and yet some more Out of the Booth mapping

There's not too many CI moms I know out there that would be happy to walk out of the sound booth with this audiogram (top line = left ear and bottom line = right ear):

now look at the speech banana and mentally place his audiogram in it (and remember, anything above the connected lines, he CANNOT hear).

not good. at all.

but, if you were a fly on the wall in the booth with us, you'd know why I am quickly learning to take his audiograms with a grain of salt. Bottom line,

Aiden does not perform well in the soundbooth. period.

How can I take this audiogram too serious when this same little boy can repeat each the six ling sounds with me (each ear alone) standing 10-12 feet behind him and speaking them at just above a whisper? According to this audiogram, he's far from hearing the /s/, and pretty darn close to barely hearing the /m/ or /sh/, yet he can imitate them and uses them all in speech pretty perfectly. Now, he has been dropping his /p/ and the endings of words (t, ed, s, k), and his audiogram does show this. But it's not a great representation of what he is truly hearing.

Aiden clams up in the booth. When he's not sure of himself, he does nothing. He's not one to sit still. He knows what he's supposed to do, but shows his power. He does great on the NUCHIPS (a speech perception test where he has to repeat back a spoken word) and even did sorta ok on the HINT (hearing in noise test where a sentence is presented in noise and listener has to repeat it back. He scored 49% on this, not good, but not bad for first time ever taking it). Listen and drop to pure tones? ya, whatever. He'll hold that block or marble or peg or whatever it is to his ear for.ever. Goldfish, he eats them. m & ms, chocolate melting all over. Stickers, sometimes, but just for a bit. Marbles, he's shaking the can (and when we move it, he reaches out to touch it just to hear it make the slightest noise, on purpose, then looks at us with that grin, again, showing his power). Tones mean no.thing to him and so it is very hard to get a true solid audiogram. 

And without a good solid audiogram, how the heck does an audiologist provide a good solid map?

based on phonemes.

Leaving the booth I was terrified at the thought of the changes they were going to do to his maps, but once we got to her office, I saw right away she was all ready to test him herself, by having him imitate back the different phonemic sounds which make up the words in our language.

and by doing this, she verified that he is actually hearing the /s/, /ah/, /sh/ and /g/ among a few others, and that he really is missing the /p/, /k/, /t/ and /f/ among a couple others. She'd then map him based on his imitated responses and test him again to confirm. 

(a little funny by my wee entertainer - as the audiologist was asking him to imitate a sound, she noticed aiden was watching and responding by which letter her finger was on instead of giving the sounds based on hearing. After a good laugh, she had to pick up her paper so he couldn't see which letter she was wanting him to imitate. She didn't realize mr. smarty pants knew all the sounds of the alphabet).

By the time she was done he imitated back a /th/ and /v/ sound! Now, he may not be able to perfectly voice these sounds in words (saying a sound in isolation is a little different than putting it together with other sounds to produce words), but the fact that he can near perfectly imitate them back, tells me something that his audiogram doesn't - HE IS HEARING ALL THESE SOUNDS! 

Here are a couple other posts about this out of the booth mapping experience.

• why we sought out a different way to mapping
• first recap of mapping out of the booth
• another CI mom's story of phonemic mapping

We have gone round and round with his maps since six months post activation. Some would blow it off that he just doesn't use his CIs as well as others, that he needs more time, that he's just a "late talker" a "boy" and that "he'll get there". Well, I don't have time to wait and see when it comes to my child's hearing and spoken language. I've learned, when a child isn't performing at a level they should be, first things first, CHECK TECHNOLOGY. and for this reason, we started this phonemic "out of the booth" mapping. We needed to know that Aiden had a good map before slapping another diagnosis on him. Yes, Aiden does have additional {small} challenges, but by golly, this has been heaven sent, and at least now we KNOW he has a good map to better tackle his other challenges; we KNOW he's hearing all the sounds in order to put them together and into words; we KNOW what he is hearing is what he should be hearing.

and if that's not enough for ya, based on the Goldman-Fristoe 2 Test of ARTICULATION, Aiden has made:

12 months progress with his speech sound production in a matter of five and a half months!

oh, and btw, we started phonemic mapping him six months ago. 

FIRST BOOTH TEST TODAY!

I have been so excited to come back and post this, but of course had to take care of my kids first! Imagine that! Anyway, we had an audiologist appt. today, one that I really thought was to meet our new audi and check Aiden's hearing aids. So when I got there I was shocked and so excited to hear we were going in the sound proof room - a.k.a. the "booth test"!


This test watches for behavioral reactions to sounds (for ex. any eye movement, starting/stopping sucking, head turns) with his hearing aids on vs. the ABR (which measures auditory brain response) without hearing aids. All I could pray was, "Please let them see some sort of reaction ... please God please!"


Let me just tell you, you are in this little room with padded gray walls and two huge speakers on each side. They gave me earplugs, which I asked if I really needed to wear and they said yes. I was too excited to realize I was nervous. I was trying not to get my hopes up knowing that Aiden's ABR showed no response at 110 dB - which is about at the loudness of a jet engine!

Aiden was hungry, but we held him off and gave him his binky. Then the voice came over the loud speakers ... and then louder ... and louder. It was just our audi calling his name "Aaaaaiden .... Aaaaaaiden", then "bop, bop, bop", and just casual talking to him. And we watched ... and the binky stopped ... and then moved real fast - the same reactions we see at home when we talk to him within his bubble, with hearing aids. At first I just blew it off, trying to think nothing of it.


When we were through, our audi came in and told me she saw responses too (the binky business) at 75 dB and 80dB, but none at 70dB (he just kept sucking on his binky...no stopping or fast fluttering of it). We also tested him without hearing aids, which again, no "binky" responses at any level.


I started to cry ... a bitter happy moment ... I was so happy that my baby showed some sort of reaction, yet was reminded once again my baby is deaf! I know the test is not 100%, but this gives us some hope his auditory nerve is there ... it tells me his hearing aids are working - even if it's just a little bit - HE IS GETTING SOMETHING! I'm so emotional over this behavior booth test, I can't imagine the day my binky boy gets his implants!


Now, just because Aiden showed response to some sound does not mean he can hear. He may have heard a loooong noise vs. a short noise, but still would not be able to distinguish what is being heard. Aiden is still deaf. Aiden will not be able to hear the sounds of speech without cochlear implants.


I included a picture of the speech banana below. The speech banana shows the conversational sounds of speech and at which dB and frequency level the sound is at (deaf/hoh can usually hear lower frequency sounds than higher frequency). If you can't hear the sounds of speech, it's very hard to reproduce them correctly. So with Aiden possibly hearing sounds at 75dB, with hearing aids, still does not even put him within the speech banana to hear speech sounds, BUT, to me, his mom, HE IS HEARING SOMETHING and that means so much!

To learn more about the speech banana and audiogram go here and here.