Dr.

Supreet Singh Nayyar, AFMC

2012

Auditory Processing Disorders

(for more ENT topic & presentations, visit www.nayyarENT.com) Definitions (ASHA) Central auditory processes mechanisms and processes responsible for the following behavioural phenomena o Temporal (RIMO DaDa CLass) Resolution Integration Masking Ordering o Auditory performance with Discrimination Degraded signals Competing signals Localization and lateralization Central Auditory Processing Disorder (CAPD) deficiency in any one or more of the behavioural phenomena listed above

Relevant anatomy Auditory pathway E COLI MA Auditory area 41 & 42 (in temporal lobe) Association auditory area 22 Broca area 44 & 45 Dominant hemisphere right Music left Information transfer b/w 2 hemispheres corpus callosum

Epidemiology 2-3 % children M:F=2:1

Aetiology OME lack of auditory stimulus during auditory maturation period Hypoxia at birth Birth trauma Viral infections Degenerative disorders Surgical compromise Lead poisoning Auditory deprivation Tumors

www.nayyarENT.com

Dr. Supreet Singh Nayyar, AFMC

2012

Classification 1. 2. 3. 4. Auditory Decoding Deficit Associative deficit Integration Deficit Organization Output deficit

(DAIO like sony VAIO)

Decoding problem with auditory closure Ability to complete the missing part of a verbally presented message is called auditory closure _uper_arket Association Inability to apply the rules of language to incoming acoustic information Integration difficulty in integrating auditory and visual functions problems in corpus callosum Output Organization Difficulty in planning e.g. following directions

Clinical features Difficulty in Hearing in noisy situations Following long conversations Hearing conversations on phone Learning a foreign language Remembering spoken information Taking notes Maintaining focus on an activity if other sounds are present Organizational skills Following multistep directions Reading Lack of music appreciation

Tests and evaluation OAE normal PTA usually normal BERA might be normal or abnormal Delayed P300 & MLR (Mid latency responses) Dichotic Digit test (DDT) o Binaural integration numbers in both ears have to be spoken o Binaural separation numbers of only one ear to be spoken

www.nayyarENT.com

Dr. Supreet Singh Nayyar, AFMC

2012

Staggered spondaic word (SSW) o Spondee words baseball o 2nd syllable of 1st spondee & 1st syllable of 2nd spondee spoken together o Competing condition o Patient to repeat all words Rapidly Alternating Speech Perception Test (RASP)

Management Goals o To perceive speech o To tolerate the adverse effect of extraneous noise o To use visual information to enhance understanding o To understand and use assistive technology Conventional hearing aid no use Hearing aid with frequency shaping e.g. in rooms with low frequency noise (e.g. AC) Sound attenuation devices e.g. ear muffs to decrease extraneous sounds Assistive listening improves speech intelligibility o FM o Infrared Environmental & classroom modifications o Design changes o Visual clues o Instruction modification

(for more ENT topic & presentations, visit www.nayyarENT.com)

www.nayyarENT.com