An adult person complaints of difficulty hearing in background noise. Pure tone audiometry and speech audiometry reveals normal findings with good speech discrimination scores. ABR and OAE results normal. What can be the further investigations required? and possible interventions
If all these audiological tests are normal, first do a Speech in Noise test and find out the score. See whether it is really affected or not. Then go ahead with some APD test which assesses the difefrent process and based on all these decide abou the conclusive diagnosis.
I agree with the opinion of the Sujjet Sinha. But may also be the evaluation with P300 and cognitive potential. After the evaluation and according to the changes found, draw an auditory training program.
Auditory processing Disorder Tests would be a good start following on from the other tests mentioned by my colleagues above. Do you have a recognised hearing therapist? They are skilled in providing councelling and tehrapies to help people with normal audiometric hearing, but still struggle to hear others.
As discussed above, the client may have (C) APD with specific problems in difficulty understanding speech. Initially The Institute of Hearing Research coined the term ‘Obscure Auditory Dysfunction’ (OAD) (Saunders and Haggard, 1989) for such condition. In addition, Hinchcliffe (1992) coined the term ‘King-Kopetzky Syndrome’ (KKS) to explain the condition seen in adults which is usually hereditary.
Assessment strategies:
1. Detailed case history regarding the complaints and possible symptoms of (C) APD
2. Screening checklist for auditory processing in adults (SCAP-A) developed by Vaidya and Yathiraj (2014) can be tried to screen for (C) APD.
3. Speech in Noise test and other APD test battery, if required as suggested earlier.
4. BIOMARK is an objective test for assessing auditory processing problems which can also be tried if the facility is available.
5. As suggested earlier, P300, MMN and other cognitive potentials may be tried for further evaluations.
Treatment strategy would depend on the nature of auditory processing problem detected. IF the problem is only listening in presence of noise - the options could be:
1. Personal FM devices which can enhance SNR and improve speech perception in presence of noise.
2. Noise Desensitization Therapy is found to be effective.
3. Therapy activities to improve speech perception in noise
4. Appropriate counselling on communication strategies to improve speech perception in noise.
The management is individualistic based on the client's difficulties, needs and preferences in the management approach.
Assuming that imaging shows nothing substantial then a complete Auditory processing evaluation is indicated. But also one needs to consider the definition of normal hearing because many times I see people whose hearing began at 0dB and now is at 25dB which means there is hearing loss. Defining normal is very important. When my hearing is at 25dB I know I will be wearing hearing aids because I will have had a 30-35dB loss. Latest research is showing that the sooner we help these little losses, the better the output.
Speech in noise test at different SNR and if the results are positive..High rate and low rate ABR would give you better idea
Diagnosis of APD is probably more straight forward than the rehabilitation in my opinion. I agree with Alan around using specific rehabilitation for these types of patients, hearing therapy / auditory rehabilitationist (depending where you are based) would be useful. More recently I have advised lipreading classes by a qualified lipreading teacher. Another possible helpful solution would be to use a hearing aid set with zero / minimal gain connected to a wireless lapel microphone to improve the signal to noise ratio for certain 1 to 1 listening situations. Re-sound can supply these. Often an explanation of the condition can help too.
I agree with what others have said above. You could also probe about the person's exposure to noise. Sometimes even though the audiogram might be "normal", there could be a "hidden hearing loss". Such patients usually present with difficulty hearing in noise and tinnitus. If the result of APD test battery are inconclusive, you might want to try out ABR at different rates. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227662/ & http://www.ncbi.nlm.nih.gov/pubmed/21940438 for details.
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