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Auditory processing training

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Update: I paid out of pocket and just got testing/results. I do indeed have ; there are only few categories I do poorly in but the results are very poor in those categories. The results also confirmed that the source is not my mild congenital hearing loss, which my hospital tried to gaslight me into.

I also see how this issue impacts me more than I was aware as I experienced disorientation, headaches, and significant fatigue as a result of the testing.

Left side is the one with the mild loss. Had my aid in for the test and left does more poor on everything compared to right except in quiet which is equal. Results are consistent with my BrainHQ experience.

My worst results were in Phonemic Synthesis and having left ear amblyaudia. Left ear amblyaudia was something I noticed after my long covid was triggered. I got multiple hearing tests from multiple places because I thought my left ear was getting worse but my results were stable.

But the left one has hearing loss. So of course that side doesn’t do as well. It’s damaged. We don’t typically test ADP in people with hearing loss because hearing loss causes changes in the auditory system, so…essentially everyone with hearing loss also has .

No, not everyone with a hearing loss would score as having . If the sound is loud enough and they understand, they should not have issues.

My test results factors in my loss. My right does poorly in the categories I had issues with and the order of magnitude of difference between the two sides doesn’t make any sense considering my loss. In categories I did fine, my left is consistently 5% worse, whereas in categories I did poorly in, my left is 50% worse. My right on its own meets the APD threshold.

@PianoJoy said:

No, not everyone with a hearing loss would score as having APD.

The audiologist who tested me said usually the patients who score as having have near normal hearing. They do not test many with hearing loss but those patients may not all score as having APD. I suspect there can be overlap but they are separate conditions.

In reply to @PianoJoy

Well that’s why I asked you about the right ear, and you initially indicated it was a left ear problem.

But the idea that if you have hearing loss you just turn the volume up enough and everything is fine is false. Plus, you said you had your aid on for the test, and the assumption that a hearing aid returns as much sound as you are missing is also false.

As for “not making sense" given a hearing loss–we can’t see into the cochlea to know which cells are damaged, so I’m not sure one can really say that either.

Sounds to me like your clinician has gone rogue and it’s doing what " makes sense to them” rather than what has any research support. But if it helps you in some way, that’s good.

Just went back up to review the beginning of the thread and I was the one suggesting a full test in the first place. :laughing:

Covid is strange.

But I would still take any left ear results with a grain of salt. We don’t have norms for APD with hearing loss. But if there are right unilateral tests that are showing problems then that does for sure point at an APD issue. But yes also you own experience pre- and post-covid points to somethin going on.

Many places said they may not recommend testing or only conduct limited test depending on the loss; none had issue after seeing my . I only have conductive loss so middle ear issues only. I do see studies of people with history of severe hearing loss that was evaluated for APD after brain trauma though.

I have more going on. My long covid was rated as being in the most severe category so I’m certainly not take the results as is. For example, there was a number memory test; my results are probably more indicative of general memory issues in that section, versus an auditory fading memory that’s seen analyzing other sections.

I fail to understand why you would link hearing loss with APD or how it would muddy the results, if results are actually analyzed versus pass/fail (I was actually concerned as I did fairly well “getting the right answers”… but ended up with pretty bad headache and fatigue). I can understand for categories like hearing in noise that someone with hearing loss may do poorly, but for example, if someone with a hearing loss scored -3 StdDev in concatenating syllables when they can clearly hear and understand each syllable, I would think this is not related to hearing loss.

Edited

In reply to @PianoJoy

Hi again - sorry to hear about your results, even if they are not unexpected given the difficulties you have described.

I’m unsure why but the forum did not notify me of any reply (despite doing so for previous replies) so I thought there were no replies, and I only just randomly checked by chance.

Yes, the issue is definitely impactful, but often in ways not directly or easily recognised by clinicians (and even by patients themselves initially.) I did also experience significant fatigue and/or headaches (including triggered by testing), and disorientation more recently (but not triggered by testing.)

The problem, however, is that no one seems to know what to do about this, if they even recognise it.

It may/may not be interesting to be able to get the of people who have this condition and see if there is any common abnormal signals.

Edit: By the way, did you get your , and if so, what were the results like?

Edited

In reply to @PianoJoy

It is interesting that you have left ear amblyaudia. I have also similar symptoms (though that could be by pure chance if one is to experience amblyaudia) but there could be a tendency for left amblyaudia to occur (as opposed to right), similar to how hearts damaged by COVID-related (vaccine/virus etc.) have a tendency for the right ventricle failure, rather than typical left ventricular failure.

