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00:00:42.542Welcome back to another episode of the Hearing Matters podcast.
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00:00:53.511I'm founder and host Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey and joining us today.
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00:00:58.026This is a guest we have been so anxiously awaiting to have on the show.
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00:01:01.472We have Dr Angela Alexander.
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00:01:04.304Angela, welcome to the Hearing Matters podcast.
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00:01:05.426Hello, hello.
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00:01:08.853It's wonderful to see you and hear you here today.
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00:01:11.625It is so awesome having you on the show.
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00:01:20.552We have been following your success but also your passion number one for central auditory processing disorder.
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00:01:26.269This is your second love, your husband being number one, capd being number two.
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00:01:33.993There's a lot of people out there today that say I can hear you, but I can't quite understand you.
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00:01:44.626So for those listening, can you explain what central auditory processing disorder is, the age detection and how you got started in the field of audiology?
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00:01:45.688Fantastic.
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00:01:52.075So auditory processing, just in general, is what our brains do with what our ears hear.
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00:02:00.942So once we receive sound, what does our brain do with it?
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00:02:04.069So when there's a problem with auditory processing, we call it an auditory processing disorder.
00:02:04.069 -->
00:02:08.686Now this is kind of crazy, but there was a study done in 1980.
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00:02:18.192It's the Framingham cohort and they found that one in five adults who report hearing loss actually have normal hearing test results.
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00:02:24.147So 20% of the population say, oh my goodness, I have so much hearing loss.
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00:02:30.592And then they go to an audiologist, have a hearing test done and find that their results are within normal limits.
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00:02:34.810But that doesn't make sense and that doesn't match their life experience.
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00:02:39.670Maybe they say, okay, I can't hear in background noise, I can't remember what people say to me.
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00:02:45.893These people are at risk for something we call auditory processing disorder or APD.
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00:02:48.949But here's one thing that I think is really interesting.
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00:03:00.793We used to think about auditory processing in terms of people who had no hearing loss whatsoever, but it is also possible to have hearing loss and processing problems.
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00:03:09.703I kind of wonder if people who have hearing aids but aren't getting the improvements they would like to see.
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00:03:14.152I wonder how much of that is within the brain and how much we can change.
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00:03:18.411So I'm really looking forward to our conversation today to unpack all of that with you.
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00:03:22.286I was really interested in audiology from a young age.
00:03:22.286 -->
00:03:31.710My mom noticed that I wasn't really responding to sound as much as a baby and so, as a nurse, she was concerned that I might have hearing loss.
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00:03:41.022Our next door neighbor was an audiologist and he did some tests and he thought that my hearing sensitivity was probably within normal limits.
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00:03:47.383But he decided to track me and he was doing audiograms quite regularly for me through fourth or fifth grade.
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00:03:51.513There were some interesting results from like tympanometry.
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00:03:55.871I had shallow temps, but other than that everything was within normal limits.
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00:04:14.649So when I was in college I was at the University of Kansas and I was pursuing my audiology and speech language pathology degrees, and in undergraduate I was late to a class, and because I was bowling, if I'm honest like it was a class that I had right beforehand.
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00:04:20.805So I walk into this classroom and I see that there's a speaker at the front who is not my professor.
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00:04:30.735I'm like, oh no, oh no, I did not realize there was a guest today and there was only one seat left and it was at the front and center of this classroom.
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00:04:39.271So I sheepishly walked in late, sat at the desk and proceeded to have my mind blown by Dr Jack Katz.
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00:04:52.432So Dr Jack Katz is a well-known audiologist who has done a lot of work, not just in auditory processing, but he wrote the Handbook of Clinical Audiology which is sometimes known as the.
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00:05:23.466Audiology Bible, but I honestly believe that Jack Katz is a little bit of a Picasso of audiology, and the major work that will be attributed to him throughout the rest of time is what he has learned about how to assess auditory processing issues in people across the lifespan and across the audiogram, and also how we treat what we see, and I think that's the real richness that he will add to this world for the rest of time.
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00:05:45.329Having been in private practice for a little over five years and working side by side with my father who, as I said, is an audiologist as well, there would be so many times and I'm not exaggerating when I say so many times and we've seen so many patients who say you know, blaze, I can hear, I just can't understand.
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00:05:49.605And I have been to two other hearing care providers.
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00:05:55.064I have normal hearing sensitivity and they tell me I'm fine, but I'm still struggling.
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00:06:05.271Then we have the conversation of going beyond the audiogram, going beyond peripheral hearing, because central auditory processing happens in the brain.
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00:06:21.814What can hearing healthcare professionals do today to raise awareness of CAPD and why is it so important that hearing care professionals add the CAPD test battery to their clinic menu, if you will?
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00:06:22.742I love it.
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00:06:23.182I love it.
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00:06:26.672Okay, so hearing healthcare providers listen in.
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00:06:31.778I'm going to give you the most fire tip I could possibly give in the next couple of minutes.
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00:06:42.608All right, so for adults these are people age 18 and older I would suggest using something called the Hearing Handicap Inventory for Adults.
