PTA(aided response) using Oticon Xceed 1 UP - Binaural aided response for 250, 500, 1k frequency are within spectrum while 2k and 4k are 60 db and 55k respectively. Attached reports.
At 2.6 years old, the child used the HA Xceed 2, but until the age of 4.5 years, the gains achieved were not sufficient to compensate for the loss. After conducting a REM test, full gain was obtained, but the response still didn’t fall within the expected range with the Xceed 2 on.
When we upgraded to the Xceed 1 a week ago, we noticed a significant improvement. Please let me know if it’s okay to continue using the hearing aid for my 6-year-old son, and whether he will be able to make progress with speech development.
I’m missing a lot of information. What’s the child’s (unaided) audiogram? Is daily hearing aid wear time approaching 10 hours or more and has it been that way historically? What is language status right now? Are there other developmental concerns? If there is no language at all at 4.5 years I would be very concerned and would seriously be considering cochlear implantation as well as immersion in sign language.
Till the age of 4.5 only 2 frequencies (500, 1k hz) were enabled and that at 70 db. Still he was able to speak 20 words i.e. Tata, Bye, Papa, Dada, Maa etc. may be using clues (leap-reading). Regular speech therapy continues from very beginning without any gap.
8 months back full gain was given and transpose high freq to mid freq, after then could see change in speech understandings. Still we have to exaggerate to made him understood, below his Aided Audiogram
We differ. If that was my child’s hearing loss I would get a CI as soon as possible and that would also be my professional recommendation. A hearing aid will never be able to provide what a CI can for this degree of hearing loss.Where I live, that child would have been implanted bilaterally by around age one and expectations would be near-normal language development with SLP support and good CI wear time. If it were my child now, I would be seeking a CI for at least the left ear on an urgent timeline followed by intensive language support.
At 4.5 this child is exiting his first critical window for language development and it sounds like he is very delayed. If a CI isn’t an option, I would continue working on oral language but I would also immerse with sign language immediately. This would mean moving to an area where a signing school was available as well as teaching the entire family a new language.
Thanks for the details. Could you please share your journey on speech development while using oticon hearing aid. If available could you share your aided audiogram on xceed.
My intention behind getting those details are simply understand “what progress my son would make on the aided response?”
Because:
I have done audiological assessments and could see he’s able to identify and differentiate high frequency sounds i.e. ss, sh and f etc. LMH sounds. Understands simple sentence and could answer simple questions like “what is your name?, what is father name etc. “ and many more.
In case of Samyak, his Binaural aided response are as below:
Frequency. Response
250 30 db
500. 30 db
1k. 45 db
2k. 60 db
4k. 55 db
Do you think he will have speech development(overall communications) if given proper and regular training in special integrated school which he already been continuing for last two months.
I’m no expert but I would say no, he won’t get good speech development without a CI.
When I was younger, my hearing was better then the one you’ve shown and my speech is awful despite having a Deaf Base at school / college and speech therapy every day for nearly 20 years.
Thanks for sharing this information. As a Paediatric Audiologist I’m happy to cautiously offer an opinion but I think I need additional information. Could you please answer the following questions:
At what age was the hearing loss first suspected?
At what age was the hearing loss first diagnosed?
What is the cause of the hearing loss (if known)?
What type of hearing loss is it (sensorineural/mixed/conductive)?
Has auditory neuropathy spectrum disorder been ruled out?
Has the hearing loss always been present at the levels documented above, or has it worsened over time?
Do you have any screenshots of his real ear measurements?
Do they have any medical or behavioural conditions that might make them unsuitable for cochlear implantation?
What is your child’s main mode of communication (aural/oral, aural/sign etc)?
This protocol is useful for determining whether a child has sufficient speech audibility with hearing aids or needs further review and consideration for cochlear implantation and if followed may have resulted in earlier referral for cochlear implantation and better outcomes for your child and other children in similar circumstances.
Thank you very much for your time and reviewing the details.
At what age was the hearing loss first suspected?
—> 9 months
At what age was the hearing loss first diagnosed?
—> 22 months
What is the cause of the hearing loss (if known)?
—> CMV infected (treated and diagnosed at age of 20 month)
What type of hearing loss is it (sensorineural/mixed/conductive)?
—-> sensorineural
Has auditory neuropathy spectrum disorder been ruled out?
Will check with audiologist and get it done.
—-> BERA(profound loss), OAE(absent) and Cochlear MRI (normal)was done.
Has the hearing loss always been present at the levels documented above, or has it worsened over time?
—> Present at same level; in fact sound awareness improved surprisingly 1 year back.
Do you have any screenshots of his real ear measurements?
—-> Purchased new HA a week back, have to get REM test done.
Do they have any medical or behavioural conditions that might make them unsuitable for cochlear implantation?
—> None
What is your child’s main mode of communication (aural/oral, aural/sign etc)?
—-> aural/oral plus sign in case he dont know words he want to express.
I purchased xceed 1 up a week back and below his aided response (binaural) has improved a lot and could see enhanced speech understandings - to conform the same get LLR(Auditory Longer Latency Response) which matches to the behavioural response
From the information available to me I would’ve referred your child for cochlear implant candidacy assessment when they were initially diagnosed at 22 months of age if their hearing were at the same levels then as they are now.
The presently available evidence from population-based studies such as LOCHI study in Australia has demonstrated that children with a bilateral severe or greater degree of early-onset sensorineural hearing loss do better with a cochlear implant than hearing aids. Your child has a profound hearing loss and the evidence is in favour of early implantation, the earlier the better.
The audibility of speech with his current hearing aids is insufficient for speech and language development. Your child should receive much better audibility of all speech with a cochlear implant.
If it were my child I would be pushing for at least a single cochlear implant with a switch-on before he turns six year of age, which isn’t far away given they’re 5 years and 9 months of age now.
Unfortunately the speech and language outcomes will be much poorer than would’ve been the case if your child were implanted at the time of diagnosis. The critical neurodevelopmental period for speech and language development closes at around 6 years of age. Unless a child has a neurodevelopmental delay, this time for early language exposure has been lost and it is very unlikely your child will ever catch up with their same-age peers. Your child has simply missed too much language exposure.
I’m guessing that your child has transitioned from an Xceed 2 SP BTE to an Xceed 1 UP BTE. You can tell the difference between the SP and UP models as the former uses a size 13 battery while the UP uses a 675 battery. If this isn’t the case and he’s just been upgraded from the Xceed 2 UP to the Xceed 1 UP BTE then I don’t think such an upgrade is worthwhile, especially if you need the funds to pay for a cochlear implant. I would simply reprogram the Xceed 2 UP to his most recent hearing aid settings that you seem happier with (if the Xceed 2 UP is in good working order).
As far as I understand, the responses at 2k and 4k Hz are slightly elevated and fall just outside the typical speech spectrum (speech banana), particularly in the binaural results. If there were a difference of just 10 dB, the results would likely be within normal range. I’m not interested in an invasive option like a cochlear implant; instead, I’d prefer to achieve the necessary gain through hearing aids.
Could you provide that level of amplification?
Also, please let me know if you’re considering any other parameters beyond those I mentioned.
Binaural aided response:
Frequency. Response
250 30 db
500. 30 db
1k. 45 db
2k. 60 db
4k. 55 db