Keep on top of your tests, as although my initial showed stable results (despite I know it doesn’t "hear” the same), it finally started showing up (subtly but consistently) on the PTA. The practitioner checked and re-checked because they didn’t really believe it to start with, but the loss was there. Again, this (finally) makes practitioners take me a little bit more seriously, but they are still at a loss for what to do. I hope yours stays stable, but it might not do so, so it may be of benefit to stay on top of it, if only to be taken seriously by practitioners.

In reply to @PianoJoy

Not putting words in Neville’s mouth, but I think essentially Neville is thinking and talking practically and you are thinking/thinking conceptually (neither of which is right/wrong in and of itself) which might add to the differences. Also add the fact that the definition of the term is not universal across different researchers etc. and is also relatively less understood.

Basically, and certainly oversimplifying, “hearing loss” (typically ) is associated with being able to hear the sound (regardless of processing/understanding it) and APD (typically central origin) is associated with being able to process the sound for understanding. So you could say that they are separate (at least conceptually/academically.)

What Neville is saying is that it muddies the waters, because if you have hearing loss, it of course makes it harder to process (in the extreme case, how can you process something you can’t hear?) Further, your processing would change in response to hearing loss, in an attempt to compensate. (Analogy - since I can’t see, I’ll turn up the light/zoom in, i.e. change processing). While SNHL and APD could be considered distinct, you would not be able to test only one without (to some extent) relying on the other with current hearing tests. So your test results are always a mixture of the two systems, but with some tests trying to heavily weight the hearing only (e.g. ), and others trying to heavily weight the processing only (e.g. APD tests), but never purely.

Since the clearest way to diagnose APD is to say they do not have any hearing loss (SNHL), but still have abnormal results, that is the “ideal” scenario to diagnose APD. If someone has hearing loss, then there’s always going to be a question of if it’s due to the SNHL (which is known to exist) or APD.

That’s not to say people with hearing loss can’t have APD (either independently, or even as a result of their hearing loss as Neville is saying), but it is just that it is often practically more difficult to put it as APD when they have significant losses. And also if there is any clinical benefit/treatment. Hearing aids may help to some extent to restore volume, but it does still change the frequency distribution as well as timing (distortion) so it would further muddy the waters.

I could be wrong but I suspect that is the gist of what Neville means.

In reply to @ironfist

The left ear amblyaudia itself is not surprising since my left is the one with mild conductive loss my whole life. I specifically asked the doctor though, if the amount of amblyaudia could be explained by my loss and she said it was too significant, which matches with my lived experience - it’s only after covid I sought repeatedly on my own for hearing tests and questioned various doctors about my test because I was sure the tests were wrong.

I don’t know what is. I’ve only had standard hearing tests from multiple hospitals and the test, which I did remotely. I do not see this term listed anything.

I’ve been trying to get my insurance to pay for treatment. As an acquired issue from covid/long covid, with my medical history of significant neurological issues from long covid, and the fact that I’m on disability, it should be something to try. Acquired is supposedly more treatable and I’ve already tried hearing aid, which isn’t working / has a ton of issues of its own. My fatigue from this is so significant that I literally cannot stay awake; I end up sleeping 1x-2x the listening time (finding out that this can cause fatigue it probably the most valuable, though, it’s not like I can stop listening to people…).

I have read many reports of people with issues after covid getting functionally better from treatments. APD treatments are also used for general LC brain fog.

In reply to @ironfist

@ironfist said:

I could be wrong but I suspect that is the gist of what Neville means.

Uh, kind of.

When you have sensorineural hearing loss, the cochlea is damaged and this damage changes the way the information is sent along the auditory nerve, and nerve fibres that are connected to cochlear cells that are dead also die, and any part of the auditory system that isn’t getting appropriate stimulation starts to change. It’s not just the case, with hearing loss, that you just turn up the volume and everything is fine. Frequency acuity changes. Loudness scaling changes. Temporal synchrony changes. That’s why I said everyone with a hearing loss has an auditory processing disorder–hearing loss changes the auditory system. In order to be able to properly pick out abnormal auditory processing in someone with mild/moderate/severe hearing loss, we’d need to know what “normal” auditory processing is in someone with mild/moderate/severe hearing loss because there’s no reason for us to expect it to be the same as someone with normal hearing. We haven’t done that work. All tests currently only have norms for typically hearing individuals. A lot of them only have norms for typically hearing ENGLISH-speaking individuals.