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00:06:48.785This questionnaire has questions like does a hearing problem cause you to feel embarrassed when meeting new people?
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00:06:53.627And a person answers these questions with yes sometimes, or no.
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00:06:59.990If they say yes, that gets four points, sometimes two points, and no is zero points.
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00:07:06.151You ask them 25 questions and ask them to go with their first thought.
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00:07:12.130Like don't overthink any questions, just come up with your first response to each one of those questions.
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00:07:13.564Let me try one with you.
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00:07:18.209Does a hearing problem cause you difficulty when talking to members of your family?
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00:07:19.752No, no, good.
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00:07:25.552So there are lots of people who may have a normal audiogram but say yes to that question.
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00:07:33.093We want to look at the audiogram and then we want to look at the HHIA and see how they match up.
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00:07:36.264The HHIA has 25 questions.
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00:07:42.723So if a person answers yes and gets four points to all 25 questions, you do the math for me, blaze.
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00:07:46.302How much would that be oh, that's 100%, 100%, right.
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00:07:53.134So if a person gets a score of 100, it's awful, and a score of zero is awesome, all right, got it.
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00:07:59.771So we can almost think about this gradient with the same gradient as an audiogram.
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00:08:03.446So where we have zero is awesome, 100 is awful.
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00:08:06.812We want to look at these same scores in the same way.
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00:08:21.528Does a person come to your clinic and they have an audiogram where, on average, their hearing sensitivity is around 15, which is either a slight loss or within normal limits and then look at their HHIA score?
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00:08:23.225Is that 50?
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00:08:25.005There is a mismatch.
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00:08:32.208So we could almost put the HHIA score into the same thought process as the audiometric gradients.
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00:08:37.085And so a 50 is moderate, right, moderate and slight.
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00:08:38.227Those don't match up.
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00:08:39.633That is a red flag.
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00:08:48.927Refer that client on to a person near you who does auditory processing testing, or become that provider yourself if you're an audiologist, yes.
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00:08:53.059So I think that, honestly, the HHIA is amazing.
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00:09:14.063It looks at a person's social and emotional impacts of hearing problems and I get worried because if we see an HHIA score that's close to 100, with essentially normal hearing sensitivity, I get worried that those people are a red flag for mental well-being issues and potentially suicide.
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00:09:25.852We talk a lot about suicide when it comes to tinnitus but honestly we have really been underserving and underhelping a group of individuals who really need our help.
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00:09:43.861I absolutely wholeheartedly agree with you, especially with the mental health aspect, angela, not only with patients that have severe hearing loss, but you're absolutely right normal hearing thresholds, peripheral hearing and struggling to understand speech in noisy situations.
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00:09:50.230Really, we are in this loneliness epidemic and these individuals may start to withdraw.
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00:10:04.190They have normal hearing and there are providers out there that can help them, but maybe they're not educated on what CAPD is, or the hearing healthcare providers they visited don't know what CAPD is either.
00:10:04.190 -->
00:10:24.291And that's what I love most about the work you're doing is you're using the gifts that you've been blessed with to spread awareness of central auditory processing disorder, and you've helped so many individuals, and I'd love to know more about the work that you've been doing with the Auditory Processing Institute.
00:10:24.291 -->
00:10:26.381When did you found this organization?
00:10:26.381 -->
00:10:30.971How does your training model look like for SLPs and audiologists?
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00:10:32.520Oh, my goodness, okay.
00:10:32.520 -->
00:10:37.761One other thing I want to fly in and just say what do we say not to do with tinnitus clients?
00:10:37.822 -->
00:10:41.657We say don't tell a tinnitus client, a person who has ringing in the ears.
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00:10:48.427We should never say to them that it doesn't exist, that it doesn't bother them, that it can't be treated.
00:10:48.427 -->
00:10:52.563But what do we continuously say to these people with normal audiograms?
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00:11:00.131That it doesn't exist, that it shouldn't bother them and that it can't be treated, which I'm going to go ahead and say right now?
00:11:00.131 -->
00:11:03.943Auditory processing difficulties are absolutely treatable.
00:11:04.404 -->
00:11:08.232Back in 2017, I was massively pregnant with my daughter.
00:11:08.232 -->
00:11:12.649I mean like gigantic, you know, I was really excited to be pregnant.
00:11:12.649 -->
00:11:13.846I really wanted to be a mom.
00:11:13.846 -->
00:11:16.346I mean, lots of people thought I was having triplets.
00:11:16.346 -->
00:11:16.889I was not.
00:11:16.889 -->
00:11:18.907I was having one child with lots of room.
00:11:18.907 -->
00:11:26.100I was kind of embarrassed when she was born slightly, you know, like lower than average weight, because I had been blaming it on a chunky baby this whole time.
00:11:26.722 -->
00:11:57.668When I was marinating that kiddo in my innards, I started realizing that the clients that I was doing auditory training with, where I was doing ear exercises to improve their auditory processing, were suddenly not going to have a clinician walking them through auditory processing treatment, because we usually do 12 to 14 weeks one hour sessions of doing actual ear workouts to help a person understand what they're hearing, to understand speech sounds, hearing background noise, remember what they hear, organize what they hear.
