PTA(aided response) on Oticon Xceed 1 UP- good to continue on hearing aid?

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.

The audiogram shows a profound loss - same loss by birth or was progressive?

If yours is profound loss by birth - could you share history?

I was born with a mixed loss which was severe mixed but mild/moderate through the bone conduction.

Since I’ve had chemotherapy I’ve lost all my hearing and was implanted with a CI last week.

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.

@samyak said:

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)?

I’m unsure which language your child uses, but if they are learning English I would encourage your audiologist to complete the University of Western Ontario Paediatric Amplification Monitoring Protocol2 (UWO PedAMP) in particular the Aided Normative SII worksheets and the PEACH questionnaire.

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.

If you expand some of what has been shared, you can see that their clinician has already recommended cochlear implant candidacy assessment.

Thanks for answering my questions

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).

I hope this information is helpful to you

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

It’s not just about gain. At that level of hearing loss, the cochlea is so damaged that frequency acuity is poor, sound does not have clarity.

No hearing aids can provide appropriate gain at that level of hearing loss.

Hi Samyak,

Unfortunately it seems that you are misunderstanding the aided audiogram results. None of the aided responses fall into the slightly elevated category, even in the low frequencies. The aided audiogram shows a mild sloping to moderate elevation in hearing thresholds. This is much worse than a “slight elevation.”

The speech intelligibility index (SII) is a better predictor of the audibility of speech sounds. It ranges from 0 for no speech intelligibility to 100 for perfect speech intelligibility for someone with normal hearing. A child needs an SII score of at least 80 for average level speech in order to develop speech and language normally.

Without his hearing aids your child has an SII of zero as he is unable to perceive sound at all. Based upon the aided thresholds you have provided the best case scenario is that with hearing aids he could have a SII of 10 for soft speech, a SII of 27 for average level speech and a SII of 54 for loud speech.

All of these values are well below 80 indicating that even with optimally fit hearing aids your child won’t be getting sufficient audibility of speech for speech and language development, even if people are talking very loudly directly into their hearing aids all day, every day.

Hearing aids couldn’t have ever provided your child with sufficient audibility of speech for normal speech and language development. There simply isn’t enough residual cochlear function for this. As a consequence of his inability to hear most of the speech sounds consistently he will also struggle with reading and writing, because hearing sounds consistently is a pre-requisite to associating them with visual symbols. You cannot attach meaning to something that is out of your perception.

A cochlear implant typically results in aided thresholds of between 15 and 30dBHL across the entire speech frequency range which will provide your child with much better audibility of speech which is necessary for continued speech and language development.

While surgery is involved with cochlear implantation, it is one of the safest and simplest surgical procedures an otologist performs with very low rates of complication. There are more than 650,000 cochlear implant users worldwide and the rates of implant failure are also very low, with many users still using the same implanted components they received back in the 1980s.

I would very strongly recommend that you reconsider cochlear implantation if you want your child’s speech, language and cognition to continue developing. The benefits strongly outweigh the risks and have done since your child was first diagnosed at 22 months of age. Every month you delay this the predicted long-term outcomes for your child’s speech and language development and cognition (even with a CI) only get worse.

In saying this, if you would prefer that your child live in the Deaf community and be in full immersion sign language there is nothing wrong with continuing the way that you are. Your child’s hearing aids provide them with enough environmental awareness of sound to be safe in most environments. They just don’t provide sufficient hearing for good speech and language development. In the long term they’ll likely need to rely on sign language for communication as hearing loss worsens as you age and choosing for your child to live in the Deaf community with full sign immersion is a legitimate choice. However you’ll also need to be fully involved with the Deaf community as well.

Whatever your choice I know you’ll pick the right one for you and your family. However if you don’t want full immersion sign language for your child in the long term then your only choice is cochlear implantation and you need to be making that decision in the very near future. Your child may no longer be considered a candidate for implantation in a years’ time.