Any cases of sensorineural hearing loss in baby improving?

Courtaney

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Sorry for the long post, but I thought this would be a good board to ask this on. I know this sounds strange, and I have yet to find anything on the web to corroborate that it's even possible, that a permanent loss can get markedly better, but here's some background on my son:

Andrew was born very early, at 23 weeks gestation exactly (1 lb. 6.5 oz/11 inches). He was on a vent for 11 weeks and in the NICU for 18 weeks. He came home on oxygen and was on it here for 4 months. Before his NICU discharge, he failed two hearing screenings in his right ear only. Follow-up testing with a pediatric audiologist, including the ABR, revealed a pretty much straight line loss in both ears, 50 to 55 dB in the left ear, that had somehow passed the screenings, and 55 to 65 in the right. Nothing better than 50 dB at any of the frequencies tested (500 to 4000) although he apparently had a clicker reading we weren't given in our paperwork, on the lest testing, of 35 dB. His ears were checked for fluid by both the audiologist, via a test, and the ENT a couple of weeks later. He had none during the times of either ABR, and essentially, has only ever had a little in the time since...once in May 2010 and then again this past winter/spring, always in the same ear (right).

Andrew was aided at 4 months corrected age and began Early Intervention services. Prior to that time, he didn't really coo. In fact, he never actually went through that phase. Four weeks after being aided, he tested at an 85 for expressive language on the Bayley test for infants, and a 109 in receptive language. The therapists were amazed at that receptive score since he hadn't had his aids long. He went on to have a good repeated babbling stage, beginning at 10 months corrected, going swiftly on to words. By 12 months corrected, he was testing at a 15-month level in expressive language and a 14-month level in receptive. The receptive language has continued to climb, now moving into the 120s/90th percentile range. However, the expressive language has fallen and now would probably be around a 90 for his corrected age, by my estimates. We will know more in a month when he is tested again on the Bayley. He has many word approximations, around 280, and a nice amount of signs, about 110, but they overlap a lot. He doesn't say second syllables, except for a few exceptions. And while he occasionally will say a phrase, it's rare still, no more than once a day. He also doesn't have many endings on his words. His ST says his speech is consistent with his hearing loss level, but what isn't consistent, according to her, is just how well he hears without his aids. She thinks some of the problem was his lack of sound play as an infant and the early move to words...something at the time we thought was good. He has almost every sound back from the babbling stage now, except initial l, but he just doesn't use a lot of them in words. Many of his word approximations sound the same. For instance, muh means anything from music to monkey to Mickey Mouse.

Here's the quandary our one ST notices...When his back is turned, Andrew can easily follow directions, respond to a simple question, imitiate, and laugh at something funny. He has heard me give a direction at about 20 ft., outside, and heard our soft-spoken speech therapist do the same inside, 15 feet away, when he couldn't see her face. He looks almost all the time when I make sounds like "ssss" or "fffff" behind him, things that he isn't supposed to hear. His hearing seems to have gotten progressively better. For instance, he used to be able to sleep through my husband and I talking in the room where he slept, but now often will awake if we talk downstairs, near the foot of the stairs. (His room is on the second floor). He has woken up to our cat meowing on the first floor (Granted she is loud). He has also stopped in mid tracks while playing upstairs, when she meowed on the first floor, and said "Meow"--his only 2-syllable, different syllable word. He awakes with the phone ringing all the time. It just seems to be getting progressively better with noises outside too. This past spring, I can remember the first time he heard the train outside without his aids, one night when I was rocking him after a bad dream--it's about a mile away. Then a month or so ago, it was the faint chimes from the church behind our house he finally heard. They begin at a very soft decibel--25/30 at best, yet he heard it, stopping what he was doing and going "Ding-ding."

This past month, the wax has gotten the best of him and he appears to hear a little less without his aids. The pediatrician checked his ears last week and said it looked awful in the right, and pretty bad in the left. The ENT doesn't favor drops and likes to have someone there clean them out. This time, though, since my son will be getting a tonsillectomy in a month, he just wants to do it then. The good news is that with his hearing aids in, he appears to still be hearing very well. Without them, I notice a difference at the fainter/softer sounds he was hearing. He may have fluid underneath the wax in his right (worse) ear, as he did last winter. If he does, they will be putting a tube in. The audiologist told me on the phone that the wax couldn't be bad if he could still hear some with his aids. I said he appears to hear as well as normal with them. I asked her if it would be normal to hold a conversation with him, at his level of loss, with a lot of wax on top of it, without his aids. She said not unless his hearing is good at the lower frequencies, as she sometimes sees. I reminded her his was 55 in the better ear at the 500. She appears to believe me now that he's hearing better than those ABR results. In the past I could tell she didn't because she kept saying they can perform a little better than those results but not a lot (something like 10 dB better). But we're seeing more with him and it isn't just his parents seeing it, it's all his therapists too.

