Permanent Hearing loss dur to ear infections and now retracted ear drum in child

[Irishgal2]

Looking for some advise please.  We are bringing our 5 year old son again to see an Audiologist for hearing tests tomorrow.  He has failed every hearing test he has ever had.  He has had grommets inserted into his ears twice and to be honest has not made a significant difference to his hearing.  This time he had his adenoids removed at my assistance and the ENT surgeon told me afterwards that they were very enlarged.  My son has a small nose and a flat bridge.  He now has permanent hearing loss of up to 30% mainly in his left ear.  This time the ENT surgeon said there is no fluid in the ears and he could not put in grommets as there was no room!!  I had to ask for clarification and was told that there was no space between the inner ear and middle ear.  I am assuming this is a retracted ear drum.  I am furious at this stage and am going for a second opinion in Feb.  All Luke's ear infections were treated asap and he has only had approx 2 in the past year and the last time he had grommets was 18 months ago, so how come the ear drum is retracted now?  I cannot sort out the permanent hearing loss, but I want to protect the hearing that he has. I also want to know how come he has permanent hearing loss now from fluid and ear infections since they were always treated and we always did what was suggested of us.  I would appreciate any help, support or suggestions that you may have.  I want to have as much information as I can when I go back to the ENT surgeon in March and the new ENT surgeon for second opinion in February.

[Wear/a/Jimmy]

Still not trying to cause offense here, I promise. My first post I tried then too, because this is a verry sensitve topic. There is a syndrome called fetal alcohol syndrome:

http://pediatrics.aappublications.org/cgi/content/abstract/82/2/147

Children with this syndrome are very characteristic of the type of face that you discribe. That said, there is an intire region, speicifically Nothern Thailand, where all babies appear to have fetal alcohol syndrome. So appearences do not always mean something. You are right, it very well could be genetic.

If the doctor wanted, he could theoritically perform a myringotomy (sp) rather than place tubes. A small incession is made in the ear drum, releives the negative pressure and allows the ear to drain. In this case, a tube is not applied, so the amount of room in the middle ear cavity is a non-issue.

I need to also state this...  if your son is a very obedient, well behaved child, an ABR or an ASSR may be able to be performed without sedation.

BUT he would have to lay down, keep his eyes shut and remain still for about 90 minutes if not more. If he can do that, then sedation is not needed.

Me, I just always call for sedation due to time constraints. I did not want to have to spend all day begging a child to behave...  I know that sounds bad, but there are two sides to every coin.

"Could it be possible that my son always had some sensory hearing loss and that the fluid and ears infections just compounded the hearing loss?"  Oh yes it could be possible. If my memory serves me correctly there is some research that showed that continious and multiple episodes of middle ear infection have have shown to have a corelation with a sensory loss. In other words the study indicated that middle ear infections could possible cause a permanent hearing loss. BUTTTTTT the study was based on adults with a history of childhood infections. My point is, if there is a permanent loss, I don't think it would show up on a 5 year old... too early.  

So my thinking is, he may of already had a permanent loss, that is if he really does have a loss. I say this because remember, if his middle ear function is abnormal, his test results will be skewed.

If anything, you could have something called BONE SPEECH PLAY AUDIOMETRY  testing. It is quick and to the point, it will show how well your child hears speech dispite his middle ear status.  I should have mentioned that test !!!!!!!!!!   But it does require your son to participate. He would have to do tasks like point to his nose, knee, ears etc.

Good luck to you and yours

[Irishgal2]

Thanks again for your helpful comments.

I did check the website your mention re fetal alcohol syndrome, but thankfully does not apply to Luke.  I had a total of about 7 glasses of wine during my whole pregnancy.  Also because of his small feet at birth and flat bridge of his nose he had a battery of tests when he was born  i.e. heart echo, body xray, cranial ultrasound, blood work including chromosone testing which all came back fine.  Let me tell you it was a long two weeks to wait to get confirmation, but thank God all tests came back fine.

I have an update for you from the Audiologist we attended last week.

- Luke's hearing loss is mild to mild/moderate i.e. around 40 d.  However Luke did have a cold on the day would could affect the results, but the results were slightly better than last time.

- Tympanometry testings showed abnormality in middle ear.  At the moment I believe this to be the retracted eardrums as there was no fluid in ear found during operation 3 weeks ago to my knowledge.  That is not to say that there is not any Ossicular Malformations either.  Nobody has even mentioned to this us, I brought it up at the meeting but really need to address with the ENT surgeon's.  As you mentioned in your previous positing, this is going to skew the results.

- There was another test where something was put into Luke's ears for a period of time and what looked like a bar chart came up on the lap top screen.  I'm not sure if this was the above test of the next test which involved again putting something into Luke's ears separately for a period of time, it was a low level machine.

- Pure Tone Audiometry (Air) i.e. Luke pressed a button when he heard any of the sounds.  He did this test later but by putting men into a boat when he heard the sounds.  The same model was used for below.

- Pure Tone Audiometry (Bone) Luke seemed to do well on this one, or relatively so.  Am I correct in assuming that this indications little or no sensory hearing loss?  The Audiologist said that in his opinion the hearing loss was conductive and if there was any sensory hearing loss it would be a max of 10% if at all.

