SALT referral for two year old but I suspect Glue Ear

[theotherfossilsister]

2yr 2month old has been referred to SALT by HV. He was born five weeks early with severe iugr and had a long neonatal stay so he could learn to remember to breathe and not go blue (that was fun!)

His development other than speech seems normal though if a little delayed (he walked at twenty months for example.)

I’ve told a few friends about referral and they’ve suggested Glue Ear although HV said nothing about this. His receptive speech is selective and sometimes I do think he doesn’t hear. He loves pointing to things but doesn’t always point to what I tell him to despite knowing the word.

He sings ‘all day dong’ repeatedly, just that, wonder if he trouble with L, although one of his friends has an L name and that is one of his few words. He also sings ‘up above du’ just that, from twinkle twinkle and has for months and ‘row, row, row’ whenever he sees a boat.

Going to call HV on Monday and ask about testing for glue ear but wondered how long it took and if there’s a wait if we could do it privately? Also is it common? Thank you

You can ask to be referred to audiology - they can test at this age (they’ll make a game of it eg when you hear a noise put the man in the boat). Even if it is glue ear they won’t necessarily do anything unless it’s affecting his speech and language. It’s really common because their ears are so tiny. My daughter is 3.5 and is yet to pass a hearing test- they aren’t worried as her speech is uneffected

You can Google private hearing tests and just pay yourself, you don't need a referral for those. The audiologist we saw the wrote to our GP with the finding if glue ear.
Or book in with a private ent surgeon if you are more certain, but I think that's a more expensive route if it might not be. Nhs waiting list fof grommets is 2-3 years in our area and it takes months a day stupidly High threshold to even get them to agree surgery

HV can't refer to ENT, it needs to go via the GP for that one. They can do SALT and a few others.

We went through the same process and SALT were very helpful but essentially the problem came and went because of the glue ear so the real solution was sorting that with grommets via ENT. Good luck though, took me over 3 years and lots of pushing!

In our local area, they do not put grommets in before 3 as they hope the issue sorts itself as they grow. That was private and on NHS. You can't even go in the looooong waiting list until they have already turned 3. I don't think this is a consistent rule across the NHS though, so worth finding out.

You absolutely can go privately. We did and our ds’s speech improved dramatically 2-3 weeks after the op.

The refusal to do the grommets op on the NHS is largely about cost saving, sadly.

I am going to pm you the name of the specialist we used op

Thank you all. My feeling is that it may be glue ear. Will ring GP on Monday too. A private ebt specialist may also be good.

Thank you, the problem with this is I don’t think he’d definitely understand the instruction. I’m not sure if that’s hearing though.

My child was referred to SALT and the first thing that they did was check her hearing at the hospital. Also, even if it is glue ear, it can still significantly impair a child's speech and language development. The longer it is left, the harder it is to resolve. My DC is now 8 and still has private speech therapy to correct a 'lisp'. She's exceeding in all other areas academically. There's nothing wrong with being diagnosed with a speech delay. You should be glad of any support that you can get (although it's unlikely to be much on the NHS).

They will use a tympanometer which is what gives a pressure reading on what bounces back from the tympanic membrane (ear drum) this shows if the issue is glue ear

I've 3 kids with glue and 2 have had the op and 1 is waiting on the op. The glue ear is so tricky in symptoms. My daughter and son would constantly get infections every month they would have burst ear drums from it. My son who's waiting is the most effected he has hardly any hearing and like 3 words at 20 months. Deffo worth getting it checked

Don't worry about him understanding the test OP, my daughter has been having her hearing tested since she was a tiny baby and she has a significant learning delay - they have all sorts of tricks and tests they can do.

Speak to the GP usually an appointment with audiology is the first thing that happens before any kind of SALT appointment. When my son was referred to paeds regarding ASD concerns he was given an audiology and sight test first

My youngest DS speech was slow to develop, only had one word at age 2. HV put it down to having older siblings and therefore no need to talk. He started SALT but when he started nursery his speech developed so no ongoing problems.

A few years later as part of my professional training I was learning how to do hearing checks using an audiometer, so I used family members to practise. I checked DS and was surprised to find he has a permanent mild hearing loss which explained the speech delay, at least in part.

It's always worth asking for hearing to be checked as mild or moderate losses aren't always picked up on the baby screening tests.

SALT will probably request a hearing test anyway.

l to d is a fairly common mispronunciation at that age so I don't think that shows hearing issues particularly.

Ds has glue ear, picked up mostly because of constant infections (talking about every 10-14 days type of constant), and it is a possibility, but I'm a bit concerned you are focusing on this after comments from friends, and whether you are prepared to find it isn't that.

Even if they find it is glue ear, there's a high chance at that age they'll adopt a wait and see approach. Ds had his first set at 20 months, and I was always aware how young he was from reaction of people in the medical profession when I mentioned this.

Thing is lots of children have glue ear.
Lots of children need SALT.
Some of them overlap, but not all.

At 2yo they can do the puff test which will show glue ear, and they'd certainly expect him to be able to follow instructions to put a man in the bus when they hear a sound. Ds did it at about 18 months (and again at 20 months, just before his grommet op), and they didn't have any concerns that he wouldn't understand. It's not really accurate until they're older and can understand better though.

There could be hearing loss which isn't glue ear. They could be processing issues. Or there might be nothing except he is a stubborn little one who prefers to ignore instructions he doesn't like. 🤣

Even when ds' hearing was at its worst, he could hear a rustle of something he liked being open from another room; but he might not hear "ds, time to tidy up" when I was standing next to him. Or apparently. 🤣

Thank you @MargaretThursday

You’recrught, there could be another reason for his speech delay. I’m not sure how the iugr and prematurity has impacted him although he does seem young for his age and small too.