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Audiology/Otolaryngology/Toddler with speech/language delay, questionable hearing issue



My 29 month old was diagnosed with mixed receptive and expressive language disorder at 24 months. She has a 50% delay. When she was born she failed her hearing test, but then passed on the rescreen. She was tested again at 24 months and she didn't officially pass. She wasn't able to complete the test(they couldn't train her to do some of the test), but the audiologist thought her hearing was probably fine and should proceed with speech therapy. But she will be tested again next month.

So, I don't know what to do at this point. She is progressing well in speech therapy. She has been seen by 2 speech therapists and a developmental disabilities evaluator and they all tell me that her speech/language disorder that she has is rare. She is very independent, has met all other developmental milestones, has excellent interpersonal and problem solving skills, has friends, attends Montessori school, etc. She does not get frustrated that she cannot communicate. She signs some words. She is a very quiet child. Toys that make sounds and  television do not interest her at all. She prefers books and pretend play.  She has some spontaneous speech, but struggles alot with imitation. She cannot say simple words such as "mama." But she can say a sentence such as "I wanna go outside." However, her sentence sounds muffled like mud and consists mostly of vowel soudns. She looks at my mouth to imitate and she struggles to imitate the sounds. Her speech therapists and the developmental evaluator have told me several times it seems like she has a hearing issue and perhaps she should be evaluated by an ENT. What, if anything, is an ENT going to do, in addition, to what an audiologist does? I feel like I'm going to go to an ENT and tell them this and they are going to refer me right back to an audiologist.

Thanks so much!

Dear Keva,

I think your continued concern about hearing is valid.  Any time speech and language delays or deficits are noticed, hearing loss should be ruled out since even mild losses can cause problems.  The key is to collect enough information to support normal hearing or hearing loss.  Audiological hearing tests are of two general kinds--behavioral and non-behavioral.  Non-behavioral tests are similar to the ones used to screen newborns and do not require patient response.  Behavioral tests are like the ones in the booth  that the child responds voluntarily to sounds/speech (and requires some training).  

At this point in your child's life, I would seek a combination of both types of tests.  Usually, booth testing using some sort of visual reinforcement, tympanograms (middle ear function), and otoacoustic emissions (measure inner ear cellular function, but require normal tympanograms).  If middle ear infections/fluid behind the eardrums is ruled out (usually by an ENT) and hearing tests are still inconclusive or show possible hearing loss, then sedated testing at a hospital can be done.  An auditory brainstem response (ABR or BAER) test is a non-behavioral test which can be used to obtain hearing threshold estimates based on the nerve response to sound.  In fact, I have done this test in the operating room (O.R.) following ENT placement of tubes for ear infections just to make sure the hearing is normal.

I would suggest you ask your audiologist if he/she works with an ENT and can perform the above testing if necessary.  If not, then get a recommendation of where to go.  If I was performing the evaluation for your child at this point, I would retest in the booth, perform tympanograms and OAEs.  If tests are abnormal or unobtainable (with normal tympanograms meaning no fluid), I would consider a sedated BAER test to rule out something called auditory neuropathy (sounds are heard, but "distorted") and to obtain hearing threshold estimates.  If tympanograms are flat or abnormal, then ENT should manage middle ear problems before retest or if tubes will be placed in the O.R., then "piggy-back" the OAE and BAER tests.

I hope this is helpful to you and good luck.  


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Dr. Clint D. Keifer, Audiologist


I am qualified to answer all questions related to the diagnosis and rehabilitative treatment of hearing and balance disorders. This includes evaluation of hearing and balance, counseling, amplification (hearing aids and assistive devices), tinnitus (noises in head) evaluation and management, cochlear implants, and audiology in general.


I started my career as a hearing instrument specialist (on a trainee license) in 1998. After almost 2 years, I decided that I needed to pursue higher education if I was to provide the best care to hearing impaired patients that I could. In 2007, I completed my Doctor of Audiology and have been providing audiological care for almost 5 years. I have vestibular, cochlear implant, and pediatric experience along with prescribing, fitting, and verification of hearing aid amplification as part of comprehensive hearing loss rehabilitation.

Audiology doctor and owner at Great Lakes Audiology in Toledo, OH. phone: 419 327-2273 website: American Academy of Audiology American Speech-Language Hearing Association Ohio Academy of Audiology

Bachelor of Science (B.S.), Western Michigan University, Speech Pathology and Audiology Doctor of Audiology (Au.D.), Ohio State University Certificate of Clinical Competence in Audiology (CCC-A)

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