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All About Auditory Processing Disorder & Sound Sensitivities -Episode 45 with Dr. Melissa Karp

Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein and today we’re going to be talking about Auditory Processing Disorder, APD, sometimes also called Central Auditory Processing disorder, or CAPD. And we’re also going to be touching on the idea of sound sensitivities and when you get that feeling that there are nails on the chalkboard or pen clicking that’s driving you crazy. Some of us have those experiences. And in fact, some people have those kind of sound sensitivities where they can become really debilitating. So, I brought in an expert, Dr. Melissa Karp, to talk to us about some of these, how to test for these things and how we can help our children and our patients that are struggling with auditory processing disorder or sound sensitivities.

And before we jump into that interview, I do want to remind you that you can come over to allaboutaudiology.com to hear all the previous episodes or read full transcripts. And in addition, you can join the email list. The email list is where I send you stories and updates behind the scenes. And it’s really fun, I send you emails and you guys respond back. And it’s kind of super fun to have little pen pals around the world who are interested in these topics who are engaging with the conversations that we’re having here on the podcast.

So, I would love for you to join and if you are interested, you can also get some free resources, free downloadables that are on the website. The first is the five step guide to navigating your child’s hearing loss and this is a beautiful guide which lays out what is the journey ahead? Whenever you had first gotten a diagnosis or even if you’ve gotten a diagnosis years ago, there are still questions that you need to address and make sure you have the support in place. So, that guide is a downloadable PDF with fill-able spaces but also can be printed out and it can really follow you along with the journey. I know there are many audiologists who share this with their patients. And it is available for free on the website at allaboutaudiology.com/guide.

There’s also a hearing aid checklist on there. And that’s perfect for establishing morning and evening routines around the hearing aids. This is really helpful to have at home. But it’s also great to give the teacher or give someone who is also helping with the care of the child; babysitter, nanny grandparents, whoever else is involved with the care to have an organized list where you have all the different things that need to be taken care of when there are hearing aids. And in general, dealing with devices is something that you know takes time, there’s an orientation, you have to learn what all the parts are and how they work together, and what happens when they break. So, those two resources are free over at allaboutaudiology.com. And that way, you can join the email list and we can stay in touch.

So, let’s go right ahead and jump into this episode. Thank you for listening, and I look forward to hearing what you think about this on Instagram, on Facebook and on the website.

3:36

Dr. Lilach Saperstein: “Welcome, Dr. Melissa Karp. Thank you so much for joining us from North Carolina. Today we’re going to be talking about sound sensitivity and auditory processing in children. And I’m really glad that you’re on the on the show with us because this is a topic that we get a lot of requests about. So, thank you so much for joining in. Tell us a little bit about yourself.”

3:58
Melissa: “Well, I am so glad to be here. I think what’s really interesting is that you say you get a lot of requests for it. Auditory Processing and sound sensitivity are some of those disorders that they’re not rare. They’re rarely known. So, a lot of people will have issues with auditory processing that may be maybe a little sub-clinical, if they learned how to compensate for it. And almost anyone you ask, has some type of sound sensitivity, whether it’s to, you know, maybe a specific sound or the way certain people chew, but it’s not really affecting their life. So, they haven’t sought treatment for it. Whereas in other people, it becomes very, very disruptive. So, a lot of times when I see children, and we diagnose, the parents are like, ‘Oh my gosh, this is me, I have the exact same thing. It’s just not as bad.’ So, you know, the good take home is that there are a lot of people with these things going on. It’s a spectrum of sorts, and that they’re not alone.”

5:02
LS: “Well, I can definitely see that if someone has it just a little bit, then they’ll say, ‘Yeah.’ I mean the nails on the chalkboard, and like pen clicking, those are common things you hear people be annoyed about. But what would it look like when it’s really disrupting someone’s life?”

5:22
MK: “So, for someone who it truly disrupts their life, we have to keep in mind for sound sensitivity, it truly releases these emotions of fear, disgust, anger, resentment, rage, and it’s not under this person’s control. They’ve created this emotional connection, this conditioned response when they hear these sounds. So, it may mean that they avoid eating with their family and they want to eat in their room. It may mean that they don’t go out with certain friends or they avoid different situations. Or in the classroom, they can’t concentrate without putting in their earbuds and drowning out the sound. It can truly impact relationships.”

