Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion

Abstract

Background:

Clinical importance of auditory processing disorder (APD) testing is often overlooked and regarded with skepticism given the challenging interpretation of results and the current growing debate of its nature and clinical entity.

Purpose:

Presentation of this case is highly educational as APD is the single clinical manifestation of a large cerebellopontine and internal auditory canal lesion.

Research Design:

A case report.

Data Collection and Analysis:

The patient underwent a standard audiological evaluation with normal results. She was referred for APD evaluation. The APD test battery consisted of speech in babble (SinB), dichotic digits (DD), frequency and duration of pattern sequence testing, Random Gap Detection Test, and gaps in noise. These were followed by otoacoustic emissions testing, auditory brainstem responses (ABR) and magnetic resonance imaging (MRI).

Results:

Her auditory processing results showed deficits in SinB and DD limited to the right ear as well as deficits in temporal processing. Both verbal and nonverbal tests exhibited deficits strictly limited to the right ear, which was in accordance with what she was experiencing as reduced loudness for the incoming sounds on the right ear. This less costly evaluation revealed that there was good reason to assess electrophysiologically the auditory system. ABR showed an abnormal waveform with either missing or severely prolongated wave V (depending on stimulus polarity). Otoacoustic emissions were normal. MRI was then implemented revealing a large cerebellopontine and internal auditory canal lesion.

Conclusions:

This clinical case stresses the importance of testing for APD with a psychoacoustical test battery despite current debate of lack of a gold standard diagnostic approach to APD. In this case, APD diagnosis led to a cerebellopontine lesion identification with extension to the right internal auditory canal. This rare cause of APD demonstrates the efficiency of the current diagnostic test battery in revealing lesional causes of central APD.

Key Words

auditory-evoked potentials - auditory processing disorder - case report - diagnostic techniques - otoacoustic emissions

Publication History

Publication Date:
26 June 2020 (online)

• REFERENCES

• 1 American Academy of Audiology (AAA) 2010 Diagnosis, treatment and management of children and adults with central auditory processing disorder. http://audiology-web.s3.amazonaws.com/migrated/CAPD%20Guidelines%208-2010.pdf_539952af956c79.73897613.pdf
• 20 American National Standards Institute (ANSI). (2004) Specifications for Audiometers. ANSI S3.6-2004. New York, NY: ANSI
• 2 American Speech-Language-Hearing Association (ASHA) 2005 Central auditory processing disorders. www.asha.org/members/deskref-journals/deskref/default
• 3 Bamiou DE, Musiek FE, Stow I, Stevens J, Cipolotti L, Brown MM, Luxon LM. 2006; Auditory temporal processing deficits in patients with insular stroke. Neurology 67 (04) 614-619
• 4 Bamiou DE, Werring D, Cox K, Stevens J, Musiek FE, Brown MM, Luxon LM. 2012; Patient-reported auditory functions after stroke of the central auditory pathway. Stroke 43 (05) 1285-1289
• 5 British Society of Audiology (BSA) 2011a Position statement: auditory processing disorder (APD). www.thebsa.org.uk/wp-content/uploads/2014/04/BSA_APD_PositionPaper_31March11_FINAL.pdf
• 6 British Society of Audiology (BSA) 2011b Recommended procedure pure-tone air-conduction and bone-conduction threshold audiometry with and without masking. http:www.thebsa.org.uk/wp-content/uploads/2014/04/BSA_RP_PTA_FINAL_24Sept11_MinorAmend06Feb12.pdf
• 7 Chermak GD, Musiek FE. 2011; Neurological substrate of central auditory processing deficits in children. Curr Pediatr Rev 7 (03) 241-251
• 8 Cho TH, Fischer C, Nighoghossian N, Hermier M, Sindou M, Mauguière F. 2005; Auditory and electrophysiological patterns of a unilateral lesion of the lateral lemniscus. Audiol Neurootol 10 (03) 153-158
• 9 Griffiths TD. 2002; Central auditory pathologies. Br Med Bull 63: 107-120
• 10 Iliadou V, Bamiou DE, Kaprinis S, Kandylis D, Kaprinis G. 2009; Auditory processing disorders in children suspected of learning disabilities—a need for screening?. Int J Pediatr Otorhinolaryngol 73 (07) 1029-1034
• 11 Iliadou V, Fourakis M, Vakalos A, Hawks JW, Kaprinis G. 2006; Bi-syllabic, modern Greek word lists for use in word recognition tests. Int J Audiol 45 (02) 74-82
• 12 Iliadou V, Kaprinis S, Kandylis D, Kaprinis GS. 2010; Hemispheric laterality assessment with dichotic digits testing in dyslexia and auditory processing disorder. Int J Audiol 49 (03) 247-252
• 13 Keith RW. 2000. Random Gap Detection Test. St. Louis, MO: Auditec;
• 14 Musiek FE, Baran JA, Pinheiro ML. 1994. Brainstem involvement. In: Musiek FE, Baran JA, Pinheiro ML. Neuroaudiology Case Studies. San Diego, CA: Singular Publishing Group; 71-112
• 15 Musiek FE, Chermak GD, Weihing J, Zappulla M, Nagle S. 2011; Diagnostic accuracy of established central auditory processing test batteries in patients with documented brain lesions. J Am Acad Audiol 22 (06) 342-358
• 16 Musiek FE, Shinn JB, Jirsa R, Bamiou DE, Baran JA, Zaida E. 2005; GIN (Gaps-In-Noise) test performance in subjects with confirmed central auditory nervous system involvement. Ear Hear 26 (06) 608-618
• 17 Ponzetto E, Vinetti M, Grandin C, Duprez T, van Pesch V, Deggouj N, Lhommel R, Hantson P. 2013; Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 119 (05) 1125-1128
• 18 Shinn JB, Chermak GD, Musiek FE. 2009; GIN (Gaps-In-Noise) performance in the pediatric population. J Am Acad Audiol 20 (04) 229-238
• 19 Tzavaras A, Kaprinis G, Gatzoyas A. 1981; Literacy and hemispheric specialization for language: digit dichotic listening in illiterates. Neuropsychologia 19 (04) 565-570