Auditory processing disorder

The term Auditory Processing Disorders ( APD) are referred to hearing impairments, in a reduction of the peripheral auditory system, ie of the hearing organ are not themselves justified. The term Auditory Processing Disorders ( APD) was introduced in 2000 in a consensus statement of the German Society of Phoniatrics and Pediatric Audiology ( DGPP ). He draws on the Anglo-Saxon terminology of Auditory Processing Disorder (APD ) or Central Auditory Processing Disorder [(C) APD ]. The auditory processing and perception of sound signals takes place after the sound recording was made by the hearing organ. The term APD includes the preconscious processes of processing ( brainstem level ) as well as the perception (higher auditory functions, including cognitive functions ) of these neural impulses. In the current consensus paper of the DGPP APD are defined as follows: An Auditory processing and / or Disorder (APD ) is when in normal audiogram central processes of listening are disturbed. Central processes of listening allow, inter alia, the preconscious and conscious analysis, differentiation and identification of time, frequency and intensity changes of acoustic or auditivsprachlicher signals and processes the binaural ( " binaural " ) interaction (eg for sound localization, lateralization, noise removal, summing ) and the dichotic processing.

Definition of Terms

The auditory processing and perception of sound stimuli comprised of various auditory part of the services which may be affected in APD in different combinations and varying degrees. In order to make a diagnosis of APD, at least two auditory part performance areas must be clearly affected ( with significant deviations from the norm ).

Symptoms of APD

Patients who are affected by such a disorder, eg, can complain about

• Impairment of auditory attention
• Problems with understanding auditory ( heard ) Information
• Misunderstandings in verbal ( spoken ) Calls
• Slowed processing of verbal ( spoken ) information
• Delayed response to auditory or verbal stimuli
• Limited auditory memory (eg Hörmerkspanne )
• Impaired recognition and discrimination of acoustic stimuli
• Problems of sound source localization ( " Directional Hearing " )
• Difficulties in speech understanding and listening in noise
• Problems in understanding modified speech signals (e.g., incomplete or reduced in its redundancy speech signals ) (eg, bad telephone line )

Many of these abnormalities also occur as a result of interference in a peripheral (ie through the outer, middle or inner ear related ) hearing on, even himself, "minor " or " minimal " peripheral hearing impairment, whether or medium by disturbances of the foreign, are inner ear related, can cause symptoms similar to an APD.

The DGPP has issued a questionnaire on the history of APD. This questionnaire was developed for structured medical history and follow-up and can be completed by parents, teachers, nursery staff; he has not been developed as a diagnostic tool and can not replace a diagnosis.

Diagnostics

Before a specific diagnosis of APD, the exclusion of peripheral hearing impairment is mandatory, ie there must be an impairment of hearing function, which is based on a disturbance of the outer, middle or inner ear, be safely ruled out. This is particularly true for low-grade or minimal hearing impairment. In addition, disturbances in the run-up to exclude that are much more common compared to APD and may be associated with similar symptoms, ie, learning disabilities or Aufmerksamkeits-/Hyperaktivitäts-Syndrome and especially receptive language development disorders ( language disorder ) as well as expressive language impairment ( dyslalia, with grammar, etc.). Provides the preliminary diagnostics not a sufficient explanation for the described symptoms, a comprehensive pediatric audiological examination of the different auditory functions is recommended. The study of auditory processing and perception is carried out by specialists of Phoniatrics and Pediatric Audiology ( syn. doctors for voice, voice and childlike hearing impairment ) in phoniatric - audiological clinics, hospital departments, phoniatric - audiological practices or by pädaudiologisch continuing formed ENT specialists. The diagnosis by the aforementioned Specialists is a standard benefit of health insurance; It is not about Individual Health Services ( IHS ). Since APD often accompanied by other impairments such as developmental language disorders, reading and spelling disorders, Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen as well as other disorders, specific differential diagnostic aspects are interdisciplinary to clarify, for example, by child and adolescent psychiatrists, child and adolescent psychologists and psychotherapists, as well as neuro- pediatrician (children € lodges ).

Treatment

The management of APD in children is done by practicing procedures, through the promotion of compensations to the impaired functions and by improving the acoustic signal quality. The treatment of APD should consider all three areas basically. When significant comorbidities, ie additional abnormalities (eg reading and spelling disorders Developmental language disorders, Attention Hyperactivity Syndrome) is the therapeutic needs for the auditory domain weighed taking into account the severity of the APD, which thus caused symptoms in everyday life and in school as well as the interdisciplinary findings. To the practicing method in APD to include a part of function-specific, vocal, auditory forms of treatment, which include, among other exercises Phonemdifferenzierung, Phonemidentifikation, phoneme in words, phoneme and phonological awareness. In addition, training method of the non-verbal auditory functions (eg order threshold training, training of auditory low-level features ) or with modified speech signals (eg Fast ForWord, Lateral-, Hochtontraining ) are offered. With regard to the effectiveness of different treatment approaches, existing research results clearly speak for the language-bound part of function-specific treatment method as treatment of choice for APD (reviewed in at Nikisch ). Decisive for the benefit of therapy for the patient is the question of whether the language development or the development of written language can be favorably influenced by the treatment. In view of the linguistic- auditory training transfer effects have been assigned to the reading and spelling performance in many studies. This applies not only for inconspicuous in the field of auditory perception benefits children, but also in particular for children with poor performance in the language- bound auditory perception areas. In addition, according to linguistic- auditory training, effects have been reported in objective methods (eg functional magnetic resonance imaging, fMRI, and late auditory evoked potentials, SAEP ).

In contrast, in most controlled studies so far no clear transfer effects of training were detected basal auditory functions on the voice or reading and spelling performance. Overall, the implementation of training forms basal auditory functions is often justified by the observations of the Working Group to Tallal. Although the product developed in the United States on the basis of these investigations auditory training (Fast ForWord ) were in children with reading and spelling disorder both in speech and in reading and writing area documented improvements, and be confirmed in fMRI, however, were these effects not detected in a number of other studies, in turn, .. Furthermore, it was a Cochrane Review from 2011 for sound therapies, among other things, the Tomatis therapy, no evidence of therapeutic effects.

In addition to practicing the method of APD therapy should be the development of compensation strategies (via the visual modality, eg Phonembestimmtes Manual System) as well as metacognitive strategies involve. Another aim of the therapy is that the patient's own assessment of the respective auditory situation and possible hearing problems countered actively independently. Finally, the signal quality can be improved by, for example, a reduction of noise sources is carried out in school classroom, is a change in the seating position in the classroom or sound insulation measures shall be taken in the classroom. Possibly can be profitable also a FM system in the classroom. This requires specialist medical phoniatric - pedaudiological diagnosis of APD as well as the impairment of hearing in noise.