SUMMARY Auditory training as part of an aural rehabilitation program was first Carol Lau introduced more than a quarter of a century ago to improve “rusty listening skills”. More contemporary auditory training techniques such as R-Aud, R-SLP, R-HIP dichotic listening training used to treat CAPD have not been readily adopted for use with the hearing impaired population, partly due to limitations related to peripheral hearing loss. This paper examines the use of staggered dichotic listening training (SDLT) in 3 adult subjects with both SUBJECT: MB FREQUENCY (Hz) 250 500 1000 2000 4000 8000 DISCUSSION CAPD and hearing loss. They completed a web-based program, CAPDOTS- Background Information SUBJECT: VS FREQUENCY (Hz) 250 500 1000 2000 4000 8000 Background Information  VS, 63yr old female teacher -10 Integrated™, based on SDLT. Results indicate significant recovery on  MB, 60yr old female Grade One All 3 subjects showed significant rating scale. All subjects reported improved diagnosed with a concussion after -10 0 behavioural test scores supported by self-reports of improved functioning teacher was involved in an MVA in improvements in dichotic listening abilities performance and where rating scales had 10 PURPOSE AND she fell off a ladder at school. 0 after completing C-I™: (1) overall test score been completed, a minimum of 3/5 was in natural listening environments. The study suggests that SDLT is not only 10 which she was rear-ended. 20  Moderate presbycusis, tinnitus and improvements were noted on dichotic reported for all questions. Where the feasible but may also be valuable for the hearing-impaired population. 20  Moderate, presbycutic hearing loss 30 METHODOLOGY reduced sound tolerance, CAPD 30 prior to accident, CAPD (auditory 40 listening tasks such as the Dichotic Digits or restitution of listening, attention and Further research investigating the use of SDLT as part of an aural (dichotic deficit) This study examines the utilization of 40 closure, dichotic deficit). 50 SCAN-3 Competing Words subtest; (2) understanding skills were intuitively rehabilitation program for appropriate individuals is strongly supported.  Failed return-to-work attempt due 60 SDLT using a web-based program, C-I™ in 50  Unable to continue teaching, improved performance on the poorer ear expected, surprising benefits related to 3 adults with co-morbid peripheral to errors and friction with 60 70 resulting in decreased interaural symmetry in improved communicative exchanges and

overwhelmed by class of 20 children LEVEL HEARING (dB HL) 80 hearing loss and CAPD, specifically a colleagues 70 both dichotic tests and in monaural low- smoother social relationships were made by HEARING LEVEL LEVEL HEARING (dB HL) 80 90 dichotic listening deficit. August January redundancy tests. Post-SDLT scores for the VS, with specific reference to reduced HEARING SCREENING Degree of Improvement 90 Test 100 QUESTIONNAIRE (per Dr 0 = none, 5 = most 2013 2014 100 110 most part fell within the normal or arguments or disagreements with her Prior to commencing C-I™, the subjects Frank Musiek) significant SCAN 3 FILTERED WORDS Figure 2: Audiogram MB, 60yr female teacher 110 borderline range for all 3 subjects. colleagues. INTRODUCTION Standard Score 1* 11* had been fitted with combination white Have you noted an Figure 3: Audiogram VS, 63yr female teacher 95% Confidence Interval 1 – 3 9 - 13 HEARING SCREENING Degree of noise/hearing aids as part of a Tinnitus improvement in 4/5 The improvements in behavioural test scores Limited hearing aid benefit, poor hearing aid Technological innovations in hearing aids Contemporary CAPD auditory training hearing/listening? Percentile Rank 1 63 QUESTIONNAIRE (per Dr Improvement SCAN-3 AUDITORY FIGURE-GROUND Frank Musiek) 0 = none, 5 = most Retraining Therapy (TRT) program. Once Has there been improvement in post-SDLT suggests that the training use and even rejection of amplification may have made phenomenal strides in paradigms like dichotic listening training 3/5 Test July 2011 October 2012 Standard Score 1* 6* significant sound tolerance had improved following directions? DICHOTIC DIGITS TEST technique may be as efficacious in the result from an underlying central processing mimicking cochlear function to address the for those with deficits in dichotic listening, 95% Confidence Interval 1 - 3 3 - 9 Have you noted an Has communications been RGT (n > 90%) 45% 92.5% significantly, the subjects commenced C- 4/5 Percentile Rank 1 9 improvement in 3/5 hearing-impaired population as that reported deficit in the elderly. The positive test effects of peripheral hearing loss. Not as binaural integration/separation or atypical easier? LFT (n > 90%) 70% 97.5% I™ from home. Average treatment time SCAN-3 COMPETING WORDS hearing/listening? in the literature for normal hearing findings provide impetus to explore the use successful, however, has been the ability to interaural symmetries have become Has there been academic Table 4: Pre- and post- C-I™ test scores for VS showing Standard Score 1* 12* Has there been improvement in was 10 weeks and conducted 5 days a N/A 4/5 individuals. The results support the use of C- of SDLT in those with CAPD from head address the resultant auditory processing increasingly popular4. Successful use of improvement? improvement to within normal range bilaterally and improved 95% Confidence Interval 1 - 3 10 - 14 following directions? interaural symmetry. Training conducted with patient’s own Percentile Rank 1 75 week, 30 minutes per day. Two of the 3 Has there been a decrease in Has communications been I™ both with and without hearing aids in mild injuries, Alzheimer’s Dementia and the deficits due to the peripheral hearing loss. dichotic listening training has been 4/5 hearing aids and Bluetooth streaming. SCAN-3 COMPETING SENTENCES 4/5 subjects used their hearing aids together asking to repeat? easier? Standard Score 4* 9* and moderately hearing-impaired individuals elderly. Callosal relay, cortical attention and Specifically, impaired dichotic listening has reported in individuals with CAPD and Has misunderstandings in with stereo Bluetooth streaming during 5/5 95% Confidence Interval 3 - 5 8 - 10 Has there been academic with diagnosed dichotic deficits. mental flexibility which are affected by 5-8 communication decreased? 