Difficulty understanding speech amid background noise is a familiar frustration for many. But for some, noisy environments create exceptional hurdles in communication and conversation – potentially signaling an underlying issue beyond basic hearing loss.
According to audiologists with the Defense Health Agency’s Hearing Center of Excellence (HCE), a specialized branch providing clinical expertise and research for the military health system, these symptoms may indicate a central auditory processing disorder.
“A person with a processing disorder is not able to interpret sound the way most of us do,” explained HCE audiologist Amy Boudin-George. “This leads to frequent misunderstandings and difficulties across environments.”
Unlike hearing loss originating in the ear, central auditory processing disorders involve the brain’s ability – or lack thereof – to make sense of auditory information. Symptoms include struggling to understand speech in noisy settings, failing to recognize some spoken words, confusing similar-sounding words, and uncertainty regarding sound sources.
“Children may be born with central auditory processing disorders or adults can acquire them after traumatic brain injuries or blast exposures,” said Navy Lt. Cmdr. Amanda Boudreaux, an HCE audiology specialist. “Studies also show some chemical exposures can cause processing disorders.”
Diagnosis Starts with Hearing Test
According to Boudin-George, differentiating an auditory processing disorder from standard hearing loss begins with a comprehensive hearing test. “If no issues appear on that initial test, further evaluation for a processing disorder may be warranted,” she advised. This additional testing and diagnosis requires specialized training and equipment to assess the brain’s ability to interpret complex auditory signals beyond simple tones.
Boudreaux explained that processing disorders may co-occur alongside other hearing problems, complicating diagnoses: “Sounds are so complex, especially speech. People with processing disorders may or may not have hearing loss, but they aren’t able to process those multifaceted signals.”
Assessing Related Issues
Given overlapping symptoms, psychological or cognitive issues related to brain trauma can also obscure auditory processing disorders. “It’s definitely important to be able to do more complex testing,” said Boudin-George. “And in some cases, it requires probing beyond standard audiological assessments based on patient history and difficulties.”
Boudin-George recalled diagnosing processing disorder in an active duty service member with extensive leadership responsibilities.
“He had been having trouble on the phone and in rooms with poor acoustics. He found himself repeatedly having to say ‘Sorry, I really can’t understand.’ But a standard hearing test showed near normal results.”
Military Clinicians Join Forces to Advance Science
To advance processing disorder testing, diagnosis, treatment, and general awareness, an assembly of Defense Health Agency and Veterans Affairs clinicians established the DOD Central Auditory Processing Working Group. Members share experiences, research, and best practices while developing new resources for military audiologists.
“We are really hoping to raise awareness of auditory processing disorders and get more support for proper management across DOD,” said Boudin-George. By disseminating knowledge, she believes improved understanding and patient care are achievable: “It’s just one piece of the puzzle.”
The working group formed AudiologyOnline webinars based on community feedback, featuring volunteer presenters from the group sharing their expertise. These webinars will be accessible on AudiologyOnline for three years, providing valuable resources for clinicians.
Boudreaux anticipates the usefulness of these resources for active duty audiologists working in various facilities with differing equipment. Boudin-George emphasized the aim to increase awareness and support for evaluating and managing auditory processing disorders within the Department of Defense (DOD), highlighting the importance of these resources as a step toward achieving that goal.
Source: Ken Cornwell, Defense Health Agency
