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Thread: Daughter With (Likely) Conductive Loss

  1. #1

    Default Daughter With (Likely) Conductive Loss

    So my five-year-old daughter failed her hearing screening at the pediatrician. Today she went to the ENT and audiologist, where she was discovered to have the following audiogram:



    The audiologist did a great job, so I'm pretty confident in the result. As you can see, she has mild bilateral LF loss. Her tymps were fine. No evidence of fluid in the ear. Bone conductivity readings are fine (although they were done with masking because she was getting pretty tired by that point). They also did OAE, which both ears passed, suggesting normal outer hair cell function. As one might expect, she had excellent speech discrimination at 40 dB.

    The ENT suggested two courses of action:

    1) Test again in 6 weeks and if the results are unchanged get a CT, or

    2) Get a CT now.

    Her thought is that it's probably a congenital issue. A cholesteatoma might cause the same pattern of loss, but probably not bilaterally. She says she's never seen bilateral ones in someone her age.

    So...what do people think? I confess that it's even more nerve-wracking when it's my child with hearing issues than when it's me. Intellectually I know that it's a mild loss, probably something she's always had and been happy and healthy with. Still...it's my kid.
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  2. #2
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    Quote Originally Posted by The Latinist View Post
    So my five-year-old daughter failed her hearing screening at the pediatrician. Today she went to the ENT and audiologist, where she was discovered to have the following audiogram:



    The audiologist did a great job, so I'm pretty confident in the result. As you can see, she has mild bilateral LF loss. Her tymps were fine. No evidence of fluid in the ear. Bone conductivity readings are fine (although they were done with masking because she was getting pretty tired by that point). They also did OAE, which both ears passed, suggesting normal outer hair cell function. As one might expect, she had excellent speech discrimination at 40 dB.

    The ENT suggested two courses of action:

    1) Test again in 6 weeks and if the results are unchanged get a CT, or

    2) Get a CT now.

    Her thought is that it's probably a congenital issue. A cholesteatoma might cause the same pattern of loss, but probably not bilaterally. She says she's never seen bilateral ones in someone her age.

    So...what do people think? I confess that it's even more nerve-wracking when it's my child with hearing issues than when it's me. Intellectually I know that it's a mild loss, probably something she's always had and been happy and healthy with. Still...it's my kid.
    Has your daughter been on any medications, had any illnesses(virus's)? If she has look and see if it causes LF hearing loss. I had a HF loss that was discovered at age 8 in a school screening and confirmed with a trip to the ENT at age 10. Initial diagnosis was inherited HF loss. Later it was changed to probably cause being mumps and measles that I had within a months time at age 4.
    Last edited by seb; 08-26-2016 at 10:45 AM.
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  3. #3

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    What do you mean her loss is HF? Her hearing thresholds in the high frequencies are 0-5 dB!

    No, she hasn't been on any medications. Amox a couple of times. Occasional Tylenol or Motrin for fevers and pain. She had RSV when she was 10 months old but has otherwise been healthy. She was small for her gestational age due to fetal growth restriction. Delivered at 4 lb 11 oz at 36 weeks.

  4. #4

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    Be guided by the ENT and Paaediatrician. They can be objective. It is hard to do that when you are the parent. Just make sure you follow up on it.
    Carol

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  5. #5
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    Quote Originally Posted by The Latinist View Post
    So my five-year-old daughter failed her hearing screening at the pediatrician. Today she went to the ENT and audiologist, where she was discovered to have the following audiogram:



    The audiologist did a great job, so I'm pretty confident in the result. As you can see, she has mild bilateral LF loss. Her tymps were fine. No evidence of fluid in the ear. Bone conductivity readings are fine (although they were done with masking because she was getting pretty tired by that point). They also did OAE, which both ears passed, suggesting normal outer hair cell function. As one might expect, she had excellent speech discrimination at 40 dB.

    The ENT suggested two courses of action:

    1) Test again in 6 weeks and if the results are unchanged get a CT, or

    2) Get a CT now.

