Audiologists generally work with those who have hearing loss due to damage to the peripheral portions of the ear, i.e. the cochlea (organ of hearing), ossicles (the bones in the middle ear space), or the external auditory canal. These peripheral losses are identified through a standard hearing assessment where a patient’s audibility is tested at a variety of frequencies in a sound booth. Treatments of these conditions can include medical or surgical intervention by an otolaryngologist, the use of implantable hearing devices, hearing aids, and auditory rehabilitation. 

But what happens when the standard audiogram reveals hearing within the normal range and word understanding that is excellent in quiet and the patient is reporting great difficulty hearing and understanding? That doesn’t mean the standard testing isn’t accurate. This generally means more specialized testing is needed.   Patients who have normal hearing and understand well in quiet situations but struggle in noise can sometimes have a condition called Auditory Processing Disorder or APD. APD is exactly what it sounds like – a problem with the way auditory input is processed. The central auditory system is responsible for sound localization, differentiating competing signals, and identifying degraded signals.

Although APD is diagnosed more often in children, adults who are diagnosed with APD report difficulties dating back to childhood.  Sometimes, APD can be acquired such as instances of traumatic brain injury or the natural aging process. These patients struggle significantly in background noise, following multi-step sequences, spelling, reading, and learning foreign languages, to name a few. The first step to diagnosing APD is a thorough audiogram. After normal hearing is established, the APD battery can be completed.  The APD battery of tests is about 90 minutes and includes a variety of tasks listening to words, sentences, and tones with different patterns, rates, and sometimes directed to a specific ear.  These tests are meant to tax the auditory system and how it processes information. The testing is long but can give valuable information regarding how the brain processes information from the auditory system. 

There are options regarding managing APD including auditory rehabilitation, training with a speech-language pathologist, and low amplification hearing aids. If you feel as if you are struggling to understand in difficulty listening environments, you could have APD.  Start with a thorough baseline and see what your options can be.