Several months back, I wrote about the results of my July audiology assessment. A few months after the assessment, I began to feel that something had gone terribly wrong and that my auditory processing had gotten significantly worse.
My first inkling came in the form of a visual. One night, as I thought about the way I’d been processing auditory information, the image that came to mind was a feeling of the walls closing in. It was as though I were in a room that was getting smaller and smaller, so that every way I turned, I hit a wall. It was terrifying. I decided to call my audiologist’s office and schedule another appointment right away. When I told the receptionist what was wrong, she agreed that I needed to come in as soon as possible.
When I went in for the appointment on November 11, the audiologist asked me how the process of tapering off Lorazepam was coming, and I told her that I was almost done. (I am now completely off the Lorazepam—for good!) In all other respects, my health has actually been improving. I’m sleeping better. My other sensory sensitivities have lessened. My thoughts are clearer. My emotions are more manageable. All of these things have gotten better while my auditory processing has felt like it’s been spiralling downward. The audiologist suggested that perhaps my auditory processing abilities were stable and only seemed worse when contrasted against everything else.
I was hoping she was right. Unfortunately, once we did the tests, we found out that she wasn’t. My auditory processing abilities have drastically gone downhill. Here are the results of each test:
Pure Tone Audiometry
This test consisted of a series of tones. When I could hear a tone, I pushed a button. The test showed no change since July. The mild hearing loss in my right ear and moderate hearing loss in my left ear have remained stable.
Auditory Patterning
The auditory patterning test measures how well the subject can hear and replicate relative pitch. The audiologist played a series of three sounds and asked me to tell her whether the pattern was “low-low-high,” “high-high-low,” and so on.
July assessment: I scored 100% in my left ear and 100% in my right ear.
November assessment: I scored 100% in my left ear and 100% in my right ear.
These results didn’t surprise me. As I’ve said before, ordering things into patterns will be the last of my faculties to go.
Auditory Closure
The auditory closure test measures how well the subject can hear words spoken very quickly. Auditory closure is an area of processing that concerns the listener’s ability to fill in missing or disorted patterns of the auditory signal and recognize the whole message. It is an area of processing that can have a direct impact on a person’s ability to understand degraded speech.
July assessment: I scored 48% in my left ear and 52% in my right ear.
November assessment: I scored 48% in my left ear and 52% in my right ear.
During both assessments, this test was very difficult because I couldn’t hear the words clearly enough to form a word-picture in my mind. I’m unable to hear soft consonant sounds like “p” or “th”; they’re at a frequency that my ears don’t pick up. Any sound at this frequency drops out at the end of a word. When words come at me slowly, I can usually run through the list of possible meanings in my mind’s eye, but when the words come at me quickly, the sense of the sound fading away is especially acute, and my ability to see the words in my mind breaks down.
When I couldn’t see the word in my mind, I became very frustrated with the process, which probably accounts for why I become overwhelmed when people around me are talking too quickly.
Both sets of scores are in the Poor range, but at least there had been no change since July. The audiologist concluded that I am “presenting below normal limits in this area of processing.”
Binaural Integration
The binaural integration test measures how well the subject can hear out of both ears simultaneously. Binaural integration is an area of processing that can have a significant impact on a person’s ability to understand multiple auditory signals at the same time. People with difficulties in this area often have a difficult time understanding when more than one person is speaking at the same time.
The audiologist played a series of four numbers: two in one ear, and two in the other. I had to repeat the numbers to her.
July assessment: I scored 90% in my left ear and 92.5% in my right ear.
November assessment: I scored 28% in my left ear and 65% in my right ear.
This test was immensely frustrating. In my July assessment, I had dealt with my processing limitations by memorizing what I’d heard, visually lining up the image of the numbers in my mind’s eye, and then speaking them. In my November assessment, I could not line up the numbers in my mind’s eye at all. By the time I had gotten to the last couple of numbers, I’d have forgotten the first ones. A few times, I remembered three of the four, but mostly, I could only identify one or two. At one point, I noticed myself listening only out of my right ear in order to simplify the process, so of course, I only heard half of what came into both ears.
The November scores are in the Poor range. The audiologist concluded that I am “currently presenting with significant difficulty in this area of processing.”
