AN EVIDENCE BASED APPROACH TO ADD

VASILIKI (VIVIAN) MARIA ILIADOU ASSOCIATE PROFESSOR MEDICAL SCHOOL

An Evidence-Based Approach to APD

APD- AUDITORY PROCESSING DISORDER

WHAT IS EVIDENCE-BASED?

EVIDENCE-BASED

CLINICAL EXPERTISE

BEST RESEARCH AVAILABLE

PATIENT VALUES & PREFERENCES

Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000

APD- AN EVIDENCE-BASED APPROACH

CLINICAL EXPERTISE

1.APD is a well-established complex disorder of the auditory system (beyond the cochlea).

2.APD test battery gold standard and norms with documented sensitivity and specificity for CANS lesions

ICD-10 & 11 BETA VERSION ASHA 2005

INTERNATIONAL BUREAU FOR AUDIOPHONOLIGIE 2007 AAA 2010

CANADIAN AUDIOLOGY 2012 DANISH MEDICAL AUDIOLOGICAL SOCIETY 2014

NEW ZEALAND REPORT 2014 GERMAN SOCIETY OF PAEDIATRIC AUDIOLOGY 2015, 2019

FRONT NEUROL NOVEMBER 2017

EUROPEAN CONSENSUS 2017 HTTPS://DOI.ORG/10.3389/FNEUR.2017.00622

APD IS A WELL ESTABLISHED DISORDER

TEST BATTERY GOLD STANDARD

THESSALONIKI

DIAGNOSTIC CRITERIA FOR APD

Symptoms & risk factorsSymptoms & risk factorsCriterion Explained

Pure Tone Audiometry ≦15dB HL for each frequency between 250Hz-8000Hz in both ears

Abnormal auditory processing results

performance at or below 2 SD below the mean in at least 2 validated auditory processing tests

Symptoms & risk factorsReported by the affected individual/their family/

educational environment AND/OR presence of risk factors

Non-Verbal intelligence coefficient (IQ) >80

Ability to follow instructions in ideal conditions

Patient can understand and reliably follow instructions for the AP tests and reliably

perform the pre-testing training

EUROPEAN CONSENSUS 2017

APD- AN EVIDENCE-BASED APPROACH

BEST RESEARCH AVAILABLE

Unfiltered info

You have to appraise!

Not for rookies!!

Filtered info

Pre-appraised!

Still needs vetting!!

Berner ES. Clinical decision support systems: State of the Art.

AHRQ Publication No. 09-0069-EF. Rockville, Maryland:

Agency for Healthcare Research and Quality. June 2009.

EUROPEAN APD STUDY GROUP

HEARING & PROCESSINGcABR

BMLD

RGDT

DD

GIN

OAE suppression

SPEECH IN NOISE/

BABBLE

TYMPSABR

OAE

Speech audiometry in quiet

STAPE-DIAL

REFLEXES

PPS

Audio-

gram

DPS

&

EFAS APD

Working Group

EAG= European APD Group

Hearing is more than we are currently testing

Interaction with HS & AP

PTA not enough

Higher order cognition Thought Process

Language

Cognition

Auditory Processing (AP)

Hearing Sensitivity (HS)

Tests of attention &

memory are often implemented

through the auditory modality

HEARING PROCESSING

LISN

Emergence of an auditory deficit is

essential

SUPPRESSION IS INFLUENCED BY THE TIME WINDOW ANALYSED, EAR TESTED

52 APD children

Abnormal SinB:Cutoff 1.33dB

HIDDEN HL (COCHLEAR SYNAPTOPATHY) MORE VALID THAN APD? NO

ADDITIONAL REFERENCES FOR APD

• Chermak, G. D., Bamiou, D. -., (Vivian) Iliadou, V., & Musiek, F. E. (2017). Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: A brief tutorial. International Journal of Audiology, 56(7), 499-506. doi:10.1080/14992027.2017.1284351

• Iliadou, V., & Kiese-Himmel, C. (2018). Common misconceptions regarding pediatric auditory processing disorder. Frontiers in Neurology, 8(JAN) doi:10.3389/fneur.2017.00732

