Audio & Speech Assessment

Hari Selasa lepas gi combined audio and speech therapy session kat Klinik Audiologi UKM. Patutnya speech therapy hari Isnin, tapi aku mintak buat hari Selasa pagi sebab ada meeting penting Isnin tu (dilema ibu bekerja). So Dr. Basyar kata takpe la combine je masa audio session masa petang.

Ingatkan diorang nak buat audio test pastu buat speech therapy. Rupanya diorang just nak borak-borak and discuss je..

Firstly diorang kata based on Afif's progress so far, Alhamdulillah he's doing good. Even though last audiogram ada certain frequency tak masuk dalam banana curve, Afif shows good hearing behavior. A few times Afif tengah leka main, aku suruh dia lompat and dia memang lompat (without having any visual hint). Bijak anak mama!

In terms of speech, walaupon belom ada a clear meaningful word, he demonstrates a wide range of sound. Aku update diorang Afif dah boleh sebut gege/, shh/, meow/ (bila nampak kucing), de/ to name a few (on top of what he can say during our last appointment in June). i also showed a few videos of Afif meowing, main masak-masak, dance to 'The Wheels on the Bus', and buang pampers bila mama suruh.. They're happy to see his progress siap kata "Bulan lepas takda lagi semua ni.."

Alhamdulillah his progress is a bit more advance compared to his hearing age yang baru 7 bulan. Good job, baby!

Dr. Basyar jugak ada tanya pasal Afif's behavior. Last month, memang Afif cranky dan asyik marah je.  Tak cooperate langsung masa therapy. Mungkin sebab Daddy dia takde (outstation sebulan). Alhamdulillah, bila Daddy dah ada ni dah takde cranky or marah-marah dah. Happy je dia. Dr. Basyar kata memang bila mak atau bapak takde for an extended period of time, a toddler would be depressed. They can't express or tell you that they miss Daddy so memang buat perangai la.

i also asked a few questions about possibility of cochlear implant. Sebabnye aku dengar drp ibu-ibu anak istimewa mcm Afif, memang pakai HA insyaAllah boleh bertutur dengan baik (provided parents are giving intensive therapy at home) tapi akan ada masalah di sekolah nanti. So Pn. Izzati (Afif's audiologist) explain, takpe sekarang progress dia okay. Kalau buat CI, diorang risau kalau akan rosakkan hair cells high frequency Afif yang elok. So we'll see in 6 months. Kalau aided audiogram tak elok and still takde first word, baru buat CI.

Diorang jugak ada tanya, bila Mr. Chenta nak amek cuti panjang untuk jaga Afif kat rumah. Because now is a critical time for him to learn language. InsyaAllah lepas Raya. Haritu nak cuti dah tapi kene posting overseas pulak. So pasni harap-harap lepas la cuti dia.

Dr. Basyar said i'm doing a good job. You don't know how much that means to me. i always feel like i'm not doing enough because i have to work instead of being at home to help Afif. That kind words from Dr. Basyar really lifts my spirit.

Anyway, we have to continue guiding him and doing speech therapy at home. i hope Afif will be able to hear and speak well. InsyaAllah.

MRI & CT Scan

Last 2 weeks Afif did MRI and CT scan. Purpose of this scan is to investigate Afif's ear structure and function, in case he needs cochlea implant.

We did the scan at UKM Specialist Center under Prof. Goh. i thought doing MRI and CT scan is simple; walk in to the hospital, sedate Afif and get him to sleep, do the scan and leave. Boy, was i wrong.

Because Afif is such an active little boy, Prof Goh said sedating him wouldn't be enough as he would probably wake up halfway through the procedure which is a complete NO as we need to be perfectly still during these scans. So Afif had to be under general anesthetic. In other word, complete knocked out under anesthetic. So we checked in at the hospital the day before the scan.

What's more challenging is that my husband is away and it was the first day of Ramadhan. Imagine dealing with an excited-to-be-in-a-new-place toddler alone and fasting at the same time. He didn't want to stay in our room. He walks all over the ward, demanding for elevator rides (we went up and down the lift a dozen times).. i can't even buy food for break fast. Thank God for the kind nurse who bought food for me.

