Audiograms: August 2014

Last two weeks we went for unaided audiogram at Klinik Audiologi UKM. Ntah kenapa hari tu Afif takut dengan puppet berlampu tu (kene respon pandang ke puppet bila dia dengar bunyi. Itu untuk menunjukkan yang dia dengar). Dia menangis dan berpeluk je masa mula-mula start test. We ended up not using the puppet, just let him draw (more like menconteng) to distract him and observe his change of facial expression/movement bila bagi dengar sound.

What's worrying is that his hearing loss seems to be progressive at the high frequency. Meaning his hearing is worse that the last time we had an unaided test.

Afif unaided test Aug 14, 2014.

i argued with Pn. Izzati about the accuracy of the test because Afif listens well and while his speech progress is not much, it does not seem to worsen. He can even pronounce shh/ (which is a high frequency sound). Pn. Izzati kata dia ulang banyak kali bunyi kat high frequency tu tapi Afif still tak respon. Lagi la mama risau :'(

We discussed about possibility of cochlea implant for Afif. Beacuse if his hearing loss is really progressive, i want to insist on him having a CI. i don't want to risk waiting and delaying him to learn to speak. Pn. Izzati suggested to run one more aided test. With both aided and unaided test, she can bring forward Afif's name in the next CI meeting.

So last week we went for another aided audiogram.

Alhamdulillah, this time he was not scared of the puppet anymore. And the more good news is, Afif's aided hearing threshold has improved from last aided test in June.

Afif aided test Aug 19, 2014.

Though relieved at this result, i'm still in doubt. Because after 8 months of consistently wearing hearing aids, and looking at the good aided hearing threshold, Afif's meaningful words are limited to Mama, meow and hai. Nothing more. 

Yes, he had produced more sounds like shh/, na/ di/ ge/ but no other meaningful words. Maybe there are certain speech sounds that he can't hear or maybe it's our teaching technique that is wrong.

At the last discussion with ENT, audiologist and speech therapist, they all agreed that Afif is progressing okay. But as a mom, i'm still worried. i'm still not satisfied.

As of today, we have decided to seek second opinion from experts from other hospitals. We feel that after hearing opinions from others, we'll be more comfortable in making decision; to continue with HA or to go for CI. At the same time, we're learning more and more to be a better speech therapist for him.

Being parents of deaf child really is exhausting. It's not the dealing with your deaf child that is exhausting; it's the pressure of making the right choice for him that is exhausting. We want the best for him but we don't know what the best is.

O' Allah. Ease our journey to make the right choice. Ease Afif's path so that he can hear and speak beautifully. Please give him the ability to hear and speak and the opportunity to learn, be accepted and have a bright future like other normal children. Amin.

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.

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.

Hearing Tests for Babies

i'm gonna explain a bit about the audio tests that Afif had taken from birth until now. Please note that this post is from my understanding, my experience and my point of view. i'm no doctor nor audiologist so i could be wrong.

1)Automated Otoacoustic Emission (AOAE)

Also known as newborn hearing test, it was conducted on Afif when he was about 3 days old. He failed it but the audiologist assured us it could mean nothing as c-sect babies tend to fail this test as fluid tend to retain in the baby's ears and nose. Afif took the test again at 1month old and still failed the test. 

How is it done?

"They place a small soft tipped earpiece in the outer part of your baby's ear which sends clicking sounds down the ear. When an ear receives sound, the inner part, known as the cochlea, usually produces an echo. The screening equipment can pick up a response." -source

2) Tympanometry

After failing his first AOAE, the audiologist conducted tympanometry on Afif. 

"Tympanometry is an examination used to test the condition of themiddle ear^[1] and mobility of the eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal." -source 

In short, the audiologist wanted to check if Afif's unfavorable AOAE result is caused by fluid in his middle ear (which means a temporary hearing loss) or not. Afif's tympanometry suggests normal middle ear function - no fluid and the eardrums are functioning okay.

How is it done:

By inserting a thin, long probe into the ears. It took around 5 minutes. 

3)Auditory Brainstem Response (ABR) and Auditory Steady State Response (ASSR)

When it is certain that he doesn't have middle ear problem, ABR and ASSR were conducted. Afif took these tests at the age of 2 month. 

For Afif, these tests confirm that he has bilateral hearing loss (HL) especially in the higher frequency. Moderate to severe reverse slope HL in the left ear and severe to profound reverse slope HL in the right ear.

How is it done?

It is done by placing a soft headphone on baby's ears, and 3 electrodes on his forehead and sides of the head. The headphone produces sound (picked up by the ears, send to the brain) and the electrodes will pick up how the brain processes the sound. A graph (called audiogram) will then chart his brain response at a particular frequency and volume. For details on the similarity and difference between ABR and ASSR, click here

To conduct these tests, the baby has to be very still, quiet or better yet, asleep. It was a challenge with Afif as he is quite a talker (he started to coo A LOT at 2 months.. which is why i found it hard to believe that he's deaf). For the first ABR and ASSR (he was 2 month old) we did the test while i was breastfeeding him as that was the most comfortable position for him. At 7 months, we looked for second opinion at a different hospital. He had to be sedated for the test to be conducted.

ABR test when Afif was 2 months young. 

So tiny in my arms.

Afif's various test report on at 2 month young.

4) Audio Test Using Audiometer

Once his hearing loss has been determined, Afif went for countless sessions of audio tests. Without hearing aids, to test his actual hearing threshold and also with hearing aids to see how effective the hearing aids are.

How is it done?

Purpose of this test is to see his hearing behavior - can he hear and respond to it?

The audiologists uses audiometer to produce sounds at different volume (decibel) and frequency (Hz). This time, the tests are conducted while he's wide awake and alert. Unlike ABR which charts brain response, Afif's physical reaction to those sounds are recorded. Did he turn to the source of sound or did he not hear the sound? His reaction is then charted into the audiogram. 

For me, these sessions are the most exhausting. To make it work, the child has to sit still and be distracted with toys/books but at the same time not too distracted that he ignore the sounds. Afif was a 14 months old toddler who is so eager to explore everything. Who won't sit still. Who has a short attention span to toys/books. Not to mention the times he's cranky/unwell. It took us around 5 sessions to complete the tests, covering all frequencies and decibels for both ears. Phew.

*  *  *  *  *  *

Writing this post took me down the memory lane.
How with every tests, confirming that our son is deaf, are like stabs in our hearts.
How speechless we were when the audiologists and doctors explain that he can't hear well.
How my heart cried, not knowing more, not knowing what to do.
How in every audio tests i silently shouted in my head at Afif "You can hear that. Turn your head to the speaker." hoping that against all odds, he is actually hearing.

i'm sure he'll have to go through more tests. we'll take it one step at a time.