4/5 been correlated with decreased mental normal hearing abilities , with VS joked that her friends and colleagues no Percentile Rank 2 37 improvement? 1 their auditory training. Incorporating the subjects’ hearing aids using dichotic listening weaknesses may be flexibility . Left ear deficits on dichotic generalized improvements into natural Has attention span increased? 3/5 longer got so angry, frustrated or annoyed with 60% WIPI Has there been a decrease in 4/5 Has hearing in background RGT (norm > 80%) 60% 80% asking to repeat? stereo Bluetooth streaming is instinctively improved with SDLT. Such improvements tasks have also been found in the elderly listening environments, academic The subjects were reassessed following 3/5 her since completing C-I™. She attributed this to noise improved? LFT (norm > 80%) 48% 80% 9 a decrease in misunderstanding and better self- Has misunderstandings in useful in allowing the subject to train with could enhance hearing aid prognosis and and those with Alzheimer’s Dementia performance and attention control . auditory training. Subjective perspectives DICHOTIC DIGITS TEST 4/5 Has the level of alertness, communication decreased? 5/5 awareness and alertness of the surrounding RGT (n > 90%) 67.5% 100% the very instrumentation that they would use usage, with long-term benefits as patients which were postulated to be due to on their own behavioural changes and responsiveness improved? Has attention span increased? 4/5 Hearing loss presents a challenge for relationship dynamics. LFT (n > 90%) 62.5% 100% in their natural environment. continue to use their hearing aids long after cortical attention network insufficiencies, personal performance in natural listening Has hearing to understand TV, Has hearing in background typical dichotic listening training programs 4/5 Table 2: Comparison of pre- and post- C-I™ test scores for 3/5 completing C-I™. callosal atrophy and increased subcortical environments were also obtained. radio and phone improved? noise improved? Post-SDLT test scores also correlated with the which utilize interaural loudness intensity MB showing significant improvements to within normal 2 Table 5: VS self-report ratings of improvement following Has the level of alertness, white matter lesions . CAPDOTS-Integrated™ training range except for monaural auditory figure-ground 4/5 subjects’ own reports and improvement differences – in particular if the hearing perception which lies within the borderline range. responsiveness improved? Training completed with patient’s own hearing aids using Has hearing to understand TV, Central Auditory Processing Disorders loss is asymmetrical. A staggered dichotic 3/5 April December Bluetooth streaming. radio and phone improved? (CAPD) has mostly evolved separately from listening training (SDLT) approach allows Test 2014 2014 Table 3: MB self-report ratings of improvement following our understanding of peripheral hearing for different timing onsets with balanced SUBJECT: CS FREQUENCY (Hz) MB was extremely pleased with the CONCLUSION 250 500 1000 2000 4000 8000 SCAN-3 AUDITORY FIGURE-GROUND C-I™ training. loss and hearing aids. Aural rehabilitation interaural loudness levels thereby RESULTS Standard Score 8* 10* outcome of her treatment and reported that The study supports the use of SDLT in the form of C-I™ in adults and CAPD auditory training developed in neutralising the effects of hearing loss and -10 95% Confidence Interval 5 - 11 7 - 13 she felt “almost normal”, referring to her Background Information Percentile Rank 25 50 with comorbid hearing loss and CAPD. These findings suggest parallel with much the same tenents possible hearing asymmetries10. There was 0 pre-accident status. She continues to be a  CS, 38yr old male suffered blow to 10 full-time user of amplification. applied to different populations – the also early speculation on the use of SDLT in SCAN-3 COMPETING WORDS (FR) that the presence of a mild or moderate peripheral hearing loss right side of his head in an industrial 20 Standard Score 5* 12* hearing-impaired and those with normal the hearing-impaired population9. explosion. 30 95% Confidence Interval 3 - 7 9 - 15 does not preclude individuals from participating in SDLT where hearing respectively. The existence of CAPDOTS-Integrated™ (C-I™) is an online Percentile Rank 5 75  Noise-induced hearing loss, tinnitus, 40 dichotic deficits are suspected. Further research investigating comorbid hearing loss and CAPD has been CAPD therapy program that provides 50 hyperacusis, CAPD (dichotic NU-#6 FILTERED WORDS CS reported that his colleagues no longer needed to “talk close to his ear” and that he the use of SDLT as part of an aural rehabilitation program for acknowledged more recently3. This has led intervention for dichotic listening deficits 60 listening deficit), post-traumatic RGT (norm > 78%) 80% 92% was picking up conversations more quickly. CS also shared that prior to the accident, to increased interest in applying CAPD using SDLT. 70 LFT (norm > 78%) 64% 78% appropriate individuals is strongly supported. stress disorder, anxiety depression LEVEL HEARING (dB HL) 80 he had played weekly Scrabble with a friend for many years but since the accident, his based auditory training to the hearing- after accident. 90 TABLE 1: Comparison of pre- and post- C-I™ test scores for CS scores had been so poor that his friend no longer wanted to continue the tradition. DISCLOSURE: Carol Lau is the designer and owner of CAPDOTS™ (CAPD Online Therapy System) used in this study. impaired population. 100 showing improvements to within normal range. Training was Since completing C-I™, CS joked that his scores had now improved back to pre-accident completed without hearing aids, headphones were adjusted to 110 levels and that this weekly game had since resumed. Figure 1: Audiogram CS, 38yr old male (elevated) comfortable loudness levels.

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