Speech and hearing in a toddler - tubes?

[blondeviolin]

My 2yo's language development is not what it should be. He's made leaps in the last six months and says plenty of words, but his receptive language is still off. This affects his expressive language - he's newly two still and doesn't really join words together yet.

 

I have him going through the hoops for speech therapy. In that process, we had his hearing checked. The clinic we went to was only able to do a "does he turn his head to the sound?" Sort of test and an OAE. He passed both.

 

But! I still wonder.... In the last 6-9 months or so he's had at least 3 ear infections. It's not as much as my 3yo did so I didn't think much about it. Someone mentioned that tubes are indicated when the child has had 3 ear infections in 6 months or 4 in a year. (FWIW, my 3yo had tubes placed at 16 mos for infections that repeated like every three weeks. His speech was a bit delayed but not enough to qualify for therapy and is fine now at 3.)

 

So now I'm wondering if his ears are complicating his language. Is it possible to pass this type of hearing test and still have it affect his speech? Should I be pushing for tubes in hopes that it helps with his language development (AND diminishes the chance for ear infections)?

[Murmer]

I don't know what kinds of tests they did but my son sounded like he had cotton in his mouth...because everything he heard sounded like it was underwater because he had constant fluid (but no ear infections).  Tubes did help A LOT!  we got tubes put in right before he turned 3 and by 5 he had graduated from the early childhood speech, and he has fabulous clear speech...that said he did not have expressive/receptive language issues (my 7 year old did and still does which is due to her autism) his speech was entirely articulation based, he would tell us strings of words they were just totally unidentifiable (then he would repeat louder and louder in hopes we would understand).  I do recommend seeing an ENT and audiologist if you think he has fluid behind his ears that never drains because that could cause speech issues.

[gardenmom5]

I would push for a hearing test with an audiologist.

it should be done in a "sound room".

is there any sign of infection?  sometimes it can be harder to detect.

 

the timpanic membrane can still be blocked with NO infection observable.  does the timpanic membrane vibrate?

I've had a few times when no infection, but the timpanic membrane wasn't moving.  it was like being underwater.

 

my son who had tubes had them at 11 months.

despiste repeated rounds of antibiotics, ear infections didn't clear up until the tubes were inserted. 

after testing in a "sound room", audioligist determined his hearing was suffering. 

 

 

it's more than 'turning towards a sound'.  does he turn towards a whisper? does he turn towards a sound when he can't see the source?  when he has no visual cues there is a sound?

[zimom]

I am very pro tubes. Pediatric audiologist in my prior life, worked for a great ENT practice for years.

 

However, you state his speech has progressed a lot in the last few months, he has only had three ear infections in 6-9 months heading into the warmer months and he passed his OAEs which he would not have done in light of significant fluid. Given these facts, I would certainly not jump into tubes at this time. I would continue with speech therapy and see where he is in another six months.

[Joker]

Are they certain his infections have cleared up? Youngest dd had issues for months with her ears, fluid, and infections. She was on antibiotics for a long while. Her speech was affected, we were worried, and we took her to a speech therapist. Fortunately, we were given great advice and waited. It took about six more months but things turned around and her speech took off (she even taught herself to read right after this despite the hearing and speech issues). It was really an issue of her needing stronger meds than she was initially being given because the infection was never fully clearing up.

 

I had tubes as a child several times and they didn't find out the real issue until I was 10. I wanted to make sure with my own dd that I looked at everything. Good luck. :grouphug:

[MyThreeSons]

Have you had his vision checked? My youngest son's speech problems were tied to his vision issues, which we didn't know about. Kids learn a lot about talking by watching us talk. 

[bolt.]

A proper hearing test is important: with an audiologist, before "pushing for" tubes as a solution to a problem that may not exist.

 

In my area, "hearing tests" at private a audiologist are often free. (As a first step towards hearing aide sales, I imagine, but still.) So, it's worth looking in to.

[wapiti]

Go see an ENT for evaluation.  The ENT will likely require a test with the audiologist before a decision about tubes can be made.

[swimmermom3]

My 2yo's language development is not what it should be. He's made leaps in the last six months and says plenty of words, but his receptive language is still off. This affects his expressive language - he's newly two still and doesn't really join words together yet.

