CAPD terminology (Audi says I'm "hearing impaired.") - Page 3

joycem137 · 12-10-2011, 01:51 AM

Quote:

Originally Posted by Jazzberry

For most people in Joyce's situation, a minor high frequency loss would probably be the reason for her listening difficulties.

Randomly, I actually do have a minor loss in a very high frequency. I haven't gotten my report from Dr. Paton yet, but she said that it was so high and so minor that I probably wouldn't have noticed it.

dogmom · 12-10-2011, 07:53 AM

Dr. Paton's was one of the sites I've been looking at about CAPD!

jillio · 12-10-2011, 10:57 AM

Quote:

Originally Posted by Bottesini

http://openlearn.open.ac.uk/mod/ouco...72&section=7.3

This is why I stated that the cochlea, and the cochlear nucleus were being confused. The claim was that the auditory cortex sent signals back to the cochlea. The cochlear nucleus is located in the brainstem. Therefore, once the stimulus has reached the brain, it does not descend back into the inner ear structure of the cochlea. It remains in the brain. It does not descend into any of the structures of the ear. However, the stimulus does ascend from the ear into the brain. Therefore, the cochlea is involved only in the ascent of stimulus.

jillio · 12-10-2011, 10:58 AM

Quote:

Originally Posted by joycem137

Randomly, I actually do have a minor loss in a very high frequency. I haven't gotten my report from Dr. Paton yet, but she said that it was so high and so minor that I probably wouldn't have noticed it.

Unless you were trying to hear a dog whistle.

**Bottesini** · 12-10-2011, 11:08 AM

Quote:

Originally Posted by jillio

This is why I stated that the cochlea, and the cochlear nucleus were being confused. The claim was that the auditory cortex sent signals back to the cochlea. The cochlear nucleus is located in the brainstem. Therefore, once the stimulus has reached the brain, it does not descend back into the inner ear structure of the cochlea. It remains in the brain. It does not descend into any of the structures of the ear. However, the stimulus does ascend from the ear into the brain. Therefore, the cochlea is involved only in the ascent of stimulus.

Glad we could clear that up. We now know how descending auditory pathways actually work!

jillio · 12-10-2011, 11:11 AM

Quote:

Originally Posted by Jazzberry

My post were influenced by another issue. In general, when someone has an uncommon physical issue, what can they do to make sure that they have received a satisfactory diagnosis and good advice?

Use an expert in the field. That is what she has done.

In the USA, in this day and age and under most existing insurance plans, I think its unlikely that one will be "overtested." Medical appointments tend to be very short and we can see from forums like this one that people find it very beneficial to get additional information from others besides their doctors. In the current health system, it appears that most doctors simply don't have the time to really inform their patients.

Most are not terribly concerned about insurance coverage if they are in the habit of overtesting. A doctor will comply if a patient insists on further testing. It isn't like this audi has recommended further testing. Further testing would come at the patient's request.

It can also be easy to end up with a wrong advice, a wrong diagnosis, misinformation, dated information, etc.

It can also be easy to suspect that, particularly when it is a case on which you do not have detailed information or less that accurate understanding of the information which you do have.

One of the things that have worked for me is to try to find out what diagnosis tools are available to the health professional and why they choose to use the ones that they do. What are the likely diagnoses, how would the treatment differ from the various possibilities, how does one know when to stop the diagnosis process?

You have recommended tools that are not considered effective for the diagnosis of CAPD. Just because a tool is available does not mean it is indicated for use in all cases.

Hearing loss has not been my only issue. I have non-optimally designed knee joints that haven't held up to sports injuries and another boring issue that is off topic to this forum. I've found that when I've been proactive in my health issues I've ended up with much better care. The way I've been proactive is by doing some research, asking other people with similar histories about their experiences, and asking my doctors and other health care professionals carefully considered questions.

There is nothing to indicate that this poster is not being proactive. There is a difference between being proactive and second guessing.

Reading between the lines in Joyce's posts, I wouldn't be surprised if she could confirm that getting to this point, a CAPD diagnosis, was not easy for her to get.

