Last week Noah had an appointment with both the ENT (ear, nose, throat doctor) and the audiologist at Seattle Children’s Hospital. As I’ve explained in more detail in this post, Noah has two things working against him regarding hearing: extremely small ear canals and fluid in his middle ears. These are the causes of his conductive hearing loss (a problem with the middle ear as opposed to the inner ear or auditory nerve). At his previous appointments, the ENT has not even been able to see his ear drums when looking into his ear with a microscope because his ear canals are so small. Until Noah’s ear canals reach a certain size, he can’t have the procedure done to place tubes in his ears. Tubes should theoretically help the fluid in his ears drain, therefore improving his hearing. We have been hopeful with each appointment that his ear canals have grown large enough to do the procedure, but even now at 14 months they are still too small. And even if he were able to get tubes, we don’t know for sure that it would improve his hearing significantly. It would likely improve it to some degree because draining the fluid will remove some of the obstruction, but the small size of his ear canals also contributes to his hearing loss. So even with tubes, he may still have some degree of hearing impairment.
At the appointment last week the ENT said he could barely see the ear drum in his left ear, which is progress! He thinks that Noah should be able to get tubes in about 6 months. The audiology appointment also went well. She was able to get almost a full range of results from his behavioral hearing test. This was a huge improvement! His past behavioral tests have not been very conclusive because Noah was not consistently turning toward noises. Prior to that, he had two BAER (brainstem auditory evoked response) tests which measure the brain wave activity that occurs in response to certain tones. BAER tests are much more accurate, but they generally only do them through 6 months old because the child has to be still or asleep for the entire test which can take up to 3 hours. This is much easier to accomplish with a newborn than a squirmy one year old. Noah’s past test results have ranged from mild to moderately severe.
How a behavioral test works: Noah sits on my lap in a sound booth. Sounds of varying intensity are played via speakers on both sides of the booth. The sounds include the audiologist’s speech and specific tones and frequencies. She records Noah’s responses to the softest sounds presented and plots them out on a graph called an audiogram. Then she repeats the same sounds and frequencies while Noah is wearing his hearing aid and plots that on the audiogram as well.
His most recent results showed moderate hearing loss in most of the “speech banana”. This term is used to describe the area where the phonemes, or sounds of human speech, appear on an audiogram. While many other sounds fall outside of the speech banana (dog barking, lawn mower, water dripping, etc.) audiologists are most concerned with the sounds within the speech banana because hearing loss in those frequencies can affect a child's ability to learn language. On the chart below, the speech banana is the blue shaded area. The “S” in red represents Noah’s hearing level without the hearing aid (mostly in the 40-60 dB range = moderate). The “>” represents his hearing level with the hearing aid (0-10 dB = normal). This means that without his hearing aid, Noah has trouble hearing people speak at a normal conversational level. The good news is that with his hearing aid, Noah can hear completely within the normal range.
Noah’s Hearing Aid
Noah first started using a bone conduction hearing aid in January, which was on loan from Seattle Children’s. He had it for about 6 months, during which time we were on the waiting list for a Baha softband (bone anchored hearing aid). This device is a newer, more advanced type of hearing aid than the one we were initially borrowing. In June, Noah’s name came up on the waiting list and we got to do a trial run with the Baha. It was a huge improvement to the previous one! No cords, smaller, better sound, easier to position on Noah’s head. When our trial was over after 30 days, we were faced with the decision to either:
1) Wait until Noah could get tubes placed in his ears (which is unknown based on how quickly his ear canals grow) and hope that the tubes would improve his hearing enough to put him in a normal hearing range.
2) Purchase our own Baha.
We opted for the second option for several reasons. First, we felt that if there was something we could do to help Noah and his development, we should pursue it. Hearing is so closely linked to speech, which we already know he will struggle with due to his low muscle tone, among other things. Why not do everything we can to help him hear? Second, we got insurance to cover it! These devices aren’t cheap, so it certainly helped that we were able to get almost full coverage by my awesome insurance. Of course that only happened after several hours on the phone with various insurance representatives, lots of paperwork and help from our audiologist (who is amazing by the way). You see, the insurance company denied the claim at first because the Baha is considered a sound processing device, which is a different insurance code than a hearing aid. They ended up approving it after making us jump through several hoops.
Noah received his very own Baha in August and has been wearing it ever since. Well…as much as we can keep it on him. He will only tolerate it for so long until he grabs it and starts chewing on it. But each day he is getting more and more used to it.
While we are hopeful that he can get tubes in 6 months that will reduce at least some of his hearing loss, we are so grateful that we have been able to provide a hearing aid for Noah in the interim. We are also thankful for the Seattle Children’s audiology staff that has been so helpful and accommodating, working hard to give Noah the best possible solution to his hearing loss. It makes such a difference to have supportive doctors and specialists on our team.