Hi, I'm Jim Cuddy and this is Ask The Hearing Doctors. And I'm joined today by Dr. Jenna Loffredo, doctor of audiology with Hearing Doctors. The Washington DC area's highest-rated audiology practice with over 1500, five-star reviews. Jenna, great to see you as always. So good to see you, thank you so much for having me today. Absolutely.
So auditory processing disorders that's what we're talking about today. What is an auditory processing disorder?
So in really simple terms the best way to describe an auditory processing disorder is our brain can't separate what's noise and what is speech or what's conversation. This is a really important thing for audiologists to look into because our ears are really the gateway to the brain. Our ears help us to hear but it's really the brain processing the speech. And so that's why our clinic has a really special interest in it.
And what sort of so are we talking about? Like can you not differentiate between say music and speech or is it just background noises? What are some examples of of an auditory processing disorder?
Absolutely. So one of the most common challenges that we hear some of our patients describe is they say, okay I'm sitting, or their parents in some cases if it's a pediatric patient will say my kiddo is sitting in the classroom. The teacher is talking to a small group of them but there are also others behind them doing group work. It's really hard for the child to focus on the teacher almost like they have a hearing loss. They're unable to really process what's being said by the teacher.
Is it hearing loss?
Great question. So, a lot of times the typical audiogram or the typical hearing test results of patients, children, adults, veterans of different wars, things like that we see a lot of this in our veteran population. But what it is is we actually see a lot of our patients have normal hearing. So one of the reasons why we have an interest in this field and that it’s really growing is because a lot of our patients are okay. They do the hearing test and it's normal. For patients it's like oh you go to a doctor like of course you're not looking to find something wrong with you, but that doesn't answer why you're having these concerns.
So for our clinic especially what we do with our whole testing approach is we look at okay where are your levels of hearing? How is the brain processing that speech discrimination and listening and background noise? When all of that comes back normal we want to look a little bit further as to why the child or the adult is experiencing some of these concerns.
Who can be tested for an auditory processing disorder and what what sort of test do you do? What are those tests like?
Sure. So the type of testing that we do is normed or meaning we have normative data for children seven and above. A lot of the patients that we see are in that pediatric range so age seven to right around 15 or 16. Then we also have a lot of patients that have suffered TBI’s or traumatic brain injuries. A lot of them are veterans. So they've been serving in the wars and we're very grateful for all they've done for our country. And we're looking for other ways that we could help them to reintegrate back into the community, into a job. And they're having these problems listening. Their hearing isn't a cause for concern but it's how that signal travels up to the brain.
What what is a, give me an example of what let's say it is a veteran, somebody who served in in in a war and they're coming to you and they say okay here's my situation. You know first thing you're going to do I guess you're going to test their hearing?
Absolutely. But they're telling you that they can't focus. They can't is that is that the automatic trigger? And then what do you do next? What what what are some of the solutions?
Absolutely. So we always will start with a hearing test and typically these appointments are broken into two parts because auditory processing testing is a lengthy process. It's not your typical hearing test especially because we're doing a full hearing test as part of the test battery.
So we always start with a very extensive case history. Meaning if they're a child, are they having trouble focusing in school? Is it the parent noticing it or is it the teacher noticing it? We're also looking at their performance as a student. Is this a new onset? Has this always been there? We're looking at what's called a combination of diagnosis. Are they, do they suffer from ADD or ADHD? Do they have other attention disorders or any other learning disabilities that we want to make sure are okay. Let's weed those out or let's treat those first and then see if we're still experiencing these concerns that the parent or the teacher has expressed. So a lot of that is a really extensive case history. To know if okay is this testing something that we should go forward with.
Another one especially for teens is concussions. So if they've never had these types of experiences or troubles of listening in background noise or some of the other
measures that we'll evaluate. We look to say did something recently change medically or physically? Are they involved in a contact sport? Have they had multiple concussions? And are they being monitored by a doctor that specializes in that? Okay, let's gather that information so that we can start to build our toolbox.
We then want to look to say okay let's test the hearing let's see if it's normal. If it is at that point then I talk to them about potentially testing for auditory processing disorder.