BUT, then PianoJoy shared that her loss is conductive. And in another thread she shared that typically her left hearing aid is set to 80% (and I bet that’s not 80% of child targets). So even though her cochlea isn’t damaged, her left ear has been consistently deprived of normal auditory stimulation. Lots of kids with APD have APD because of temporary periods of auditory deprivation in childhood due to middle ear fluid issues that interferred with them developing typical auditory skills. And if it’s consistently the left ear, then yes this is going to lead to left amblyaudia. In young children amblyaudia can sometimes be corrected. Can it be corrected in the case of an ear that will always be in a situation of mild deprivation? In an adult whose brain is less flexible and also recently impacted by covid? Unknown. Maybe a little. Might be worth listening to audiobooks or podcasts or some other clear speech signal only in that ear for a while.

In reply to @PianoJoy

@PianoJoy said:

I don’t know what DPOAE is.

You will likely see it referred to as Otoacoustic emissions () - DP is just one way to calculate them and probably the most common in this scenario. Not all clinics do them, (but largish hospital audiology departments likely do) but even those that do don’t always do it so you might have to ask them. It would probably be less informative for us for your left ear but it could be potentially informative for the right ear.

Good luck with insurance - it will be a slog (unfortunately.) Yes, they should pay for it, but until there is more evidence and legal actions etc. they will almost definitely deny liability. I’ve not given up on my own claims but I’m definitely paying everything out of pocket (and it’s a lot) and expecting many years before I see a cent, if that. My hearing is too important to me to delay over money (and luckily I’m not starving), even if it has been costly and so far, very frustrating in terms of progress and recognition/diagnosis. They are hopeful it is treatable and reversible but honestly, I don’t think they really know.

In reply to @Neville

@Neville said:

Uh, kind of.

I did say I was (over)-simplifying…and I did say “your processing would change in response to hearing loss”. So while I didn’t go into all the details, I’m not sure anything I said contradicts what you said.

@Neville said:

It’s not just the case, with hearing loss, that you just turn up the volume and everything is fine.

Fully agree that it’s not just volume. I did mention timing (and thus distortion i.e. temporal synchrony) as one of those things, but yes, all those other things change too. I have clearly experienced all of these (but can’t prove to others objectively).

I assume you’re referring to cochlear synaptopathy and DCN hyperactivity, amongst other things such as changes in waveform. Having any of this recognised by a clinician (officially) is challenging though, probably due to lack of standardised objective tests and relatively subtle symptoms.

@Neville said:

We haven’t done that work. All APD tests currently only have norms for typically hearing individuals. A lot of them only have norms for typically hearing ENGLISH-speaking individuals.

Yes, that’s part of the problem. Not to mention normal is also pointless if there’s a lot of variation within the “normal” which there often is, so subject-specific information is probably more useful (assuming not a large retest variation), but the problem is you will almost never have pre-onset data for the subject.

It’s also worse for me because although I know I’m going very deaf compared to where I was, comparing to normal is not helpful both for the reasons above, but also because it seems my hearing before was significantly above “normal”, so even if I test normal now (which I don’t for all categories), it is still a significant impairment compared to prior to onset. Like an athlete clearly becoming slower and weaker, but being compared to a non-athlete reference, and then no recognition that they have been impacted since they are “normal”. And there is no prior subject-specific reference (or even a general athlete reference.)

As one example, my frequency discrimination is clearly worse than before, but still within “normal”, but my prior frequency discrimination was either extreme upper end of normal or above normal. I know this from subjective experience, but objectively I can assert this because I can no longer tune my own instruments to the same level of precision and accuracy (relying on perfect pitch only, with accuracy then verified with a tuner). But they don’t recognise this both because there was no formal frequency discrimination test before (even though it’s the same frequency, and the difference is significant, but not a formal test so they’re likely worried about verifiability and/or influence of timbre), and because it is still currently testing within the normal range (but much worse than before). There are many, many other ways in which I have noticed my hearing becoming noticeably worse, but they are hard to prove with standard tests with their limited scope and sensitivity. The drop has happened over 1-2years, so it is likely far more marked than you would expect from typical “aging”.

Again not putting words in Neville’s mouth (and he can happily confirm/correct), but something such as 3FPTA below some threshold (such as 23 ) would be a possible measure in this context.

Definitions vary etc. but essentially a that doesn’t show significant (often >25) losses at normally tested frequencies. Exact definitions will vary but generally are some variation of this general concept.

Whether such a measure is all that great is a whole other debate entirely…

Even with >25 some will pass testing. That does not mean perfect scores. There likely is a threshold above which almost no one will pass. Perhaps auditory processing disorder (pure tone measured hearing loss or hearing loss generally) and Auditory Processing Disorder overlap in only a subset of patients?

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