Sunday, February 28, 2010

More hearing lost

After a six week stint of very little activity, Julia and I had a big Thursday.  She had magic ear school and an audiologist appointment.  Then in the evening I had to go to a transitional meeting to switch her hearing support services from preschool to kindergarten.  It was an epic day in the context of our typical home-bound winter schedule.

It goes without saying that I had contracted a cold earlier in the week.  I do, in fact, get sick each time I leave my house.  I was buzzing on Mucinex with ironic drowsiness mixed in.

Mentally prepared for a quick audiologist appointment where we filled out a form and talked a little, I was already surprised that we were having a hearing test in the booth.  The appointment was to order an FM system for our home since the county will take theirs back this summer.  I hadn't prepared Julia to do work.  I got the stink eye.

An attempt was made at getting Julia to wear the ear insert do-hickeys that she hates.  She got her favored headphones back in pretty short order.  After each word the audiologist wanted her to identify she turned to me and said, "these are hurting me!"  I can't imagine how they hurt her, but the audiologist went back to the headphones.  Even imaginary plight can be distracting from sound identification tasks.

Her picture identification is usually strong and steady.  I've watched her do this test numerous times and she's a pro.  The audiologist says a word, Julia points to the picture, they move on.  This day, it was WHAT?  HUH?  WHAT IS SHE SAYING?

Then it was time for the test where Julia is required to feed a toy animal when she hears a sound.  It was exciting this time because a new bunny needed fed realistic looking carrots.  Previous tests have used cardboard cutout foods.  Julia kept turning around and asking me if I heard the sound.  "I didn't hear the sound.  Did you hear the sound?"

I didn't hear the sound.  It is not played for the benefit of the audience.  There was no way to communicate this to my child when she wasn't wearing hearing aids and had big headphones over her ears.  I did some strange pantomime and willed her to finish the test.

We went in to get an FM and came out feeling pretty certain Julia has lost 10-15 dB of hearing across the three middle frequencies.  This means we're looking at a 70 dB loss in the middle frequencies.  Prior to this appointment we were 50-55 dB at all frequencies.  Her hearing aids were reprogrammed.

By the next day, Julia had the cold.  Her hearing was still very poor even with the added amplification.  And even though she'd had a tympanogram and her ears were clear the previous day, I still can't let go of those 10 dB.  I'm still hoping they'll come back in the spring.  I'm still hoping it's ear wax.  I can't let go of the denial even though this isn't the first test that has revealed this extra loss.

By the next week our lives returned to normal.  Her hearing seems okay.  I'm now waiting on the report to see if it will say "fluctuating" or "progressive" or maybe just "severe".  None are words I wanted to see.

Other posts on childhood hearing can be found on the hearing loss page.

Sunday, February 21, 2010

Hearing Aid Tax Credit

When deciding whether to aid a young child with hearing loss, cost is surely a factor for parents.  After years of advocacy by groups such as The Alexander Graham Bell Association for the Deaf and Hard of Hearing, the House of Representatives is moving closer to enacting the Hearing Aid Tax Credit.

This bill would provide a tax credit of $500 per hearing aid purchased for dependent children.  The tax credit would also be available for adults over age 55. 

The Better Hearing Institute includes a link to write your congressional leaders in support of this tax credit.  My letter will include a request that they add tax credits for younger adults.  Hearing aids should be made affordable at any age.  Young adults should not be left out of this benefit until they turn 55.

AG Bell's advocacy page also listed a call to action issued by the American Speech-Language-Hearing Association:
Urge Congress to Include Pediatric Hearing Benefit in Health Care Reform
This week, the American Speech-Language-Hearing Association (ASHA) issued a call to action to help ensure that a comprehensive pediatric hearing benefit is preserved in the U.S. House of Representatives version of health care reform and included in the Senate version. Currently, the House's health care reform package (H.R. 3200) provides coverage of infant and child hearing services, equipment and supplies for children up to 21 years of age. However, the Senate has yet to name the same level of pediatric hearing services in its version of health care reform.

Write your congressman because no parent should have to struggle to pay for their child's hearing aids!

Sunday, February 14, 2010

Listening checks and keeping ear molds clean

Julia finished up January with a nasty head cold.  Her hearing typically takes a dive when she's congested. We went to the doctor figuring she had an ear infection.  There wasn't even fluid in her ears, but her left ear had a large ball of wax in the canal.  The doctor irrigated and washed the wax ball away.  Now she is saying that her left ear hurts.  I'm having fits.  Did they scratch her ear digging around in there?  Is she getting an outer ear infection?

She gave me a near anxiety attack a week later when she suddenly couldn't hear at all.

I figured her batteries had died.  I was painting the entry way and she was in the living room watching Pinocchio.  Perhaps she neglected to tell me the hearing aids were beeping.  We couldn't communicate to figure out any of this.  She couldn't hear a thing.

I get the batteries changed and ask her, "is that better?" 
She tells me, "It sounds funny mama." 
"Sounds funny quiet or sounds funny bad or what?"  I'm getting wound up now.
"Quiet," she answers.

I spin her around and let her know I'm going to check her hearing.  I administer a LING six sound test.  The ling sounds are:  aaa, eee, ooo, sss, sh, mmm.  She repeated the first three only.