 Kepenatan lepas nangis sebab tangan kene cucuk

 i'm bored, Mama..

Strike a pose

Afif's scan is scheduled at 9am next morning. He had to fast for 6 hours prior to that. That. Is. The. Hardest. Part. He is still breastfed and still wakes up 3-4 times a night. That morning, he's awoke at 5am (thanks to the nurse who insisted on taking his blood pressure.. Last-last tak valid pon bacaan) and refused to go back to sleep without being breastfed. He cried and cried. i tried distracting him but distraction didn't last long. He's too thirsty that he even tried to drink from mineral water bottle. Watching your child cries in hunger is the worst.

Before going to the Radiology Department. 

Dia macam tau-tau je orang nak buat something kat dia. 

Crying coz he wants milk.

The Procedure

After hours of denying my poor boy any food and drink, it's 9am. The procedure started at 9.30am. They put him to sleep ( a bit heartbreaking as he was crying and refusing to lay on the MRI bed. i had to hold him still while the medical people drugged him and watched as he slowly drift into sleep). All sorts of wires are attached to his body. Nak MRI je pon tapi macam kene major surgery je rupanya..

 Looking like Casper the Friendly Ghost

i managed to take this pic of him in the CT scan room

i was not allowed to be in the MRI and CT scan room so i waited outside. Thankfully, my sister in law came at around 11am. At around 11.30am, everything's done. We waited a few minutes for him to wake up. The doctor and medical team waited for him to wake up to make sure that he's okay. Then, we went back to our room and later that afternoon, discharged and went home.

Anxiously waiting for him.

The Results

After 2 weeks, we went to see Prof. Goh to know the findings of the scans. Using the scan images, she explains a bit about Afif's ears. Thankfully, both of Afif's cochlea (which is the main objective here) looks good and in normal shape. It means if he needs cochlea implant, it can be done without any complications. i asked about the cochlea hair cells that are not developed (which caused deafness) but that can't be seen from MRI. To see that you need micro-something and usually done for study purposes.

Prof Goh looks happy with the scan results. For now, Afif does not need implant as his progress using hearing aids are good. If in 6 months he does not show any improvement, only then we'll look into cochlea implant. 

Audiogram: April-June '14

Last April, we (meaning the audiologists, Afif and i) managed to finally complete the audio tests covering almost all the frequencies in the audiogram. i must say it is not easy with a curious and active toddler. He hates wearing the headphone. In the end, they plug the machine in Afif's earmold instead as it it more comfortable for him.We went for 3 sessions to complete it. His unaided audiogram:

Afif's unaided audiogram.

Red line = right ear

Blue line = left ear

From this audiogram,  he has moderate to severe hearing loss on right ear and severe to profound deafness on the left ear.

From this audiogram, it's clear that he can't hear speech sounds (located in the white lines, or as we call it banana area). 

After obtaining the complete audiogram, the audiologists had done some re-setting to Afif's HAs. They add some gain in the low frequency sounds and minimize the gain in the high frequency sounds according to the newly acquired audiogram. Then, audio test with the newly set HAs was conducted. We could only obtain the right ear audiogram due to Afif's impatience (-____-)

Afif's aided audiogram (April 2014)

The results are not that good. The audiologist assured us that it's because Afif has not yet adapted to the new setting. In one or two months he will respond better to the sound.

True enough, we notice that Afif hears better after that. He now picks up low freq sounds (like daddy's and uncle's voices) better than before. Yippieee!

In late June, we went for another aided audio test to see his progress after the newly-set HAs. Alhamdulillah, as expected, there are improvements.

Afif's aided audiogram, June 2014.

Although the audiogram shows some improvement, the audiologist and speech therapist are concerned over his bad response in the lower frequency. Yes, they fall in the banana area but he's still missing sounds like 'u', 'ng', etc. At the last appointment, i can see that they're more suggestive of cochlear implant.

We're giving it a few more weeks, to see if he adapts better. Another audio test will take place next week.

In the meantime, the ENT specialist suggested Afif to get MRI and CT scan, which were conducted last week. We'll know the result next week. Hopefully we'll know if he's a candidate for cochlear implant or not.