Of course it wasn't. It is a rare diagnosis, and all other possibilities are generally looked at prior to coming up with a CAPD diagnosis. That is why it is silly to suggest that it is a "wrong diagnosis" and that further testing should be done to confirm.
But now she has it, and this gives her better information to figure out how to make some listening situations easier for her.

The diagnosis in and of itself doesn't give her that information. The treatment following the diagnosis will do that.

--

Sometimes I like to use examples. Lets pretend that Joyce lived out in the boondocks somewhere and her only local option was to go to a poorly informed and overlooked-by-state regulators retailer who owned a combo eyeglasses/hearing aid store.

That is not the case here. Hypotheticals are useless.

He could say -- "Well since you have trouble listening its likely that you have a minor high frequency loss. I'll let you try out these aids for a month and if you like them, keep them. If you don't, we'll try something else."
(Unfortunately, I've heard of crazier stories.)

Again, hypotheticals are useless. Let's stick to what is actually going on in this case.

For most people in Joyce's situation, a minor high frequency loss would probably be the reason for her listening difficulties. But would it be a good idea for her to try the retailer's solution? Obviously not. A poor fitting hearing aid can damage existing hearing and not running tests to diagnose the cause of her symptoms has the possibility of putting her health in serious jeopardy.

I think that is why if we can, we are all better off looking into what information is available.

Based on Joyce's posts, it seems she has done this. Even though there are no standardized tests for C/APD diagnosis and her audiologists didn't opt to give her more of the ones that are available -- it appears that Joyce has looked into it enough that its very unlikely that there is another cause that could be the source of similar symptoms. Following suggestions on how to make it easier to hear in noisy situations is not going to harm her and can only help her.

If she were receiving those suggestions, that would be true.

jillio · 12-10-2011, 11:18 AM

Quote:

Originally Posted by Bottesini

Glad we could clear that up. We now know how descending auditory pathways actually work!

Yes, we do. They stay withing the brain and do not descend back into the cochlea. But then, most neuronal pathways, once reaching the brain, will both ascend to specific areas, and descend to specific areas. That does not mean, however, that they descend back to the point of received stimulus. For instance, if you burn your finger, the receptors in the finger responsible for transmitting the specific type of pain stimulus you have experienced will follow the pathways into the brain all the way to the area responsible for processing the experience of pain, and once it is recognized as pain from that processing, travel back to the brainstem where muscles are told to contract and move away from the source of the pain. However, that pathway does not descend all the way back to the finger.

Since the auditory pathways include everything from the outer ear to the areas specific to the auditory cortex, it is incorrect to say that they are descending. They only descend localized to one part of the auditory pathway; the brain. The do not descend back into the inner ear, or the cochlea.

**TXgolfer** · 12-10-2011, 11:36 AM

Quote:

Originally Posted by jillio

Yes, we do. They stay withing the brain and do not descend back into the cochlea. But then, most neuronal pathways, once reaching the brain, will both ascend to specific areas, and descend to specific areas. That does not mean, however, that they descend back to the point of received stimulus. For instance, if you burn your finger, the receptors in the finger responsible for transmitting the specific type of pain stimulus you have experienced will follow the pathways into the brain all the way to the area responsible for processing the experience of pain, and once it is recognized as pain from that processing, travel back to the brainstem where muscles are told to contract and move away from the source of the pain. However, that pathway does not descend all the way back to the finger.

Since the auditory pathways include everything from the outer ear to the areas specific to the auditory cortex, it is incorrect to say that they are descending. They only descend localized to one part of the auditory pathway; the brain. The do not descend back into the inner ear, or the cochlea.

Link?

jillio · 12-10-2011, 11:44 AM

Quote:

Originally Posted by TXgolfer

Link?

Some people use more than the internet for information. You want the names of the numerous textbooks I used to gain this information? Will you actually obtain and read those textbooks? I think not. Trolling again.

**TXgolfer** · 12-10-2011, 12:00 PM

Quote:

Originally Posted by jillio

Some people use more than the internet for information. You want the names of the numerous textbooks I used to gain this information? Will you actually obtain and read those textbooks? I think not. Trolling again.

Perhaps your textbooks are outdated.

