As seen in Figure 1, performance was abnormal for all tests with the exception of FWT and LiSN-S. Speech audiometry demonstrated excellent word recognition bilaterally (100% right ear, 90% left ear).įollowing the audiological evaluation, the patient underwent an auditory processing evaluation, which included the following: the Dichotic Digits (DDT), Duration Pattern (DPT), Filtered Words (FWT), Competing Sentences (CS), Compressed Speech (CST) and Listening in Spatialized Noise (LiSN-S) tests. This patient was initially evaluated with a comprehensive audiological evaluation which demonstrated normal peripheral hearing sensitivity from 250-3000 Hz with a mild, symmetric sensorineural hearing loss for the remaining frequencies. We ask that all adult patients complete the questionnaire at the time of their evaluation. The SSQ is self-report questionnaire designed to evaluate hearing difficulties across the domains of speech, spatial hearing, qualities of hearing. The patient was also asked to complete the Speech, Spatial and Qualities of Hearing Scale (SSQ) (Gatehouse and Noble, 2004). With effort and tutors, he has done well academically and holds a Masters degree. He also had significant difficulty with reading comprehension, learning music and foreign languages. He also received speech therapy as a child for articulation deficits (it has been our experience that some children with articulation deficits present with APD). He discontinued use of pharmacological management of his ADHD in high school. Other relevant history includes that he was diagnosed with ADHD during elementary school and was on Ritalin for a number of years. No significant otologic history was reported.
While he did admit to a history of noise exposure, he reported that he has consistently used hearing protection. He and his wife both reported significant difficulties following multistep directions. He reported that in general his rate of auditory processing is slower than most individuals. As we have observed with many patients during the pandemic, he also noted difficulty hearing due to masks (which have built-in filtering) and an inability to rely on visual cues. He reported having difficulty with this as traffic control often communicates quickly and he is unable to always understand what has been said. This requires him to rely heavily on auditory information with little visual cues.
Interestingly, he is a recreational pilot with the goal of obtaining his instrument reading certification. He indicated no concerns regarding hearing sensitivity (an important distinction to make during a case history). In particular, he reported significant difficulty understanding speech in the presence of background noise and when people are speaking quickly. With respect to his auditory history, he reported longstanding difficulty hearing. In a phone consultation with the patient, the SLP felt that an APD evaluation would be a more appropriate first step based on his history and thus referred him to our clinic. He had not actually been evaluated by the SLP. This is the case of a 39-year-old male who was referred by a speech-language pathologist (SLP) due to concerns for an auditory processing disorder. We will review the tests results, management approaches and outcomes of this case.
The purpose of this article is to present the reader with a case example of an adult patient who recently presented in our office with auditory complaints and was subsequently diagnosed with an auditory processing disorder. Adults with auditory complaints in spite of normal peripheral hearing sensitivity are interesting and sometimes challenging cases. The majority of the patients seen in our clinic who are evaluated for APD are in fact adults. In addition, patients who present with normal peripheral hearing sensitivity may be told that there is no hearing loss, but clinicians fail to evaluate central auditory function. All too often adults are overlooked when it comes to evaluation of the central auditory system because these evaluations are primarily performed in the pediatric population. Trey Cline, AuD, Clinical Audiologist, Department of Otolaryngology, University of Kentucky Medical CenterĪ significant part of our clinical practice is evaluating and managing patients with auditory processing disorders (APD).
Jennifer Shinn, PhD, Professor and Chief of Audiology, Department of Otolaryngology, University of Kentucky Medical Center
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