Diagnosis

Alex’s First Hearing Aid Fitting

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We had our appointment at Buffalo Hearing and Speech this morning. I think that it actually went quite well.

The audiologist (who won’t be our long-term audiologist because she primarily does hearing aids) gave us a quick breakdown of what we were going to be doing, which included talking to the head of the oral school that we want to send Alex to if he’s eligible. Not only was she going to be available to answer our questions, but she was going to be there in person! This was a great kindness on the part of the audiologist as well as the administrator, because it was clearly going above and beyond what was required for that meeting. The second part of the appointment was to get Alex fitted for hearing aids.

The audiologist showed us the hearing aids that Alex would be using (she had some sample models), which was nice. They’re relatively small, certainly compared to the speech processors of the cochlear implants. We were then given the opportunity to pick out colors for the hearing aids. The audiologist made a great point, and that was that the beige color was a bit medicinal / clinical. We agreed and went for a silver color for our little guy.

We asked quite a few questions about what the hearing aids could do for Alex, and the answers we got were pretty uplifting. For hearing loss like Alex’s, the analogy was made that voices to him would sound something like what adults in Charlie Brown cartoons sound like – he will probably be able to make out vowels, but not much more. However, that’s still more than we were expecting, and we were told that it’s probably enough for him to be able to understand things like “mamama.” If he gets that sort of benefit on top of the basic things that we’re longing for (i.e., for him to look at us if we’re saying something loud, to startle, etc), it will really feel like he will have already begun his hearing journey. Hearing about the possibilities of what sort of help Alex can get in the near-term was probably my favorite part of the appointment. Yes, it’s going to be a monster to try to keep them on his head, but compared to him having NOTHING and feeling helpless about it, it’s just not a huge concern.

Anyhow – projections from the audiologist were about four or five weeks to get the hearing aids. That’s longer than what we were told by Early Intervention, but obviously they don’t know all of the nuances of the process. Between that and the benefits we might get out of the hearing aids, I’m not upset or annoyed at all, just excited to get them on Alex.

We then met with the administrator of the oral school, who was a pleasure to speak with. She answered all of our questions and gave us a little bit of background. Bulleted version:

  • We asked what the difference between Auditory Oral (what her school does) and Auditory Verbal (what all of the kids from the cochlear implant board are generally using) was. Her answer was that generally, the AO approach allows natural visual cues whereas the AV approach is more strict. There were a few other differences, but for the most part, they were roughly the same.
  • I asked her about using ASL with Alex – it’s definitely something we all want to learn at some point if not just because his hearing aids / implants won’t always be on, but we will certainly hold off on using it with him if it delays his speech or hearing skills in the early stages. She said that it was definitely up to the parents and that there was no research that indicated anything definite in terms of impeding oral / hearing skills, but she DID say that the school had some experience with kids who came in with ASL and that they would lean on it a bit, so to keep that in mind. The gist I got out of it was that there’s a balance to be considered, which makes sense. If Alex does well with the implants in terms of what they get him with hearing, we will likely not push ASL to maximize the potential he can get out of the oral school, then bring it into the equation later after he’s established. If he doesn’t do as well, we’ll definitely use more ASL.
  • She stated that, accounting for hearing aid and cochlear users, the school saw a ROUGH success rate of 80% with mainstreaming their students over the past six or seven years. She emphasized that that accounted for everyone in the school, including those with additional cognitive delays. I thought that was pretty impressive, and I would guess that with some of the better technology available that has noise reduction and other helpful features, it’s probably a better number as you lean toward recent years.
  • The oral school first gives kids one-on-one speech therapy, then it later becomes group therapy. The reason behind that is that group therapy more closely resembles the noisier environments that kids will encounter in more mainstreamed environments.
  • The school will actually “kick” your child out if it becomes clear that they don’t stand to benefit anymore. Nice to see that that’s actually “a thing” that they have to account for because the kids are too successful, and also nice to know that they’re constantly being evaluated.

