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Deafness/Hearing Impairment/toddler's suspected hearing loss results differ


Hi Dr. Linton,
My 27 month old son has a suspected hearing loss but we're having trouble moving forward with any sort of support for him since the test results are differing. Here's the information I have so far:
Private and public health audiology booth tests recorded loss across all frequencies - 2 tests at mild-moderate (30-50db) with good reliability and third test moderate-severe with questionable (he was tired when tested this time). Sedated ABR came back statistically perfect numbers, ie. perfect hearing. At home, he responds to loud sounds and raised voices only.

His receptive (oral) language is poor but I've had great success over the past few months in his 'listening' with sign language assisting my talking to him. His expressive language is poor and when he does try to talk to me it is VERY garbled, so I can only understand maybe a handful of words when he is speaking.

Can you comment on any of this? I'm trying to find the appropriate Early Intervention services and it appears I'm caught between a rock and a hard place... EI for speech won't admit him because he has a suspected hearing loss and EI for d/hoh children won't provide full access because it is only "suspected loss" at this time.

Thank you!

Good timing...I happen to be sitting at my desk.  First need to confidently establish your child's hearing.  Find an audiologist that you are comfortable with and stay there until the degree of hearing is determined.  This may take multiple visits.  The child has to be clear of any middle ear fluid (this is not always easy in toddlers as they have middle ear fluid often)and the child has to be co-operative.  We always say "the child determines how much information we obtain at an appointment"....and this is true....if he is tired, we thrown in the towel for that day and try again another day.  If he doesn't sleep well for the ABR...we reschedule until we get a good ABR.  If he has fluid on the day we planned to test, we send mom and baby home and try again once the fluid is cleared.
If the ABR was normal but the "booth" testing was not....I would question whether he had middle ear fluid during the booth testing.  ABR results are typically more definitive than any other type of testing on an infant and/or toddler...provided he was either sleeping during the ABR or very, very quiet and still. However, the booth testing and ABR should support each other.
It is possible that the ABR determined normal hearing but he now has middle ear fluid again causing him to respond poorly at home and develop language poorly. Having middle ear fluid does not always mean the child has an ear infection.  The fluid can be stopping his ears up, causing any degree of hearing loss and causing delay in his speech/language development.
Children talk how they hear....if his speech is very garbled and unintelligible then you can assume that is how he is hearing it.  It doesn't mean the hearing loss is permanent but it does indicate he is not hearing it properly.

Whether the hearing loss is temporary (like fluid) or permanent...we often put hearing aids on so that the speech and language development is not behind.  Even kids that have chronic middle ear fluid benefit from the use of hearing aids during the time their ears are stopped up.  EI usually will not move one way or another until degree of hearing is determined and if there is loss, he will need to have hearing aids on for them to provide beneficial services.  So I would find an audiologist and keep after the testing until the results compliment each other consistently.  

I hope this was helpful.  Please let me know if you have any further questions.  
Kelley Linton, AuD.

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Dr. Kelley Linton


I'm an audiologist in private practice in Arkansas. I graduated from the University of Florida medical school. I specialize in hearing loss; hearing rehabilitation; hearing aids; noise induced hearing loss; occupational noise exposure; OSHA guidelines and regulations; hearing protection; tinnitis; newborn hearing testing; children and hearing loss and diagnosis and etiology of hearing loss.


I've been a practicing audiologist for 20 years and have owned a private practice for 14 years. I am also an audiologist in the United States Army where I teach DOD hearing conservation regulations and manage 3000 DOD employees at an army industrial facility.

Arkansas Academy of Audiology American Academy of Audiology Academy of Doctors of Audiology American Speech and Hearing Association National Hearing Conservation Association

Journal of the Academy of Audiology Southwest Times Record, Fort Smith, Arkansas Press Argus Courier, Van Buren, Arkansas

Au.D. - Doctor of Audiology, University of Florida American Academy of Audiology fellow member Audiology Board Certification American Speech and Hearing Association certification Arkansas State Audiology license-current CPT United States Army Medical Corps

Awards and Honors
American Speech and Hearing Association "ACE" award x 7 years United States Army Accommodation Award Arkansas Academy of Audiology elected board of director x 3 years Better community award, Fort Smith, AR for volunteer audiology service to free community health clinic

Past/Present Clients
Serving newborn to geriatric ages.....unable to provide specific names.

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