Audiologist or an ENT? UPDATE and advice/opinions needed

[DesertBlossom]

UPDATE: Just for reference, DD is rarely sick. Literally this may have been her 2nd visit to a dr, ever. She gets colds and mild things when they go around, but I have not been worried about her health at all.

 

So we get in to see the dr, she looks in her mouth and says her tonsils are huge, asks if she snores or mouth breathes (no, she doesn't, that I am aware of), and then says "she's at the age to have her tonsils taken out."

 

Then we saw the audiologist who did the hearing test. DD did great as far as cooperating. I wish I had asked for a copy of the test results and she explained them to me. One of her ears had one mark below the normal hearing range (so barely barely) and the other ear showed mild hearing loss. She says she has fluid behind her ears causing it. We get back in to the doctor and she's inmediately suggesting we schedule an appt to put tubes in her ears. I was a little aghast at that, and then she said we could wait a month and retake the test first. But she seemed to lean towards tubes. I said I would wait and retest. She said to come back in a month and schedule with the surgeon who would be doing the tubes.

 

Does this seem overly aggressive? Pushy even? I asked if fluid will sometimes clear up on its own and she said sometimes, but didn't sound optimistic. I am definitely a "wait and see" type so I feel a little wary of this doctor's recommendations. Maybe if she hadn't immediately began with talking about tonsil removal...

 

 

 

 

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My recently turned 4 year old DD seems to have trouble hearing lately. It's a new problem, in the last couple months maybe. DH noticed it as well, that she often asks "what?" and needs things repeated several times. I can't see anything inside her ears, like wax buildup.

 

Should I take her to an audiologist or an ENT? She's been really healthy, besides the minor sniffles that go around the family now and then and never had an ear infection.

 

This is also the child who I took to TWO eye doctors because she kept looking at me out of the side of her eye, and both said her eyes were just fine. (She has quit doing that) So I haven't ruled out the possibility that she is just yanking my chain.

Edited June 9, 2017 by DesertBlossom

[rainbowmama]

I would ask for a referral from my pediatrician. For us, the audiologist is in the ENT practice: you see the audiologist first and then the ENT.

[Faithful_Steward]

Yes, I agree with the pp. I got a referral from the pediatrician and they called to set up an apt with audiology. The audiologist then sent us to the ENT doctor.

[prairiewindmomma]

Audiology first so that you have baseline hearing stuff in place. No mechanical hearing issue  = look at attention and processing issues. Hearing loss = ENT.

[Paige]

In our experience, the ENT and audiologist work together. The ENT has been the audiologists' gatekeepers. 

[nixpix5]

In our experience, the ENT and audiologist work together. The ENT has been the audiologists' gatekeepers.

This. My 1st grader wears hearing aids and an ENT has always been the first person you see to make sure there are not any obstructions and so forth. If a visual look at the ear is done and all is well then they will send you on to the audiologist. You will probably need your pediatrician to give the initial referral.

[Crimson Wife]

It was our experience that the ENT referral came only after my child had abnormal result on audiology testing. The audiologist did the visual inspection, testing of the middle ear, and testing of the inner ear. When the latter was abnormal, we got referrals to the ENT and neurologist for a MRI scan.

[DesertBlossom]

I found one place that our insurance covers that appears to be both an audiologist and ENT. I don't need a referral from our family doctor, so I didn't think to ask them who they refer to. But I got an appointment for right away, so that's awesome. If there isn't actually something wrong with her hearing, I may never trust this child's symptoms again. :P She's a spunky one.

Edited June 7, 2017 by DesertBlossom

[Monica_in_Switzerland]

We went through this with a (then) 4-5yo.  She had never had an ear infection, but it turned out her ears were full of fluid anyway.  She spent an entire winter essentially deaf.  Diagnosing was easy, her pediatrician just stuck a thing in her ear and went, "Yep, totally full of fluid."  From there, we saw a pediatric ENT who ultimately drained her ears but decided not to put tubes in, and also sectioned her giant tonsils.  I hope the solution for your dd is that simple!

[Crimson Wife]

 If there isn't actually something wrong with her hearing, I may never trust this child's symptoms again. :p She's a spunky one.

 

There can be legitimate problems processing spoken language in the brain even if the physical ability to hear sound is fine. Think of it like your internet connection. There can be a problem with your modem/wireless router (the ear) or with the ISP (the brain). Your modem/router could get the signal to the ISP just fine but if the ISP is having problems, you won't be able to use your internet.

 

4 is unfortunately too young to test for Central Auditory Processing Disorder. Most audiologists who specialize in CAPD testing won't do it before the age of 7 or 8.

[DesertBlossom]

There can be legitimate problems processing spoken language in the brain even if the physical ability to hear sound is fine. Think of it like your internet connection. There can be a problem with your modem/wireless router (the ear) or with the ISP (the brain). Your modem/router could get the signal to the ISP just fine but if the ISP is having problems, you won't be able to use your internet.