 

I have him going through the hoops for speech therapy. In that process, we had his hearing checked. The clinic we went to was only able to do a "does he turn his head to the sound?" Sort of test and an OAE. He passed both.

 

But! I still wonder.... In the last 6-9 months or so he's had at least 3 ear infections. It's not as much as my 3yo did so I didn't think much about it. Someone mentioned that tubes are indicated when the child has had 3 ear infections in 6 months or 4 in a year. (FWIW, my 3yo had tubes placed at 16 mos for infections that repeated like every three weeks. His speech was a bit delayed but not enough to qualify for therapy and is fine now at 3.)

 

So now I'm wondering if his ears are complicating his language. Is it possible to pass this type of hearing test and still have it affect his speech? Should I be pushing for tubes in hopes that it helps with his language development (AND diminishes the chance for ear infections)?

 

Our oldest son had chronic ear infections, but was right at the border for the requirements to get tubes. He started in speech therapy and his therapist finally told the pediatrician there was nothing she could do until he got tubes. :glare:

 

He was at least four and we really regret that he did not get tubes earlier. My feeling is that if their speech is affected, it needs to be done. He's 20 now and has to be careful to enunciate clearly. He's had two sets of tubes and a recent ear drum rupture that didn't help his hearing. Please look into this. A lifetime of diminished hearing loss is no small matter and a huge source of guilt here.

 

[swimmermom3]

Are they certain his infections have cleared up? Youngest dd had issues for months with her ears, fluid, and infections. She was on antibiotics for a long while. Her speech was affected, we were worried, and we took her to a speech therapist. Fortunately, we were given great advice and waited. It took about six more months but things turned around and her speech took off (she even taught herself to read right after this despite the hearing and speech issues). It was really an issue of her needing stronger meds than she was initially being given because the infection was never fully clearing up.

 

I had tubes as a child several times and they didn't find out the real issue until I was 10. I wanted to make sure with my own dd that I looked at everything. Good luck. :grouphug:

 

Fluid can be retained even though the ears look clear on a visual inspection is my understanding.

 

[blondeviolin]

It was an audiology clinic in a sound booth . But at just-under-two at the time, and being an adult clinic, they were only able to test if he turned his head toward the noise-making toys. He does hear sounds but I'm wondering about if we'd have been able to tell if words or sounds are muffled or not as clear.

 

He has yet to have his eyes checked. I couldn't find an optometrist that would take a kid under two and my pedi wouldn't refer to an ophthalmologist. I'll be making calls now that he's two. I don't necessarily see any signs that his vision is off. He can point out a jet in the sky. He doesn't walk into things. He will point things out in a book after much encouragement and modeling.

 

Though, we just took him to the zoo and he was completely confused when I pointed out the animals. It was almost as if he didn't see them. It wasn't until the wolves howled or the turkey gobbled that he laughed and he turned and said, "listen!" He also thoroughly enjoyed the goats he could pet or feed. Otherwise he hardly differentiated the animals in their cages. (Though, the Alaska zoo doesn't have a whole ton of super impressive animals you can see up close. There are no elephants, giraffes, etc. And the bears and tiger's enclosures are far enough away it's hard to tell where they are at times.) Most of what you can see up close are birds or small foxes in big cages. If the animal moved with a big movement, he was more inclined to notice it.

[J'swife]

My son did not pass a hearing test and required tubes, after the tubes, could hear 100%.  I would push for a test as well.

[zimom]

A proper hearing test is important: with an audiologist, before "pushing for" tubes as a solution to a problem that may not exist.

 

In my area, "hearing tests" at private a audiologist are often free. (As a first step towards hearing aide sales, I imagine, but still.) So, it's worth looking in to.

 

These are likely audiologist, or even just hearing aid dispensers NOT trained to work with pediatrics.  Please do not go to someone that offers their hearing testing for free.   Go to an audiologist with pediatric experience.  You should be billed for the exam.

[zimom]

I am very pro tubes. Pediatric audiologist in my prior life, worked for a great ENT practice for years.

 

However, you state his speech has progressed a lot in the last few months, he has only had three ear infections in 6-9 months heading into the warmer months and he passed his OAEs which he would not have done in light of significant fluid. Given these facts, I would certainly not jump into tubes at this time. I would continue with speech therapy and see where he is in another six months.