- At the end the Audiologist carried out a word/speech audiometry test i.e. giving Luke a selection of objects and then asking him for "give me the spoon, or give me the pen, or give me the fish etc" from behind him with his hand over his mouth muffling the sounds.  He continued to raise his voice until Luke responded to each request.  This test was definitely very rushed as we were well over our allotted time as we had so many questions.  I know for a fact that Luke performs better on this test at home as I have done it myself many times at home.

The Audiologist will do the testing again at the end of Jan/early Feb.  At the moment he is suggesting hearing aids for Luke for both ears for education purposes.  His overall observation is that the problem is in the middle ear but cannot tell me for definite if this is due to constant build up of fluid, eustachian tube dysfunction, repeated middle ear infections or Ossicular Malformations or other Middle Ear Malformations.  So all I know is that Luke still has a hearing loss and to be honest I am at a loss now and have no idea how to protect the remainder of his hearing although the Audiologist did advise me that conductive hearing loss is rarely severe and never profound - well, sorry..... but I think I need a lot more than that!!!!.

Luke has retracted eardrums, that was why no grommets were put in at the time by the ENT surgeon 3 weeks ago.  I am meeting a new ENT surgeon who comes highly recommended at the end of Feb for an alternative opinion.  I meet the current ENT Surgeon in March so I will be all over him like a rash for answers and at least I have someone to compare him against.  I needs answers.  I have also heard about an operation called Tympanoplasty which would rebuilt the middle ear if necessary and resume the hearing loss. I was told the hearing loss was permanent, get used to it.  Nobody has even thought to mentioned this operaton to me. I may not be appropriate but as far as I can tell, the current ENT Surgeon does not have sufficient information about Luke's ears to make a recommendation on this. Should I be requesting an MRI scan from the new ENT Surgeon at the end of Feb so I can get a clear picture of what the ear looks like in order to know what we are dealing with.  I am also quite sure that the new ENT Surgeon will request new Audiology tests to be carried out in the Children's Hospital facility as it would have all the latest technology and be more clinical.

Thank you so much for your advise to date and hopefully I will find all the answers I need in the next few months.

[Irishgal2]

Thank you so much for your comprehenisve answers.  

Just to give you more information.  There was no problem inserting the grommets on the first two occasions.  The last time there was space between the middle and inner ear.  However this time around (3rd) time there was no space because the inner ear moved to the middle ear, my local doctor assumes this meant it was a retracted ear drum. How can this situation be corrected i.e. surgery, exercise etc???

Both my sons have a small nose and flat bridge, part of my family genes.  Other than that there are no other unusal facial or head features. I have not taken offence.  My other sons hearing is fine, but I suspect he may now have fluid in his ear from colds, he is 2 years 6 months.

Could it be possible that my son always had some sensory hearing loss and that the fluid and ears infections just compounded the hearing loss?

I will let you know how I get on today with the audiologist.

Thank you

[Wear/a/Jimmy]

If it were me working with your son, I would absolutley insist on a sedated testing session.

These are the things you need in order to get the BEST possible picture/diagnossis of what is really going on with your son

1) Case History (incuding gestational period, mothers health, medications, substance abuse etc)
2) Sedation
3) Otoscopy
3) Tympanometry
4) Acoustic Reflexes
5) OAE
6) Air and bone ABR testing
7) ASSR testing



But theoritically, if you could get all of those test done, you would have a very thoruough picture of what is going on with your son. An MRI of the cohleas and middle ears may also be helpful. It sounds as though your child has a malformed head or face. I guess this from your discription of "no room in the ear, small nose and a flat bridge." I mean no offense in this guess, but I can not see your child, all I can go by is what you have written.

Just to let you know, many times if one has a facial anomoly, a sensory (permanent) hearing loss can be suspected. This is because the eyes and the face are being formed at the same time during the gestation process/period. So if there is a problem with the head/face, there very well can be a problem with the ears.

So in this case your child may have a sensory loss, that is not related at all to middle ear infections. This is not to refute your statement that your child heard better after tubes... if he had a mixed loss at the time, that would be expected.

Any how, you need all of those tests listed, to get a full picure of what is going on with your child...

Until that time, the rest is all conjecture.


But to be more concise, if his tympanomtry results are normal, and he has normal OAE scores, you will then know his outer hair cells are functioning correctly. 90% of all Sensory losses are due to abnormal cochlear function. So in other words normal OAEs are a great indicator that all is well with your son. If they are normal, and you are still concerned that he may fall into the 10% of sensour neural hearing loss, caused by an abnormality beyond the cochlea then an ABR or ASSR would be necessary.

All of these tests rely on normal middle ear function, if your childs tympanometry scores are abnormal, then it will skew the test results for all other tests. At this point an Air and Bone ABR can be done.

Trouble is, there are few people that actually own an ABR machine with Bone testing ability. Due to this, even if you found an ABR machine with bone testing abiltiy, it is difficult to find someone that is proffecient in testing bone ABR.

A long and complicated answer to your question, and I appogize.