Binaural Interaction
The binaural interaction test measures word recognition in noise. Binaural interaction is an area of processing that can have a significant impact on a person’s ability to understand speech in the presence of background noise. The noise can include anything from the scraping of chairs to the hum of fans and overhead projectors or speech. People with difficulties in this area often require a greater signal-to-noise ratio in order to pick up and understand more of what is being said.
For this test, the audiologist played a series of words spoken in the midst of noise. For each word, I had to repeat what I had heard.
July assessment: In my left ear, I scored 80%, and in my right ear, I scored 68%.
November assessment: In my left ear, I scored 32%, and in my right ear, I scored 20%.
In my July assessment, I had been able to fish many of the words out of the noise, hold them in my visual memory as word-pictures, and then speak them. In my November assessment, I couldn’t make out enough sounds in most of the words to form a word-picture in my mind at all. A number of words simply disappeared into the background noise. For others, I could make out a vowel sound and a consonant, but I could not even venture a guess as to the other letters.
At one point, when I was nearly in tears, the audiologist stopped the test and simply played a series of words in quiet, first in one ear, and then in the other. It was as though I were looking at black letters standing out against a white background. I scored 100% in quiet. Then, she kept going with the words in noise and the letters began fading out again.
Needless to say, the November scores are in the Poor range. The audiologist again concluded that “I am currently presenting with significant difficulty in this area of processing.”
The audiologist was perplexed about my scores dropping so sharply, so she gave me a referral to a neurologist. My sense of what’s happening is that my compensatory mechanisms have broken down, probably from decades of overuse, so that I’m now left to deal with an auditory processing system in shambles. In February, I have an appointment with a neurologist at Dartmouth-Hitchcock to do further testing, so I’ll let you all know if anything interesting comes to light.
© 2010 by Rachel Cohen-Rottenberg
{{{hugs}}} I’m sorry this is happening, and I hope it’s nothing serious. I’m also impressed and proud of you for always taking the necessary steps to take care of you.
Good luck. Sending those positive vibes you asked for!
Hi Laura,
Thank you for the hugs! The neurologist ordered an MRI of my brain, and everything looks normal, so there’s nothing of a life-threatening nature going on. I was pretty freaked out after the assessment; it’s one thing to know something’s wrong, but another thing to actually watch the scores plunge. At the moment, though, I’m in “dealing with it” mode. As Bob always says, I don’t deal with the unknown very well, but I’m quite good at dealing with the known.
I’m the same way when it comes to my kids, but for myself…something pretty much has to be falling off before I’ll do something about it. I should probably work on that.
Yeah, I know what you mean. I was “lucky,” in a way, because when Ashlynne was just over a year old, I failed to take care of myself and ended up with bacterial pneumonia. Scary, scary. That’s when I realized that taking care of myself couldn’t be left for another day.
Rachel, this looks like it’s more a problem with your ability to interpret/separate sound than your ability to hear it (which is actually better news). I still understand that it’s a shock to you.
Hopefully it’s only a temporary thing.
Yes, it’s definitely a processing problem and not a hearing problem. Unfortunately, it’s not temporary. I’ve had difficulties processing sound all my life, and they’ve only gotten worse over time. It’s a huge help to know what’s going on, though. It makes everything easier to handle.
I’ve never been tested in these areas, but definitely have sound sensitivity and processing issues, so I can sympathize. The first thing I thought was that this was due to burn-out, and I’m so sorry.
Upside: no lorazepam! Downside: new sensory processing issues! Crap.
big hugs.
Thanks, Ben. I’m trying to concentrate on the thank-God-I’m-done-with-benzos part of the equation, and it helps.
Sorry to hear about your hearing problems. Being an aspie myself, I have similar issues with sound processing, but nowhere near as bad as you describe. I don’t know what I would do if my ability to hear suddenly dropped off like that.
Hi Robert,
Thanks for your kind words. So many times, I’ve had that feeling of “I don’t kow what I would do if…”, and every time, I’ve dealt with it and kept going. I think that’s one of the hidden strengths involved with disability: I’ve found out that I’m far stronger and more resourceful than I’d realized.
I’m actually in a good frame of mind right now, despite the challenges of the moment. I think I’ve gotten used to the idea that my life is a creative process.