 

To repeat, he would not have passed his OAEs if he had significant fluid at the time.  

[wapiti]

Fwiw, when my ds got tube at 2y.o., it was due to the audiology test that checked for fluid - might have been called a tympanogram. The result is a computer-generated chart that graphs across frequencies, IIRC. The test did not require him to do anything. We were seeing a ped ENT and the audiologist was in-office, though a separate appt.

 

For vision, there are optometrists who will see babies (I'm pretty sure our old covd did). That would take some calling around.

[zimom]

Fwiw, when my ds got tube at 2y.o., it was due to the audiology test that checked for fluid - might have been called a tympanogram. The result is a computer-generated chart that graphs across frequencies, IIRC. The test did not require him to do anything. We were seeing a ped ENT and the audiologist was in-office, though a separate appt.

 

For vision, there are optometrists who will see babies (I'm pretty sure our old covd did). That would take some calling around.

 

Yes, wapiti, a test for fluid is called a tympanogram.  a flat line on the test is indicative of the tympanic membrane (the ear drum) not moving.  

 

The OAE is a hearing test (specifically a test of the outer hair cells making sound back in response to sound presented).   However, if there is fluid then they will not pass the OAE.  So if a flat tympanogram is found, it would not be productive to even attempt the OAE.  If a normal OAE is found, you can then assume there is no significant fluid.  

[blondeviolin]

To repeat, he would not have passed his OAEs if he had significant fluid at the time.

This is good to know. So more than likely his hearing is fine when he has no fluid. I'd rather not push for tubes if it won't help. I don't have an issue with an ear infection here or there.

 

I'll try and run down an optometrist just to make sure all of our ducks are in a row.

 

Like I said, he's making progress. He points things out to me. He says words in proper context. He babbles at me all of the time. He can finally point out major body parts consistently. He understands some commands now. ("Let's go outside." "Where are your shoes?" "Do you want a snack?"). But some things is expect him to get are still beyond him. ("Which one do you want?" "Can you give me [whatever]?" He will give me something but only knows what I'm talking about if I point it out.). His expressive language includes labeling things and just now words like "listen" (complete with hand by his ear), "hand" quickly followed by "mon!" (In this case "hand" is a request for me to take his hand and "mon" is "come on!").

 

Socially, he shares things with me or his dad. He points out or brings me things of interest. If I can't help him at a certain point, I can ask him to take it to someone else and he will. He does not play with other kids besides his brothers and sisters. He does acknowledge them but his stranger anxiety restricts him from playing with anyone unfamiliar. He glares at any stranger that talks with him. If they continue to talk with him, he will turn his head pointedly in rejection. Yesterday at the doctor, when they checked his pulse ox, he glared and when the tech took his foot anyway, he glared further and screamed, "no! Done! Done" He is very clingy and dependent on personal touch at home. He has had a few non-family members that he has opened up to, but only on his terms. Most notably, he was evaluated by a speech therapist who works with children. She waited until he invited HER to play. After glares and mom-clinging, she continued to hang back. By the end of the evaluation, he actually was sharing things with her and encouraging her to play with him. When we left, he took her hand and walked out with her. This sort of social/stranger anxiety is the sort of behavior my oldest exhibited as a toddler as well. (She wore hats that she'd pull over her eyes so she could ignore whoever she wanted.)

[J-rap]

Stranger anxiety at that age is certainly not unusual at all for some kids, and even the language could be just the schedule he is on.  One of my daughters barely talked (in words, yes, but not sentences) until she was about 3, and now she is a song-writer.  :)

 

It could be other things too, hearing-related, so you might want to meet with an audiologist just to rule things out.  Or, an ENT.  Probably both.  Another daughter was actually talking at a typical age, but her speech was muffled sounding and when she was 5, she didn't pass the hearing test.  We found out that she had an unusual condition (for a child), where the bones in her ear had hardened together, in the same way that a very elderly person's might be.  She could hear sounds, but not the low tones, so the sounds came to her distorted.  It had probably affected how she heard sounds all along, and that's why her speech sounded muffled.

 

The audiologist caught the hearing loss, but the ENT was able to pinpoint the cause.