    Her thought is that it's probably a congenital issue. A cholesteatoma might cause the same pattern of loss, but probably not bilaterally. She says she's never seen bilateral ones in someone her age.

    So...what do people think? I confess that it's even more nerve-wracking when it's my child with hearing issues than when it's me. Intellectually I know that it's a mild loss, probably something she's always had and been happy and healthy with. Still...it's my kid.
    Did they use cans or inserts for the test?
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  6. #6

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    They first tried cans, then switched to inserts. I believe her best results were with the inserts, and that's what's represented here. She also switched back to cans at the end and retested the lows. She was very thorough.

  7. #7
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    Quote Originally Posted by The Latinist View Post
    What do you mean her loss is HF? Her hearing thresholds in the high frequencies are 0-5 dB!

    No, she hasn't been on any medications. Amox a couple of times. Occasional Tylenol or Motrin for fevers and pain. She had RSV when she was 10 months old but has otherwise been healthy. She was small for her gestational age due to fetal growth restriction. Delivered at 4 lb 11 oz at 36 weeks.
    Sorry, it was late and I didn't proofread my response. I edited it to what I meant to say.
    Oticon Agil Pro w/streamer

    -250 500 1000 1500 2000 3000 4000 6000 8000
    L 10--5----10----30---50----70----85---80---80
    R 5--10----20----35---45----85----85--100--100

    SP Disc ------------- SRT
    L 88% @55db ------- L-10
    R 90% @55db------- R-25

  8. #8
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    Quote Originally Posted by Um bongo View Post
    Did they use cans or inserts for the test?
    If the test us repeated elsewhere and shows the same result it's LF mild conductive. Forget all the 'Doctors' above. It's possibly a middle ear function or congenital issue, though it might be something as simple as an extra layer of thick mucous on the inside of the tymp. The drum compliance is ok, but a bit low.

    In in terms of speech development, don't sweat it, there's very little important low energy sound that she's missing: she's actually got her own built in noise filter too. Just watch her levels if she starts turning up the Tv too loud etc.

    its unlikely that a scan us going to show much more, she might also grow out of it as her jawline develops with age.
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  9. #9

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    Quote Originally Posted by Um bongo View Post
    If the test us repeated elsewhere and shows the same result it's LF mild conductive. Forget all the 'Doctors' above. It's possibly a middle ear function or congenital issue, though it might be something as simple as an extra layer of thick mucous on the inside of the tymp. The drum compliance is ok, but a bit low.
    When you say "repeated elsewhere," are you saying that it should be repeated by a different audiologist? Or would repeating in six weeks with the same audiologist be adequate? That's the current plan.

    In in terms of speech development, don't sweat it, there's very little important low energy sound that she's missing: she's actually got her own built in noise filter too. Just watch her levels if she starts turning up the Tv too loud etc.
    I'm not really worried for speech development; her speech development is entirely within normal range for her age and sex and of course the thresholds for the most important frequencies for speech intelligibility are all excellent. Am I correct in thinking that it's mostly going to affect her overall impression of loudness?

    its unlikely that a scan us going to show much more, she might also grow out of it as her jawline develops with age.
    Would it be a good idea to do the CT just to rule out unlikely things, or would you suggest holding off unless things change? (I'm not going to base my decision entirely on your advice--we've got our own surgeon and audiologist--I'm just interested).
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  10. #10

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    I think I would wait and do a re-test in 6 weeks. They're pretty conservative about doing CT scans in children. I'm not afraid of CT scans for myself, but I'm old. I think it's good policy to hold off doing one on a child.

    I guess I would ask what they are looking for in the CT scan, and if they find something what would the next step be? Would it lead to a way to reverse or stop the loss?

    I think it's a little unusual to see someone in this forum having a CT scan. It's pretty common to do an MRI when a conductive loss is found, to rule out a tumor on the auditory nerve. MRI scans take quite a while, the patient has to remain absolutely still for as long as 4 minutes at a stretch, and the machine makes a lot of noise. I asked the technician what they do when a child needs an MRI and she said usually they sedate the child.
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