I need help. I’m so lost. A little background. My 30 month old has had 4 booth test that came back with mild/moderate hearing loss. His ABR shows mild bilateral “conductive “ hearing loss. Or this is what the doctor told us. But his OAE’s were normal. The ENT states no history of ear disease, fluid or infections and said that there was no evidence that he has had any of that when they looked before the ABR in the OR. But can’t tell me what’s causing it or his speech delay but they don’t think he has hearing loss to have him tested for autism. They will not give him aids and continually tell me to have him tested forr autism. 
his Peds doc and therapist all say he shows no signs of autism. well he was tested and I have proof he doesn’t have autism but they said he doesn’t have hearing loss still . What’s the point of the ABR if the results don’t matter??? What do I do??? How do I get him help??? He had an eval with the School for death and blind and they said they can see and hear his hearing loss and speech issues and it’s definitely hearing related. I don’t know what to do . The doctor isn’t listening. Here is a picture of his ABR results.
Where do you live? What is your access to pediatric audiology services?
South Carolina. We see a pediatric ENT/audiologist team at the Children’s Hospital.
That should be a good team. They should know what they are doing; if they say that there is no hearing loss I would lean towards trusting them. In the majority of cases, conductive hearing loss present at birth is temporary. The results you’ve posted, however, are not really conclusive. Do you have other results? Are there audiograms from the booth tests?
What’s the speech delay like? There can be other causes of speech delay than autism and hearing loss. Is he in speech therapy now?
I’m sorry you’re going through this. 30 months is a tricky age to test, and it’s hard when you don’t feel that you have clear answers.
Edit: If it helps, while I don’t know the protocol that is being used, those ABR results as they are presented are basically normal. 4000 Hz is normal. 1000 Hz appears to only be elevated by 5 dB. If the child also had middle ear dysfunction as measured by tympanometry at the time of that test and no risk factors, I would also assume a mild temporary conductive loss and discharge. Normal OAEs further support normal hearing at that time. So at least at birth, hearing appeared to be largely normal.
I don’t trust them. They told me he had mild hearing loss and out it in his chart and now they say he doesn’t that they believe he has autism. Well he was tested and does not have autism. The school of the deaf and blind did their evaluation and said he does have hearing loss and they can hear and see it. He’s been in speech therapy for over a year. He has a 5 word vocabulary. He understands and comprehends perfectly WHEN he can hear you or you show him first. The evaluator and therapist say he is very smart and above average in all categories but speech.
That is the only results they gave me from his ABR and all that is in his chart. I wanted someone else to interpret it and explain to me what they believe it is and compare to the doctors. Since they keep changing their minds. Without a diagnosis getting my son help is very limited.
If you do not trust them, what are you options for a second opinion? How far would you have to travel to see a new pediatric audiologist? How was his hearing tested at the school of the deaf and blind (and when)?
Is it actually the case that he had a recent ABR? Last December? That’s old for an ABR. Was he sedated or did you manage natural sleep? Looks like there has been some fluctuating middle ear dysfunction and that can result in fluctuating conductive hearing loss, but as I said earlier the ABR results look pretty good. Have you seen a jump forward in speech in the past month since the ABR?
We live in a rural area and travel over 3 hours to the Childrens hospital now. We’re in the process of finding a new team. The ABR is not old. It was done 2 months ago and he was put to sleep for it. He has never had any fluid or ear infections. The doctor also has never seen any fluid or infections not even when they look before the ABR in the OR. The school did a booth test and that was today. If the ABR is “normal” why did they put on the report and tell us mild loss? His speech has not improved any since the ABR 2 months ago. Not just our opinion as parents but also his therapist opinions.
Really? That type B tympanogram suggests he had fluid behind one eardrum in November and they indicate right eustachian tube dysfunction in October. That said, it looks like at least one eardrum has always been moving reasonably at his appointments. Is he sick a lot? Congested? Transient, fluctuating middle ear dysfunction is very common at this age and can certainly delay speech, but usually as it clears up you’ll see a jump in language.
The ABR is elevated by 5 dB at 1 kHz and normal at 4 kHz, so that 5 dB elevation is “mild loss”, which you say that they have indicated is conductive, which suggests that your son’s eardrums were not moving normally at the ABR appointment and they expect that it is a temporary results of transient middle ear dysfunction. Permanent low frequency conductive hearing loss would be quite odd in an otherwise well-baby, but even if it were the case that your son has a mild permanent loss at 1 kHz, that level of mild loss may lead to monitoring rather than aiding. But your son’s speech delay sounds more significant than would be expected from that sort of mild loss. ABR results are reliable in that while you may miss small responses that are actually present, you do not get fake responses that aren’t actually there. So the ABR rules out hearing loss at 4 kHz and rules out more than mild hearing loss at 1 kHz. Present OAEs support normal cochlear function, although they only look at high frequencies and can be present with mild to moderate loss. They’ve also ruled out auditory neuropathy with the ABR.
So it sounds like, given reasonably good ABR results, they are trying to find a reason that your son has been struggling with the behavioural testing and that’s why they suggested ruling out autism. However, his age group can also just be very hard to test behaviourally. Two is often too old to be interested in the one where they sit and look at light-up toys, but regularly too young to sit quietly and perform a task in response to a sound (say, throw a ball in a bucket–usually the throwing is fine but the waiting is difficult). It’s also often an age where children can be fearful at appointments, or tired, or busy, and it can be a bit random whether it goes smoothly or whether the kid just flops on the floor and screams, or something in between.
How DID his appointments go? If you are looking for another opinion and re-assessment, practicing any sort of ready-set-go task at home would be helpful. At this age, it can be just a matter of months between a kid being unable to do it and being able to do it reliably.
I know it’s just awful to be in this place where there are no clear answers, just waiting and worrying. Keep exposing him to as much language as you can–I’m sure you’re already doing that.