00:11:57.668 -->
00:12:00.668And it's not just telling a person you need to try harder.
00:12:00.668 -->
00:12:06.503It's like actually doing kind of like physical therapy for the ears and the brain more importantly, the brain.
00:12:06.503 -->
00:12:14.306But I thought, okay, what am I going to do if, like, once, I give birth, to help these clients continue to move forward?
00:12:14.306 -->
00:12:26.187So I made a series of videos where a client could take themselves through the therapy and I released that online and I'm like, yeah, this is going to be like the biggest thing ever, it's going to be so awesome, it's going to be so sick.
00:12:26.187 -->
00:12:30.946And then, you know, a few weeks later I'm like, yeah, that's the worst thing I've ever done.
00:12:30.946 -->
00:12:33.961It's terrible, it's horrific, I should just erase it.
00:12:34.442 -->
00:12:47.163And then I had a client who came in and she had the testing done, found out she had auditory processing disorder, went and did the video exercises and came back and her retest results looked like what it looked like.
00:12:47.163 -->
00:13:04.568When I was doing the work with her I was like, okay, maybe there's something to this, but there wasn't really necessarily a big market out there Cause not a lot of people knew about auditory processing, but there were clinicians who said to me hey, could I learn how to do this treatment for clients?
00:13:04.568 -->
00:13:08.576And so I started out on that journey in 2017.
00:13:08.576 -->
00:13:15.883And I thought, okay, here we go, I will teach audiologists and speech language pathologists how to do the treatment.
00:13:15.883 -->
00:13:18.471And then I got an email.
00:13:18.471 -->
00:13:27.590I got messages from Dr Tom Goyne and Dr Megan Thomas on the same day, within 24 hours, and it said hey, you, and they're just Facebook messages.
00:13:27.590 -->
00:13:33.549Hey, you teach people how to treat auditory processing, will you train us how to evaluate it?
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00:13:39.066And I was really overwhelmed by this, because there's a lot of things I don't know.
00:13:39.066 -->
00:13:51.274There's a lot of things I don't necessarily understand, but I also am glad that I went ahead and said I will try, because I've learned more in the last two years than I had previously.
00:13:51.274 -->
00:14:01.863Clinically and together as a group, I'm now trained 170 audiologists and speech language pathologists how to do central testing and treatment.
00:14:01.863 -->
00:14:17.269For people who are the youngest, I really test is three and a half and you know I had a client who was 99, who signed up for therapy, but then she decided to do it the next year and I didn't hear from her since that was like seven years ago.
00:14:17.269 -->
00:14:21.451So I can only assume that she has matured out of auditory processing disorder.
00:14:22.299 -->
00:14:23.971One hundred and seventy.
00:14:23.971 -->
00:14:28.345Wow, For lack of a better term that has to fill your cup.
00:14:28.585 -->
00:14:30.620It does because Because you're paying it forward.
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00:14:35.626I mean well, okay, but these people have added as much to my life as I have added to theirs.
00:14:35.626 -->
00:14:50.683Back in 2008, I realized that it was really hard for clients with auditory processing to find clinicians in their area who were doing this work, and so I created an online searchable map where people could go on and find someone close to them.
00:14:50.683 -->
00:14:52.418I'll go ahead and plug that here.
00:14:52.418 -->
00:14:55.586It's APDSupportcom forward slash APD map.
00:14:55.586 -->
00:15:03.389Once again, apd like auditory processing disorder supportcom forward slash APD map.
00:15:03.389 -->
00:15:08.684On this map, you can enter your location and find the clinician nearest to you.
00:15:08.684 -->
00:15:10.107Who's doing this.
00:15:10.355 -->
00:15:15.725And when I first started the map in 2008, there were 250 providers worldwide.
00:15:15.725 -->
00:15:18.818So then I did an update of the map in 2018.
00:15:18.818 -->
00:15:22.187I was like, okay, here we go, let's see how many people are there.
00:15:22.187 -->
00:15:25.239Like some people had retired, some people had added their practice.
00:15:25.239 -->
00:15:26.761Guess how many people there were?
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00:15:35.041Blaise, 250 still Hadn't changed, won some, lost some, but the net difference was nothing.
00:15:35.041 -->
00:15:39.216So it was my goal to double that number in the next four years.
00:15:39.216 -->
00:15:45.548So as many as 300 million people worldwide who have auditory processing issues.
00:15:46.255 -->
00:16:01.722We say one out of every thousand children is born with permanent childhood hearing loss and we say that between five to 6% of the child population may have auditory processing issues.
00:16:01.722 -->
00:16:13.899So that's 50 to 60 times the rate of permanent childhood hearing loss, and there's only 200, well, now there's 400 of us worldwide doing auditory processing services.
00:16:13.899 -->
00:16:17.207But the great thing is that more people are testing younger.
00:16:17.207 -->
00:16:19.863They're not just testing at seven years of age.