I took the right hearing aid and headed upstairs to where I keep the stethoscope.  I attached the listening device and said the LING sounds again.  It was working.  I looked at it and saw that some ear wax was in the opening of the ear mold.  I took off the ear mold and hooked the stethoscope directly to the hearing aid.  It was much louder.  So they just need cleaned.

I ran the ear mold under warm water and then blew it out with the bulby thing that came in the hearing aid kit.  I put it back in and Julia agrees it sounds better.  I cleaned the left ear mold and put it back in.  "The left one still sounds funny," she says.

I was at my wits end because she obviously still couldn't hear.  I remembered we had her personal FM at home and we used it for the rest of the evening.  It really saved my voice because without it I had to shout as though she wasn't even wearing her hearing aids.

I felt like crying.  I had to keep reminding myself that it's just the cold.  She's not getting deafer.  It's just that stuffed up thing we all get and it takes weeks to go away.  It had better be just the cold.

I'm very diligent about checking the hearing aids by saying the LING sounds and listening with the stethoscope every morning.  Before I put the hearing aids in the drying jar at night I inspect them to see if they need cleaned.  This winter she is an ear wax factory.  I can't keep these things clean.
The readership of Big Teeth & Clouds ranges from parents with newly diagnosed kids to adult hearing aid wearers that have cared for hearing aids for their whole lives.  To those seasoned hearing aid veterans I'm requesting that you please send along any tips you have on cleaning your ear molds.  And, how do you know if they need cleaned? Is it by a visual inspection or do you wait until you hear a difference?

I've got one little pair of ears here giving me a rough time!

Sunday, February 7, 2010

Literacy skills in children with hearing loss

Julia and I are one month into our 100 easy lessons that will ultimately teach her to read. As we worked through the tasks in the very well planned lessons, I found a weakness in Julia's understanding of rhyming and wondered if this was in any way attributed to her hearing loss. She is really insistent on matching the beginnings of words rather than the end.

Over the past weeks we've made progress. She now remembers some rhyming words, but I don't think she's really getting it yet. A listing of skills that develop during kindergarten indicates rhyming is an emergent skill for the 5 to 6 year old set.

Even if that is the case, some skills take more time for my daughter to master. She has some difficulty with what I would term her auditory memory. Learning a new word or the name of a playmate she's just met takes a lot of practice and repetition. If she mishears a word and pronounces it improperly there can be a whole extra level added to the process. Last summer, Julia was insistent her new friend was Kayton. The name was Peyton. We ended up writing it on a note card so we could point to it when we tried to say the name. Peyton with a popper sound.

It was because of this concern and the debate over its cause that I picked up an old copy of The Volta Review published in the fall of 2008. I'd been saving it to read sometime and given its title: Emergent Literacy Skills During Early Childhood in Children With Hearing Loss: Strengths and Weaknesses; there's no time like the present.

The study involved 44 children age 4 to 6, all with more hearing loss than my daughter. Some of the children used cochlear implants and some had hearing aids. All had access to sound and had "some speech perception skills".

Various tests were used over the course of one school year to measure different literacy skills. In the rhyming test, the children had to pick the picture of the word that rhymed with the target word. The findings revealed that the hard of hearing kids "progressed on some phonological awareness skills (alliteration, blending, and elision) but not on others (rhyming, syllable segmentation)." This was over the course of the year long study.

The good news is that hard of hearing kids were on par with typically hearing children when it came to recognizing the letters of the alphabet and common written words.

The bad news is that vocabulary developed more slowly. This was attributed to typical children acquiring vocabulary incidentally. Hard of hearing children must have more direct instruction to remember new words.

The hard of hearing children "performed poorly, particularly on recognition of rhyming words." It goes on to say this task was the toughest for their study participants.

Their speculative conclusion as to why this might be so is that "in speech therapy, children are taught that 'sounding the same' refers to minimal pairs that share the same phonemes. This might result in confusion if children are told by adults that two words rhyme because they 'sound the same at the end'." They continued to hypothesis that often teachers (and parents) assume that a child is learning rhyming because nursery rhymes and Dr. Seuss are regularly being read.

The recommendation: more repetition and slower instruction.

This study supported my conclusion that rhyming is tougher for a hard of hearing child. We've been grouping words for years because they start with the bitey sound or the popcorn sound. Now I'm asking her to make this leap to listen to the end of the word. She can see that C-A-T and H-A-T rhyme on paper, but she doesn't yet hear it. Her ears need a bit more training.

The literacy skills presented in this study have renewed my campaign to build Julia's vocabulary. Now that she's saying words correctly we can learn off-the-wall things like "silo" and "turret". Also, our reading lessons are going really well! In just seventy more days, she'll be reading!

Above quotes are from:
Emergent Literacy Skills During Early Childhood in Children With Hearing Loss: Strengths and Weaknesses
Susan R. Easterbrooks; Ed.D.;
Amy R. Lederberg, Ph.D.;
Elizabeth M. Miller, M.Ed.:
Jessica P. Bergeron, M.Ed.;
and Carol McDonald Connor, Ph.D.