LS: “Yeah. And it seems like what the pathways that are happening there is that it like crosses over into the limbic system, the emotions. So, how much do we know about that?”

MK: “Not as much as we’d like to. We do know it does tend to be this, you know, conditioned reflex arc. So, you have the stimuli or the trigger sound, and it can be auditory, but for some people it transfers and becomes a visual trigger as well. So, if you tend to be very bothered by chewing sounds, then the next thing you might become very bothered by or triggered by is someone’s jaw moving a certain way. Because our system, it’s trying to protect you. It’s trying to keep you safe. It doesn’t realize this isn’t a threat. And their system is going crazy saying, ‘Oh my gosh, it’s going to make that sound, it’s going to make that sound and then I’m going to feel bad.’ So, you have to kind of keep that in mind as well.

But the other thing we know with that conditioned reflex arc is that it’s not just that stimuli that trigger sounds. But there tends to be a physical reaction as well, we tend to see a muscle contraction of some pipe. So, it might be a tightening of the jaw, pulling up the shoulders, intake of breath. There’s some other, in about 90% of people, some other type of response that gets tied into this reflex arc. So, while some of our treatment is looking at reducing the, I guess, the intensity of the sound and creating a positive experience with other sounds, some of our treatment actually looks at reducing that physical response and breaking that reflex arc in another way. So, it’s multi pronged.”

8:00
LS: “Yeah, it’s like an aversion. That’s just like a gut reaction, a body reaction.”

MK: “Yes.”

LS: “Okay. And so how do you diagnose these kinds of sound sensitivities? Is there another term for it also, like misophonia comes into it, or is it different?”

8:19
MK: “There’s a lot of different types of sound sensitivity. So, there’s hyperacusis, which is a generalized sensitivity to all of the sounds around you either that at a normal level. There’s misophonia, where you have that emotional reaction to very specific sounds usually made by specific people. That’s the one that I tend to see the most of. There’s photophobia, which is fear of sound. What else is there? Those are really the main ones that I’m thinking of off the top of my head.”

8:51
LS: “I think we learned about diplacusis back in the day, where if they hear one tone, like one tone is played, a person will hear two tones, and that some musicians have this where they play one key on the piano, but they are perceiving two different notes.”

9:05
MK: “That’s a little different than sound sensitivity.”

LS: “Right.”

MK: “But very cool.”

LS: “Okay, that is like one of those super rare things. And I was like, no one has that. And then I asked my cousin who was a musician, and he was like, I have that and it’s crazy for like one note, and he’s telling me which key it is. It’s really weird. Anyway, we can move along from that. It’s not relevant.

There’s all sorts of things that our auditory system does, which is, I guess the point of this whole topic and why people are so interested in it, is because it’s not either you hear or you don’t, that we definitely know, is not the case. And then it’s also if you have a typical hearing, and you’re able to hear and don’t have hearing loss, that’s also not the whole story.”

9:48
MK: “Well, exactly if we hear with our ears and our brain, so the first part of any evaluation is making sure that the ears are giving a full picture to the brain. Then the next step is what is the brain doing with the sound. So, that might mean central auditory processing testing. That might mean sound sensitivity testing. In some cases, if someone has ringing or buzzing in their ears, it might mean testing for tinnitus and trying to pitch match and loudness match for those things. So, it’s not just do you hear the beeps?”

LS: “How do you test, what are the testing procedures that you do?”

10:25
MK: “So, for sound sensitivity, it’s looking if the person hears well, and checking all of those frequencies. Then it’s looking at what sounds are uncomfortably loud. And that’s a UCL or an LDL measure, where you basically turn up the volume until it reaches an uncomfortable loudness. For most people with misophonia, those levels are normal. It’s not the tones. It’s not the auditory system that’s overly sensitive to regular input. It’s very specific, usually person specific or sound specific triggers that bother them. But overall, they don’t have sound sensitivity. So, that helps differentiate between misophonia and hyperacusis. And someone with a hyperacusis, those levels are going to be very, very elevated. And what I mean when I say elevated, is that very soft sounds are painfully loud.

For auditory processing, it’s a whole battery of tests. It’s looking at what does the right hemisphere do? What does the left hemisphere do? How do they work together? How do they separate sound? And it’s not just language based tests, its numbers and tones, and its temporal processing, dichotic, listening, all sorts of processes that the brain uses to get information. We try to create kind of a map of sorts to see what areas work really, really well and where are those areas of weakness that might respond well to intervention.”

