AO Journal Group: Auditory Neuropathy/Dys-synchrony

Do you want to stay up on the latest research related to hearing? Tune into the AO Journal Group where on a monthly basis our group of Contributing Editors will provide reviews of timely journal articles that relate to your clinical practice.

This article review was submitted by Susan Scollie, Ph.D., who is an Assistant Professor in the School of Communication Sciences and Disorders at the University of Western Ontario and a Contributing Editor for Audiology Online in the area of pediatric amplification.

Article:

Rance G. (2005). Auditory neuropathy/dys-synchrony and its perceptual consequences. Trends in Amplification. 9(1), 1-43.
The website for this journal is: www.westminsterpublications.com

Review:

Auditory neuropathy/auditory dysynchrony (AN/AD) is one of the most challenging topics in pediatric audiology today. Much has been learned in the past several years, and many new cases of AN/AD are now being identified due to the more routine use of systematic assessment batteries in early infancy. However, for the pediatric audiologist faced with communicating information concerning prevalence, impacts, and management of AN/AD to caregivers, uncertainties remain the biggest difficulty.

This review article by Gary Rance holds a summary of current best knowledge of AN/AD on a variety of topics ranging from the underlying mechanisms, through causal factors, appropriate diagnostic procedures, and key issues in management. As a review article, the scope of this paper very broad, and is about the size of a textbook chapter. It does not report the results of one study, but rather reviews the literature on the topic of AN/AD. Despite the broad range of this paper, it has direct implications for clinicians practicing in assessment of auditory function, as well as those who work in management of patients diagnosed with AN/AD.

For audiologists who assess the auditory system, Rance provides the classic diagnostic pattern of AN/AD, as well as a thorough discussion of how AN/AD relates to measurement of the auditory brainstem response. The literature review throughout relates not only to the infant/pediatric literature but also to reports of adults who are now known to have AN/AD but who may have been initially diagnosed with sensorineural hearing impairment as children. The various possible sites of lesion are discussed, along with related, nonauditory symptoms that can occur when the AN/AD profile is due to a more broad-reaching pathology.

For audiologists who manage cases of AN/AD, Rance provides an excellent review of the controversies surrounding provision of amplification to children and adults with the disorder. His review questions the often-heard arguments against the trial of hearing aids in those with AN/AD, as well as the use of a low-gain strategy. Those of us fitting hearing aids routinely in this population would benefit from reading this section, as well as the accompanying tutorial on the perceptual disruptions that can arise from AN/AD. Doing so lets us have a better understanding of the complexities of AN/AD, hopefully assisting us in providing better recommendations and services to these patients.