Acquired Central Auditory Processing Disorder in Service Members and Veterans.

Victoria Tepe,Shoshannah Russell,Nina Pryor,M Samantha Lewis,Lisa Guillory,Melissa Papesh

doi:10.1044/2019_jslhr-19-00293

Abstract

Purpose A growing body of evidence suggests that military service members and military veterans are at risk for deficits in central auditory processing. Risk factors include exposure to blast, neurotrauma, hazardous noise, and ototoxicants. We overview these risk factors and comorbidities, address implications for clinical assessment and care of central auditory processing deficits in service members and veterans, and specify knowledge gaps that warrant research. Method We reviewed the literature to identify studies of risk factors, assessment, and care of central auditory processing deficits in service members and veterans. We also assessed the current state of the science for knowledge gaps that warrant additional study. This literature review describes key findings relating to military risk factors and clinical considerations for the assessment and care of those exposed. Conclusions Central auditory processing deficits are associated with exposure to known military risk factors. Research is needed to characterize mechanisms, sources of variance, and differential diagnosis in this population. Existing best practices do not explicitly consider confounds faced by military personnel. Assessment and rehabilitation strategies that account for these challenges are needed. Finally, investment is critical to ensure that Veterans Affairs and Department of Defense clinical staff are informed, trained, and equipped to implement effective patient care.

Highlights

A growing body of evidence suggests that military service members and military veterans are at risk for deficits in central auditory processing
While the risk of hearing loss due to noise exposure and damage to peripheral auditory structures is well established, accumulating evidence suggests that service members and military veterans may be at risk for central auditory aDepartment of Defense Hearing Center of Excellence, JBSA Lackland, TX bThe Geneva Foundation, Tacoma, WA cVA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs (VA) Portland Health Care System, OR dDepartment of Otolaryngology—Head & Neck Surgery, Oregon Health & Science University, Portland eWalter Reed National Military Medical Center, Bethesda, MD fHenry Jackson Foundation, Bethesda, MD gSchool of Audiology, Pacific University, Hillsboro, OR hAir Force Research Laboratory, Wright-Patterson Air Force Base, OH iHarry S
Research to date has rarely focused on central auditory processing disorder (CAPD) in service members and veterans, available findings suggest that auditory deficits in this population may be linked to high-intensity blast exposure (Fausti et al, 2009; Gallun, Lewis, et al, 2012; Saunders & Echt, 2012), neurotrauma (Lew et al, 2007; Oleksiak et al, 2012), prolonged exposure to hazardous noise (Helfer et al, 2011; 1This study was approved by the institutional review board of the VA Portland Health Care System (Study ID 4345)

Summary

Introduction

A growing body of evidence suggests that military service members and military veterans are at risk for deficits in central auditory processing. The VA-DoD CAPD working group has defined its population of interest to include service members and veterans whose audiometric thresholds are consistent with an “H1” hearing status profile2 but who have functional symptoms and perform worse than expected on behavioral tests of central auditory processing (see Figure 1).

Results

Conclusion