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AN EVIDENCE BASED APPROACH TO ADD
VASILIKI (VIVIAN) MARIA ILIADOU ASSOCIATE PROFESSOR MEDICAL SCHOOL
An Evidence-Based Approach to APD
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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
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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
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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
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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
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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.
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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
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SUPPRESSION IS INFLUENCED BY THE TIME WINDOW ANALYSED, EAR TESTED
52 APD children
Abnormal SinB:Cutoff 1.33dB
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HIDDEN HL (COCHLEAR SYNAPTOPATHY) MORE VALID THAN APD? NO
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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.