In the “Journey into silence” series, I’m about to go to an audiologist for the second time (spoiler). They will talk about hearing loss (not a spoiler), but what they won’t mention is auditory processing disorder (APD). I won’t hear about that for quite some time (spoiler).

APD is defined as difficulty understanding sounds, including speech, rather than difficulty hearing words. Although it is often referred to as a neurodevelopmental disorder, it can be an acquired condition. Whatever its origin, doesn’t relate to the process of sound moving through the structures of the ear. It’s all about how the auditory centre of the brain deciphers the information that reaches it.

To put it another way, if the ear isn’t “pushing” enough sound data into the auditory cortex, you have a hearing difference. Your ear isn’t capturing all the syllables, words, tones or sounds. If the ear is “pushing” enough sound data in, but your brain can’t decide (for example) what’s speech, what’s background noise or which of five similar words has been said, you have an APD. Your ear is capturing everything, but it doesn’t feel like you are.

In both cases, you might “fill in the gaps” from context, but that’s not guaranteed. It depends on the degree of hearing difference or type of APD. Also, it’s exhausting to maintain focus all the time, straining to capture or decipher as much sounds as you can. If you’re like me and you have both, it becomes nigh-on impossible.

Audiologists should understand and look out for APD when they’re running hearing tests. However, research from 2024 has shown a lack of understanding and education in this area (1, 2). In the first, fewer than half of the surveyed hearing specialists reported screening for APD and around half indicated that an APD diagnosis wouldn’t affect the patient management plan. In the second, fewer than 50% of ENTs and speech or language therapists had sufficient knowledge of APD. Knowing that now, I understand my journey towards silence a lot more.

I wish I’d known sooner.

If you’re going for a hearing test, advocate for yourself. Talk to the audiologist or ENT about the possibility of hearing difference and APD. Ask if they screen for both. Make sure the management strategy they propose accounts for APD if there’s a suspicion that you might have it. I’ll try to cover the current recommendations and research over the coming months so that you have some resources.

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1. Berard, M.W., Koohi, N. and Bamiou, D.-E. (2025) Auditory processing disorder: an online survey of hearing healthcare professionals’ knowledge and practices. International Journal of Audiology, vol 64.
2. Meimaroglou, S., Eleftheriadis, N. and Illiadou, V.M. (2024) Better education required for professionals in healthcare regarding auditory processing disorder. Otology, vol. 282.