Shannon and I were both very appreciative of the administrator actually being there, and it certainly ensured that our introduction to the oral school got off on the right foot. She left us her contact information and invited us to watch the classes at some point – we’ll certainly take her up on that.

The last part of the meeting was the actual fitting. This was a pretty straightforward and simple process. Alex sat on my lap, the audiologist injected some putty into both of his ears (maybe only a centimeter deep, Alex wasn’t too uncomfortable), and we waited for about five minutes for the putty to harden up. She pulled the putty out and showed us what the inside of Alex’s ears looked like. Those molds will be used to anchor the hearing aid speaker in Alex’s ears. We had read a story on the internet of a parent who felt like she was constantly getting new molds because her baby was growing so fast and so the hearing aids would squeal as the “seal” was broken, but our audiologist told us that we’d probably be good for a few months. The newer hearing aids don’t squeal as much as the older ones due to better technology, so they give a little more wiggle room in avoiding the rampant squealing that we had read about. Go technology.

So ended our meeting. We generally liked everything we heard, especially with regard to what was possible with the hearing aids alone, and it was very nice to get that warm introduction to the oral school that we’re hoping will be appropriate for Alex.

I think our next meeting is with genetics – more to come there.

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Introduction, Part Three

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Continuing…

After the ABR where we discovered that Alex was functionally deaf, Shannon and I were obviously distraught to the core.  His “out of the box” hearing was practically non-existent.

One of the last kindnesses the audiologist gave us was to refer us to a new ENT whom she referred to as “THE guy for cochlear implants around here.”  She even called their office for us on the spot and arranged an appointment; she got us in something like four days later, which is apparently miraculous because this doctor is very sought after.

She also gave us a quick background on our two basic options that we’d have at this point – we could try for a listening / speech approach, or we could go the ASL route.  No decisions were or have been made at this point because we don’t have enough information to make an informed choice, but I’d be lying if I said that we didn’t ask more questions about the hearing / speech approach.  Apparently most of the kids that go through that program have great success in mainstreaming (that is, going to typical schools and basically being brought up to be a part of the hearing world), which was good to know.

Our nights were awful.  One thing that was particularly difficult was falling asleep, because the silence beforehand gives plenty of room for the mind to race.  To make things worse, Alex was still waking up once or twice a night to feed, so we had to go through the process multiple times per night.  Each time we woke up we realized that it still wasn’t just a nightmare that we were waking up from; our child was still deaf.

During the days, much research was done around cochlear implants, including how well they work, how they do with music, what sort of future-tech was coming up, etc.  Again, it was all a compromise, so it was all very difficult to feel positive about.

The day of our appointment with the ENT rolled around.  Our new doctor was definitely an improvement from the last guy – our audiologist had given us a heads-up that this would just be a very quick and cursory check, but our doctor answered almost every question we had accumulated at that point.  It was nice to be able to ask an actual professional questions and get real-world answers rather than reading clinical statistics from Google Scholar.  He seemed rather matter-of-fact about going with cochlears at that point, and most importantly, he said that if that’s the approach we were to take, he’d want to do so as early as possible.  The earliest he had implanted was eight months, but typically he could get them done by nine months.  The FDA currently recommends waiting until one year despite all of the studies that scream “THE EARLIER THE BETTER!”, but the doctor ensured us that he could petition and we’d have a decent chance of pushing it through.

Throughout the discussion, the doctor brought up the term “auditory neuropathy.”  I didn’t think anything of it at the time because it basically sounded like the medical term for “deaf” or “hearing damage brought on by damaged nerves.”  On our way out, the doctor mentioned that he wanted to line up an MRI if possible so he could get a better idea of what was going on with Alex’s ears.  A challenge with this is that it takes something to the order of 40 minutes to complete and requires the subject to stay very still.  No easy task with a squirming infant.  Typically, children are anesthetized, but he wasn’t sure if we could do it with Alex being this young.  Nevertheless, they would follow up and see what the MRI folks would recommend (we haven’t heard back from them yet, but I’ll share that info here when we do).

