Speech disorder and delay from glue ear hearing loss

[Lovethesea]

I know this is not a big thing compared to many but wanted to gather some knowledge from you wise women who have been involved in this area for years.

DS had grommets put in last March and has been having speech therapy from last summer. He is 4 in June this year and starting reception in September.

I was hoping for a quick improvement in his speech once the grommets were in place (it took a year to get them in, I raised concerns about speech, hearing checked, told to return in 3 months to see if bilateral glue ear had cleared, hadn't so told to come in and see a consultant in 3 months, then appointment for op etc)

He has improved a lot but still has a nasal sound to his speech and cannot do key sounds at all. After a lot of work with the Salt he can now make a blowing sound for fffffffff but says bour not four as that is what he used to hear and so what he automatically uses. He can do a ffffff or if he really really concentrates hard. But not in normal conversation.

My big concern is the sssssss sound, he cannot do it at all and blows a bit through his one. Neither can he do ch, sh or z sounds.

School use Read, Write Inc which DD is flying through in reception so i know one of the first 5 sounds to learn is ssssssss. I don't see how he can do phonics without being able to do sounds?

I am concerned that come September he will still be making slow progress which will mean he cannot do phonics or reading, starts to lose even more confidence and hates school and learning. He does say Its too hard for me, or I can't do it about various things at home that he never used to hesitate to try.

He should be getting a place at the infant school where he is in nursery so some children will be familiar but it affects his social communication as he can't be understood and gets frustrated and sad.

Sorry, essay.

So, my plan to is to talk to the school once we know he has a place there after Easter hols. Maybe a meeting with nursery teacher, salt and senco?

What can I push for? What are the options? Someone helping him with reading each day? How if he can't do sounds still?

Is sight reading easier for him?

Any thoughts or help really appreciated, I am worried for him and while I know it isn't a major additional need it is impacting on all areas of his life and he seems to be becoming anxious about it.

[Lovethesea]

With the sssss sound he blows through his nose not his one. Thanks iPad.

[Lovethesea]

Bump

[occasionalposter]

Hi,

This sounds very like DD at age 4/5 - it turned out that she actually had a non-functioning soft palate as well as glue ear. It was the palate problem that prevented her from making appropriate speech sounds, not the glue ear (although that too was caused by the non-functioning palate).
Like your son, she was nasal and the only sounds she could reliably make were vowels, 'm', 'n' and 'y'. She had to hold her nose to blow out the candles on her birthday cake oherwise the air escaped through her nose.

If your DS is having speech therapy I would expect the therapist to have recognised that he may have a physical problem that might respond to further therapy or may require further investigation. It might be worth asking if she has considered velopharyngeal insufficiency as a possible cause of his difficulties.

In terms of phonics, DD managed surprisingly well, but we had to tell her to sound out the words 'in her head' not 'out of her mouth', as the sounds in her head were right, whereas what was actually coming out of her mouth was not!

DD learnt to read perfectly well, what she could not do was speak in a way that was comprehensible to everyone, although her peers seemed to understand her much better than adults.

I don't know if any of that is helpful. I hope so.

[nennypops]

I read somewhere that there has been some research suggesting glue ear doesn't produce speech impairment, though that could be in the long term. OTOH, Lindsay Peer is very keen on the connection between glue ear and dyslexia on the basis that, if children don't hear properly how words are pronounced they will have difficulty in working out how to read them.

[Bilberry]

Did he have his adenoids out when he had his grommets done? Apparently, if he is very nasal this can be a help; ENT can advise. My ds is now 4.8 and has only just mastered 'fffff' though has been able to say 'sssss' for a while. He can now put them at the beginning of words in therapy but this has not yet transferred to natural speech. It can take a while for things to transfer from therapy to natural speech.

Are nursery providing him with any extra support? I would ask for that SEN meeting now as they could support him in nursery as well as start the planning for his needs for next year. I wouldn't worry too much about reading just yet ( though reading with him is good). But don't underestimate how much speech issues impacts life. My ds has a LSA for half-hour three times a week in nursery. She (under guidance from salt) plays with him in a small group (2 others) and facilitates interaction/discussion between them.

One more thing; 'social communication disorders' are a group of disorders mostly on the autistic spectrum. So, it is probably best to avoid saying 'social communication difficulties' as that has a specific meaning - I have been caught out on this.

[Lovethesea]

Thank you for the thoughts.

I'll look up velopharyngeal insufficiency and make sure I ask about it when we get to see the ENT, useful thanks.

Pre learning is a good plan, I need to be more proactive with him. He used to really resist my practising speech sounds with him whereas he accepted it from the salt, I'll need to see if that's changed now and I can do more games without a frustrated boy collapsing and hiding in a ball so only his bottom is visible! Amazingly his NO if very clear.

He didn't have his adenoids out or tonsils, they were deemed not a problem for him.

Interesting that some get sssssss but can't get fffffff for a while. Comforting in an odd way.

I'm just trying to get all my thoughts together, he's so lovely I don't want to let him down.

[Lovethesea]

Oh and thanks for the reminder on terminology, bilberry, I don't want them thinking I am concerned about something I'm not (his desire to communicate, style, vocab, order grammar etc all seem NT to me, it's just the phonology that is disordered).

If I'm going to be a pain I want to be an effective pain!