They attempted booth tests with him last January and March. Before that time, they tested him as an infant with his aids on. On both of those occasions as a toddler, he didn't cooperate. The first one, only one eardrum turned, so she only tested the ear that was fluid free, the better ear, his left (We had the ears cleaned out a couple of hours after the test). She didn't get double hits at any frequency, but decided to go with what she got rather than call it inconclusive. She labelled him moderately severe only in that ear (down from moderate before) but didn't give us a printout of every frequency. I knew from his behavior, even back then, that he wasn't moderately severe, when she wanted to talk about turning up his aids. In March, they could do very little in the booth, as he cried most of the time. But in between the cries, they got a clicker test reading of 25 dB. However, that's about all they got, and couldn't do any individual frequencies.

I guess my question is, can sensorineural hearing loss improve? Are there cases like this? And if it can, will that show up on an ABR? Even if the improvement is what his brain has done since being aided (growing more neurons or whatever)? The audiologist made it sound like it would, but our speech therapists think the ABR will be the same, but the booth test, if we got one where he cooperated, would show the big improvements we have seen with him at home. I am hoping the audiologist is right, and if there's improvement, we'll find out with the upcoming ABR. I have a feeling it will be a while before he stops crying in the booth...he cries everywhere we go that is medical related.
 
It is not unusual for a child's performance, and even testing results, to improve after they learn to use their residual hearing in combination with their HAs. Very young infants do not understand what is expected of them in testing. Nor do they understand what sounds they need to pay attention to for meaning, and which they don't. It is something they learn as they get a bit older.

That is one of the reasons that I am against early infant implantation.
 
well I had a sensorineuaral hearing loss as an infant and my loss is improved with hearing aids :)
 
So maybe somehow he is more in tune with his residual hearing? That could explain things, that it is appearing to progress then, overtime. His speech therapists were saying that since he was aided as a young infant, maybe more neurons were able to grow and improvement came from that, but I don't know. I sometimes wonder with him if there is a connection with his being born so early too. He was born before the ear is completely developed (that comes at 24 weeks or later). What if his body or brain put things on hold while trying to survive? I know that sounds crazy, but his eye doctor said his blood vessels in his eyes were extremely late in developing. They should be done at term (40 weeks), and it took his more than a couple of months beyond that to finish. What if somehow his ears were the same way and at the time of the tests, just weren't completely ready to go? I know that seems farfetched, but the eye doctor told me there is so little they know about 23-weekers.

His ENT believes the straight line loss is indicative of a medicine induced loss, likely from the early antiobiotics he received, like gentamycin. He also was given IV lasix, which is ototoxic too. But with the way the one ear passed two initial screenings, I don't know...just wondering if there was somehow a fluctuating loss they missed, and not just a typical sensorineural loss, in that one ear at least. I guess we'll learn more next month when he gets his ABR.

The audiologists I've heard from basically say there's no way a child with sensorineural loss, and no conductive factors at the time of the test, could show improvement more than 10 dB, and that that limit of 10 is stretching it. Yet what we are seeing may indicate he is hearing 25 or 30 dB better...he's even hearing better now unaided, with a load of wax and probably fluid too, than the ABRs show. I guess we'll find out soon if it's truly that much better, and then try to find out how it can be, if it is.
 
So maybe somehow he is more in tune with his residual hearing? That could explain things, that it is appearing to progress then, overtime. His speech therapists were saying that since he was aided as a young infant, maybe more neurons were able to grow and improvement came from that, but I don't know. I sometimes wonder with him if there is a connection with his being born so early too. He was born before the ear is completely developed (that comes at 24 weeks or later). What if his body or brain put things on hold while trying to survive? I know that sounds crazy, but his eye doctor said his blood vessels in his eyes were extremely late in developing. They should be done at term (40 weeks), and it took his more than a couple of months beyond that to finish. What if somehow his ears were the same way and at the time of the tests, just weren't completely ready to go? I know that seems farfetched, but the eye doctor told me there is so little they know about 23-weekers.

His ENT believes the straight line loss is indicative of a medicine induced loss, likely from the early antiobiotics he received, like gentamycin. He also was given IV lasix, which is ototoxic too. But with the way the one ear passed two initial screenings, I don't know...just wondering if there was somehow a fluctuating loss they missed, and not just a typical sensorineural loss, in that one ear at least. I guess we'll learn more next month when he gets his ABR.

The audiologists I've heard from basically say there's no way a child with sensorineural loss, and no conductive factors at the time of the test, could show improvement more than 10 dB, and that that limit of 10 is stretching it. Yet what we are seeing may indicate he is hearing 25 or 30 dB better...he's even hearing better now unaided, with a load of wax and probably fluid too, than the ABRs show. I guess we'll find out soon if it's truly that much better, and then try to find out how it can be, if it is.
 