• Iliadou, V., Moschopoulos, N., Sidiras, C., Eleftheriadou, A., & Nimatoudis, I. (2018). Over-diagnosis of cognitive deficits in psychiatric patients may be the result of not controlling for hearing sensitivity and auditory processing. Psychiatry and Clinical Neurosciences, 72(9), 742. doi:10.1111/pcn.12768

• Jutras, B., Lafontaine, L., East, M. -., & Noël, M. (2018). Listening in noise training in children with auditory processing disorder: Exploring group and individual data. Disability and Rehabilitation, , 1-9. doi:10.1080/09638288.2018.1482377

• Ptok, M., Kiese-Himmel, C., & Nickisch, A. (2019). Guideline: Auditive processing and perception disorders: Definition: Guideline of the german society of phoniatrics and pediatric audiology. [Leitlinie „Auditive Verarbeitungs- und Wahrnehmungsstörungen“: Definition: S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie] HNO, 67(1), 8-14. doi:10.1007/s00106-018-0598-y

• Raben Pedersen, E. (2018). The danish test battery for auditory processing disorder evaluated with patient and control data. International Journal of Audiology, 57(10), 755-763. doi:10.1080/14992027.2018.1481537

• Iliadou, V., Ptok, M., Grech, H., Pedersen, E. R., Brechmann, A., Deggouj, N., . . . Bamiou, D. -. (2017). A european perspective on auditory processing disorder-current knowledge and future research focus. Frontiers in Neurology, 8(NOV) doi:10.3389/fneur.2017.00622

• Musiek, F. E., Chermak, G. D., Bamiou, D. -., & Shinn, J. (2018). CAPD: The most common ‘hidden hearing loss’ central auditory processing disorder-and not cochlear synaptopathy-is the most likely source of difficulty understanding speech in noise (despite normal audiograms). ASHA Leader, 23(3) doi:10.1044/leader.FMP.23032018.6

• Iliadou, V. V., Chermak, G. D., Bamiou, D. -., Rawool, V. W., Ptok, M., Purdy, S., . . . Musiek, F. E. (2018). Letter to the editor: An affront to scientific inquiry re: Moore, D. R. (2018) editorial: Auditory processing disorder, ear hear, 39, 617-620. Ear and Hearing, 39(6), 1236-1242. doi:10.1097/AUD.0000000000000644

• Mattsson, T. S., Follestad, T., Andersson, S., Lind, O., Øygarden, J., & Nordgård, S. (2018). Normative data for diagnosing auditory processing disorder in norwegian children aged 7–12 years. International Journal of Audiology, 57(1), 10-20. doi:10.1080/14992027.2017.1366670

• Stavrinos, G., Iliadou, V. -., Edwards, L., Sirimanna, T., & Bamiou, D. -. (2018). The relationship between types of attention and auditory processing skills: Reconsidering auditory processing disorder diagnosis. Frontiers in Psychology, 9(JAN) doi:10.3389/fpsyg.2018.00034

• Keith, W. J., Keith, R. W., & Purdy, S. C. (2018). Letter to the editor: Comments on the ear and hearing ban on certain auditory processing disorder articles re: Moore, D. R. (2018) editorial: Auditory processing disorder, ear hear, 39, 617-620. Ear and Hearing, 39(6), 1242-1243. doi:10.1097/AUD.0000000000000643

• Ptok, M., Kiese-Himmel, C., & Nickisch, A. (2019). Guideline: Auditive processing and perception disorders: Definition: Guideline of the german society of phoniatrics and pediatric audiology. [Leitlinie „Auditive Verarbeitungs- und Wahrnehmungsstörungen“: Definition: S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie] HNO, 67(1), 8-14. doi:10.1007/s00106-018-0598-y

• Gyldenkærne, P., Dillon, H., Sharma, M., & Purdy, S. C. (2014). Attend to this: The relationship between auditory processing disorders and attention deficits. Journal of the American Academy of Audiology, 25(7), 676-687.