Quote:

Recent Findings on Efferent Synapses
In addition to sending information to the brain, the inner ear is subject to feedback regulation from the brain. Neurons in the superior olivary complex of the brainstem send axons out to the cochlea where they release the neurotransmitter acetylcholine to inhibit mechanosensory hair cells. By recording from individual hair cells during this inhibitory process, we have shown that their acetylcholine receptors are related to the nicotinic receptors found in skeletal muscle, but with quite unusual pharmacology.

Surprisingly, while acetylcholine excites skeletal muscle via its nicotinic receptors, hair cells are inhibited by theirs. Calcium ions play a central role in nicotinic inhibition, serving as a second messenger to activate potassium channels that hyperpolarize the hair cell. The molecular mechanisms underlying these native inhibitory processes may provide candidate approaches for therapeutic intervention.

Recent Findings on Efferent Synapses, Cochlear Neurotransmission Group

jillio · 12-10-2011, 12:10 PM

Quote:

Originally Posted by TXgolfer

Perhaps your textbooks are outdated.

Recent Findings on Efferent Synapses, Cochlear Neurotransmission Group

No, my textbooks are not outdated. I understand what you have posted. I also know that you are misinterpreting what you have posted based on a basic lack of understanding of the neurological process. When you can explain this copy and paste in your own words, thus demonstrating understanding, we will have something to discuss. Until then, I will not waste my time explaining something to someone whose only intent is to use the net to find things they think contradict my posts, but don't actually. Again, trolling. You should be ashamed of yourself for hijacking yet another thread with your pettiness.

**TXgolfer** · 12-10-2011, 12:12 PM

Quote:

OHCs receive a prominent efferent innervation from the brainstemthat is predominantly cholinergic (for review, see Warr, 1992).
Electrical stimulation of the olivocochlear (OC) efferent fibers
suppresses sound-evoked afferent discharge within 100 msec (Galambos,
1956). This fast effect is thought to arise from the hyperpolarization
of OHCs, which decreases their amplification of
basilar membrane motion, and hence decreases stimulation of the
inner hair cells. Recently, we have reported an additional slower
suppression of sound-evoked auditory nerve activity that is also
efferent-mediated (Sridhar et al., 1995). This slow effect has a
much longer time course, building up and dissipating over tens of
seconds. Whereas the fast effects modulate the coding of acoustic
information by the cochlea, the slow effect may have an additional
action of protecting the OHCs from trauma attributable to acoustic
overstimulation (Reiter and Liberman, 1995).

http://www.jneurosci.org/content/17/1/428.full.pdf

jillio · 12-10-2011, 12:16 PM

Quote:

Originally Posted by TXgolfer

http://www.jneurosci.org/content/17/1/428.full.pdf

And again, when you can put this in your own words, thus demonstrating understanding, we will have something to discuss. Because what you think you are doing is not what you are accomplishing at all. That happens when you don't understand what you are copying and pasting.

You will not that you always have to ask me for a link because I do not have to copy and paste. I have the information available and it is posted in my own words. Only those that have no understanding are constanting searching the web for something to copy and paste. The problem with that is, it is obvious that they don't comprehend that which they are copying and pasting.

Again, you should be ashamed of yourself for hijacking another thread with your pettiness.

**TXgolfer** · 12-10-2011, 12:25 PM

Quote:

Originally Posted by jillio

And again, when you can put this in your own words, thus demonstrating understanding, we will have something to discuss. Because what you think you are doing is not what you are accomplishing at all. That happens when you don't understand what you are copying and pasting.

You will not that you always have to ask me for a link because I do not have to copy and paste. I have the information available and it is posted in my own words. Only those that have no understanding are constanting searching the web for something to copy and paste. The problem with that is, it is obvious that they don't comprehend that which they are copying and pasting.

Again, you should be ashamed of yourself for hijacking another thread with your pettiness.

No pettiness at all. As always you are welcome to your opinion.

jillio · 12-10-2011, 12:33 PM

Quote:

Originally Posted by TXgolfer

No pettiness at all. As always you are welcome to your opinion.

So I guess it can be safely assumed that you are not going to be putting your copy and pastes into your own words to demonstrate understanding so that a discussion can actually take place.

And then you claim no pettiness. Right.

