Many years ago, long before I became active in an auditory processing (CAPD) specialty, I would occasionally see a patient who complained of significant hearing difficulties, but their peripheral hearing tests all came back normal. What we were trained to say was, “Your hearing is normal; there’s nothing we can do.” We might offer some communication techniques and suggest environment modification to give better speech recognition in noise, but that was about it. The patient went away largely unhelped.
One patient in particular was adamant: she demanded that I fit her with hearing aids because her career was made difficult and communication was continually frustrating due to auditory problems. Feeling a little bit like a “snake oil” salesman, and worried that I would need to wear a trench coat and dark glasses in public, I nevertheless allowed a “little voice” in my head to remind me: “Listen to the patient!”
As an “experiment,” I fitted her with mild-power, open-ear hearing devices with noise-reducing features (directional microphones, and digital noise reduction), not expecting that it would work for her. A week later she came in for her first follow-up visit and said, “You couldn’t GET these back from me if you tried!” Across the board, she reported greatly improved ease of communication, especially in her work which involved a lot of travel and meetings. Her husband was also delighted! I was beginning to learn that central auditory processing disorder (CAPD) was more than a theoretical abstraction.
She was the first of many. I also discovered that other “closet” professionals were doing the same thing here and there. Occasionally, at professional meetings, a speaker would quickly touch on this as a possible approach for addressing auditory problems of patients with normal or minimal peripheral hearing loss, though the professional standards status quo wasn’t getting on board just yet. But the move to legitimacy for this approach was being felt.
Then, in 2008, the Journal of the American Academy of Audiology (JAAA) published the results of a study by Kuk, et. al., “”Personal Amplification for School-Age Children with Auditory Processing Disorders,” which demonstrated improved classroom and APD test performance for children with CAPD who were fitted with the type of hearing aid option I’ve been discussing. This was a landmark, not just the study itself, but recognition by a major peer-reviewed audiology journal for this type of CAPD treatment. It was a strong encouragement to those of us who used this approach with significant success, but longed for some verification in the research world to offer validation of positive outcomes for the concept.
In 2012, Dr. Kuk posted as a guest blogger on the “A. U. Bankaitis’s Audiology Blog” about his ideas in this realm. Click here to read the blog. [Disclosure: Dr. Kuk is a clinical researcher for Widex Hearing Instruments. He refers to some of Widex’s products in the blogpost. Currently hearing devices from all the major manufacturers (Widex included) have features and options available for this type of use with CAPD patients.]
One traditional recommendation for students with CAPD was an FM system use in classes. As Dr. Kuk pointed out in the above blog, FM systems are now only one possibility for students. Modern hearing aids are capable of remote microphone transmission via bluetooth, permitting students in classrooms to get direct input from their teacher, much like with an FM system. Plus the personal hearing devices go home with the user, permitting hearing enhancement beyond the school setting. APD patients require help across their daily listening experiences, not just classes. Adults, also, benefit from remote microphones in meetings and in very challenging situations like listening to a companion in a noisy restaurant or traveling in a vehicle. By using a streaming device or hearing aid “boot” receptacle, school-based FM (or “Roger” DM) systems can be interfaced with modern hearing aids without the need to wear cumbersome receiver headsets or earbuds.
2018 UPDATE: The emerging trend in hearing devices is to have personal hearing aids interfaced with the patient’s mobile phones, which gives streaming capability for audio signals and phone calls (usually without an intermediate streaming device) via a cell phone. But additionally, these systems typically provide a dedicated hearing aid/ cellphone app which can give patients extra customization capabilities (in addition to regular remote control functions) in their phone! Some even permit long-distance reprogramming data to be sent via the internet and downloaded into devices to bypass having to travel to your specialist for many reprogramming needs. The early versions of phone-based hearing aids lacked the quality and versatility in connectivity that I felt CAPD patients needed, so I urged people to avoid them. Now, however, the pace of development has pretty much eliminated those limitations. The main caveat I share is that, in general, you will pay significantly more for phone-based devices than more traditional configurations. Either option can work very well, but as phone fascination grows in our society, the phone-based systems are becoming very popular, and, in all honesty, some of the dedicated phone apps are tremendous tools in the hands of sophisiticated and tech-savvy patients. Some of them even have apps for the Apple Watch®! For “pre-phone-age” kids, I still believe there’s a good case for going with more traditional systems, and you’ll definitely save money.
Not all APD patients need to consider hearing devices. Some may not find the devices helpful for their specific APD problems. Some may benefit, but the cost might be prohibitive, especially if they have no healthcare benefits to help defray the cost. A complimentary in-office demo of devices can usually be arranged with your audiologist, if desired. If the demo indicates a potential benefit, then a longer-term trial period should be arranged (usually 30 – 45 days), for which you can expect some non-refundable charge for professional time, programming, shipping, restocking fees; etc, should the hearing aids be returned.
A final caveat: hearing aid technology holds great promise for helping many patients with CAPD. The nuances of fitting normal peripheral hearing with such devices, however, should be undertaken with an experienced audiologist (preferably one seasoned in CAPD practice), using real-ear verification procedures to make sure that safe, yet effective amplification levels are provided, and that appropriate accessories can be discussed and utilized when needed.
I’m not generally in favor of hearing aid sales in non-professional settings (your local department store or warehouse store), but I strongly discourage it for CAPD patients. Hearing technology is not an “over-the-counter” commodity: a professional component is needed. Avoid internet and mail-order hearing aid purchases under all circumstances, but especially for a CAPD fitting! And FDA regulations require that children be seen by an Ear-Nose-Throat (ENT) physician for medical clearance, then by an audiologist, not just a hearing aid dealer.