00:16:19.863 -->
00:16:28.395There was this terrible bit of information which got misconstrued a long time ago and then taken for fact that we couldn't test before seven years of age.
00:16:28.395 -->
00:16:29.279It's total BS.
00:16:29.279 -->
00:16:35.836It's not true.
00:16:35.836 -->
00:16:37.642Most of the clinicians are testing earlier than seven.
00:16:37.642 -->
00:16:40.330They're testing and treating, and a majority of them are doing work over telepractice as well.
00:16:40.330 -->
00:16:47.154So a hundred percent of my work is over telepractice and let me tell you, march of 2020 was a total game changer.
00:16:47.154 -->
00:16:56.684I went from seeing almost all children with normal hearing sensitivity to seeing mostly adults with severe hearing loss.
00:16:56.684 -->
00:16:58.428So here we go.
00:16:58.995 -->
00:17:02.143The statistics are alarming, to say the least.
00:17:02.143 -->
00:17:09.340You had said that that would equate to about 300 million individuals who present with central auditory processing disorder.
00:17:09.340 -->
00:17:12.164So there's about what is it like?
00:17:12.164 -->
00:17:21.228315 million individuals in the United States, that's almost everyone in this country in the United States like presents with CAPD.
00:17:21.228 -->
00:17:25.219That is insane and we're not saying disclaimer.
00:17:25.219 -->
00:17:29.559It's not all 300 million in the United States that present with CAPD.
00:18:12.875 -->
00:18:17.326There's only 15 million normal people wandering the streets understanding what they hear.
00:18:17.326 -->
00:18:21.121All the rest of them are just eh, what Huh.
00:18:21.562 -->
00:18:35.257When I was in graduate school, one of my first clients presented with CAPD and I used some of Jack Katz's tools, thankful that my father had those, because they really did help me.
00:18:35.257 -->
00:18:38.805Because I'm, you know, mid-20s I'm like CAPD.
00:18:38.805 -->
00:18:47.479I've heard about this during dinner conversations but I don't know how to like treat this and you know I'll shout out Dr Susan Dillmuth-Miller.
00:18:47.479 -->
00:18:49.985She's the audiologist at East Stroudsburg University.
00:18:49.985 -->
00:18:52.050Shout out Dr Susan Dillmuth-Miller.
00:18:52.050 -->
00:18:53.774She's the audiologist at East Stroudsburg University.
00:18:53.774 -->
00:18:59.658She is so passionate not only about audiology but also CAPD and she taught us so much about it.
00:18:59.658 -->
00:19:07.058But to have the CATS tools really did help with this client and it was so amazing to see the improvement throughout the semester.
00:19:08.000 -->
00:19:37.467Angela, you have quite the voice in the hearing healthcare industry and the space in and of itself, and I've been following you on social media for a few years now and I saw that you recently met with Matt Hay, nina Krause, judy Hutch and a few other thought leaders in the hearing healthcare space, and whenever thought leaders like yourself get together, some amazing industry breakthroughs are often the result.
00:19:37.467 -->
00:19:42.881What can you share with us about this retreat slash get together, or is that confidential?
00:19:45.005 -->
00:19:47.259Let me just tell you there's going to be more to come.
00:19:47.259 -->
00:19:52.216However, let me give you a tasty little nugget, a little tidbit of information.
00:19:52.216 -->
00:19:57.828So first of all, matt Hay, who you've had on your podcast, loved that episode.
00:19:57.828 -->
00:19:59.678I listened to it in an airport once.
00:19:59.678 -->
00:20:00.459It was quite good.
00:20:00.459 -->
00:20:03.466So Matt Hay is a phenomenal person.
00:20:03.906 -->
00:20:21.020He was in college and had a hard time hearing on the phone, went and found out that his hearing was asymmetrical and as a result of that hearing test, he went and had an MRI done which just made him discover that he has neurofibromatosis type 2.
00:20:21.020 -->
00:20:30.687He gets these benign tumors on any nerve of his body and unfortunately, those tumors often like the auditory nerve.
00:20:30.687 -->
00:20:35.446So he had acoustic neuromas and he found out that, okay, he was going to lose his hearing.
00:20:35.446 -->
00:21:02.368It was kind of a slow process, so he taught himself he actually he didn't realize that he was creating the tools to help himself in the future, but he took 67 of his favorite songs and he played them on repeat to himself his little soundtrack of silence and kept listening to these songs over and over because he said if in the future he heard nothing, he wanted these songs stuck in his head.
00:21:03.094 -->
00:21:07.843One day he lost his hearing and they said we could do an auditory brainstem implant.
00:21:07.843 -->
00:21:23.261So they opened up his brainstem and implanted 12 electrodes where basically anytime sound is in his environment, it shocks his brainstem, which is perceived in his brain as sound.
00:21:23.261 -->
00:21:28.038Now they didn't expect that he was really going to understand what he was hearing.
00:21:28.038 -->
00:21:31.947They said you just will know that life noises exist.