Your intent is obvious. But on the off chance that I have misjudged your intent, I will be happy to discuss neurological processes with you as soon as you demonstrate understanding of the basics.

**TXgolfer** · 12-10-2011, 12:39 PM

Quote:

Originally Posted by jillio

So I guess it can be safely assumed that you are not going to be putting your copy and pastes into your own words to demonstrate understanding so that a discussion can actually take place.

And then you claim no pettiness. Right.

No, I don't intend to play games here. If you care to disprove the links provided by me and Jazzberry that's cool. If not that is cool too. No biggie to me either way.

**Beowulf** · 12-10-2011, 12:50 PM

Quote:

Originally Posted by joycem137

It sounds similar to what I was thinking. I'll avoid using the "HoH" reference.

Since you sound interested, I'll share the explanation for my problem that my audi gave me. Apparently, people without my particular flavor of CAPD have a sort of filter in their brainstem area that is capable of amplifying "important" sounds while quieting "unimportant" sounds. In a noisy situation, it can amplify the sounds of people's speech to be louder than the surrounding noise, even if they are actually of equal volume.

But in me, that filter doesn't work quite right. As a result, the problem isn't that I don't hear enough, it's that I hear to much. I'm hearing all of the sound information, unimportant and important, at unmodified volume levels. It means I have to work much harder to pick out the "important" sounds like speech from the "unimportant" background sounds.

I guess it is a neurological disorder. The audi suspects that it is a result of brain damage due to temporary oxygen deprivation during my birth. My umbilical cord wrapped around my neck and suffocated me during birth, and I wasn't breathing for a short while. Not bad enough to cause serious damange, but enough to permanent damage my ability to process sound.

Hmmm. I do not think it is the brain stem damage, because I have the same problems you do, and I became deaf when a drug given to combat my pneumonia at age two destroyed the nerves in my ears. Interesting theory, anyway. Maybe we can postulate that lack of oxygen killed the nerves in your case?

joycem137 · 12-10-2011, 12:52 PM

Quote:

Originally Posted by jillio

Unless you were trying to hear a dog whistle.

I'm going to miss listening to dog whistles...

**Beowulf** · 12-10-2011, 12:55 PM

Quote:

Originally Posted by joycem137

I'm going to miss listening to dog whistles...

That's the feedback from my hearing aid.
Yikes, tell the others I am wanted in the ER.

joycem137 · 12-10-2011, 01:16 PM

Quote:

Originally Posted by Beowulf

Hmmm. I do not think it is the brain stem damage, because I have the same problems you do, and I became deaf when a drug given to combat my pneumonia at age two destroyed the nerves in my ears. Interesting theory, anyway. Maybe we can postulate that lack of oxygen killed the nerves in your case?

From what I understand, many people with hearing loss have many of the same sorts of issues as me. As background noise increases, the ability to understand people diminishes rapidly. Telephones present a challenge, particularly when dealing with a person you don't know or a context you're unfamiliar with. And don't bother trying to get our attention using an auditory cue. We'll just sit there, oblivious to your attempts. So on and so forth.

I understand, however, that people with actual hearing loss as opposed to processing issues have additional problems that go beyond my problems.

EDIT: I should add that although we might have the same issues, presumably they are for different reasons. To be honest, I don't really understand all this stuff very well and am very pleased to be reading things like jillio and the others arguing about some of the underlying science, even if I don't understand all of it.

jillio · 12-10-2011, 01:17 PM

Quote:

Originally Posted by joycem137

I'm going to miss listening to dog whistles...

**Beowulf** · 12-10-2011, 01:19 PM

Quote:

Originally Posted by joycem137

From what I understand, many people with hearing loss have many of the same sorts of issues as me. As background noise increases, the ability to understand people diminishes rapidly. Telephones present a challenge, particularly when dealing with a person you don't know or a context you're unfamiliar with. And don't bother trying to get our attention using an auditory cue. We'll just sit there, oblivious to your attempts. So on and so forth.

I understand, however, that people with actual hearing loss as opposed to processing issues have additional problems that go beyond my problems.

Oh yes, indeed. I am constantly at a Jimi Hendrix concert. Arghhh.