Is it curable?
So as of right now what we're looking at is we are looking at diagnosing a patient with auditory processing and then giving them management techniques.
So at this time it's different for whether you're pediatrics and you're in the school system. One of the biggest ones that we've actually been working with is looking at that transition from either middle school to high school, high school to either employment or college, university or trade school. The reason why is some of these kids have really established a routine or something that works well for them. Or their natural abilities have carried them throughout maybe elementary school and now their systems are being taxed a little bit more by adding adding in more challenging information. So what we look at is we look to make sure, okay the teacher is on board or if they're in a college, university or trade school that their office of disabilities is on board. That they're just aware that this diagnosis exists. So that we can ensure that professors at the college level are providing written materials in advance. Really things to complement their system. So visually and auditorily the best thing to do is we can strengthen everything all at once.
So something that I have been recommending is let's say there's test results that indicate that there's a weakness on the auditory system on one side versus the other. What we do is we recommend some free apps where the student, the child or the adult can read along to a book and also listen to it in that weaker ear to really strengthen the system visually as well as auditorily.
Now there are a lot of different tests that we do to look at different areas of our auditory processing. So the testing begins with something called competing words. Meaning you have a word in one ear and a word in the other ear at the same time. Our brain, if we don't have an auditory processing disorder, can integrate both words at the same time and you're able to repeat them back. Call it kind of like brain games because we really are challenging our brain here. And it also is one of those things that when you and I are sitting here it's like thinking like can I do that? Our brain does all that naturally so we don't think about it. But for someone with an auditory processing disorder it's really hard to integrate that information.
We also look at something called competing sentences. Meaning not only is a word played in each ear but a sentence is played in each ear at the same time. And the patient then has to repeat back what they hear in their right ear or repeat what they hear back in their left ear.
And we then move into different areas of breaking words down to the phoneme level or the sounds and the parts of each word. And evaluating how that's integrated. We're looking at how sounds, the greatest theme is how sounds, are integrated in the brain. And then we also do numerous tests of listening and background noise. As well as some tests with some numbers as well. That will allow us to make a really strong recommendation.
Now the workplace recommendations are going to be a little bit different because in work you're not always sitting and listening to listening to one person or listening to a professor talking back and forth to you. That would be too easy if you only had one person you had to listen to each day. So something that we do in work is we maximize the employer's ability to provide them with a quiet listening environment. Because sometimes if we can't differentiate what’s speech and what's noise everything is heard at the same volume. It's really hard to differentiate between
the noise that's happening in the break room, the bathroom down the hallway, all of these things are just all kind of smooshed into the brain at one time. So we provide a little bit of history to the employer, of course with the employee's permission, to say this is what they're experiencing and this is how we can help.
Something that we also do for both pediatrics and adults is we talk about assisted listening devices. Sometimes that's in the form of a hearing aid. Even if the hearing is normal. Just providing a low level of amplification gives the brain enough to separate okay that's speech that's someone talking to me versus the noise. Or what's very popular for some of our school-aged patients is a device that's a microphone that's worn or held by the teacher that streams the signal direct to the child's ear. It doesn't necessarily provide it louder but it provides it more of a direct way. So that's something that we use very regularly with both our pediatrics and some of our adults alike.
So if you're talking to a parent or to to a veteran or you know somebody that has had
concussions in life, just because you get a clean audiogram and they send you on your way, if you're still having issues perhaps come see an audiologist like Hearing Doctors where we're going to take that a little further?
Absolutely, we've said it again and again in these podcasts. That we are more than just looking at okay how do your ears help you to hear. What we look at is we look how does the brain help you to hear. It's always worth having more information if you're still having some concerns and you have a normal audiogram. We just want our patients to know that there is more out there. And we can determine whether this test is the best avenue to go. But we're always going to refer you out to a different professional if we feel that a different evaluation, whether that's one with a neuro psychologist or a neuro-otologist, a speech language pathologist or even a neuropsychologist to see if further evaluations are needed to enhance the performance in both school and in the workplace.
It's wonderful that you do what you do and we certainly appreciate your time with us today. Thank you so much for having me. I appreciate it as well. Thank you.
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