What a worry. but, like Laura says, well done for taking steps to find out the extent of the problem rather than trying to pretend there isn’t one.
Thanks for the support, bbsmum. In these last couple of years, as I’ve come to understand all the things that make me different from others, I’ve learned the necessity of defining each difficulty, adapting as well as I can, and doing my best to stay in a positive frame of mind.
Rachel you really are an inspiration in showing how to define the problem, adapt, and stay in a positive frame of mind. I hope all goes well with your interview next Thursday, and with your appointment in February. We’re pulling for you!
Thank you, Born2bme!
Eep! How frustrating. I hope so much they can figure something out for you.
{sending good vibes}
Thanks for the good vibes, chavisory! I’ve been concentrating on getting ready for my disability interview, and it feels really empowering to be preparing to self-advocate. Plus, I’m studying Spanish and French every day, which I’m enjoying immensely. It keeps me from dwelling too much on my difficulties.
You may consider using an attorney for your hearing. Disability is often turned down on the
first application. I had a relative whose wife was trying to get disability for him. He had a
ruptured aorta and was in intensive care for months with his heart wide open for all the
world to see. He was denied the first time and she kept waiting. Finally after a year of
appealing, she found the administrative judge in charge of the whole thing and sent him pictures
of Chris with tubes sticking out. He got the decision out in a week in her favor. Beware,
the system is rigged to give you the run around. Filing for disability should be a straightforward
matter with just your statement and the doctors’ reports but it isn’t always. She did get the
back pay so its good that you are applying early as they will backdate your benefit. Theoretically,
you should be able to have the system work for you by yourself without an attorney but it is quite a
broken system and you may need someone to crack heads. Good luck.
Regarding your hearing, I know you’ve had real problems lining up an audiologist…and this
truly is not a simple matter. But, while you are at Dartmouth, you might consider a second opinion from another audiologist. I am not sure if your audiologist went over the risks of using ear plugs
for hyperacusis — that it might lead to loss of hearing. Another option is sound desensitization.
There are some medical drugs you may wish to use or not.
For auditory processing, I have been working with Maxine Young, who is on the CAPD committee of the
American Audiological Association. To start with, she has recommended crossing the midline exercises that I did with my PT/OT and the Interactive Metronome. I also did tomatis while doing the crossing
the midline exercises. Maxine isn’t a fan of Tomatis but I said what
the hell, it can’t hurt anything. I got an increase in my listening from this.
Then I developed tinnitus and had some hearing loss. How, I don’t know. But I can listen better.
I had sinus surgery which improved my hearing and cleaned up fluid in the ears. I have been
doing Posit Science’s Brain Fitness which helps with both hearing, working memory, and tinnitus.
We will see what January’s assessment brings… but I think it will involve Fast Forward for
auditory processing, tinnitus retraining, and maybe a hearing aide.
Also, for tinnitus there are options including tinnitus retraining to get you to ignore the
ringing in your ears. There are a number of options for treating tinnitus. I clipped an article
written by Dr. Mezernich, a leading neuroscientist, surveying the treatment options (http://journeythroughthecortex.blogspot.com/2010/12/tinnitus-special-example-of-failure.html).
Tinnitus is getting a lot of research money these days as a lot of troops are coming come with it from the
concussions.
I don’t know whether any of my experiences is valid in your case or not… or even whether you would want
to go through all the aggravation of all these therapies. Everyone on the spectrum is quite
different and what works for one is not valid for another. I am just throwing it out there just in case it is helpful.
Hi Traveller,
Thanks for all the suggestions and information. I’m hoping that the disability claim won’t end up in a hearing. I know two people in town who are on disability, and neither of them had to go past one appeal. I’m expecting that, like any bureaucratic process, the disability process is set up to discourage people who aren’t serious, and thereby ends up discouraging people who are. But I recently found out that more than half of the people who appeal a denial of a claim are ultimately approved, so it’s definitely worth pursuing–especially since I have a valid claim. If I have to go to a hearing at any point, I will definitely bring an attorney.
Hope the interview went well, Rachel. Wishing you, Bob and Ashlynne happy holidays. Hope the coming year will be filled with blessings and joy for all of you!
Bruce (born2bme)
And many joys and blessings to you too, Bruce!