00:21:31.947 -->
00:21:39.798And he said that when you're used to not hearing anything, even hearing an oven timer sounds like a choir of angels.
00:21:39.798 -->
00:21:43.111So basically we didn't expect him to understand what he heard.
00:21:43.412 -->
00:22:01.757But he started listening to that music, that soundtrack of silence, over and over again and pairing what he was hearing with what his brain remembered and he was able to, over 16 years, get up to 60% correct on hearing in noise sentences.
00:22:01.757 -->
00:22:04.228These were in quiet, though at a comfortable level.
00:22:04.228 -->
00:22:05.654So that is mind blowing.
00:22:05.654 -->
00:22:16.986First of all, we do not expect someone with an auditory brainstem implant to have that good of word recognition and at the point where he was implanted there were only 200 in the world.
00:22:16.986 -->
00:22:18.598That is just mind-blowing.
00:22:18.979 -->
00:22:20.625That's incredible, isn't it cool?
00:22:20.625 -->
00:22:22.599Matt Hay is amazing.
00:22:22.640 -->
00:22:34.279He is a legend, and that is the reason why Channing Tatum reached out to Matt and bought his life story to make a movie with Paramount Pictures about Matt Hayes' story.
00:22:34.279 -->
00:22:36.063He's just absolutely incredible.
00:22:36.063 -->
00:22:42.135So then last year he reached out to me on LinkedIn and he was like hey, angela, I see you're an audiologist in Australia.
00:22:42.135 -->
00:22:45.081You want a Redux Wink, wink.
00:22:45.081 -->
00:22:50.780And I'm like Hi, matt, my name is Angela and, yeah, I'm not really into that, but that's because I'm not dispensing.
00:22:50.780 -->
00:22:54.794Know, hi, matt, my name is Angela and, yeah, I'm not really into that, but that's because I'm not dispensing hearing aids in my practice.
00:22:54.794 -->
00:22:58.285I'm doing 100% auditory processing and 100% on telepractice.
00:22:58.285 -->
00:23:00.802And he was like well, could we still get together?
00:23:00.802 -->
00:23:05.799I have an auditory brainstem implant and I'm like let's do this, I would love to hear you.
00:23:05.799 -->
00:23:14.360So I met with him and I said can I do some of these tests that I would do on a child with normal hearing sensitivity?
00:23:14.360 -->
00:23:22.388And based on the results of that test, I said to Matt yo, I think there are some things we could do to optimize what you've got going on.
00:23:22.388 -->
00:23:24.475And he was like all right, I guess.
00:23:24.475 -->
00:23:37.363So we met once a week for 12 weeks we did auditory training and after that, for 12 weeks, we did auditory training and after that his word recognition score went up to 87% and 92% correct in quiet.
00:23:37.363 -->
00:23:41.596So he said, over 16 years he taught himself how to get 60% of the way.
00:23:41.596 -->
00:23:49.544And then in three months we worked together in kind of a coach-like way in an auditory training format and got him another 30%.
00:23:49.544 -->
00:23:52.346Wow, now that's in quiet, and we all know noise is.
00:23:52.346 -->
00:23:54.256Wow, now that's in quiet, and we all know noise is everywhere.
00:23:54.256 -->
00:23:55.221So that's more important.
00:23:55.401 -->
00:24:04.065But Matt reached out to Nina Krause, who is a world famous researcher at university of Northwestern, and he said hey, I know you love music.
00:24:04.326 -->
00:24:05.168I love music.
00:24:05.168 -->
00:24:15.079I taught myself how to understand with music and, as Nina Krauss and Carol Flexer say, we don't hear with our ears, we hear with our brains.
00:24:15.079 -->
00:24:20.217So Nina said Matt, you don't hear with your ears at all, you only hear with your brain.
00:24:20.217 -->
00:24:32.083She didn't actually say that, cause that would be like here explaining, but she was like I want to understand, I want to study your brain and I want to see how your brain is understanding what you hear.
00:24:32.083 -->
00:24:38.018And he was like yo, nina, I'd love to come to your lab, but I'm going to bring my friend Angela, is that okay?
00:24:38.018 -->
00:24:52.129And so I got looped into this conversation and on my birthday morning I woke up to a conversation between Matt Hay and Nina Krause over online and I started ugly crying.
00:24:52.129 -->
00:24:54.842I have never ugly cried before.
00:24:54.842 -->
00:25:00.062My tears were spraying out of my eyes because Nina was like you know what?
00:25:00.062 -->
00:25:06.065What you and Matt have done together is going to change the course of the hearing care industry.
00:25:07.254 -->
00:25:10.073That gives me goosebumps, angela, it's really exciting, I know.
00:25:10.073 -->
00:25:10.897Yo.
00:25:11.078 -->
00:25:13.495Oh my gosh, I'm not going to spray my eye water at you.
00:25:13.495 -->
00:25:20.339My, my husband was pretty sure my mom had passed away, but I was like no, that's incredible.
00:25:20.780 -->
00:25:23.388All right, I'm excited Then we went to Chicago.
