However, this visit I was more concerned about what his doctor had to say about his daycare teacher's concerns and about his speech. She didn't agree with the concerns about "odd movements" or think he seemed off or delayed as far as social development, fine or large motor skills, etc. She did, however, agree that his speech seemed delayed and felt intervention would be for the best. Her first referral was to an audiologist to have his hearing tested because she felt like he seemed to be taking an extra beat between hearing and comprehending, like he couldn't hear properly. Depending on what the audiologist found, we would then talk to the state early intervention program about having a speech assessment done to see if he qualified for therapy.
I was able to get an appointment with the audiologist two days later and we brought him in to have her test his hearing. She did a simple test where we sat in a sound booth and she talked to him or made noises and watched him look to respond. He did well over all but he did seem to ignore or not hear a certain range. Then she did this:
Tympanometry: To check how well the eardrum moves. The doctor places a soft plug snugly into the ear canal and a probe is connected to a machine. The child hears a low noise for a short time while the machine records how the eardrum reacts. An eardrum with fluid behind it doesn't move as well as one without fluid.
The tympanometry showed fluid in both ears that might have been there for a long time. She asked me about his health over the past months and I told her he'd been sick a lot since it was his first time in daycare, but was never diagnosed with an ear infection. Her theory is that with all of the colds and infections, he's probably had a build up of fluid in his ears for months that is non-infectious (because infection may have been partially treated by his other antibiotics) but has never been able to drain away. He could hear, but every thing would be muffled, which could account for his delays in picking up speech and speaking not as clearly. She referred him to an ENT and recommended that we not proceed with a speech evaluation until the fluid is cleared and he has a chance to improve his speech on his own after his hearing is improved. The good news is that she doesn't feel like he has suffered hearing loss or impairment, as he demonstrates a wide range of sounds in his speech that she says is not typical if hearing loss has occurred. Of course, it's hard to say with a 2 year old how well they can really hear. I'm sure we'll be doing many hearing tests in the future to make sure no permanent damage was done.
The next step will be seeing the ENT, which when that happens will depend a lot on when Bebo decides to be born. The ENT will determine how to proceed with clearing the fluid, either "wait and see" if his body will drain the fluid itself now that cold and flu season is over, possibly antibiotics, or tubes to drain the ears. I hope we can get Z in as currently scheduled so we can get this show on the road, but unfortunately, the timing for all of this just isn't great.
Thus stands Mr. Z-pants. I was initially really surprised that he had fluid in his ears but now that I've had some time to simmer on it, it does make sense. It fits with why his speech has developed, just not quite as fast. It even fits with why his daycare teacher felt like he never takes direction since it's probably harder for him to hear in the loud classroom environment and why she thought his movements seem "clumsy" (though part of that I'm sure is his taking after me and my terrible habit of getting distracted by things around me resulting in my running into walls, doors, other humans, bushes, parking meters... plus, I'm just clumsy). He's probably had his equilibrium off a bit for months. The audiologist said it usually takes non-infectious fluid 3-6 months to drain and clear after the child is healthy, and Z has not been healthy for... well, he actually woke up with a cold this morning and sounds all froggy. I can hear him coughing in his sleep right now. Poor guy. It also could explain why he seems to mess with his ears so much. I've been attributing that to his second year molars cutting over the last 6 months (yes, it's been a painfully slow experience) but now I wonder how much was teeth and how much was discomfort.
Either way, we have a path forward that I feel comfortable with and I'm glad we took the referral to see the audiologist.
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