First, 28th April Australian Hearing follow-up.
This appointment was to confirm the results from the 11th April tests showing right ear recovery and left ear deterioration. Jonica was absolutely brilliant as they did a huge range of testing and she remained engaged the whole time, even as lunchtime approached. We did air-conduction on both sides at the usual 5 frequencies, we did unmasked bone conduction at 4 frequencies to get the response from whichever ear is better, then they did masked bone conduction on the left side at 3 frequencies to get an idea of what the left ear was doing. All up nearly an hour of testing, and she was super-reliable and compliant. What a champion!
The results were a mixed blessing. Middle ears were clear on both sides today, so the fluid on the right side has mostly gone, just a blocked eustachian tube still. Here they are:
Right Ear, air conduction
250Hz - 65dB
500Hz - 70dB
1kHz - 65dB
2kHz - 65dB
3kHz - 75dB
4kHz - 105dB
Slight improvements at 250Hz & 2kHz though still within the margin of error, significant improvement at 4kHz, all due to clearing of fluid from middle ears, as expected.
Left Ear, air conduction
250Hz - 80dB
500Hz - 90dB
1kHz - 95dB
2kHz - 105dB
4kHz - 120dB
Slight improvements at 250Hz & 1kHz though still within the margin of error, and further deterioration at 4kHz
Umasked Bone Conduction, response from the better ear
500Hz - 30dB (!!! Previously 55dB)
1kHz - 40dB (!! Previously 50dB)
2kHz - 55dB (Previously 70dB)
4kHz - 80dB (Previously 75dB)
These are very odd results, as they include significant improvements on previous results. Since we also isolated the left ear and none of its results were better, we can reasonably assume that this is what her right ear can do.
Masked Bone Conduction, left ear only
Masked bone conduction is interesting. We've never had it done before, so i was interested in how it worked. They use the same test frequencies and the same bone conductor appliance, but they have to keep the other ear busy so they only get a response from the target ear. To do this, they put an air conduction insert into the other ear and play a beach-like sound (undulating white noise, perhaps?), then send the test frequency only to the bone conductor on the target ear. Amazing! Anyway, technical distraction...
500Hz - 80dB
1kHz - 75dB
2kHz - no response at 80dB
Bone conduction can only be tested up to 80dB, so at 2kHz there was no response at the maximum level. 4kHz was not tested, probably because since there was no response at 2kHz and her air conduction gets worse in the higher frequencies, they wouldn't expect any response at 4kHz.
For those of you who prefer a visual representation, here's the audiogram:
So, this confirms it. The only thing to do is to consider an implant for Jonica's left ear. She can still wear her hearing aid, and they adjusted it while we went and got pizza for lunch, but it's really not going to do enough for her. She's especially lacking in the high frequencies and mostly at 4kHz, which is where a number of speech sounds sit, so she's missing sounds like "sss" and "t". Her speech quality is still deteriorating, so it's becoming clear that an implant is the way to go.
Cranial surgery on my 3yr-old. Fantastic. How do I explain this to her? How do i tell her that they're going to put something in her head to help her hear without scaring the daylights out of her? She's aware enough to be frightened by new things, strange things, things she doesn't understand, people she's not familiar with, so I really need to discuss this with her, I can't just send her off to surgery without telling her something about what's going to happen. She knows her left ear is quiet, she knows it doesn't work like it used to. A few delicate conversations coming, methinks.
I think I'll do the other appointments as separate posts...
Next appt: Mon 12th May Paediatric Dental specialist for Jonica. I will explain...
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