Hearing Matters Podcast

Friday Audiogram: When You Can Hear But Can't Understand

• Hearing Matters

Share episode

Send us a text

Have you ever met someone who says they can hear perfectly fine, but still struggles to understand speech, especially in noisy environments? That puzzling disconnect might be explained by Central Auditory Processing Disorder (CAPD) – a condition affecting what our brains do with the sounds our ears detect.

Dr. Angela Alexander reveals a startling finding from the Framingham cohort study: approximately 20% of adults who report hearing difficulties actually have normal hearing test results. These individuals aren't imagining their struggles – they're experiencing processing issues that standard hearing tests don't capture. "We used to think about auditory processing in terms of people who had no hearing loss whatsoever," Dr. Alexander explains, "but it is also possible to have hearing loss and processing problems." This insight opens new possibilities for helping people who have hearing aids but aren't getting the improvements they expected.

The conversation takes a serious turn when discussing the profound psychological impact of undiagnosed CAPD. People with this condition often withdraw from social situations, creating isolation that contributes to our national loneliness epidemic. Dr. Alexander shares a practical screening tool – the Hearing Handicap Inventory for Adults (HHIA) – that can help identify potential CAPD cases by measuring the mismatch between audiogram results and self-reported difficulties. This simple questionnaire could be the difference between continued frustration and finding appropriate help for millions of people.

For hearing healthcare professionals listening, this episode provides valuable insights on expanding your practice to better serve this underrecognized population. For those struggling with hearing but told their tests are normal, it offers validation and hope. Listen now to understand the critical difference between hearing and processing – and discover how addressing both can transform lives.

Connect with the Hearing Matters Podcast Team

Email: hearingmatterspodcast@gmail.com

Instagram: @hearing_matters_podcast

Twitter: @hearing_mattas

Facebook: Hearing Matters Podcast

Blaise M. Delfino, M.S. - HIS:

This is the Friday Audiogram. Let's go. There's a lot of people out there today that say I can hear you, but I can't quite understand you. So for those listening, can you explain what central auditory processing disorder is, the age detection, and how you got started in the field of audiology?

Dr. Angela Alexander:

Fantastic. So auditory processing, just in general, is what our brains do with what our ears hear. So once we receive sound, what does our brain do with it? So when there's a problem with auditory processing, we call it an auditory processing disorder. Now this is kind of crazy, but there was a study done in 1980. It's the Framingham cohort and they found that one in five adults who report hearing loss actually have normal hearing test results. So 20% of the population say, oh my goodness, I have so much hearing loss. And then they go to an audiologist, have a hearing test done and find that their results are within normal limits. But that doesn't make sense and that doesn't match their life experience. Maybe they say, okay, I can't hear in background noise, I can't remember what people say to me. These people are at risk for something we call auditory processing disorder or APD. But here's one thing that I think is really interesting. We used to think about auditory processing in terms of people who had no hearing loss whatsoever, but it is also possible to have hearing loss and processing problems. I kind of wonder if people who have hearing aids but aren't getting the improvements they would like to see. I wonder how much of that is within the brain and how much we can change. So I'm really looking forward to our conversation today to unpack all of that with you.

Dr. Angela Alexander:

I was really interested in audiology from a young age. My mom noticed that I wasn't really responding to sound as much as a baby, and so, as a nurse, she was concerned that I wasn't really responding to sound as much as a baby and so, as a nurse, she was concerned that I might have hearing loss. Our next door neighbor was an audiologist and he did some tests and he thought that my hearing sensitivity was probably within normal limits. But he decided to track me and he was doing audiograms quite regularly for me through fourth or fifth grade. There were some interesting results from like tympanometry. I had shallow temps, but other than that everything was within normal limits. So when I was in college I was at the University of Kansas and I was pursuing my audiology and speech language pathology degrees and in undergraduate I was late to a class, and because I was bowling, if I'm honest it was a bowling class that I had right beforehand.

Dr. Angela Alexander:

So I walk into this classroom and I see that there's a speaker at the front who is not my professor. I'm like, oh no, oh no, I did not realize there was a guest today and there was only one seat left and it was at the front and center of this classroom. So I sheepishly walked in late, sat at the desk and proceeded to have my mind blown by Dr Jack Katz.

