Week 2, Fall 2007

This week I saw a college-aged female client who reported that she was having difficulties hearing. She was a student in a dentistry program, and she described having extreme difficulty understanding her professors during clinical practicum. She explained that the background noise and muffled speech (due to wearing surgical masks) was making it nearly impossible to listen to lectures. She was receiving no visual cues because she was unable to see her professors' mouths behind the surgical masks. She also reported having difficulty at home and in social situations. She noted that she was born with a hearing loss, but she was unsure of the details regarding that diagnosis. From the client's case history, I anticipated that she would have a mild to moderate sensorineural hearing loss.

Immittance testing revealed normal tympanograms and normal ipsilateral and contralateral ARTs at all test frequencies. Air conduction and bone conduction testing revealed normal hearing from 250 to 4000 Hz with a slight bilateral S-N hearing loss at 500 Hz. Diagnostic OAEs were performed, and robust responses were noted at all test frequencies. Speech testing was not performed due to time constraints in the client's schedule.

Test results did not agree with my initial impression of the client. She had difficulty understanding my speech when I was not looking directly at her or when others were speaking in the clinic, and her case history suggested that she had a more severe HL. Further speech testing and CAPD testing were scheduled to evaluate other issues that may be the source of her difficulty. Attention issues or central auditory processing issues may be affecting her speech perception and still need to be assessed in order to rule out a functional loss.

Separating attention deficits and auditory processing disorders has been a controversial issue lately in audiology. The following article describes a multimodal testing approach. According to the authors, a CAPD diagnosis cannot be made from a hearing evaluation alone. They contend that evaluating receptive language, cognition, and attention are all requisites to making a CAPD diagnosis. The authors claim there can be some peripheral segregation of different related modalities. By evaluating auditory processing, language, cognition, attention, and motivation separately, problems in other modalities can be ruled out and can lead to a more definitive diagnosis of CAPD.

ASHA (1996) asserts, however, that "modality specificity, as a diagnostic criterion, is ‘neurophysiologically untenable.’" ASHA also claims that their are no "entirely compartmentalized areas in the brain that are solely responsible for a single sensory
modality.’" In other words, ASHA believes that there is no way to test modalities separately. In the community of healthcare providers, there is still no general consensus.

What do you think ... is it possible to assess modalities separately or is that unattainable?

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