00:25:23.829 -->
00:25:30.180Yeah, so we went to Chicago and we met up and we studied Matt's brain and to, to be continued, to be continued.
00:25:30.301 -->
00:25:37.190Oh, I'm so excited to hear, no pun intended, about what the results of that trip are going to be.
00:25:37.190 -->
00:25:49.983Matt Hay, incredible human being, puts family and friends number one, and then to link up with you, for you to use your gifts, help him, and then Nina Krause and the rest of the team.
00:25:49.983 -->
00:25:53.094This is like the audiology all-stars.
00:25:53.194 -->
00:25:58.606I think this is the issue is that a lot of people think that APD is only this one little thing.
00:25:58.606 -->
00:26:01.439Yes, but auditory processing is huge.
00:26:01.439 -->
00:26:03.504Let's say a person has hearing aids.
00:26:03.504 -->
00:26:04.847Hearing aids are like a bike.
00:26:04.847 -->
00:26:10.315Right, they're like a bike, but if you don't know how to ride a bike, you're not going to do very well.
00:26:10.315 -->
00:26:13.281Auditory processing is like the ability to ride a bike.
00:26:13.281 -->
00:26:20.685Do you think that a person who gets like a performance bike is going to do better than a person who gets a walmart bike?
00:26:20.685 -->
00:26:31.783If the person with the walmart bike actually has like an olympic level trainer, yeah, helping them with their walmart exactly ring, ring little bells with you there.
00:26:31.843 -->
00:26:32.125Angela.
00:26:32.125 -->
00:26:34.698Parents looking for answers.
00:26:34.698 -->
00:26:36.461What does treatment look like?
00:26:36.461 -->
00:26:39.788My child was just diagnosed with CAPD.
00:26:39.788 -->
00:26:41.637Now what I want?
00:26:41.637 -->
00:26:43.620An FM system in their classroom.
00:26:43.620 -->
00:26:51.864The school doesn't want to do that, so what does remediation and treatment look like for those with CAPD?
00:26:52.465 -->
00:26:53.287Yep, okay.
00:26:53.287 -->
00:27:06.089So there are both technical and non-technical options and I will be very honest with you that I have a bias toward using low-gain hearing aids for adults more than kids.
00:27:06.089 -->
00:27:14.080So let's say, in particular, you have a client who comes to your office and they have a high HHIA, but their audiogram is normal.
00:27:14.080 -->
00:27:28.202You can try hearing aids with them and look at the ROOP et al 2018 study to get the settings for the hearing aids, but it's basically 10 dB of gain from one to four for soft and medium inputs and nothing for loud sounds.
00:27:28.202 -->
00:27:29.784Just throwing that out there.
00:27:30.325 -->
00:27:37.861If you put these hearing aids on them, have them come back in a week's time and check their HHIA again.
00:27:37.861 -->
00:27:39.826Has it dropped?
00:27:39.826 -->
00:27:46.941Let's say, like I said before, the patient has an audiogram that's 15 across the board and an HHIA of 50.
00:27:46.941 -->
00:27:49.101There's a mismatch which is a red flag.
00:27:49.101 -->
00:27:50.144They need more help.
00:27:50.144 -->
00:27:53.435So let's say, you fit low gain hearing aids on them.
00:27:53.435 -->
00:27:58.979Boom, it's like up to 20 or something like that, where it's a lot closer together.
00:27:58.979 -->
00:28:02.248Then you've done your job and that's good enough.
00:28:02.248 -->
00:28:05.248If not, have them come back the next week.
00:28:05.248 -->
00:28:17.082Try a better level product, like a higher level product, or maybe add like a remote mic yes, then have them come back into the clinic again check again.
00:28:17.603 -->
00:28:19.349Has their HHIA dropped?
00:28:19.349 -->
00:28:23.439If it hasn't, you need to refer them on for APD testing.
00:28:23.439 -->
00:28:25.507You need to refer them on for treatment.
00:28:25.507 -->
00:28:33.208I would like for every single person in the world who has APD to have auditory training given by an individual audiologist.
00:28:33.208 -->
00:28:40.509I know that is not realistic, especially with only 500 audiologists eventually online doing this work.
00:28:40.509 -->
00:28:47.941However, I think we have to start measuring what the impacts are of our interventions.
00:28:47.941 -->
00:28:49.245Have we done enough?
00:28:49.245 -->
00:28:50.609And I don't think we've been doing that.
00:28:51.319 -->
00:29:03.429We've had adults come into the practice and they've only had pure tones bone conduction but no otoacoustic emissions, no tympanometry and no speech and noise testing.
00:29:03.429 -->
00:29:11.500And, to your point, patients can have normal hearing and then if you test their speech and noise, it's severe speech and noise scores.
00:29:11.500 -->
00:29:13.946So something's definitely not matching up.
00:29:13.946 -->
00:29:17.093Let's change gears to children specifically.
00:29:17.093 -->
00:29:20.985Parent is not sure what CAPD is.
00:29:20.985 -->
00:29:23.649Their child was just diagnosed with CAPD.
00:29:23.649 -->
00:29:28.103This news to a parent, number one, is scary.