 

4 is unfortunately too young to test for Central Auditory Processing Disorder. Most audiologists who specialize in CAPD testing won't do it before the age of 7 or 8.

She's only 4 so it's hard to say, but I never felt before like she couldn't hear what I saying the 1st time. I know sometimes she'll ask me to repeat what I said if she doesn't understand, like the vocabularly or situation is new. But she does it a lot more often than that too.

[nixpix5]

It was our experience that the ENT referral came only after my child had abnormal result on audiology testing. The audiologist did the visual inspection, testing of the middle ear, and testing of the inner ear. When the latter was abnormal, we got referrals to the ENT and neurologist for a MRI scan.

This is interesting. I wonder if it is handled differently based on location. We are in Washington State and go to Children's for our evaluations twice a year to make sure she hasn't lost anymore hearing. When out ENT visit has "expired" we have to go get ENT clearance again before resuming our audiology appointments. Same thing every time she gets new hearing aids, she has to get ENT clearance and even when we purchased our own FM system. It always makes me scratch my head because it makes more sense to do this through the audiologist like your experience.

[Paige]

This is interesting. I wonder if it is handled differently based on location. We are in Washington State and go to Children's for our evaluations twice a year to make sure she hasn't lost anymore hearing. When out ENT visit has "expired" we have to go get ENT clearance again before resuming our audiology appointments. Same thing every time she gets new hearing aids, she has to get ENT clearance and even when we purchased our own FM system. It always makes me scratch my head because it makes more sense to do this through the audiologist like your experience.

 

Same for us. DS's audiologist just said we need a new ENT referral for his full audiologist retest next time. He wears aids and has an FM system too, but they want or need the ENT referral again. Maybe it depends on your insurance. 

 

For our DS, the process was this: failed quick screen at school or pediatrician. Go to ENT for eval. and check for fluid or other obstructionist or visual causes. ENT sends to audiologist when they decide to. 

[zaichiki]

When my oldest dd (the musician) was about 4 or 5, she went months asking "what?" all the time. I called the pediatrician who used an otoscope to check the eardrum for middle ear fluid. If there is excess fluid in there (usually comes with cold/congestion but can also happen with allergies), the eardrum doesn't move as well and so doesn't conduct sound as well into the inner ear and on into the brain. So, anyway, she had fluid. No infection, but fluid. For weeks! (We were told to show up every week to check on it. Thankfully covered by our insurance.) Pediatrician ended up suggesting a decongestant... if that didn't work, next step was antihistamine (for possible undiagnosed allergies). Last step would have been tubes in the ears. 

 

A month later she was fine and the "what?" responses never resurfaced. Go figure.

 

I hope it's something temporary and simple. Good luck!

 

 

Edited June 8, 2017 by zaichiki

[fdrinca]

You can also try a preliminary hearing check at the ped's office en route to a hearing professional.

 

My son has congenital sensorineural hearing loss in one ear, but it was undetected until his 5 year check up. Once he failed the hearing test, he was referred to an audiologist and ENT. He saw both on the same visit, and continues to do so.

[DesertBlossom]

UPDATE: Just for reference, DD is rarely sick. Literally this may have been her 2nd visit to a dr, ever. She gets colds and mild things when they go around, but I have not been worried about her health at all.

 

So we get in to see the dr, she looks in her mouth and says her tonsils are huge, asks if she snores or mouth breathes (no, she doesn't, that I am aware of), and then says "she's at the age to have her tonsils taken out."

 

Then we saw the audiologist who did the hearing test. DD did great as far as cooperating. I wish I had asked for a copy of the test results and she explained them to me. One of her ears had one mark below the normal hearing range (so barely barely) and the other ear showed mild hearing loss. She says she has fluid behind her ears causing it. We get back in to the doctor and she's inmediately suggesting we schedule an appt to put tubes in her ears. I was a little aghast at that, and then she said we could wait a month and retake the test first. But she seemed to lean towards tubes. I said I would wait and retest. She said to come back in a month and schedule with the surgeon who would be doing the tubes.

 

Does this seem overly aggressive? Pushy even? I asked if fluid will sometimes clear up on its own and she said sometimes, but didn't sound optimistic. I am definitely a "wait and see" type so I feel a little wary of this doctor's recommendations. Maybe if she hadn't immediately began with talking about tonsil removal...

[wonderchica]

I know you said she doesn't get sick, but does she have a stuffy nose often? Throat hurting? Ear, nose, and throat are all connected (hence ENT) and absolutely affect one another. Everything the doctor asked sounds typical for what you've described.

 

PE tubes and (sometimes/often) tonsil/adenoid removal is a very common treatment for persistent fluid in the ears. Fluid in the ears often leads to conductive hearing loss (meaning the fluid is physically stopping the sound from getting through). The tubes is a very short, minor procedure. Most kids are up and playing the same day. I think you're okay to wait, but if the hearing loss continues I'd definitely seriously consider it.

[zaichiki]

I had tubes in my ears twice when I was a kid. Pediatricians have told me this happens in "cycles." For a number of years, tubes are recommended quickly/frequently, then for a number of years, it's "the last resort."

