FINAL EMAIL FROM ME TO DIRECTOR OF AUDIOLOGY ACH (4-27-2010)

Patti, 

Thank you for your offer of a second opinion, but it will not be needed. Not short of a miracle a friend of ours has a son who recently got hearing aids for the exact same loss.  He is a 3 year old with similar speech to how Alex was at that age and also failed his initial newborn screening. We felt really blessed as when we went to the same audiologist they used, our son was finally prescribed air conduction hearing aids; he will get them this Wednesday.  I am tremendously grateful as I feel, regardless of how this impacts his speech, he needs the hearing aids to prevent additional difficulties in education.  So many pieces of the audiological picture just does not match up. Never present OAE's, always type As tymps, absent middle ear reflexes. . .I mean I understand passing off one of these things permanently missing, but all of them together. . .  

I have been through test after endless test with my son.  I have seen the facts of education at school, through the Dennis development center and through early childhood intervention. He has been tested by the school psychologist, the school speech therapist, Dennis Developmental, the state education consultants, the ACH Genetecist and endocrinology. We have been more than thorough. We have done every recommended battery for my son to check every possible diagnosis.  Nothing has been turned up.  I have stuck to hearing, because I have noticed a pattern in these tests.  His IQ is consistent with a minimal hearing loss.  His sound omissions on the Goldman Fistoe is consistent with his Audiogram. The Genetecist pointed us back to the hearing loss when his tests drew a blank. He has struggled with reading, writing, and spelling.  We have found programs that work for reading, writing is coming along through practice.  NOTHING  works for spelling and Apraxia techniques DO NOT work for speech nor ever have. So many things are consistent with a hearing impairment, for which there is a solution.  On the other hand there is no treatment for Apraxia.  Why sit here and do nothing, if there IS a possible solution?  Still again why would we want to complicate his education by untreated hearing loss. If an undetected minimal hearing impairment affects the average students IQ by 1 standard deviation, how much more severe would the affects be on a student with another disability. 

ASHA's classification of Minimal for a child is a PTA from 16-25dB the American Academy of Otolaryngology's classification is mild for a PTA from 15-40dB there is no requirement of the plotted PTA's to cross the speech range per either of these entities. I find it interesting that hearing aids would not be prescribed at ACH until the PTAs reflect that some speech sounds are not heard.  Isn't that too late? Speech sounds should be loud enough to be intelligible not just audible.  ASHA's recommendation of amplification 15dB over threshold gives insight to this.  Children need to have access to speech sounds with at least 15dB of strength.  By the Audiogram, Alex does not hear 'Z' and 'V' and hears the other low frequency speech sounds at about 5dB only hearing the loudest 3 at the recommended 15dB.  The high frequencies are the same, 5dB gain (are you surprised that he does not produce 'Z', 'V' & 'J' or 'F' & 'TH' and produces 'S' imperfectly?) .  Look on Karen Anderson's website http://www.kandersonaudconsulting.com/Listening_and_Learning.html  She states in her document on Reverse slope losses that a hearing loss of 25-40 dB in the low to mid frequencies causes a child to miss 30% of speech information if not amplified and some sounds may be heard inconsistently, which may affect speech production. Does this not seem bothersome enough for a child to need hearing aids?

Only 1/12,000 hearing impaired individuals have a reverse slope loss; that is 1 appointment in 5-6 years of working as a full time Audiologist. It makes me wonder how much information is really known about how this type of loss affects a young child prelingually.

I do hope that you take into consideration these facts. And still again, I do hope that I will make the way for the next family less difficult.

Regards,

Sara Solis