Later that night, we had our first social dinner outing since having Alex with Shannon’s best friend and her fiancee.  Though we weren’t sure if we would really be able to enjoy ourselves, it proved to be extremely therapeutic.  They asked questions about it.  They offered encouraging words.  They didn’t try changing the subject.  They obviously were interested in what was going on with Alex as well as our well-being.  Basically, it was fantastic, and it’s yet another reason that I appreciate that we have the two of them in our lives.  Yes, some alcohol might have helped as well, but it was great to feel somewhat normal for a few hours.

Again, this good feeling would be unfortunately short-lived.

Shannon brought up that the term “auditory neuropathy” sounded strange when the doctor had brought it up.  I told her my initial thought on it, which was that it was just a fancy term for “deaf.”  We went to sleep for the night.  Alex woke up at around 3:00 in the morning to be fed.  During that time, Shannon and I started looking up the actual term “auditory neuropathy,” which was also present on the ABR report we had received that day.

Our third drop straight into deep depression commenced.

Auditory neuropathy, as it turns out, is a SPECIAL type of deafness (you have to win the lottery to get this, it’s something like 1 in every 100,000 children will have it) with a few terrifying characteristics.

  1. Cochlear implants don’t always work with it, or they don’t work as well.
  2. Hearing aids flat-out won’t do anything for it except for rare cases.  Therefore, putting hearing aids on Alex prior to getting cochlear implants (if we were to go that route) would likely do absolutely nothing for him.
  3. It’s something that’s relatively “new” in terms of being diagnosed, so there isn’t a dearth of experience in treating it.
  4. Worst of all – auditory neuropathy is often accompanied with other issues.

That was the end of our sleep for that night.  We had gone from adjusting to a perfectly healthy baby to a baby with moderate hearing loss to a baby with profound hearing loss to, now, a baby who would potentially not even benefit from cochlear implants AND who was more at risk for having additional health issues.

The latest bit hit us the hardest.  This might be because we’d already endured the previous two hits, so we were already raw.  There was a lot of pleading for the evil to cease.  “Please stop.  That’s enough.  We can’t take any more.”  We began to make peace and accept that we could have a child who would simply not have hearing, and potentially have worse things coming on the horizon.  We’re still trying to make peace with this possibility.

Two days later, we went to Shannon’s mom’s house to spend the day.  It’s always been a boost to the soul to visit for a few hours – Taylor and Alex’s grammy and grampa love taking care of them and spoiling us.  It’s also nice to get out of the house occasionally, especially when you’re sending so many hours writhing in depression within it.  Shannon and I had a good discussion on the way over (as we usually do) about what sort of GOOD things the future might hold, and how that rational thought that we’d deal with whatever came our way and adjust our lives accordingly was worth holding on to even as we were bottoming out.

Upon arriving at the house, the kids were immediately spoiled.  The TV was tuned to Disney Junior, which contains most of Taylor’s favorite TV shows.  At one point, there was a show called “Little Einsteins” on.  It’s basically an educational cartoon that places a lot of emphasis on a few bits of classical music every episode.  While it was on, I was holding Alex, who was resting in my arms, looking innocent and beautiful.  Every time they played a little musical hook was like taking a knife to the heart.  He couldn’t hear this.  Even if he had cochlear implants, he probably wouldn’t hear it with the same fidelity that we could.  I broke down and cried silently on the couch.  I even received the added bonus of feeling guilty about doing it because I know that Shannon’s mom could probably see me, and I highly doubt that made her feel any better.  Certainly one of the lowest emotional moments I had had so far.  In my life.

I think that by this point I had lost something to the tune of 15 pounds in just over a week.

The following day we had another ABR with the hospital we had performed the first one with.  The main objective of this particular ABR was to get a good measurement of Alex’s left ear now that Buffalo Hearing and Speech had gotten a solid reading out of Alex’s right.  I held Alex again while Shannon waited in the hospital waiting room.  Before the audiologist began the test, I gave her an update (suspected auditory neuropathy, profound hearing loss), mostly to encourage her to tell me what she was doing as she went along without worrying that she was going to casually deliver horrific news to a dad who thought everything was AOK.

