In order to address auditory processing disorder (APD) in adults, concepts that frame auditory processing must be defined. However, the recent interest on aging of the auditory nervous system and the interaction between peripheral hearing loss and central auditory processing disorders ((C)APD) should not be overlooked (Gates, Anderson, Feeney, McCurry, & Larson, 2008). The primary focus of this paper is on those patients with normal hearing acuity who report auditory deficits. Auditory processing skills may be considered to occur on a continuum of hearing and listening, and in some cases there is co-morbidity between peripheral hearing loss and deficits in auditory processing. However, the labels of "peripheral" and "central" are somewhat artificial differentiations, as both contribute to the behavioral or functional auditory deficits reported by the patient. Thus, there is a need to both assess the peripheral auditory system and the central auditory nervous system to effectively address patient complaints. Although the peripheral and central auditory nervous systems work together to process all types of auditory information, from simple pure tones to comprehending complex speech signals, in order to truly tax the auditory nervous system, pure tones are too simple to accomplish this task thus the results on the audiogram tells very little about the more complex processing abilities of the auditory nervous system. In order to assess this "real world" perspective, the auditory nervous system must be challenged or "taxed," making the auditory nervous system work beyond what is required for a detection task using pure-tone signals.
When the auditory nervous system is compromised, the ability to listen effectively is negatively impacted. The auditory nervous system is also designed to process information quickly and flexibly, ranging from simple detection tasks to much more complex tasks such as listening to speech in a reverberant or noisy environment. The auditory nervous system is designed to capitalize on redundancies in both the auditory nervous system and in language in order to utilize cues that enhance predictability in communication, particularly in less than optimal listening situations, such as when background noise is present. In these cases, the role of auditory processing and its disorders must be explored to understand the patient's concerns and to develop a treatment plan to manage their communication difficulties.Īs noted previously, auditory behaviors are complex.
This is particularly problematic when the patient has a history of an etiology that may explain their communication deficits. However, patients express frustration when told by the audiologist that communication issues do not exist based on the fact that the audiogram is "normal," as if to negate their presenting concerns.
The audiogram must certainly be a starting point. Despite this observation more than 50 years ago, audiologists often continue to hold the audiogram as the primary tool for addressing auditory behavior. Karlin (1942) noted that tests of conventional auditory acuity had little value in predicting auditory behavior in more complex social situations. The concept of looking beyond the audiogram is not new. The purpose of this paper is to address the need to look beyond the audiogram to further validate the concerns raised by the patient. The assumption is often made that because the results of the audiogram are consistent with normal peripheral hearing acuity, the person's reported concerns are not validated. However, some patients who present with concerns will demonstrate normal peripheral hearing acuity based on the results of standard audiometric testing. For many of these patients, the results of an audiologic evaluation are consistent with a peripheral hearing loss, and the findings of the evaluation help to direct audiologic treatment to address these communication difficulties or to direct recommendations. Patients report that these communication issues impact the quality of their lives- often the reason for seeking audiology services. These types of communication issues may include difficulty hearing in less than optimal listening situations, reliance on visual information to augment auditory information, a reduced appreciation of listening to music, and difficulty understanding speech when the speaker is unfamiliar. Audiologists are faced daily with patients who report communication issues that they may attribute to hearing loss.
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