11:55
LS: “So, what are the ages that you are able to test for these kinds of things? Because if they are so young, it’s hard to get reliable responses. But maybe those kids are really in need of help?”

12:06
MK: “Sure. So, for auditory processing disorder, usually by age four, there’s some really good screening tests that we can use. I don’t typically diagnosed until age seven. But you know, we don’t want to wait till age seven, to intervene. So, if we can start seeing some areas that, you know, on really good normative data on those normative data tests that are outside the norm, we can start working on interventions and treatments and working on those skill sets. There’s no reason to wait. For children who are having sound sensitivity, we usually wait a little bit. You know, I would say probably the youngest, I really started working with was five. But for individuals with misophonia, the peak onset of age for that disorder is about nine or ten. So, we don’t typically see the really, really young ones having misophonia, they might have more typical essential suppression issues that are developmentally appropriate, you know, covering their ears when they come up with a fire engine or a loud sound, and then that goes away. They get very accustomed to it. So, you have to be sure that it’s not something that’s just developmental, and that it’s truly in that disorder realm before you start treating.”

13:29

LS: “Yeah. And I think maybe a lot of parents who are listening might say, ‘Hey, my kid doesn’t like when there’s loud sounds around and wants to leave the room when the blender is going’ and things like that, you know. At what point should someone be concerned that there’s something else going on versus the typical things?”

13:50
MK: “Yeah. So, is it really a loud sound? Is it a sound that it’s appropriate to be uncomfortable with. I have parents download sound level meters for their phones. There’s great apps that are free. NIOSH has a great app.”

LS: “Have you seen that some people have it on their Apple watch?”

MK: “Yes.”

LS: “And now they’re just like glancing at their watch and saying it’s too loud in here.”

14:14

MK: “Yeah, so that’s great. If your child’s reacting to that, that’s normal. I wouldn’t worry about that. I know I’ve got a blender. It’s really loud. I find that, you know, I don’t particularly like being near it. But that’s a typical issue. If you’ve got a child that’s refusing to participate in activities or different things, and the sound isn’t in that range. That’s when you want to start looking at it and say, ‘Okay, well, what can we start doing?’ “

14:43
LS: “How can you differentiate when it’s like a behavioral thing? That, you know, it’s not just sounds, it’s like other things, but maybe they have that sensitivity also as a sensory overload like for touching different things. Like, do these things overlap and they both may be comorbid. Like, what is your approach to that?”

15:05
MK: “They can. You can have a child that has multiple sensory processing difficulties. And that’s really where you want to be careful, because what are they reacting to? And a lot of times, things that I’ll have parents look at is when they’re making noise if the child is interested in something else, is it bothersome? That tells me if it’s a behavioral issue? Have they discovered that if they get more attention if they cover their ears, if they tantrum, or if they want to be out of the situation? Those are the things we want to try and roll out. It’s a lot of history and a lot of observation and talking to families. But it’s also important to work with the families to try and normalize some of the responses. So, if a child puts their hands over their ears and say, ‘Oh, it’s too loud’, but it’s really not too loud, you can say, ‘Oh, yep, that is a loud sound, but it’s okay.’ And, you know, show them and really model the behavior that you’re looking for. Because you’re trying to normalize it, you’re not trying to pass negative pathology that’s not there.”

16:20
LS: “So, in other words, you want to validate their experience of it, and then try to neutralize it.”

MK: “Absolutely. That’s a great way of putting it.”

16:30
LS: “Yeah, because I think you know, if every time that happens, then they’re, on top of it, met with what’s wrong with you, everything’s fine. It’s not loud at all. Everyone else is okay. Like, well, that would be very difficult, I think, to experience.”

MK: “I mean, there’s certain things that as occupational therapists we pair with, but audiologists really do still own the auditory system. And when you have some of these sensitivities that lean more towards hyperacusis and misophonia, it is important to have an audiologist working with the occupational therapist if there are other sensory processing issues.”

17:10
LS: “Okay, so let’s say we’ve gotten this diagnosis where we’re able to identify the specific areas that are hard for a child, that are challenging for them. Then what do we do? What can we help them with?”

17:21
MK: “In terms of…”

LS: “Their, I don’t know, is it therapy? Is it sound training? Is it just a lot of counseling?