So maybe somehow he is more in tune with his residual hearing? That could explain things, that it is appearing to progress then, overtime. His speech therapists were saying that since he was aided as a young infant, maybe more neurons were able to grow and improvement came from that, but I don't know. I sometimes wonder with him if there is a connection with his being born so early too. He was born before the ear is completely developed (that comes at 24 weeks or later). What if his body or brain put things on hold while trying to survive? I know that sounds crazy, but his eye doctor said his blood vessels in his eyes were extremely late in developing. They should be done at term (40 weeks), and it took his more than a couple of months beyond that to finish. What if somehow his ears were the same way and at the time of the tests, just weren't completely ready to go? I know that seems farfetched, but the eye doctor told me there is so little they know about 23-weekers.

His ENT believes the straight line loss is indicative of a medicine induced loss, likely from the early antiobiotics he received, like gentamycin. He also was given IV lasix, which is ototoxic too. But with the way the one ear passed two initial screenings, I don't know...just wondering if there was somehow a fluctuating loss they missed, and not just a typical sensorineural loss, in that one ear at least. I guess we'll learn more next month when he gets his ABR.

The audiologists I've heard from basically say there's no way a child with sensorineural loss, and no conductive factors at the time of the test, could show improvement more than 10 dB, and that that limit of 10 is stretching it. Yet what we are seeing may indicate he is hearing 25 or 30 dB better...he's even hearing better now unaided, with a load of wax and probably fluid too, than the ABRs show. I guess we'll find out soon if it's truly that much better, and then try to find out how it can be, if it is.

The part that I bolded certainly sounds plausible to me.

My youngest nephew was born 8 weeks early. For the first 8 weeks of his life, all he did was eat and sleep. He barely responded to anything. He made very few interactive noises or faces or anything like that with his parents or grandparents. Eating and sleeping, those were his activities, period.

Then at about the time he should have been born, he seemed to "wake up" and suddenly was beginning to interact, to look around, to do the things babies should do.

My mom said the difference was quite amazing. After that, he hit all the baby milestones (turning over, smiling, babbling, focusing on bright colors, etc.) at the right time if you counted from the time he *should* have been born, not from when he really *was* born, 8 weeks earlier.

So it does make sense to me that perhaps your baby went through something similar, that he used the first few weeks and perhaps as much as two months of his life doing the continued growing that he should have been doing in the womb.
 
Sorry for the long post, but I thought this would be a good board to ask this on. I know this sounds strange, and I have yet to find anything on the web to corroborate that it's even possible, that a permanent loss can get markedly better, but here's some background on my son:

Andrew was born very early, at 23 weeks gestation exactly (1 lb. 6.5 oz/11 inches).
I guess my question is, can sensorineural hearing loss improve? Are there cases like this? And if it can, will that show up on an ABR? Even if the improvement is what his brain has done since being aided (growing more neurons or whatever)? I have a feeling it will be a while before he stops crying in the booth...he cries everywhere we go that is medical related.

As a adult(19) who was born at 25 weeks.who had a "neuroplasty regrowing"
(growing more neurons or whatever)?
based childhood i have this say

Over use of plasticity in young diffident children is scary. And there has been little research into the long term effects on the whole body.

and i still cry before, sometimes during and after medical appointments.
 
So maybe somehow he is more in tune with his residual hearing? That could explain things, that it is appearing to progress then, overtime. His speech therapists were saying that since he was aided as a young infant, maybe more neurons were able to grow and improvement came from that, but I don't know. I sometimes wonder with him if there is a connection with his being born so early too. He was born before the ear is completely developed (that comes at 24 weeks or later). What if his body or brain put things on hold while trying to survive? I know that sounds crazy, but his eye doctor said his blood vessels in his eyes were extremely late in developing. They should be done at term (40 weeks), and it took his more than a couple of months beyond that to finish. What if somehow his ears were the same way and at the time of the tests, just weren't completely ready to go? I know that seems farfetched, but the eye doctor told me there is so little they know about 23-weekers.

His ENT believes the straight line loss is indicative of a medicine induced loss, likely from the early antiobiotics he received, like gentamycin. He also was given IV lasix, which is ototoxic too. But with the way the one ear passed two initial screenings, I don't know...just wondering if there was somehow a fluctuating loss they missed, and not just a typical sensorineural loss, in that one ear at least. I guess we'll learn more next month when he gets his ABR.

The audiologists I've heard from basically say there's no way a child with sensorineural loss, and no conductive factors at the time of the test, could show improvement more than 10 dB, and that that limit of 10 is stretching it. Yet what we are seeing may indicate he is hearing 25 or 30 dB better...he's even hearing better now unaided, with a load of wax and probably fluid too, than the ABRs show. I guess we'll find out soon if it's truly that much better, and then try to find out how it can be, if it is.

Exactly...the first sentence. Audiologists tend to look at hard and fast numbers instead of actual ability to function despite those numbers. People are remarkably adaptive creatures, and that is particularly true for children. The way an individual is able to function is not dependent on baseline hearing levels alone. There are numerous variables involved, not the least if which is personal response and innate personality characteristics that influence coping mechanisms. An audiogram takes none of these into consideration.
 
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