Auditory Processing Evaluation
Updated: Jul 21, 2022
This is much more than just a hearing test. A thorough auditory processing evaluation will not just test your hearing ability and sensitivity, it will also test the ability for your brain to process what you are hearing as well.
Let me start with the basics. Auditory Processing, like many other functions in your body, has 2 parts that have to work together. The hardware function (sound traveling through your ears and ear canals) and the software function (how your brain recognizes and interprets the sounds that made it into your ears). Auditory problems can be an issue of the ear itself, but in the case of someone with brain injury, ptsd, autism, aspergers, etc, the problem more than likely lies with how the brain is processing the information that the ear is sending in from the world around them.
Many times, people with brain challenges will pass a standard hearing test. In fact, most have too good of hearing. However, because many of us with brain challenges don’t filter sounds like a normal person, we hear more than we should – this is why we can be so sensitive to sound in general.
Just a warning…. if you go for the evaluation, your insurance may only cover the standard hearing part of the test and you may have to pay for the more important “auditory processing evaluation” part of this test out-of-pocket. Surprise Surprise! However, even with my insurance only covering a portion, it was still under $150, which is nothing compared to a lot of other testing I have done in the past.
I was referred to a doctor of audiology at a large Ear, Nose, and Throat (ENT) office for my evaluation and was very pleased with her. She was not only familiar with Traumatic Brain Injury (TBI) through her profession, but also had personal experience because her sister was still rehabilitating from a brain injury due to an accident that happened a couple years prior. It is always a breath of fresh air when we can talk to a professional who is actually familiar with TBI. They ask the right questions, and our answers that include odd descriptions of our peculiar symptoms actually make sense to them.
After going over my history and current challenges, Dr. V had me go into a soundproof booth. It was glorious! Anyone with hyperacusis, or any sensory processing challenges, can appreciate the instant calm that happens in our brains when we are able to escape the hostile sounds of a public building (especially a doctor’s office exam room fully equipped with echoing tile floors, florescent lighting, and forced air vent). This was my favorite part of the testing. I never wanted to leave this “safe haven” once I went into the booth. In fact, after the testing was completed, Dr. V let me stay in the soundproof booth for our closing conversation when she realized the difference it made in my ability to communicate.
Okay, back to the testing. Once inside the booth, Dr. V inserted special earphones into my ears and then exited the booth to sit down at her desk on the other side of a window that I was facing. Other than the initial startle whenever her voice or the recording came over the earphones, I was quite comfortable. She even lowered the volume of her microphone to me to ease the discomfort.
This is an overview of what my evaluation consisted of.
A normal hearing test – The typical “listen for the beep and push the button when you hear it” routine. I performed within normal range for this test in both ears, which wasn’t surprising.
Speech reception – A single syllable word was presented and I repeated it. I also performed within the normal range for this test in both ears.
Speech in noise test – Single syllable words were presented in the presence of background noise. I was to repeat back all the words that I heard. I tested within normal range for my right ear but my left ear showed a mild impairment.
Pitch Pattern Sequence Test – 3 tone bursts were presented in random orders of high and low pitched tones. I was to repeat back the order by stating “high-high-low” or “low-high-low” or “low-high-low,” etc. The struggle for me with this one was putting the tones into the words high or low. Because I was so slow at using words to describe the tones, she let me just hum them as I heard them. I ended up scoring at 80%, which was within the normal range. This showed that I heard the tones well and could process the order but the abnormal part of the result was the cognitive struggle of being unable to describe the tones with the words high and low and having to hum them.
Staggered Spondaic Words Test – A series of 4 words are presented of which the 2nd and 3rd are presented at the same time in the opposite ear, and I had to repeat them. This test was a doozy. My initial reaction after hearing the first set of words was a crying spell. Right away, tears were flowing as if I had no control over it. Immediately, I knew that this was the same feeling I get in busy public places. The urgent need to cry and throw up at the same time. I apologized for my episode – Dr. V explained that it is not out of the ordinary for TBI patients to have that reaction because a person’s auditory processing is directly tied to their limbic system and can cause that automatic reaction when overwhelmed. I did get through a few of them but had to stop the testing early because I felt sick from it. We took a break and when I got up to go to the bathroom, I realized how “drunk” I had gotten from the testing. This explains a lot of my struggles in environments where there is noise, especially conversation noise coming in on both sides.