MK: “Okay, so it’s kind of hard because I know we’re talking about two different things here. And I don’t want to get into waters too muddy. So, for sound sensitivity, sometimes it is using intervention as far as wearable sound generators. We could be using different music, creating buffer sounds, things like that, desensitization protocols, and working with the parents to parent their child in a different way where they’re not drawing such negative attention. So, as we’re working with the auditory system, and we’re giving it this enriched sound environment, we also want to take care that the parents are doing their part too, because the child gets their information and the way they should feel about things, they get those cues from their parents.

For auditory processing disorder, that’s a little bit different. It might mean intervention with technologies such as moving hearing aids or FM systems. It might mean direct intervention for speech and language therapy. It might mean phonemic discrimination training with an audiologist or rehabilitation, or it may be in accommodations in the classroom, as far as extra time or assistance with notes or simple directions. So, it depends. With auditory processing, it’s so complicated. It’s not just that you have it or you don’t. There are different types of auditory processing that benefit from very specific recommendations. That’s why it’s important to go ahead and have it tested so that you know exactly what type you’re working with so that the recommendations make sense.”

19:07
LS: “Yeah, would you describe some of the testing for our listeners to learn about? How do we test for auditory processing disorder? And what’s the experience like? If they maybe have that scheduled and coming up for their kid, how can they help prepare them for those tests?”

19:23
MK: “Yeah. A good night’s sleep the night before. We always do this test first thing in the morning, because by the end of the day, an individual with auditory processing disorder is going to be tired. It’s so much. Listening is so much more effortful when you have a processing disorder. So, first thing in the morning only. A good night’s sleep, so they’re ready to go. We always talk about, do you know why you’re here. And most of the kids will say it’s because I’m bad at school. No, that’s not why you’re here. So, really making sure that they have an idea. We’re just going to see how your brain hears. That’s often surprising to them because they don’t think about their brain hearing.

So, we do different tests that look at how the auditory system works, that they don’t have to participate at all for. We look at tympanograms, acoustic reflexes, OAEs. These are tests that look at the auditory reflex, it looks at some integration measures, it looks at the health of the inner ear. They also have to do a hearing test. In my clinic, we do a test of attention, because I want to make sure and rule out that attention deficit is not causing or contributing to a lot of the issues that the child is having.”

LS: “What tests do you do for that?”

MK: “I either use the ACPT, which is the auditory continuous performance test, or I use the IVAQS, which is a visual and auditory screen test that’s on the computer. And I like that because it goes anywhere from five years to adult where the ACPT only goes from six to 11.”

21:02
LS: “Yeah. I think that’s so important to have as part of your battery so that people don’t then look at the results and say, ‘Well, how do you know they weren’t paying attention when they got this, this and this incorrectly? And you say, ‘Well, this is how I know because I’ve ruled it out.”

21:18
MK: “Exactly. It is important because when I’m looking at the testing and I’m interpreting all of the testing, I’m looking for patterns. If there’s an issue on every single test, it doesn’t mean that this kid has horrible auditory processing, it means that there’s a global overarching issue that’s preventing them from processing.”

LS: “If they get it all wrong: patterns, global issues.”

MK: “If there’s no pattern on the test, if everything is impacted, we know that it’s not auditory processing alone. We can’t necessarily say that there’s not an auditory processing disorder, but we can’t actually evaluate for the auditory processing. For example, in the case of attention, information is not staying in the brain long enough to process so it impacts all of the testing. It’s not a good result. So, if any of our clients come in, and they don’t pass the attention screening, we stop there. We wait until the attention is taken care of, and then we try again.”

22:16
LS: “Yeah. How often do you think you see someone coming in and saying, ‘I think it’s auditory processing or I think it’s one of these things that are less common like misophonia.’ And then you actually identify hearing loss, is that something that happens often?”

MK: “Not often. I see that a lot for people that have tinnitus, they just say, ‘I could hear fine, I just have ringing in the ear.’ So, I see that a lot with tinnitus. I have had some individuals come in for auditory processing testing, and we found cookiebite hearing losses. And they had passed their screening in school, which I found kind of unbelievable. We ended up fitting hearing aids. And then from there, their reading level shot up multiple grade levels, because they could hear. It’s important to be very methodical. And maybe that’s part of what I like about auditory processing is that it is very methodical, and you have to look at all of these different areas. But then it’s like a puzzle, because you have to take into account things like their attention, you have to look at their cognitive testing, you have to look at the psycho educational information, you have to take information from the parents and the teachers, and what’s going on in the classroom and what’s going on in day to day life and come up with recommendations, and a treatment plan that really suits the individual.

