Mixed News

About ten days ago, O pulled out his NG tube.  At that time, he was taking nearly his entire volume goal of milk by mouth.  We decided to leave the tube out and fortunately, we have not needed to re-place it since he's eating very well by mouth and continues to gain weight on target.  We're still thickening the milk with some rice cereal.

O is acting like a normal two-month old in many respects.  He is exploring the world with his eyes, making great eye contact, smiling at us, and even seemed to "coo" a few times this morning.  He is lifting his head up well and also did a torso stretch towards his mommy when he transferred between parents the other day.  All of that (plus his progress in eating) is important context for the following paragraphs.

Today, we took O in for his ENT appointment, which was his first evaluation by an ENT since he left the hospital.  When we made the follow-up appointment, we thought that the main focus of the visit would be his laryngomalacia but that turned out to be a minor focus with his hearing issues moving to the forefront.

The appointment proceeded smoothly although O hated the ear exam (once again, quite normal).  We had to lay him on the exam table for this part and it required three people to restrain his flailing little head, arms, and legs.  A heartwarming moment occurred midway through examination of the second ear when he went from screaming bloody murder/purple face to relatively calm/wimpering, and all it seemed to take was a parent capturing his eye-contact at a really close distance. 

As previously mentioned, O's audiogram suggested that fluid in the middle ear might be the cause of his hearing loss.  After this appointment, we have another potential explanation.  You see, Oliver's findings on the audiogram were not "diagnostic" for middle ear fluid.  Rather, the findings were suggestive of conductive hearing loss, and while middle ear fluid is a common cause of this type of hearing loss in infants/toddlers, it's not the only cause.  Anything that stops the transmission of sound waves through the ear will cause a conductive hearing loss.  (Ear wax anyone?)

In O's case, we learned today that his ear canals are quite narrow.  You can't tell this from external inspection of his ears.  He does have skin tags in front of both of his ears which hinted at the possibility of other ear issues, so we're not entirely surprised.

So what's next?

Later this month, O will be evaluated by an audiologist at Riley.  He will have yet another hearing test.  This time, he'll have a bone conduction ABR.  If this is "normal" (ie if sound transmits through the bone, bypassing the external ear mechanism, to the inner ear resulting in a "normal" hearing response), then he will likely benefit from bone conduction hearing aids. 

The immediate goal is to help O hear as normally as possible by 3-6 months of age so that any impact on his language development would be minimized.  A longer term goal might be to actually fix the cause of the hearing loss.  To fix the problem would require surgery, though, and that won't happen any time soon.

Stay tuned.