Case 9

Patient:  MH

Age: 6

Gender:  Male

This case was sent by a speech-language pathologist Linda Harris, SLP.D., who wanted consultation about the child’s status and management options.

FIRST EVALUATION RESULTS

The patient’s mother reports that “MH” passed a neonatal hearing screening, and also passed a hearing evaluation at another clinic at age 4.

MH is legally blind.  Usher syndrome was initially suspected, but evidently ruled out in further testing.

His mother says she thinks there are hearing problems, and that he may hear some pitches better than others. He typically does not respond when called, nor does he tend to notice low-intensity sounds.  He doesn’t understand verbal commands, but is aware of some environmental sounds.

His expressive language skills are limited.  His speech is generally not intelligible.  His mother says MH has a developmental age of 3.

MH has been generally healthy since birth. The pregnancy was complicated: MH’s mother began labor at 5 months and was given medication to halt delivery. Delivery was near term via C-section after a prolonged attempt at vaginal delivery.

  • If the developmental age is 3 years, do you predict that the child will or will not be able to condition to play audiometry?

 

Initial evaluation:

  • The otoacoustic emission results are shown.  Please interpret the findings.  Click on the image if you would like to see it in full size.

Tympanograms were type A. Acoustic reflex results are not reported, perhaps there were problems with the child’s cooperation (e.g. child moving), or perhaps the audiologist opted to omit testing for another reason.

Using insert earphones, a left ear speech awareness threshold was obtained at 75 dB HL. No response was obtained from the right ear.

Play audiometry was attempted, but MH could not condition.

  • What strategies would you use to help to condition MH?

Visual audiometry yielded the results shown. Reliability was considered “fair.”

  • The child is reportedly legally blind.  How would VRA work for a blind child?
  • Given the results so far, what is your tentative diagnosis of site of lesion, and what testing would you conduct next?