It’s not the same thing every day. I know a lot of people think, Oh, well, you know, this test battery, you just do it over and over again. And there’s this written list of recommendations and it’s not that at all. And it shouldn’t be that.”

23:51
LS: “Absolutely. You have so much scoring and different tests that you do, depending on, I mean, from what I remember.”

24:00
MK: “Typically a child will come into the office, they’ll be here at least 90 minutes. I’ll talk to the parent either ahead of time, or, you know, at least another 30 minutes, sometimes more. I go through their records and all other information, which I can get charts that are, you know, an inch thick of information. It takes at least 90 minutes to go through and write the report, at least. And then it’s another hour going over in a conference with the parents or with their teachers or whoever they want to get that information, that feedback afterwards. So, it’s a lot of time to do auditory processing, but it’s a labor of love.”

LS: “And that would explain the cost structure where people are very concerned and surprised with how expensive it might be to get that kind of testing.”

24:56
MK: “Yeah, it’s interesting. I actually have that information on my website very laid out. These are the CPT codes that we use. These are the pricing associated with each CPT code. This is why it’s expensive because you’re not just paying for that 90 minutes in the office. But if you look at other professionals, if we look at some of the neuropsychologists, psychologists doing testing, it can be $1,000, $1500 for a psychological evaluation. So, I don’t think that we are priced out of the ballpark. I think that people are just not used to thinking about how much work and effort goes into some of these tests that they don’t see.”

25:41
LS: “Yeah, and I think especially now, people are taking a look at health care and health care delivery in general, as something that needs to be looked at. Let’s put it that way. Hahaha.”

MK: “It is really hard too because things to remember about auditory processing, auditory processing disorder is diagnosed by audiologists. We are the professionals that have the proper equipment, we have the proper training, it’s our scope of practice. In our community, we actually have speech language pathologists, and some psychologists saying, ‘Oh, we test for that too.’ And they can’t diagnose. So, it’s very difficult when I have a patient that comes in and they’ve seen another professional, and they think they have a diagnosis, but they don’t. And that impacts their service delivery in the schools. So, making sure that the correct professional is actually diagnosing is really important too.”

26:42
LS: “Absolutely. I think my favorite thing of what you said in the beginning was about telling the child what’s happening. And I think that’s like, part of my whole thing all the time is, are you honest with children about what’s happening? Because they know, they can understand and feel it.”

MK: “Yeah. And they know what they have a hard time with. And I think sometimes explaining to them, especially if they’re a little bit older, I actually like to have them in that session where we go over everything, the parent session, because they need to know what are things that they can do. How can they advocate for themselves? How can they position themselves to get information. They need to know where the breakdown is and what they can do.

So, a lot of it is talking about them and what their responsibility is. It’s the teacher’s responsibility to provide the information, it’s your responsibility to bring it home, it’s your responsibility to give the FM to your teacher. And giving them that ability, when we talk about children with organization disorder, and we come up with different strategies, a lot of times a strategy, we want them involved. We want them going to staples and picking out what post it notes they want, what color notebooks and how do they want to organize their area? And what are the things that they like. So, making them a part of it is very important.”

28:14
LS: “That’s so beautiful. Having the child with you in the room when you explain to them, what are the areas that we’re striking, to say, ‘Hey, this is actually something that when we did the testing, this was especially hard for you.’ And then having that validation that it’s not just them making it up. You know, it’s not just them being not good at something or unable to focus. And it’s like, this is actually something of how your ears are processing, how your brain is processing.

So, what comes to mind for me is the speech and noise testing. And to know that you can have two children take the exact same tests where they have the same hearing levels and they have, you know, everything else being equal. But one will really struggle when there’s other sounds with that filtering, picking out what they want to hear versus the noise will just be so, so challenging for their system. Whereas another child will be able to filter that out just fine.”

29:08
MK: “So, they like that. They like knowing what does that mean in real life? So, when you’re in the cafeteria, and you can’t hear your friends, this is why. You’re making it very real life. Or if you’re sitting in your tables and the teacher is talking behind you, and this person’s talking, it’s harder. Or when the teacher is talking but their back is turned to you. Or when somebody says this, you heard this (something else). And that’s why sometimes you get this funny look. It’s not the man mailed an otter, it’s the man mailed a letter.

