To Your Health!
Diagnosing Auditory Processing Disorders in People with Mild TBI and PTSD
By Rachel A. R. Porter
Auditory Processing Disorder (APD) is a condition that affects the brain’s ability to comprehend, filter and interpret sounds. It is not a form of hearing loss and is instead related to how the brain perceives sound and processes meaning. Acquired Auditory Processing Disorder - APD that occurs as a result of injury or trauma - is common among both patients diagnosed with traumatic brain injury (TBI) and those diagnosed with Post-Traumatic Stress Disorder (PTSD). In patients who are diagnosed with both TBI and PTSD, it can be difficult for doctors to identify the underlying cause of APD. Both TBI and PTSD can independently lead to symptoms consistent with an APD diagnosis and it is unclear if having TBI and PTSD concurrently increases the likelihood of developing APD. It is also possible to develop APD years after being diagnosed with TBI and/or PTSD. For this reason, it is critical that the auditory processing function of patients with TBI is monitored closely immediately following diagnosis and steadily throughout short and long term recovery.
In an ideal world, patients who experience concurrent TBI and PTSD would have integrated care teams comprised of primary care physicians, psychologists, psychiatrists, neurologists, neuropsychologists, audiologists, ear, nose and throat specialists and when appropriate chronic pain specialists, chiropractors, orthopedists and surgeons. In the real world, patients are left to assemble and coordinate these teams by themselves, often limited by finances and resources and the nature of the conditions themselves. Mild TBIs (mTBI) account for 75-85% of cases and for a long time were not considered to be injuries with long-term effects. Clinicians know now that symptoms can appear throughout a person’s life post-TBI and when mTBI is sustained under psychologically traumatic circumstances patients are more likely to develop PTSD. Too often mTBI (also known as concussion) lands a patient in the emergency room where they are quickly diagnosed and discharged with little insight into the realities of post-concussive syndrome or related conditions - like APD - that could emerge over time. For these reasons, many patients do not receive the care they need and APD can be left undiagnosed, untreated or misattributed for years.
APD profoundly impacts a person's life. The five types of APD are Hypersensitivity, Decoding, Integration, Prosodic and Organizational. Hypersensitivity to sound which is diagnosed as misophonia (physical reactions to sound) or hyperacusis (sensitivity and pain in response to even low decibel sounds) can lead to phonophobia (fear of sound) and is a well documented symptom of some PTSD patients. Patients with hypersensitivity may begin to isolate and avoid social environments which can exacerbate symptoms of depression and anxiety both of which are associated with TBI and PTSD. While the relationship between APD and PTSD may be more familiar to nonmedical audiences (for example the often observed exaggerated startle response in PTSD patients) it is important to note that over 50% of TBI patients are at risk for developing APD.
The burden of pushing for an APD diagnosis (and obtaining necessary treatment, support and relief) should not be a patient’s responsibility, especially patients who are already dealing with mTBI and PTSD diagnosis. mTBI and PTSD share many symptoms such as headaches and difficulty concentrating, irritability, anxiety, depression, and sensitivity to noise and light. While some of these symptoms can be treated non-specifically for others the epidemiology (why something is happening) needs to be discovered - this is particularly necessary for the treatment of PTSD related symptoms.
It is important to remember that mTBI, PTSD and APD can all be experienced as invisible disabilities. This means that some patients may present as outwardly able-bodied. This makes it even easier for a doctor to overlook asking questions about auditory processing. Additionally 80% of TBIs cannot be seen on an MRI or CT scan making TBI actually “invisible” to doctors and leaving them with only behavioral and emotional testing to diagnose. Unfortunately given the nature of medical specialization and the reality of medical silos, symptoms can be easily missed and the proper specialists never notified. This is even more likely when a patient might be struggling themself to make sense of and articulate an unfamiliar and new experience.
If you are reading this and you or your loved one is experiencing mTBI, PTSD, APD or some combination, know that you do not have to accept a lifetime of disruptive, debilitating and painful symptoms. The medical system is not built to make getting the help you need easy, but by asking your doctor how to find the cause of your APD you can increase the likelihood that you will be referred to the specialist you need to help you find the right treatment path for you.
Rachel A. R. Porter (she/her) is the Co-Founder of Kneading Change LLC, a liberation-focused consulting and facilitation practice. She is the former Editor-In-Chief of Rematriation -an Indigenous women led media project – and has consulted for numerous climate justice nonprofits. Rachel earned her B.A. from Middlebury College and M.A. in Law and Diplomacy from Tufts University. Rachel is a caregiver and patient advocate who is passionate about increasing patient access to resources related to mental health care, chronic pain relief and reproductive justice. She is currently pursuing a M.F.A. in Creative Nonfiction at the Institute of American Indian Arts. Rachel is a Senior Contributor at Today’s Patient.
November 2022 page 3