00:29:28.103 -->
00:29:29.707What's going on with my child?
00:29:29.707 -->
00:29:32.052So I know this is sort of a loaded question.
00:29:32.052 -->
00:29:44.491How would you, with the 10,000-foot view, counsel these parents assist these children to ensure that they're better able to comprehend the world around them?
00:29:47.080 -->
00:29:47.763Ooh, I love it.
00:29:47.763 -->
00:29:57.912Okay, first of all, auditory processing disorder is a hopeful diagnosis because there's so much we can do about it as long as you work with the right people.
00:29:57.912 -->
00:30:02.429I'm not seeing clients myself, other than case studies right now.
00:30:02.429 -->
00:30:06.840So on that map clients myself other than case studies right now.
00:30:06.840 -->
00:30:08.283So on that map you can find people to help you with your child.
00:30:08.303 -->
00:30:16.475But auditory processing can co-occur with dyslexia, adhd, autism, brain injury.
00:30:16.475 -->
00:30:23.722There are a lot of different reasons why a person might have auditory processing and it can also co-occur with all these other things.
00:30:23.722 -->
00:30:28.431But unlike those other things, auditory processing is easier to change.
00:30:28.431 -->
00:30:29.854It's easier to improve.
00:30:29.854 -->
00:30:42.501So for me, I almost feel like everyone who gets a diagnosis of ADHD should also have an auditory processing test just to see how much of this is sensory and what can we improve from a sensory side.
00:30:42.501 -->
00:30:47.825That will also help with a behavior, and you know on that side of things.
00:30:48.988 -->
00:30:56.848Number one if you realize that your child might have auditory processing disorder, go get an auditory processing evaluation done.
00:30:56.848 -->
00:31:06.966Find a clinician who also does therapy, because those clinicians have a really clear understanding of what things can change and what the potential for improvement might be.
00:31:06.966 -->
00:31:11.691I also am a big fan of not putting a glass ceiling on top of children.
00:31:11.691 -->
00:31:33.261I have worked with children who have congenital brain anomalies, children with severe speech, children who are nonverbal, and the results that we have from auditory training training just really basic understanding of speech sounds can have huge, huge improvements throughout everything in the child's life.
00:31:33.261 -->
00:31:36.310It's amazing I sound like a crazy person talking like that.
00:31:36.620 -->
00:31:37.685Oh, I love it, it's passion.
00:31:37.779 -->
00:31:41.869It really is actually kind of miraculous For me.
00:31:41.869 -->
00:31:47.462If it's my kid, I would rather look into auditory training than devices.
00:31:47.462 -->
00:32:02.787But if you don't have the luxury of having someone near you who can do the auditory training or who is knowledgeable about this, then looking into devices can also be helpful, and there is some good research behind that as well.
00:32:03.239 -->
00:32:03.860I love it, angela.
00:32:03.860 -->
00:32:06.546I love the passion I so appreciate.
00:32:06.546 -->
00:32:10.302On behalf of the entire hearing healthcare industry, thank you for all that you're doing.
00:32:10.583 -->
00:32:11.487I'm nothing, man.
00:32:11.688 -->
00:32:12.531No, no, this is.
00:32:12.531 -->
00:32:24.669We love the Hearing Matters podcast because all of the guests that we have on it's like we've established such great professional relationships with and we're raising awareness of these best practices.
00:32:24.669 -->
00:32:25.611That's number one.
00:32:25.611 -->
00:32:31.649Because you go on Google and it's like whoa, there's a lot of misinformation out there.
00:32:31.649 -->
00:32:46.885And when you were saying to team up with an audiologist who treats CAPD, my hope one day is that the majority of hearing healthcare clinics, because hearing healthcare is more than just a hearing aid.
00:32:47.307 -->
00:32:47.488Yeah.
00:32:48.159 -->
00:32:59.519Just you know, throwing that out there, that there is an SLP speech language pathologist on staff who can assist with some of these services that are being administered.
00:32:59.519 -->
00:33:01.161The last question that we have for you this is a big question.
00:33:01.161 -->
00:33:04.365The last question that we have for you this is a big question.
00:33:04.365 -->
00:33:15.567Share with us the experience that you had with TEDx, because your TEDx video is absolutely incredible 13 steps in one click.
00:33:15.567 -->
00:33:23.490You are an inspiration to so many, so thank you for your strength and sharing your story and being vulnerable.
00:33:23.831 -->
00:33:25.545Thank you oh, my goodness, tedx.
00:33:25.545 -->
00:33:29.750So I've been on the TEDx journey for a very long time.
00:33:29.750 -->
00:33:37.432You get nominated or you are a total winker and you nominate yourself, which is what I did.
00:33:37.432 -->
00:33:48.363I nominated myself many years ago and I started down a journey and interviewed with one TEDx group and they said everyone in the world needs to hear this.
00:33:48.363 -->
00:33:49.967I'm like I know.
00:33:49.967 -->
00:33:51.550And then they ghosted me.