So, sometimes they get the giggles when they hear what it really was and what they thought it was. But also explaining that by the end of the day, that’s why you’re tired. You’re working so, so hard. And talking about compensation mechanisms that they have because they’re smart. So, they figured out how to compensate. Quick responses, trying to rush and fill in is a compensation mechanism for shorter auditory memory. So, it’s like, ‘Wow, you’re so smart that you figured out that you have a hard time remembering. So, this is what you’ve been doing. But it doesn’t help you, because then you miss this part. So, what do you think we could do instead?’ And then we bring up, you know, jotting a note or other techniques or strategies. Oh, it’s very cool to do it.”

30:45
LS: “And the fact that in the session, the parent is also there. I mean, obviously, they need to hear the results, but for them to know, ‘Oh, for my child, specifically, they’re having trouble with remembering a couple of multi step directions.’ So, they can change the way that they give directions.”

31:06
MK: “Even something as simple as for someone with a decoding deficit, repeating what you said instead of rephrasing, because with decoding, you’re missing bits and pieces. So, if you repeat, you’re giving your child the chance to fill in those blanks. If you rephrase, you’re giving them a whole new set of information and new blanks. It’s something really simple, but it’s easy.”

31:29
LS: “Yeah. And that’s so counter-intuitive, because that’s exactly the opposite recommendation for someone with hearing loss because they’re going to keep missing the same sounds over and over. So, try a different word. Instead of saying I went to the beach, say, I went to the boardwalk, because maybe they’re missing the “ch” sound at the end of beach. Hahaha.”

31:47
MK: “I mean, I think as parents and educators, we’re all about teaching and communicating. And knowing the best way that we can communicate, it’s really good too.”

31:58
LS: “And sometimes a parent will get a giant report, because I’m sure the reports you write are seven to twelve or more pages long.”

32:06
MK: “Of course, of course. So, that’s the way it was when I started my practice, it was all about all of the data and all of the information and very technical. And reports are only as good as the person can understand. So, I changed my report writing a lot over the years and my first page are clinical impressions. That is the first thing that you see. What is it and what does it mean? Yes, they have auditory processing. No, they don’t. And how is it impacting them? So, then all the data and all the technical stuff, and then the recommendations. You know what, no one needs twenty recommendations. They really don’t, it’s overwhelming. There’s only so many hours in the day. There’s only so many things that you can do. So, prioritizing and what are the most important things to do now, and then we can look some other things later.”

33:01
LS: “Oh, I love that. Doing a prioritized [list of] immediate recommendations. And then for the future consider [these other options.]”

MK: “Yeah, because if I can, for example, get a school to do three things. That’s awesome. That’s amazing. And the school doesn’t necessarily need that whole big report, they might do better with a one page letter that says, this child has auditory processing disorder, it doesn’t impact their intelligence, but for them to be able to get the information that they need, here are some strategies that are necessary. And three or four things.”

33:42
LS: “I wanted to ask you about, if maybe you could tell us a story, like a whole patient journey that can make it clear, you know. Some real “Jim” case study that’s like on your mind, you know, that one kid. Hahaha.”

MK: “So, I can tell you about a really cool kid I had with misophonia. She was 15 or 16, and to the point where she was being home-schooled because she couldn’t really function in a classroom. She would go in for one or two classes, and then she would come home. She was active in dance, wanted to go out and do things but just could not handle the chewing sounds. So, there were certain classes that she could work in, but other classes where they allowed people to eat, she couldn’t function. So, it impacted her social life. It impacted her family life.

Yeah, so it was really very interesting because the more we sat and talked, the thing that came out that she really really loved, were Marvel movies, Marvel Avengers… And she hadn’t been able to see any of them in the theaters. That’s what she wanted to do, but she was afraid to go in because of crunching and chewing with people eating popcorn and candy in the movie theater. So, what we ended up doing is we ended up using noise generators to help change that sensory contrast between her trigger sounds.”

LS: “So, she wanted to watch Marvel movies.”

MK: “Yeah, she wanted to watch Marvel movies. So, we used that as our positive sound. We ended up working with her so that we would desensitize her to the sounds that bothered her the most, or using a pleasant stimuli. So, while she was watching Marvel movies, we used an app and recorded sounds and we started desensitizing her to the trigger sounds and using that, using the white noise generators, she was able to start going back to class, she was able to go to the movies, she was able to become much more a part of her family life. And you know, there still were some trigger sounds that were annoying, but they weren’t the ones that she was with every single day. So, much more manageable.