[Bilberry]

I get what you mean about ability to communicate socially - our ds IEP focuses on interaction with peers mostly as a confidence thing (though phonology is a problem, he uses 2-4 word sentences and has no grammar). I blathered on about my son having some social communication difficulties to a language unit when we looked round and couldn't understand why they kept saying they didn't take kids on the autistic spectrum. I only realised a few weeks later when our pead told us he didn't have any social communication difficulties!

[Jellyandjam]

Hi, as far as the speech sounds this sounds very much like my DS 7 months ago. He started school in sept with a severe speech disorder, almost completely unintelligible to anyone who was not familiar with him. He didn't have glue ear or any hearing problems, it was/is solely a speech issue. At that point he was unable to produce f, s, l, v, z, sh and missed off the ends of most words. His therapist started off with f as his name begins with this so she thought this would have more meaning for him. To help him make it she said to put his teeth into his lip like a bunny. We also had some apps on the iPad we used to help him (big mouth sounds). At first I honestly didn't see how it would become natural for him as it seemed so difficult for him, but it did and now this sound is used in conversation with no issues. I Remember having a conversation with the therapist snout it and she said that conversation is the very last step and we wouldn't expect to see it in conversation for a while- and she was right. The way we work is he makes the sound in isolation, then with vowel sounds e.g. F-oo, f-ah etc and when this is mastered he moves on to word level, then sentence level, before it will be used in conversation. After f she worked on s- to make the hissy s sound he had to make sure his mouth was in a smiling position- a mirror was great to get him to check his mouth was in the right position. After the first sound he tended to pick others up more quickly.
As for learning to read. I was worried that it might be difficult but actually he has done really well and is above where they would expect him to be at this stage. The reading for DS seems to help his speech e.g. If he sees and s he says it rather than miss if off as he had done before and then this became habit and helped him to generalise the sound.

[uggerthebugger]

Has anyone from audiology ever shown you a "speech banana"? - If not, then feast your eyes on this

Glue ear's a funny thing, and it's hard to predict what range of sounds it'll affect. But very generally speaking, glue ear tends to make it harder to hear lower-frequency sounds (the stuff on the left of the speech banana), and doesn't have so much impact at higher frequencies.

The sounds your DS seems to have most trouble with - f, s, ch, sh, z - are mostly at the middle or the right side of the speech banana, at the higher frequency end of things.

It's very possible that glue ear is getting in the way of overall speech development, and these tend to be some of the speech sounds that it takes people with a hearing problem longest to master. But once the glue ear goes, it'd be well worth checking with an audiologist to rule out the possibility of any other underlying hearing problem. What you've said about his language development is very encouraging though.

In any case, it's worth asking the nursery to communicate with him for now using some basic deaf awareness principles - always looking at DS when talking to him, repeating what has been said if he hasn't understood, placing him directly in front of the speaker for story times. Providing environments where background noise is minimised is also very important; not always easy to do in a pre-school placement, but there should be some quiet space to do reading in small groups or with an adult. These are all perfectly reasonable adjustments to make, and some pre-school places will already be doing some of them for children who don't have English as a first language.

[Lovethesea]

It's really encouraging to hear of others getting on with reading ok despite hearing loss. He loves looking at stories but is now so often saying I'm not good at this, I can't do this, that I fear his confidence will crash when presented with phonic sound blending.


It is the soft front mouth sounds at high frequency that he couldn't hear on his tests before the grommets op.

His recent hearing test showed perfect hearing so now the query is the oral issues. I looked up the velopharyngeal insufficiency and it sounds like something only a specialist would see so I am hoping the referral is made quickly to ENT.

Would be ironic if the glue ear issue has masked other speech issues due to physical mouth structure. He does still dribble a fair bit which has made me wonder.

Salt is in nursery next week so I will gather her thoughts then and see if I can push nursery who have been positive, if they say no time to do more individual or small group then I can ask about senco meeting etc. and see if someone can go in.

I've an nhs salt review end of March as they only had a group session to offer and agreed with me that his individual private sessions were more of use to him at this time.

I made private and nhs salts swap emails and reports so I am going to try and keep everyone in the loop whether they want to. E or not! Never know when I might need them.

[SallyBear]

The best thing would be to go to a cleft team. Nasal air escape is very tricky to cure. There may well be some palate issues and I'd advise that you see a Cleft SALT. In the mean time you can practice the front sounds by using a nose peg. Model the sounds back so that he can hear the difference. Try and make it fun, and do short bursts of therapy twice a day for about 15 minutes. Too long and they lose interest and patience.

A Cleft SALT will also be able to prescribe electropalatography or EPG plate. This is a plate with electrodes that is connected to the PC. It shows you exactly where the tongue placement is. The other thing that can be done, but this really is a last resort is a prosthesis device. Speech bulb obturators fill in the palate space to prevent air escape. They're not pleasant. The Spires Cleft Centre in Salisbury and Oxford have been trialling nasal prosthesis devices that are less invasive. They basically make the patient sound bunged up. It means that the sounds are produced through the mouth rather than the nose.

[SallyBear]

VPI is, in my experience, best seen by a Cleft Palate Surgeon. They would be the ones operating if there were issues such as an incomplete palate.

[Lovethesea]

Brilliant thank you. We are having an NHS Salt team review on 21st so I will ask them about a cleft salt etc and raise all these more complex issues that could be behind the slow progress.

I'm gathering information at the moment and pushing for checks so all this is really useful.