After about an hour’s worth of testing, we received some interesting news – she didn’t see any sign of auditory neuropathy in Alex’s left ear.  That was somewhat unbelievable, considering that auditory neuropathy is almost ALWAYS present in both ears.  She explained something about a wave V (I’ll try to get more detail on this as it unfolds in case it helps anyone else) and how it wasn’t exhibiting signs of neuropathy.  It might’ve been because it was smooth?  I’ll clarify later.  My hope didn’t skyrocket (or, at least, I won’t let myself admit it), but it was a potential win.  I eagerly asked her if she could re-test Alex’s right ear to scan solely for auditory neuropathy.  She agreed.  Flipping Alex over woke him up, but luckily I was able to get him back down again after about twenty minutes.

She couldn’t find any signs of neuropathy again.

The testing concluded and Shannon was brought into the room to discuss the results (I specifically asked for this to make sure she could hear everything the audiologist had to say as well as have the opportunity to ask questions).  She re-iterated that she couldn’t find any signs of AN, but she also didn’t have the report from Buffalo Hearing and Speech that might’ve shed some more light on what THEY had seen.  Again, I tried not to get my hopes up too much.  We had been told that Buffalo Hearing and Speech had the latest and greatest equipment, so maybe they were looking for something different than the hospital was.  Our souls had already been squashed three times in the past two weeks, so this the prospect of any hope just felt like a cruel setup.

The audiologist went on to answer all of our myriad questions.  She had previously been involved with the early intervention program, so we got to find out a lot of great information about the two tracks – one for auditory / verbal, one for ASL.  We discovered that the ASL track was actually more based on total communication (so ASL, speech, hearing, lip-reading, everything available) which made us feel better about that program.  It was pretty informative.  She was also kind enough to give us the opportunity to email her the ABR report stating that Alex had auditory neuropathy so that she could take a look, and she promised to get back to us with her input.  She did so a few days later and stated that she didn’t read anything on the report that would make her back her opinion out that Alex was free and clear of AN.

At this point, I think we’re basically caught up in terms of diagnosis.  We don’t know if Alex has AN or not.  Over the past few days I’ll admit that I have some hope that he doesn’t have AN on the basis of the latest ABR as well as a few things that we thought were odd that the audiologist agreed with – namely, that his OAE test was always coming back as negative.  With AN, an OAE typically shows as normal for a period of time and then goes to abnormal, but that takes a lot longer than the ten weeks that Alex had been around for.  Typing this, I can feel the letdown that I’m already setting myself for, but I guess we’ll just call it cautious optimism.

We haven’t heard back from our doctor yet regarding Alex getting an MRI (step one in determining whether cochlear implants would work for him).  We have our first early intervention meeting scheduled this week, but that’s just going to be boilerplate.

At least we’re moving.

Introduction, Part Two

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I’ve struggled a bit to figure out how to keep this from just becoming a babbling stream of consciousness for the sake of keeping things organized and helpful.  I literally have four other posts that I’ve started and not finished for various reasons; regardless, it’s probably best to keep catching up with Alex’s story.

Where we last left off, Shannon and I had found out that Alex had some degree of hearing loss.  We had no idea what the extent of it was at this point.  When we got home, we immediately took to Google and started investigating hearing aids and feeling awful.  Some hearing loss might not sound bad, but understand – our child would now depend on hearing aids for the rest of his life.  And if you know anything about hearing aids, then you know that they’re far from perfect.  Unfortunately, hearing issues can’t be boiled down to “just amplify it!”  It doesn’t work that way.  They contain speech processors, noise reducers, different programs for different sound environments, etc.  Basically – Alex’s hearing would not be able to fixed or brought back up to 100%, at least using today’s hearing aids.  Everything from here out would be a compromise for our boy.

