What is Auditory Processing?
Auditory processing refers to how the brain interprets and makes sense of the sounds heard by the ears. While the ears detect sound waves, it’s the brain’s responsibility to decode these signals and convert them into meaningful information, such as speech and environmental sounds.
Symptoms of Auditory Processing Difficulties
Individuals with auditory processing difficulties often experience:
Difficulty understanding speech, especially in noisy environments Frequent requests for repetition or clarification Misinterpretation of spoken information Difficulty distinguishing similar-sounding words Poor auditory memory and concentration Challenges following verbal instructions
Common Causes
Auditory processing issues can result from various factors, including:
Aging and cognitive decline Genetic predisposition Neurological conditions Developmental delays or disorders (e.g., autism spectrum disorder) Traumatic brain injury Chronic middle-ear infections (especially in children) Unknown factors
Limitations of Hearing Aids and tips to get the best out of them
While hearing aids amplify sound, they do not directly enhance the brain’s ability to process and interpret these sounds. People with auditory processing disorders may find limited benefit from hearing aids alone, as amplification doesn’t resolve the underlying neurological processing issues. I have clients who believe from advertising they have seen that you can walk into the ATW or Brothers club on a Friday night with all those people and just hear everything. I have normal hearing and even I struggle in those places.
But if you hare still having issues hearing around a family dinner table etc., further investigations on the cause of the issues may need to be looked at.
Another big one is paying attention and concentrating. Many wearers do much better when they are facing the other person rather than them being behind or beside the person with hearing loss. When we are looking at the person talking to us we are getting both a Auditory and a optical signal going to the brain. Without even realizing it our eyes are reading facial cues and picking up subtle contextual cues so when combined with amplification looking at someone can fill in a lot of those contextual gaps (Truck, Suck Duck) as our faces change ever so slightly in those words and seeing that we have been reading facial cues since we were in the crib you will do considerably better than just a auditory signal alone even if amplified. Just remember what our mems said when we were kids “Look at someone when you speak to them” It is not just a respect thing but it also lets the sender and receiver know the message is for them and the receiver is more likely to be paying attention of the message going to them rather than someone talking from behind the chair or another room trying to get a response.
The Role of Auditory Training
Auditory training involves structured exercises aimed at enhancing auditory processing abilities. Techniques used include:
Listening exercises focusing on speech discrimination Practice distinguishing sounds in noisy environments Exercises designed to improve memory and auditory sequencing
Research shows that targeted auditory training can significantly improve auditory processing and communication skills, even when hearing aids alone offer insufficient benefits.
Exploring Cochlear Implant Candidacy
For individuals who receive limited benefits from hearing aids and auditory training, a cochlear implant candidacy evaluation might be recommended. Cochlear implants bypass damaged portions of the ear to directly stimulate the auditory nerve, significantly improving auditory processing capabilities for some users, especially in severe cases. This needs to be discussed with your GP and most likely an ENT before a Cochlear Candidacy appointment course of action is taken.
APD or Not APD???
Auditory processing disorder (APD) can sometimes be confused with simpler issues of speech intelligibility, attention, listening environment challenges, or unrealistic hearing aid expectations. Here’s why this confusion occurs and how audiologists can differentiate between these situations clearly:
1. Inattention vs. APD
Similarities: Both inattentive listeners and those with APD may frequently ask for repetition, misunderstand instructions, or seem distracted. Distinction: Inattention: Usually situational or temporary. The listener improves when engaged or in a quieter, less distracting environment. APD: Persistent difficulties across multiple listening scenarios, even when the listener is actively focused.
2. Background Noise vs. APD
Similarities: Difficulty understanding speech in noisy environments is a hallmark sign of both APD and simple hearing difficulties. Distinction: Noise Issues Only: Clear improvement when noise is reduced; listeners manage easily in quiet, controlled environments. APD: Challenges persist even in quieter environments, indicating underlying neural processing issues.
3. Unrealistic Expectations vs. APD
Similarities: Both can lead to disappointment in hearing aid outcomes. Distinction: Unrealistic Expectations: Typically due to misunderstanding what hearing aids can realistically achieve, especially with severe hearing losses. Improvement noted after proper education and counseling. APD: Continued problems understanding speech clearly despite proper hearing aid fittings and appropriate counseling; the underlying neural decoding issue remains.
Key Audiological Differentiators
Comprehensive Testing: Include specific APD tests alongside traditional hearing tests (e.g., dichotic listening tests, speech-in-noise tests, auditory memory assessments). Detailed Patient Interview: Clarify scenarios when listening is hardest or easiest. Observation of Consistency: Note whether the difficulties persist despite controlled improvements in listening conditions or counseling on expectations.
We are finding that clients who combine Hearing aids with hearing rehabilitation such as apps like the Lace Ai Pro (Coming to Australia in 2025) show better ability for speech discrimination than people relying on the hearing aids to do the job alone but it’s is not perfect and it will not guarantee success, it is on a individual basis. All options should be considered and worked on before we gown the path of referring a client to a Specialist Audiologist for APD assessment.
References
American Speech-Language-Hearing Association (ASHA). (n.d.). Auditory Processing Disorder (APD). Retrieved from https://www.asha.org/public/hearing/Auditory-Processing-Disorder/ National Institute on Deafness and Other Communication Disorders (NIDCD). (2021). Auditory Processing Disorder in Children. Retrieved from https://www.nidcd.nih.gov/health/auditory-processing-disorder-children Musiek, F. E., & Chermak, G. D. (2014). Handbook of Central Auditory Processing Disorder, Volume I: Auditory Neuroscience and Diagnosis (2nd ed.). Plural Publishing, Inc. Sharma, A., & Dorman, M. F. (2006). Central auditory development in children with cochlear implants: clinical implications. Advances in Otorhinolaryngology, 64, 66-88.