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a worried father

Jeffrey Sirianni audioman at HCTC.NET
Wed Jul 16 01:29:09 EST 1997

John Tarczon <johnt at kcco.com> writes:

>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.

This is not uncommon for relaibility testing in children to be
fair to poor.  Whenever I see a child who's results are questionble,
I sway to the conservative side in that I'll re-test in a month
before making recommendations, such as hearing aids.  Your child
appears to be a boderline case, so jumping in too fast may mean
placing hearing aids on a child sho may not need them.

>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).

Familiar story.  We very often see children with 30-40 dB of hearing
loss with flat tympanograms due to long-standing fluid in the middle
ear space.  There does not have to be an active infection for fluid
to remain in the middle ear space.  If fluid was present, myringotomy
and tubes was the right way to go (IMHO).

>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. Then proceed from there.
>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?

An ABR would surely identify any amount of sensorineural hearing loss.
If this was my child, I would tell the audiologist that you would like
to have this done, whether they agree on having it done or not.  I say
this based on the fact that there was little to no improvement in his
hearing following the myringotmy and placement of tubes.

Good Luck....

* Jeff Sirianni, M.A., CCC-A                      *
* Sound Advice / R.G. Delaney, M.D.               *
* 710 Water Street / Suite 404                    *
* Kerrville, TX  78028                            *
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