Then, of course, there’s the visual.  He would always be wearing these.  As a guy, he doesn’t have the same benefit as most ladies do in terms of being able to grow his hair out.  Well, of course he COULD, but let’s be real.  Only a select few guys can do that.  Dark thought – he would never be able to approach a girl at a bar and stand on the same footing as another guy who doesn’t have hearing aids.  There’s nothing cruel about that in itself; we’re biologically wired to look for attractive partners who don’t have any potential issues that could be passed to their children.  But as a parent?  It’s a fucked up thought to have.  And I knew it was a fucked up thought to have, so I felt guilty about it.  The dark thought -> guilt -> depression cycle has been a common theme through much of this.

We felt terrible, had trouble sleeping, felt victimized.  It might have been the day after we took the test that we decided to immediately get moving as quickly as possible and call up an ENT specialist.  I’ve worked in the healthcare system.  I know how inefficient and slow it is.  We also scheduled a follow-up ABR with the hospital to get a better diagnosis of what sort of loss we were actually dealing with.  The closest we could get was something like three weeks away.

And just a quick note on those three weeks.  Three weeks is a very.  Long.  Time.  Especially when you’re talking about something as emotionally charged about this.  It’s three weeks of pure uncertainty.  Gives the mind plenty of time to conjure up stressful visions.

Getting back on track – shortly after the initial news, we hosted Halloween at our house with my parents, some of my friends, and Shannon’s family.  I asked my dad (who wears hearing aids) many questions, to which he had many rationally reassuring things to say.  I qualify that with “rationally” because at this stage of grief, nothing rational really helps.  At the end of the day, it’s still a compromise regarding something you would NEVER, EVER, want to do so on – the welfare of your kids.  Speaking with my dad, though, was very helpful.  He’s someone who’s living in the world of less-than-perfect hearing, so to hear his perspective was real, and hopeful.  Much was said about how far the technology has come along since he started wearing hearing aids.

After many tears and heartaches, Shannon and I came to a base form of acceptance regarding Alex’s hearing loss.  Hearing aids wouldn’t be too bad.  There’s some pretty crazy stuff out there for hearing aids, including aids that fit directly into the ear canal.  No one would have to see them down the road, so Alex wouldn’t have to deal with any sort of obvious social stigma from looking slightly different.

Just as long as it isn’t something like, oh, say, cochlear implants… we’ll be alright.

Shortly after Halloween, we had our appointment with the ENT.  Nice building, but the guy sucked.  He wouldn’t look us in the eye.  He didn’t introduce himself when he walked in.  He talked over my questions (Shannon later told me that she knew that I was getting increasingly angry).  He spent much of our time together talking about late night hearing aid infomercials.  Worst of all, though, is that he thought we had come to him a little bit too early, and that typically they don’t engage until the patient is about six months old.  Nope.  Everything we had read up to this point was that getting your baby as much hearing help as possible, as early as possible, is paramount.  As if that didn’t seal the deal that this was going to be a one-appointment thing, his detached manner really drove it home.  It’s amazing to me that someone can get their doctorate and have such a shitty bedside manner.  I didn’t need the guy to give me some hugely compassionate speech or anything and I get that not all doctors are psychiatrists, but this guy was just completely disinterested.  We weren’t there to talk about subjects that interested his whim, we were there to do the best thing that we could for OUR CHILD, which most parents would probably agree is probably the most important part of their lives.  Before we had left the room I was relatively certain that Shannon and I had already telepathically agreed to never see this guy again.

There were two good things that came out of this appointment, however.  One – he looked at the results of the wonky ABR we had taken and made some mention of how it looked like it was mild-moderate or something to that tune.  For those who haven’t done eighty hours of research on this, mild-moderate is basically “get some hearing aids to help you hear optimally, but you’ll be fine” territory.  That was reassuring.  The other positive was that he recommended that we arrange an appointment with Buffalo Hearing and Speech, who have the best equipment, etc.  On our way out of the office the helpful secretary got us an appointment with them that fell before our follow-up ABR with the hospital, so speeding that along was appreciated.

The time leading up to that next ABR was relatively peaceful.  Shannon and I still discussed Alex’s hearing loss at length, but at this point we had a doctor implying that this didn’t look like any major sort of loss.  A hugely important calming factor that was introduced here was Shannon’s best friend.  She wears hearing aids, but you truly wouldn’t know it.  It hasn’t slowed her down at all in terms of being social, intelligent, or generally awesome.  She’s been instrumental in bringing Shannon and I up from the dregs of depression, and for that I’ll always be very grateful to her.

