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      A European Perspective on Auditory Processing Disorder-Current Knowledge and Future Research Focus

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      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , *
      Frontiers in Neurology
      Frontiers Media S.A.
      auditory processing disorder, auditory processing, hearing, listening difficulties, ear, central auditory nervous system, hidden hearing loss, psychoacoustic

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          Abstract

          Current notions of “hearing impairment,” as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as “Auditory Processing Disorder” (APD) or “Central Auditory Processing Disorder” is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.

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          Dementia prevention, intervention, and care

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            Perceptual Consequences of “Hidden” Hearing Loss

            Dramatic results from recent animal experiments show that noise exposure can cause a selective loss of high-threshold auditory nerve fibers without affecting absolute sensitivity permanently. This cochlear neuropathy has been described as hidden hearing loss, as it is not thought to be detectable using standard measures of audiometric threshold. It is possible that hidden hearing loss is a common condition in humans and may underlie some of the perceptual deficits experienced by people with clinically normal hearing. There is some evidence that a history of noise exposure is associated with difficulties in speech discrimination and temporal processing, even in the absence of any audiometric loss. There is also evidence that the tinnitus experienced by listeners with clinically normal hearing is associated with cochlear neuropathy, as measured using Wave I of the auditory brainstem response. To date, however, there has been no direct link made between noise exposure, cochlear neuropathy, and perceptual difficulties. Animal experiments also reveal that the aging process itself, in the absence of significant noise exposure, is associated with loss of auditory nerve fibers. Evidence from human temporal bone studies and auditory brainstem response measures suggests that this form of hidden loss is common in humans and may have perceptual consequences, in particular, regarding the coding of the temporal aspects of sounds. Hidden hearing loss is potentially a major health issue, and investigations are ongoing to identify the causes and consequences of this troubling condition.
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              Perspectives on the Pure-Tone Audiogram.

              The pure-tone audiogram, though fundamental to audiology, presents limitations, especially in the case of central auditory involvement. Advances in auditory neuroscience underscore the considerably larger role of the central auditory nervous system (CANS) in hearing and related disorders. Given the availability of behavioral audiological tests and electrophysiological procedures that can provide better insights as to the function of the various components of the auditory system, this perspective piece reviews the limitations of the pure-tone audiogram and notes some of the advantages of other tests and procedures used in tandem with the pure-tone threshold measurement.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/428530
                URI : http://frontiersin.org/people/u/479199
                URI : http://frontiersin.org/people/u/479313
                URI : http://frontiersin.org/people/u/66605
                URI : http://frontiersin.org/people/u/495698
                URI : http://frontiersin.org/people/u/476084
                URI : http://frontiersin.org/people/u/482218
                URI : http://frontiersin.org/people/u/482273
                URI : http://frontiersin.org/people/u/495645
                URI : http://frontiersin.org/people/u/496512
                URI : http://frontiersin.org/people/u/479131
                URI : http://frontiersin.org/people/u/388136
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                21 November 2017
                2017
                : 8
                : 622
                Affiliations
                [1] 1Neuroscience, Medical School, Aristotle University of Thessaloniki , Thessaloniki, Greece
                [2] 2Department of Phoniatrics and Pediatric Audiology , Hannover, Germany
                [3] 3University of Malta , Msida, Malta
                [4] 4The Maersk Mc-Kinney Moller Institute, University of Southern Denmark , Odense, Denmark
                [5] 5Leibniz Institute for Neurobiology , Magdeburg, Germany
                [6] 6Audio-Phonological Center, St Luc’s University Hospital, Université Catholique de Louvain (UcL) , Brussels, Belgium
                [7] 7Phoniatric and Pediatric Audiological Psychology, University Medical Center Göttingen, Georg-August-University , Göttingen, Germany
                [8] 8Department of Audiology and Phoniatrics, Nofer Institute of Occupational Medicine , Lodz, Poland
                [9] 9Department of Hearing-Language-Cochlear Implants, Kbo-Kinderzentrum München , Munich, Germany
                [10] 10ENT Department, CHU Liège , Liege, Belgium
                [11] 11CRNL and the Hospices Civils de Lyon , Lyon, France
                [12] 12Department of Audiology and Audiological Medicine, Great Ormond Street Hospital , London, United Kingdom
                [13] 13ENT and Audiology Department, Nicosia General Hospital , Nicosia, Cyprus
                [14] 14Department of Neurosciences, University of Padova , Padova, Italy
                [15] 15Latvia Children Hearing Center , Riga, Latvia
                [16] 16Clnica Barajas, Santa Cruz de Tenerife , Canary Islands, Spain
                [17] 17Faculty of Education and Rehabilitation Sciences, Speech Therapy Department, University of Zagreb , Zagreb, Croatia
                [18] 18Faculty of Health Sciences, Audiology Department, Istanbul Aydın University , Istanbul, Turkey
                [19] 19Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich , Switzerland
                [20] 20Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, NTNU , Trondheim, Norway
                [21] 21Cochlear Implant Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Centro Hospitalar e Universitário de Coimbra , Coimbra, Portugal
                [22] 22Faculty of Brain Sciences, UCL Ear Institute, University College London , London, United Kingdom
                Author notes

                Edited by: Toshihisa Murofushi, Teikyo University, Japan

                Reviewed by: Hideo Shojaku, University of Toyama, Takaoka, Japan; Ken Ito, Teikyo University, Japan

                *Correspondence: Doris-Eva Bamiou, d.bamiou@ 123456ucl.ac.uk

                Specialty section: This article was submitted to Neuro-Otology, a section of the journal Frontiers in Neurology

                Article
                10.3389/fneur.2017.00622
                5702335
                29209272
                1105d914-6a32-43c0-adf3-a1e86e2deafd
                Copyright © 2017 Iliadou, Ptok, Grech, Pedersen, Brechmann, Deggouj, Kiese-Himmel, Śliwińska-Kowalska, Nickisch, Demanez, Veuillet, Thai-Van, Sirimanna, Callimachou, Santarelli, Kuske, Barajas, Hedjever, Konukseven, Veraguth, Stokkereit Mattsson, Martins and Bamiou.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 28 September 2017
                : 07 November 2017
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 59, Pages: 7, Words: 5865
                Categories
                Neuroscience
                Perspective

                Neurology
                auditory processing disorder,auditory processing,hearing,listening difficulties,ear,central auditory nervous system,hidden hearing loss,psychoacoustic

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