Dichotic Digits test – I was presented with 4 numbers at the same time and had to repeat them back in any order. We had to take many breaks because of the overwhelming stimulation but I did get through this one. I even scored a 90% for accuracy which was within normal limits for my age. These two tests reflected one thing I already knew about myself – I do so much better with numbers than words.
Loudness discomfort levels – This was a testing of different tones to determine at what level discomfort occurred. This test revealed my hyperacusis (noise sensitivity).
The resulting diagnosis was hyperacusis, auditory processing deficits, and difficulty with auditory memory and auditory decoding, as well as difficulty with cognitive word finding skills.
The treatment recommendations were:
Referral to a speech language pathologist for evaluation and therapies to include noise desensitization, auditory memory and decoding, and cognitive word finding.
Memory training and compensatory strategies for auditory memory such as imposing delays, chunking, or 4 step rehearsal.
Some apps that Dr. V suggested for at-home therapy are:
Sleep Mask is a white noise app that can be used as a sleep-aid or distraction blocker. It produces high quality white, pink, and brown noise sounds as well as some variations of these. I only found this one for Apple, so a cool Android app that’s similar would be Noise Machine. If you are like me and can’t stand white noise I think you might appreciate pink or brown noise. Try them all and see what gives you the best feeling of calm.
Auditory Processing Studio
Auditory Processing Studio was created by a certified speech and language pathologist for adults and children ages 7 and up who exhibit Central Auditory Processing Disorder or other auditory processing disorders. This research-based app implements the bottom-top approach to treatment of auditory processing disorders and focuses on improving auditory processing through auditory discrimination, auditory closure, and phonological awareness activities. Users can also introduce background noise to help children or adults practice their listening skills in a noisy environment. It is available on Apple for 29.99
The closest Android app that I could find for this was Auditory Workout for 18.99 which is also mentioned below. If you know of one that is closer to it. Please comment below.
Sound Match is a unique twist of the classic memory game – it challenges your ears, not the eyes. Remember the sounds and put them in pairs. Available for Apple and Android devices and FREE
EASe Listening Therapy
EASe was studied by researchers at Brenau university in 2012 and found effective in reducing auditory hypersensitivity in children with sensory processing disorder.
The EASe Listening Therapy app for iPhone, iPod touch and iPad for 39.99 was developed for children with autism and other sensory processing disorders (SPD), who often respond to noise with exaggerated reactions and behavioral or learning issues.
I have yet to find an Android app quite like this one so please comment below if you know of one.
Auditory Workout was created by a certified speech and language pathologist for students ages 4–10 who exhibit auditory processing disorders or other related disorders (e.g., receptive language disorder or autism). Auditory Workout is research-based and focuses on improving auditory attention and memory and auditory processing of verbal directions. This engaging, colorful app includes hundreds of audio instructions and the feature that allows users to set background noise (classroom noise). It is available for 18.99 on Android and 24.99 on Apple
The Comprehension Aphasia app was created by a certified speech and language pathologist for adults and children, and it focuses on auditory comprehension of increasingly longer and complex yes-no- questions and directions with the ability to turn on background noise. The Comprehension Aphasia app can be used by individuals who exhibit: Aphasia, secondary to brain injury such as stroke, Cognitive deficits such as decreased attention, Central Auditory Processing Disorder (CAPD), Receptive language disorders and Autism. It can be downloaded for 19.99 on both the Apple store and Google Play Store
Follow Simon’s Music
Simon will blink a light while buzzing a sound.Wait for him to finish and then click that same button. This way you watch the computer and follow the pattern sequence in the same order for as long as you can remember. It is the only game is appstore on the Simon Says concept having different level of difficulties. Available on Apple Store for free.
This particular app doesn’t look like it is available on Android. There are many Simon Games on there though. Feel free to try them out and let me know what you think.