 

Did your dd see the pediatrician or the ENT. FWIW, the ENT is usually going to want to jump right to the "quick and thorough" solution. It's what they do. The pediatrician is more likely to try other (simpler, cheaper, and less invasive) things first.

 

If the doctor said you can wait, go ahead and wait, but don't just do nothing. In the meantime, try a decongestant. See if it makes a difference. Try allergy medication. Maybe your dd has an allergy that you didn't realize she had developed.  (Happened to my kid.)  You've got a month. Capitalize on it.

 

Good luck!

[Carol in Cal.]

I'd consider visiting an allergist first.

Then tubes.

Then if that doesn't work, consider the surgery.  Because if she can move beyond this age OK, my guess is that she will 'grow into' those tonsils.

[Noreen Claire]

I second (third?) the antihistamine/decongestant. It will dry out the ears/relieve compression on the eardrums a bit. See if it helps?

 

As a toddler/preschooler, DS8 got multiple, antibiotic-resistant ear infections that caused temporary hearing issues. Never got tubes. That stopped as he got older and hasn't been a problem since.

 

Good luck!

[prairiewindmomma]

4yo is old enough for OTC fluticasone nasal spray. Add that + Zyrtec. Audiologists tend to be aggressive because so much is lost when hearing is impaired. We have a child who still has some speech issues from longtime fluid in the ears during the toddler-elementary years.

 

I think it's totally reasonable to try allergy treatment first, but I wouldn't let this drag out into the fall.

[DesertBlossom]

I know you said she doesn't get sick, but does she have a stuffy nose often? Throat hurting? Ear, nose, and throat are all connected (hence ENT) and absolutely affect one another. Everything the doctor asked sounds typical for what you've described.

 

PE tubes and (sometimes/often) tonsil/adenoid removal is a very common treatment for persistent fluid in the ears. Fluid in the ears often leads to conductive hearing loss (meaning the fluid is physically stopping the sound from getting through). The tubes is a very short, minor procedure. Most kids are up and playing the same day. I think you're okay to wait, but if the hearing loss continues I'd definitely seriously consider it.

At the moment she has a little bit of a runny nose, but this is not typical. She is not usually congested and has never complained of a sore throat.

 

I will try the otc allery med and see if that helps.

[DesertBlossom]

Did your dd see the pediatrician or the ENT. FWIW, the ENT is usually going to want to jump right to the "quick and thorough" solution. It's what they do. The pediatrician is more likely to try other (simpler, cheaper, and less invasive) things first.

 

I called our family doctor about doing a hearing test. They don't do them there, so I made an appointment with a combo ENT/audiologist office.

[magnificent_baby]

I would not rush to get tonsils removed nor getting tubes placed. There are guidelines on when a tonsillectomy is appropriate and it doesn't seem like she fits the criteria. Ds had hearing loss as well from fluid, it resolved itself with time (several months). His ENT (a cochlear implant surgeon) recommended to wait it out. As long as she's not in pain, I would be patient. 

[Crimson Wife]

You can also try a preliminary hearing check at the ped's office en route to a hearing professional.

 

I would not bother with the screening at the pediatrician's office since it only tests a few frequencies and at a deciBel level that won't catch a mild loss. My daughter was mild-sloping-to-profound but passed the screening since they didn't test the frequencies she is profound at.

[gardenmom5]

no - it doesn't.  if she'd normally fine between colds (and doesn't have them often) wait a month or so.  if she's frequently has fluid in her ears - or you question her hearing- go ahead and have them done. 

I have one who had tubes.  he was the only one who had so many incidents of fluid build up that his hearing was affected.   one came out not long afterwards - but the other -I knew when he had an infection because fluid was draining.   this was only one out of five.  it was just the angle of his Eustachian tubes.  they didn't drain very well - that resolves with age as they grow.

 

and I agree - the hearing screen at the ped's office is very very cursory.  an audiologist is much more thorough.  I assume they did a decent one in the sound booth?

 

My friend was sick a lot - but various drs thought her tonsils weren't a big deal. . . . she went ahead and had them out.  the surgeon commented how they were very surprised by how infected they actually were.

[katilac]

At the moment she has a little bit of a runny nose, but this is not typical. She is not usually congested and has never complained of a sore throat.

 

I will try the otc allery med and see if that helps.

 

My sister never complained about her eyesight, but when she watched TV for the first time after getting glasses, she gasped, "You can see their faces!" 

 

Just an amusing story to point out that a young child may not realize that a mild, ongoing sore throat is anything to mention. It could be her normal. 

[sassenach]

I would bring her to a chiropractor before getting tubes. I was amazed out how instantaneously my ears drained after getting an adjustment. Have they tried any meds to dry her ears out? Lymph massage?

 

My eldest got tubes in her ears and it was a total solution, but that was after one ear infection after another. She had constant puss in her ears, blocking her ear canals. It was definitely the right decision.

 

I would just want to try some other things first because anesthesia is never my first choice.