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a worried father

Zipjack zip at jack.com
Thu Jul 10 19:52:01 EST 1997

John Tarczon <johnt at kcco.com> wrote:

>Hello all:
>My son (age 3 years 1 month) is having some difficulty developing
>his speech and language skills. It may be related to his hearing.
>I give a summary of the history of the problem and ask a couple
>of questions at the end. If anyone out there can help me I would
>deeply appreciate it.  I apologize in advance for this long post
>and thank everyone who takes the time to read it.
>My son was (and is) slow to develop his speech, language, and
>articulation skills. In mid Feb., on the advice of 
>his pediatrician, my son underwent
>a speech and language exam at a local clinic which included a hearing
>test.  He was diagnosed with significant expressive and some receptive
>speech delay.  His hearing was ~45 - 50 db hl soundfield flat across
>.5k - 4k Hz. The audiologist rated the test reliability as
>fair/poor, saying he really did not sit and cooperate. He also had 
>flat tympanograms bilaterally, suggesting
>fluid in the middle ears. We went to an ENT who saw the fluid and
>diagnosed him with otitis media with effusion (which means, as far
>as I can tell, that there is fluid present without any inflammation
>of the ear drum).  He showed absolutely no symptoms of any kind of ear
>infection in the past year. In mid May he had a myringotomy and tubes
>inserted. In mid June his hearing was tested again by a different
>audiologist (one associated with the ENT). His hearing was
>45 db hl  - 250 hz
>40 db hl  - 500 hz
>40 db hl  - 1000 hz
>30 db hl  - 2000 hz
>20 db hl  - 4000 hz
>50 db hl  - 8000 hz
>roughly the same in both ears (using headphones) and his speech
>reception threshold (SRT) was 35 db both ears (using headphones and
>picture pointing spondees).  This audiologist rated the test reliability
>as good.  At this point, the second audiologist
>and my son's ENT recommended that he get hearing aids.  The ENT said
>that a normal hearing child should show about a 10 db SRT.
>My wife and I wanted a confirmation of these results before proceeding,
>so we took him to yet another audiologist.  This was early July.  
>Audiologist #3 was skeptical right from the start about the last
>test (especially the 8000 hz point). This time my son tested 25 db
>SRT in one ear and 20 - 25 db in the other
>ear. He did not cooperate well enough to produce any kind of meaningful
>audiogram.  This audiologist said 20 - 25 db SRT is about all one can
>expect out of a normal hearing 3 year old due to their lack of
>concentration/attendence skills with the quieter sounds.  She
>recommended no hearing aids, and retest him in three months, at which
>time she expects a little more improvement.

There are specific norms regarding your question here.
When you visit your Audiologist, ask what the norms say about 3 year
Many times, children only respond to very definite levels of
intensity, but can actually hear more than they are responding to.
It is sometimes quite difficult to tell.
It is possible that your Audiologist didn't recommend a brainstem at
this time, because brainstem tests are not always as specific about
exact levels of hearing as you may have been led to believe.

>She also said she did not recommend an ABR test at this time, which
>we were considering, and
>suggested that he may be readjusting to his ears again after
>who knows how many months of fluid filled ears. (We do not know when
>the fluid buildup happened, as it was asymptomatic).
>As you might guess, I am worried about him. Can anyone address the
>following questions?
>What kind of results can be expected of a normal hearing 3 year old
>on a behavioral hearing test, especially SRT?

Ideal results would be about 10-15 dB.
Still, 20-25 dB is not alarming in a young child, and it can't be
assumed that they are not hearing better, because they are difficult
to test.
Some young children can understand the need to respond to "the
smallest" sounds they hear, and others are only comfortable responding
to more definite stimuli.
>Has anyone heard about, read about, or have experience with the
>"readjusting to his ears" idea?  There is nothing about this
>in the literature the doctor/hospital gives out about otitis media
>and myringtomy surgery and I have not heard of it from any 
>other source.

During the very early years, "Auditory templates", or blueprints for
language are being set in the brain.
When there is a long-standing, or repetitive conductive loss, even if
its mild to moderate, there can be a slowing in phonological or "sound
system" development.
In other words, the interplay of auditory stimulation and neurological
processing of sound eventually creates a system for recognizing and
categorizing sounds onto meaningful information.
Children and adults who regain hearing after a period of loss will
often still require more time to process things they have heard , when
adjusting to more sound.
In short, it will take time for your son's brain to speed up its
comprehension of sound received.
Eventually, word recognition and general response to speech improves,
in the vast majority of people, as long a the hearing loss is kept at
>If his hearing is no better than this, is this contributing to speech
>delay?  Would hearing aids help a child in the 20 - 25 db range
>in view of his speech delay?

Yes, I would say that his hearing difficulties have contributed, but
therapy will help a great deal.
Your son should recieve some sort of evaluation for amplifcation.
He is in a borderline area. His hearing is almost adequate, but
because he is still learning language, he may still benefit from some
help. Your Audiologist should be able to help you with this one.
Good luck,

Dave and Kate
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