1. FITTING AMPLIFICATION ON CONDUCTIVE HEARING LOSS CASE PRESENTATION KATHLEEN HAUSBECK-MILLER AU.D

2. PATIENT “O” Referred originally by The Newborn Hearing Screening Program at her local hospital. Parent reported she consulted the pediatrician who told her “not to worry”, “nothing is wrong” No rescreen was recommended Parent began to be concerned regarding child’s lack of response to her voice Also concerns regarding speech/language were noted

3. I saw patient “O” for an evaluation when she was 18 months old. Results via VRA in the soundfield were consistent with a moderately-severe rising to mild hearing loss for at least the better ear Ear specific testing was attempted with Insert earphones but patient would not tolerate SDT was noted at 45 dB HL Tympanograms were Type B bilaterally suggestive of middle ear effusion OAE’s were absent bilaterally

5. Referral was made for medical management Patient returned 6 weeks later Tympanograms continued to indicate middle ear effusion for each ear Hearing levels improved 10-15 dB Referred to ENT

6. PE tubes inserted at age 21 months Post op audiogram indicated responses in the soundfield between 20-25 for at least the better ear We put patient on 6 month routine monitoring schedule Patient continued to have chronic otitis media bilaterally By age 2 ½ the PE tubes again extruded and left bilateral TM perforations Audiogram indicated a mild conductive hearing loss for the left ear and a mild to moderate conductive hearing loss for the right ear

8. ENT recommended a 6 months wait to see if perforations would heal Child began speech/language therapy due to articulation errors The perforations did not heal and amplification was recommended Fit child at age 3 with binaural amplification Aided responses were excellent

11. Tympanoplasty performed at age 4 years An evaluation 6 weeks post-op indicated mild conductive hearing loss bilaterally Tympanograms were consistent with continued TM perforations Tympanoplasty was unsuccessful  Hearing and hearing aids were monitored every 3-6 months At age 5, the left TM perforation healed on its own, but mild hearing loss in that ear persisted

13. At age 7, the left ear perforated again

16. Today, the patient is 11 years old and the TM perforations persist, with a moderate rising to mild conductive hearing loss for the left ear and a moderately-severe rising to mild conductive hearing loss for the right ear.