Friday, August 13, 2010

Not So Pretty

In my last post, I begged Aiden to perform in the soundbooth and to my surprise, he did beautifully. Aiden has typically been very good at repeating the Ling Six Sounds (ah, oo, ee, s, sh, m), which truly helps at home, but not so much in the soundbooth where they test using pure tones.

At one time, Aiden would try to repeat the sound of the tone, which at least showed us he heard it, but he's dropped that. We're trying to steer him away from Visual Response Audiometry (VRA), which is where Aiden has been trained to look at a toy light up in a box every time he hears a sound. I've never liked this though, because Aiden is constantly looking for that damn toy to light up, even if there's not sound. We've been conditioning him in using Play Audiometry or the "listen and drop" method for quite some time. (for friends and family, remember taking hearing tests and they always wanted you to raise your hand on the side you heard the sound? Well, for Aiden, he holds an object (ball or peg or whatever it may be) to his ear and then when he hears the tone, he should drop the ball in a bucket, or place a peg on a board etc.). This doesn't always work since Aiden likes to decide if he wants to "play" this game or not, which can make for testing in the soundbooth, quite difficult.

For those of you who know Aiden, know he likes being his own boss. So this time around he decided he'd take on his own way of showing us he heard a sound by yelling out "YAHOO" or "YAY" each time he heard it and would then drop the ball. Hey, whatever it takes right?

By playing along with him, we were able to get reliable results from how he was hearing from 250Hz to 4000Hz. We were in the soundbooth for nearly an hour with Aiden cooperating with his YAHOO's and YAY's the whole time. I am so proud of my little trooper!

Now, on the other hand, the actual picture of his audiogram is not so pretty. Take a look.

He had better results in the low frequencies with his hearing aids (about 45 to 50db). Seriously.

His SATs (speech awareness thresholds) were 30db for his right and 20db for his left.

For those newer to an audiogram, it is a graph that provides a look at the levels Aiden is hearing. The top of the chart shows 125 to 8000 Hz which are low to high pitches from left to right AND the left side of the chart shows 0 to 130db which is soft to loud intensity of sound from top to bottom. Normal hearing lies at 20db or better across all frequencies (pitches).

I took his audiogram and mapped it out on the speech banana so I could see exactly what Aiden was missing. It looks like this ... (sorry you have to squint your eyes to really see it).

The two straight red lines on 20db and 30db is where we WANT Aiden's results to be, and particularly closer to the 20db mark as possible. We do take into consideration that Aiden is two, he had just sat through an hour plus of AV therapy, that it was late in the day, and that he's probably hearing a little better than what he chooses to respond to. BUT, I have to admit his YAY's and YAHOO's were right on, and even if you add on 5 to 10db to some of the lowest points, he's still missing out on some sounds of speech. Not good at all in my book.

I used a purple L and line to indicate his left CI results and a blue-green R and line for his right CI.
  • All the sounds above both the purple and blue-green lines, he is not hearing at all, like the /z/ and /v/ (which he had /z/ at one point constantly imitating a bee). It also shows he's not hearing m, d, or b, but he does use them in his speech, so he probably is hearing them somewhat, but definitely not the /m/ with his right CI and definitely not as well as he should be with the left.
  • All the sounds between the purple and blue-green lines he's hearing with only the CI the sound is BELOW. For example, it shows he's hearing i, a, and o with his RIGHT, but not the LEFT.
  • All the sounds below both lines, he's hearing with both CIs. For example, h, sh, and ch.
I am VERY FRUSTRATED with all the mapping issues he's been having and I just don't understand why we can't get him between 20db and 25db across the board. Honestly, this is the same boy who was hearing at 15db to 20db across ALL frequencies for the first four to five months with his CIs and we haven't seen 20db since (except for at 8000 hz with his left CI). Ever since the appointment I wasn't too excited about, about a year ago, that continued to get worse and ultimately led to these results, we've been trying to get his maps back on track but can't seem to find that destination.

The hardest part about it all is that Aiden does repeat the lings AND his vocabulary is growing. Yet, in the same breath, it really is pretty indicative of his ling checks at home. We've been having trouble with him repeating the lower frequencies, particularly /m/ and /u/, but he rocks out the higher ones (/s/ and /sh/) even when whispered. Hence my crazed mom madness lately about getting him in to see the audiologist every couple of months. Follow your gut ...

... and although we've seen his vocabulary growing the last few months, you can tell by this audiogram, that he's compensating for lost sounds in one ear with the other ear.


So with all said and done, we left with four new programs on each CI to work with over the next few weeks. They increased the T&Cs (threshold and comfort levels) for the lower levels (up to about 1000Hz) on his right and left CI, as well as the 4000Hz level for his left CI. About every four days we'll switch to the next program and watch Aiden's reactions very carefully. We go back in about three weeks to do another soundbooth check and pray the new programs are working and we see better results.

I feel like we're back to square one. Again, we've seen some great strides with Aiden the past six months (I'm in the process of documenting his recent IFSP review), but we're still not where we need to be, not with that audiogram. I'm not one for guessing games, so until we get this right, we'll be making frequent two hour treks to the audiologists office.

Let's just hope Aiden continues to cooperate, even if it is through "YAHOO's" and "YAY's"!


Renae said...

We have issues with the m and u confusion on just his left ear as well. According to our Audiologist is VERY common because they are so close pitch wise. Our SLP said almost all of her ci kids have the /m/ /u/ confusion at some point. It is frustrating! Hang in there!

leah said...

Hey, his CI audiogram looks like Nolan's aided audiogram: terrible! It can be so frustrating when you KNOW there is an issue, and you can't get the audiologist to take it seriously. We got our first aided audiogram at JTC and it showed terrible hearing levels (we can't test each side independently, but his "better ear" was hearing at a moderately severe level in the lows and a moderate level in the highs, WITH aids)!

I hope the new programs work well and that Aiden cooperates in further testing. Here's to getting 25dB across the board!

Herding Grasshoppers said...

YAY for Aiden, for cooperating - he's growing and understanding more all that time.

But, oh how frustrating, to see the results.

I know you'll keep working for his best - hang in there.


Melanie said...

That is an unacceptable CI audiogram. :( Do they think he is just not testing well in the booth? Is he hard to read? What is the reason for such junky results? Hope he is doing well with the stronger MAP and hope you are going back for another soundbooth test sooner rather than later. We went every 3 weeks for almost a year before we got Peas to a good place. HUGS, Tammy.

Kel said...

Wow! Yikes, yeah, not so pretty indeed. What a bummer :( Danny is still pretty difficult in the booth too, but whenever we do get some tones, they're always in the 20-30 range thank goodness! I hope they can fix that up for him.

And I agree with the /m/ and /u/ as well, we haven't run into troubles with it yet, but our audiologists have told us to watch for it because it IS common.

tammy said...

Thank you for all your comments. Aiden's not mixing up the /m/ and /u/, it's just that he's not responding to them unless I'm right next to him in normal voice tone. He was barely responding to /m/ at all. Makes me wonder though too if this is part of the reason his /ee/ is so nasally too. Poor baby probably hasn't been hearing it correctly.

You're right Mel, this is unacceptable in our book too and believe me, we'll be in there as often as possible until they get his map fixed. I've been thinking about you and need to go through your old posts when you went through something similar.