The morning of the next ABR with Buffalo Hearing and Speech arrived.  I treated it as any other morning, so I got changed into my work clothes so I could head out afterward.  I would say that we were nervous, but shaking in our boots, encouraged by the “mild-moderate” bit from the doctor as well as the fact that we still thought that Alex was reacting to some sounds.  Shannon said that she was hoping for just that mild-moderate loss.  I thought I would be more conservative and go with expecting moderate-severe (which is at the upper end of hearing aids getting the job done well).  Something that sticks out to me now as I write this is that as we pulled up to the building and turned the car off, I had this feeling that the next time I’d walk out of the building in front of me, my life would be completely changed.

We had a wonderful and compassionate audiologist who performed the ABR.  She explained what she was about to test.  Shannon and I explained that we felt that Alex had some hearing loss at this point just so she knew she probably wouldn’t be dropping any bombs on us, we went through the family history question (we have none), and then we got started.  I held Alex this time around to take some of the load off of Shannon.  Alex was VERY sleepy at this point, so we were sure we’d get solid test results back this time.  To setup an ABR, a small tube is inserted into the ear, which is basically the speaker.  It goes into the ear rather deeply.  Electrodes are then placed at various spots of the head to measure brainwave activity.  The idea is that if you can correlate the sound coming out of the speaker to the brainwaves, you know that the person is hearing it.  Again, everything seemed to start off fine, and stayed that way for about twenty minutes.  By “fine,” I mean the audiologist wasn’t really making any notes or saying anything was up.  I couldn’t see the results of her testing from where I was sitting, though.  After those twenty minutes, though, I could hear one of the sounds that was being played into Alex’s ear.  And he didn’t move.  My stomach dropped.  Again, these tubes were placed relatively far in his ear… and I could hear what they were trying to get him to react to.  He slept like it was nothing.  I held on to some hope, though.  Maybe the speaker was firing backward and out of his ear for some strange test.  Maybe it wasn’t abnormal to be able to hear that.  Maybe his brain registered it even though I didn’t feel him move.

At some point Shannon stepped out of the room to call my dad, who was mercifully watching Taylor while we were at the test.  During that window, the audiologist wanted to test the other ear.  I asked her how everything looked.  She very gently, but directly, stated that we were in the profound hearing loss territory.  Or in layman’s terms – he’s straight-up deaf in that ear.  I went back to the feeling of grief when we first learned that Alex had hearing loss.  It wasn’t quite as shocking this time, but that was probably because we had immersed ourselves in the world of hearing loss, so this sort of diagnosis was more like a worst-case scenario vs. what had initially felt like an impossibility.  When Shannon walked back into the room, I told her, because I felt she deserved to know it immediately.  The look on her face made it apparent she was immediately back to grieving as well.

Testing on the other ear was indeterminate because Alex woke up and started wiggling.  At that point, it didn’t seem to matter, though.  We had gone from light hearing loss to DEAF.  We did learn that his hearing loss in the other ear wasn’t quite as awful, but it was still very bad.  No consolation there.  I asked the audiologist “So we’re now in cochlear implant territory, aren’t we?”  She sullenly nodded.  During the next twenty minutes, we were introduced to what was going to be our world.  Early intervention.  Special schooling.  Therapies.  Appointments.  Mercifully, the audiologist who we were dealing with was very sweet.  She told us many encouraging things, including that most of the kids that went through the program were successfully mainstreamed.  That was important, as it helped to frame early intervention as a lot of up-front work to help your child go through life otherwise “normally” afterward.

Of course, none of that helped the complete defeat that we felt again.  I called in sick to work because there was no way I would’ve been able to cope with it at that point.  More tears and mourning.  The most evil part of depression, in my mind, is that when you’re experiencing it, it truly feels like it is never going to end.  Welcome to your new existence.

Still not completely caught up, but it’s a good stopping point…