She became a really big advocate in her circle for misophonia. The last time she came to visit, she had a big T-shirt that she had made with misophonia and facts on the back about it. And, you know, putting out all sorts of information. She had a project for a class, she did a video on these misophonia. And she became very involved. The thing of it was that she was going back to class, she was being with her friends. She was being able to eat lunch with them, she was able to do the things that she wanted to do. And the coolest part, the reason I think it’s very cool, is that there’s not too many times where you say, ‘Oh, I prescribed Marvel movies.’ “

LS: “Hahaha.”

MK: “We’re treating with superheroes. I think that’s just cool.”

36:41
LS: “Yes, I think we don’t get that as much as our SLP colleagues, that really know all their favorites. Peppa Pig is a big one. When I was working at the school, there was one kid, she was just Peppa Pig all day, every day. So, they had stickers and they had a plush pillow and they had all these cute things.”

MK: “Yeah, it’s all about what motivates each individual client and each individual patient. Because if it doesn’t mean anything to them, why are they going to work for it. It has to be, ‘What do you want to do? What is it keeping you from doing? Much in the way that we talk to our hearing aid patients, too.”

LS: “Yeah. Do we have any ideas about where it comes from? What is the cause or the onset of these sensitivities?”

37:28
MK: “For misophonia, we don’t have a whole lot of information. We know that about 20% of the general population has some form of misophonia. Most people can tolerate it, and it doesn’t interfere with their day to day living. But there is that percentage for some reason or another. It tends to be more prevalent in females. It tends to start anywhere from nine to twelve years of age. For some reason, that limbic system catches a particular sound and it attaches to it. We don’t know why.”

LS: “Well, I’m sure glad that people will know and get educated on the fact that they’re not alone. And they’re not crazy. They’re not just hearing sounds that are bothering them. Like, how come everybody else is okay and not me? Well, maybe you have to find your people who know what you’re going through.”

38:22
MK: “Yeah, yeah, there’s a lot of really good information online now. You tend to be able to find your community and find resources, which is great.”

LS: “There’s a very popular business coach that I follow and learn from, Jenny Shih, and she writes about how part of why she started her business was because she really wanted to work from home. That was something that was really important to her. And while other people say they want to be entrepreneurs, for whatever reasons, they had a specific message, they wanted to work from home just for the convenience or for making money or whatever. She said this was like a medical situation for me, I had to make this work so that I could be in that kind of circumstance. I think that’s fascinating. Any last advice or message for our listeners?”

39:11
MK: “Don’t be afraid to ask. Don’t be afraid to reach out, find a practitioner that knows what they’re doing. I think I gave you the APD map of practitioners that work with auditory processing disorders. I gave you the Jastreboff website for TRTA, tinnitus retraining therapy, because that’s one way that we treat misophonia is with TRT. So, there’s a whole list of providers that people can find near them that know what these conditions are and they know how to work with them, and they should be able to get help all across the country.”

39:46
LS: “Yeah, we’ll definitely link those in the show notes and at allaboutaudiology.com and we also have a full episode all about tinnitus with Dr. Kelly Dyson. So, if you want to learn more about that, we’ll link that as well.”

MK: “Fantastic.”

LS: “And if anybody wants to reach out to you or find you, where can they find you?”

MK: “They can find me through my website which is audiologycharlotte.com. You can contact me directly through there.”

LS: “Thank you so much. I really appreciate having you on the show.”

MK: “Thank you so much for having me.”

LS: “Stay well. Bye.”

Thank you for listening to this week’s episode of the All About Audiology podcast. And thank you to Dr. Melissa Karp for sharing her expertise and her tips all about auditory processing and sound sensitivity.

I am so grateful that you are a listener to the show and I cannot wait to hear your thoughts, your comments, your questions, your reactions. My favorite thing is when you screenshot when you are listening to the episode and tag it on Instagram @allaboutaudiologypodcast. That makes me so, so happy and so grateful to have so many listeners that are around the world. Remember that to stay up to date with everything going on in the audiology world or to find out about ways to work with me, just visit the website allaboutaudiology.com and I look forward to being a part of your journey.

I’m Dr. Lilach Saperstein and this is the All About Audiology podcast.

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