00:33:51.550 -->
00:33:55.686Oh, no, because, let's be honest, I wasn't ready.
00:33:55.686 -->
00:33:56.508I was not ready.
00:33:56.508 -->
00:33:59.481Everything I was sending to them they're like no, this is crap.
00:34:00.023 -->
00:34:05.213Any TEDx journey, if you're doing it right, is just completely full of rejection.
00:34:05.213 -->
00:34:10.509So I was rejected heaps and applied to other TEDxs in the area.
00:34:10.509 -->
00:34:17.175Ted talks are like they're like the unicorn, like Bill Gates and Oprah and whatnot and Brene Brown get.
00:34:17.175 -->
00:34:22.286Those TEDx are independently organized with much lower quality, thank God.
00:34:22.286 -->
00:34:36.626So I went for another TEDx and I applied to them two years ago and literally last year I wrote down in the next three to five years, I want to do a TEDx in my goal setting.
00:34:36.626 -->
00:34:42.722And four hours later I got an email asking if I would be interested in doing a TEDx.
00:34:42.722 -->
00:34:43.525That was in May.
00:34:43.525 -->
00:34:45.840Would I be ready to go in July?
00:34:45.840 -->
00:34:46.442Wow.
00:34:46.442 -->
00:34:48.425So I interviewed with them.
00:34:48.425 -->
00:34:49.588I threw it out there.
00:34:49.588 -->
00:34:50.810They did not ghost me.
00:34:50.810 -->
00:34:52.822I was not rejected that time.
00:34:52.822 -->
00:34:54.487Very surprising Actually.
00:34:54.487 -->
00:34:55.589I went into that interview.
00:34:55.589 -->
00:34:56.612I'm like you are not.
00:34:56.839 -->
00:35:10.786You are not rejecting me, I refuse, I am you are going to give me this opportunity now it is going to be at least okay, but my goal was to get between 4,000 and 5,000 views over the lifetime of that talk.
00:35:10.786 -->
00:35:23.846I was watching talks that had about those numbers, so I don't know if you Were we connected when my TEDx finally went up Because I was like it was almost like I was in labor.
00:35:23.846 -->
00:35:24.281It was climbing.
00:35:24.281 -->
00:35:26.311It was climbing the crazy thing was because I was like it was almost like I was in labor.
00:35:26.331 -->
00:35:27.135It was climbing Well it was climbing.
00:35:27.155 -->
00:35:30.984The crazy thing was I was like, okay, I know it's going to hit YouTube soon, it's going to hit YouTube soon.
00:35:30.984 -->
00:35:35.182I want to get you know like it would be cool to get a couple hundred views in the first day.
00:35:35.182 -->
00:35:35.902That would be sick.
00:35:35.902 -->
00:35:45.231And then I it's up and it had been up for 17 minutes and had 1700 views already and I almost fell on my chair.
00:35:45.231 -->
00:35:47.934And then now it's at like a little over a million.
00:35:48.516 -->
00:35:49.476Yeah, over a million.
00:35:49.616 -->
00:35:53.088I mean a million people know my daddy issues 2 million years.
00:35:53.108 -->
00:35:56.425That's wild 2 million years.
00:35:57.429 -->
00:36:03.112Oh, this just in 2 million years, and at least one auditory brainstem implant.
00:36:03.112 -->
00:36:05.489Cause Matt Hay also helped me write that speech.
00:36:06.099 -->
00:36:13.346Reading the comments and I love the fact that you submitted a comment from the speaker and so many people connected with you.
00:36:13.346 -->
00:36:16.347Thank you, this is one of the best talks that I've heard.
00:36:16.347 -->
00:36:18.929She speaks so clear and precise.
00:36:18.929 -->
00:36:23.391I'm like, yes, that's Dr Angela Alexander Mic drop.
00:36:23.579 -->
00:36:24.806Thank you so much, my friend.
00:36:25.340 -->
00:36:29.291Dr Angela, thank you so much for joining us on the Hearing Matters podcast.
00:36:29.291 -->
00:36:33.891For our listeners tuned in, where can they connect with you?
00:36:33.891 -->
00:36:39.051And please share the APD Institute website with us again.
00:36:39.051 -->
00:36:42.007We're also going to put that information in the show notes.
00:36:42.409 -->
00:36:43.070Fantastic.
00:36:43.070 -->
00:36:51.942So audiologists and speech language pathologists can be trained to do evaluation, if you're an AUD, or treatment, if you're an AUD or SLP.
00:36:51.942 -->
00:37:06.126Auditoryprocessinginstitutecom and then APDSupportcom is where you can find the APD map if you are a parent of an individual, or if you are an individual themselves who has auditory processing issues, with or without hearing loss.
00:37:06.126 -->
00:37:08.532Let's see what we can do to get your processing better.
00:37:09.099 -->
00:37:11.424You're tuned in to the Hearing Matters podcast.
00:37:11.424 -->
00:37:19.060Today we had Dr Angela Alexander join us talking all things central auditory processing disorder.
00:37:19.060 -->
00:37:22.163And until next time, hear life's story.