Dr. Angela Alexander:

So Dr Jack Katz is a well-known audiologist who has done a lot of work, not just in auditory processing, but he wrote the Handbook of Clinical Audiology, which is sometimes known as the Audiology Bible, but I honestly believe that Jack Katz is a little bit of a Picasso of audiology, and the major work that will be attributed to him throughout the rest of time is what he has learned about how to assess auditory processing issues in people across the lifespan and across the audiogram, and also how we treat what we see, and I think that's the real richness that he will add to this world for the rest of time.

Blaise M. Delfino, M.S. - HIS:

Having been in private practice for a little over five years and working side by side with my father who, as I said, is an audiologist as well, there would be so many times and I'm not exaggerating when I say so many times and we've seen so many patients who say you know, blaze, I can hear, I just can't understand. And I have been to two other hearing care providers I have normal hearing sensitivity and they tell me I'm fine, but I'm still struggling. Then we have the conversation of going beyond the audiogram, going beyond peripheral hearing, because central auditory processing happens in the brain. What can hearing healthcare professionals do today to raise awareness of CAPD, and why is it so important that hearing care professionals add the CAPD test battery to their clinic menu, if you will?

Dr. Angela Alexander:

I love it. I love it. Okay, so hearing healthcare providers listen in. I'm going to give you the most fire tip I could possibly give in the next couple of minutes. All right, so for adults these are people age 18 and older I would suggest using something called the Hearing Handicap Inventory for Adults. This questionnaire has questions like does a hearing problem cause you to feel embarrassed when meeting new people? And a person answers these questions with yes sometimes, or no? If they say yes, that gets four points, sometimes two points and no is zero points. You ask them 25 questions and ask them to go with their first thought. Don't overthink any questions, just come up with your first response to each one of those questions. Let me try one with you Does a hearing problem cause you difficulty when talking to members of your family?

Blaise M. Delfino, M.S. - HIS:

No.

Dr. Angela Alexander:

No Good. So there are lots of people who may have a normal audiogram but say yes to that question. We want to look at the audiogram and then we want to look at the HHIA and see how they match up. The HHIA has 25 questions. So if a person answers yes and gets four points to all 25 questions, you do the math for me, blaze. How much would that be? Oh, that's 100%, 100%, right. So if a person gets a score of 100, it's awful and a score of zero is awesome, all right, got it. So we can almost think about this gradient with the same gradient as an audiogram. So where we have zero is awesome, 100 is awful. We want to look at these same scores in the same way.

Dr. Angela Alexander:

Does a person come to your clinic and they have an audiogram where, on average, their hearing sensitivity is around 15, which is either a slight loss or within normal limits and then look at their HHIA score. Is that 50? There is a mismatch. So we could almost put the HHIA score into the same thought process as the audiometric gradients. And so a 50 is moderate, right, moderate and slight. Those don't match up. That is a red flag. Refer that client on to a person near you who does auditory processing testing, or become that provider yourself if you're an audiologist processing testing, or become that provider yourself if you're an audiologist, yes.

Dr. Angela Alexander:

So I think that, honestly, the HHIA is amazing. It looks at a person's social and emotional impacts of hearing problems and I get worried because if we see an HHIA score that's close to 100, with essentially normal hearing sensitivity, I get worried that those people are a red flag for mental well-being issues and potentially suicide. We talk a lot about suicide when it comes to tinnitus but honestly, we have really been underserving and underhelping a group of individuals who really need our help.

Blaise M. Delfino, M.S. - HIS:

I absolutely wholeheartedly agree with you, especially with the mental health aspect, angela, not only with patients that have severe hearing loss, but you're absolutely right normal hearing thresholds, peripheral hearing and struggling to understand speech in noisy situations. Really, we are in this loneliness epidemic and these individuals may start to withdraw. They have normal hearing and there are providers out there that can help them, but maybe they're not educated on what CAPD is, or the hearing healthcare providers they visited don't know what CAPD is either. And that's what I love most about the work you're doing is you're using the gifts that you've been blessed with to spread awareness of central auditory processing disorder, and you've helped so many individuals.

People on this episode

Head Shot

Blaise M. Delfino, M.S. - HIS

Host