**Bottesini** · 12-10-2011, 01:54 PM

Quote:

Originally Posted by joycem137

From what I understand, many people with hearing loss have many of the same sorts of issues as me. As background noise increases, the ability to understand people diminishes rapidly. Telephones present a challenge, particularly when dealing with a person you don't know or a context you're unfamiliar with. And don't bother trying to get our attention using an auditory cue. We'll just sit there, oblivious to your attempts. So on and so forth.

I understand, however, that people with actual hearing loss as opposed to processing issues have additional problems that go beyond my problems.

EDIT: I should add that although we might have the same issues, presumably they are for different reasons. To be honest, I don't really understand all this stuff very well and am very pleased to be reading things like jillio and the others arguing about some of the underlying science, even if I don't understand all of it.

You should be a happy member here for years to come, then!

**deafskeptic** · 12-10-2011, 02:04 PM

Quote:

Originally Posted by joycem137

I'm going to miss listening to dog whistles...

kokonut · 12-10-2011, 03:54 PM

I like this link. Sums it up nicely about the auditory pathways. The human body is an amazing thing!
The Ear & Auditory Pathways

Jazzberry · 12-10-2011, 04:15 PM

Quote:

Originally Posted by Anij

I just thought I would add some additional information regarding APD/CAPD that I've learned from multiple Audiologists over the 25 years.

<snip>

I find neurobiology fascinating and I wish I knew more about it. If I woke up tomorrow and was 18 again, I would explore going into that area.

So, if I can rephrase part of your post to make sure that I understand it -- the human brain is efficient and if it can’t use a piece of brain real estate for its original purpose, it has the capability to repurpose it.

Thanks for explaining why the neurological medical tests are not useful for older children and adults in diagnosing APD. I find the entire ear-brain interface fascinating and I really appreciate your sharing your knowledge about APD testing.

Jazzberry · 12-10-2011, 04:23 PM

Quote:

Originally Posted by TXgolfer

Cool info.

I feel like I just took a whole semester in one day

I found a "For dummies" version...since...ya know....I'm a dummy.

I highly doubt that!

But I do agree that this is cool info. I've read that the ear/brain functions and interfaces are among the most complicated ones in the human body -- and I believe it!

Quote:

Auditory Nerve Definition

Great web site. I’m sort of familiar with the web master who put that site together. AFAICT, he is a very knowledgeable guy who has contributed a lot of time to the HH online community by building web sites like that and also by answering a lot of questions, clearly and knowledgeably, in a Yahoo group. He may still be doing so, I don’t have time to read all the web sites, Yahoo Groups and forums that I would like to.

My only beef with his online glossary is that he didn’t include footnotes. I know a lot of people think that footnotes should not be included in materials intended for laypeople, but I strongly disagree. I’m a citations fan and the guy has done a lot of good work, I just wish he had included the citations. I think his hard work would be more widely known if he had done so.

Jazzberry · 12-10-2011, 04:36 PM

Quote:

Originally Posted by joycem137

Randomly, I actually do have a minor loss in a very high frequency. I haven't gotten my report from Dr. Paton yet, but she said that it was so high and so minor that I probably wouldn't have noticed it.

Interesting. I use to work with a man who was an opera singer and who use to work in the 2nd or 3rd tier circuits or the C and D houses. (Not being an opera buff, I’m not sure I expressed that correctly -- but hopefully the idea is coming across.

) When he started to loose his hearing he somehow managed to switch over to a numbers job in the corporate world which is how I got to know him.

He lost high frequencies in the range beyond which most people get their hearing tested at the average audiologist. Most babies can hear up to 20,000 Hz and most audiologists stop testing hearing around 8,000 Hz. He had to go out of his way to find a clinic that tested his hearing above 8,000 Hz. While he didn’t need to get hearing aids (there probably were no hearing aids manufactured to help him where he had hearing loss anyway) he decided to stop singing because of his hearing loss. He believed it affected his ability to sing well and he also believed it did affect how he heard in day to day life.

His story confirms my suspicions that most audiologists and oto-neurologists don’t give the proper credit to how much harmonics of the base sound wave contributes to the understanding of speech. In other words -- sure, most human speech occurs between just below 250 Hz and 5000, 6,000 Hz * but being able to hear the harmonics of the speech above 6,000 Hz helps understanding (and being able to hear well in noise).

