binky boy is hearing as well as he is. He's moved up to the "moderate to severe" hearing loss category and is on his way to being successful. He wants to listen. He loves to hear. He continues to use new sounds every week (we were so excited to hear /r/, /m/, and /b/ from his loud mouth this week!) He will succeed. He already shows it.


leahlefler said...

Holy cow! Is there any way to improve his aided responses to sound? Nolan's moderate to moderately severe (55-60dB) and we've never gotten an aided audiogram.

It certainly looks like Aiden is using his residual hearing to the max! I understand your angst about being on the borderline for a CI. We are anxious about Nolan losing more hearing, because if he does he'll start entering that severe/borderline status. It is easier when it is clear-cut and they say, "Hearing aids are the way to go" or "he needs a cochlear implant to hear."

MB said...

I was wondering the same thing as Leah. Marielle's responses to aided sound were in the 40s too until they cranked up her aids. Are they as loud as they can go and still work properly?

Drew's Mom said...

I have some thoughts, take it or leave it...

When you start really cranking the hearing aids up, you can distort the sound. So, while Aiden can hear at 30, 40, 50 db, what is the *quality* of the sound he is hearing? In order for a child to develop normal speech and language, they must me able to hear all of the nuances of our speech. For a child with a profound loss, many times these little nuances are lost while cranking up the aids and therefore the child will not be able to produce the /s/ or /sh/ sounds, to name a few, because the quality of the sound is impaired.

There is some EXCELLENT research right now coming out about the benefit for binural hearing with regard to children having profound hearing loss. That having one CI and one HA is an excellent way to provide the child with access to clear speech sounds, while still giving the child the benefit of acoustic hearing through the HA.

We were in a situation where Drew was not getting any benefit from his HA's, so going with bilateral CI's was a very easy decision. But, there are a number of families where children with profound loss have had excellent access to sound through their HA's. These children, some in town, some on the internet like Christian, are doing excellent with a CI/HA combo. They are able to access the nuances of speech with their CI, while preserving natural, acuostic hearing with their HA. This gives these children the benefits of hearing in noise, localizing sounds (which is why you get two CI's), as well as an acute awareness of music which some with CI's do not have.

Just something to think if you needed another idea. But with these results, I think I would strongly consider this. Just my opinion...

Shari said...

Hi, Tammy, just had to stop by and check out your place. :)

That's great that Aiden's audiogram shows improvement. Mayve he's getting used to hearing and is more responsive.

LIke MB, I always wondered if HAs may add to the hearing loss when it's cranked up, earmolds don't fit right anymore (constant whistling), or just that the amplification is doing more harm than good. I don't know.

In any case, I'm glad that he's doing so well and has such a supportive family. :)

Julie said...

There may be the option of different (stronger... but not just louder) aids??

We "stepped up" Tate's HA awhile ago and he experienced a BIG benefit. But on the other hand...

When Tate lost a huge chunk of hearing in his left ear, Children's loaned us a better/stronger HA to try. No benefit. Everything was SO distorted.

So many decisions! But you're doing a GREAT job of staying on top of it all and getting Aiden what he needs :0)


Dr.Rutledge said...

Hi Tammy,
I'm an academic physician (formerly at Harvard and Stanford) who found your blog while looking for the best health writers. I think your writing is great! I would like to feature you in the Hearing Loss & Deafness Commuity on Wellsphere, a top 10 health website that has well over 2 million visitors monthly.

If you would like to learn more, just drop me an email to

AJ's Mom said...

Remember the days when we didn't know what a speech banana was? Now we have them on our blogs and are determined to educate others!! :) Congrats on the better results in the soundbooth!! I just read Drew's Mom's wasn't until recently I learned that just because AJ can hear at 75db aided, doesn't mean he's hearing clearly. What he's getting is soooooooo distorted. In fact, its more vibro-tactile than anything. But, its stimulating that nerve :) Our little guys truly are amazing, aren't they!!

Mom to Toes said...

I'm just catching up on my blogs now... and I have to say... WOW!

I'm trying to remember, is Aiden a Connexin 26 kid?