Depending where your high frequency loss begins, and how much of a decibel loss it is and also if you have the inclination to experiment, perhaps augmenting your high frequencies would help you understand human speech in noise better?

--

Just another story, one of my audiologists told me that a researcher had done a study years ago that favorably correlated HH people’s ability to lip read with better hearing in the high frequencies that we are not normally tested in -- 8,000 Hz and beyond. That is, more HH people who had hearing in the high pitches above where we are normally tested in the audiologist’s sound booth lip read better than HH people who didn’t have hearing in those pitches. She forgot to send me the article and I could never find it on the web myself, but I do believe that she had read it. She was not the kind of person to make things up or get easily confused. But being a citations fan, I can't help but let ya'll know I never read the article myself.

* Note: See speech banana in middle of web page at this link.

Jazzberry · 12-10-2011, 04:53 PM

Quote:

Originally Posted by jillio

This is why I stated that the cochlea, and the cochlear nucleus were being confused. The claim was that the auditory cortex sent signals back to the cochlea. The cochlear nucleus is located in the brainstem. Therefore, once the stimulus has reached the brain, it does not descend back into the inner ear structure of the cochlea. It remains in the brain. It does not descend into any of the structures of the ear. However, the stimulus does ascend from the ear into the brain. Therefore, the cochlea is involved only in the ascent of stimulus.

That paragraph at the Open University’s web site was very terse. The last sentence in the paragraph did say that the cochlea was affected:

Quote:

The olivocochlear bundle, which arises from the olivary complex, is involved in sharpening or otherwise modifying the analysis that is made in the cochlea.

I don’t think it was a typo, or that the author was confused.

There are many web sites and articles that support that description of how the hearing system works.

Dr. Joseph Santos-Sacchi and others have found, from their work in the lab, that that the OHCS (outer hair cells in the cochlea) function as both receptors ( i.e., sense organs) and effectors. (post #58).

It's true that I cannot think of any other structure in the human body that is known to operate as both a receptor and effector -- but it is already known that the hearing system is one of the more complicated ones in the human body.

I am not aware of any studies that have disputed Dr. Santos-Sachhi's and others findings about the OHCS. I cannot find any current dispute about this area from any other scientist or researcher.

ETA: I see in some of the posts that some people think I'm a guy? Nope, female here.

Jazzberry · 12-10-2011, 05:03 PM

Quote:

Originally Posted by jillio

Some people use more than the internet for information. You want the names of the numerous textbooks I used to gain this information? Will you actually obtain and read those textbooks? I think not. Trolling again.

I'm not interested in fighting but I think this was an overaction to someone just asking for a link.

The reason I'm posting is because from what I've seen this is the kind of post that will shut down the thread for EVERYONE.

If you don't want to provide a link, just don't. No biggie.

But I really would hate to see this thread shut down, I've learned a lot from it and it may still have some life left in it -- as long as it doesn't get shut down.

So I'm just respectfully requesting that posts focus on the information and not on other people writing posts as it looks like that is the only way a thread can stay open at this forum.

Please consider it, thank you.

ETA: I do enjoy most of your posts Jillio -- even during the few times I disagree with you. It's because I do enjoy your posts that I hope we can all figure out a way to keep this thread open.

I write slow -- this thread already has hours of my life invested in it!

Which reminds me that I'm going to walk away from the forum for now and do something besides stare at a computer screen. See you all again tomorrow or Monday.

12-10-2011, 03:54 PM	#85 (permalink)
kokonut Registered User Join Date: Jul 2006 Posts: 15,348	I like this link. Sums it up nicely about the auditory pathways. The human body is an amazing thing! The Ear & Auditory Pathways __________________ Before AD. After AD. "Restriction on free thought and free speech is the most dangerous of all subversions. It is the one un-American act that could most easily defeat us." -Thurgood Marshall, former Supreme Court Justice "... turns out they are telling the truth."

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12-10-2011, 07:53 AM	#62 (permalink)
dogmom Registered User Join Date: Feb 2009 Posts: 5,471	Dr. Paton's was one of the sites I've been looking at about CAPD!