What are the disorders causing difficulty in understanding speech, requiring extensive evaluation?

From the Guidelines

Disorders that make it difficult to understand what others are saying, such as aphasia, cognitive-communication disorders, dysarthria, and apraxia of speech, require extensive evaluation by a certified speech and language pathologist to improve communication, social participation, and quality of life. These disorders can affect speaking, listening, reading, writing, gestures, and pragmatics, and their presence can negatively impact social participation, psychosocial well-being, and quality of life 1. The evaluation and treatment of these disorders are crucial to facilitate recovery, develop compensatory strategies, and educate patients and their environment on assistive communication supports.

Some key aspects to consider in the evaluation and treatment of these disorders include:

• The overall goals of speech and language treatment, which are to facilitate the recovery of communication, assist patients in developing strategies to compensate for communication disorders, and counsel and educate people in the patient’s environment on assistive communication supports 1.
• The use of low-tech strategies such as paper/pencil and communication boards/books, as well as high-tech devices like smartphones and speech-generating devices, as compensatory and assistive communication supports 1.
• The importance of early identification and treatment, as these disorders can significantly impact academic performance, social interactions, and quality of life 1.
• The need for a comprehensive diagnostic evaluation, including pure-tone audiometry, speech audiometry, tympanometry, and acoustic reflex testing, to distinguish types and severity of hearing loss and to inform diagnosis, symptom etiology, and treatment 1.

In terms of specific evaluation and treatment approaches, a certified speech and language pathologist should perform a comprehensive evaluation, including assessments of speaking, listening, reading, writing, gestures, and pragmatics, to develop an individualized treatment plan. This plan may include auditory training exercises, environmental modifications, compensatory strategies, and assistive listening devices, as well as counseling and education for patients and their environment 1.

From the Research

Disorders Affecting Speech Understanding

Disorders that make it difficult to understand what others are saying often require extensive evaluation. Some of these disorders include:

• Sensorineural hearing loss (SNHL) 2
• Cochlear disorders 2
• Mixed hearing loss 3

Evaluation and Treatment

Evaluation of these disorders often involves:

• Pure tone audiometry (PTA) 3, 4
• Speech audiometry 3, 4
• Word recognition testing 2
• Psychoacoustic measures such as pitch discrimination and intensity perception 5 Treatment options may include:
• Cochlear implantation 3, 4, 6, 5
• BAHA (Bone Anchored Hearing Aid) devices 3
• Active middle ear devices 3

Challenges in Understanding Speech

Understanding speech in noise is a common challenge for individuals with these disorders. Research has shown that:

• Auditory stream segregation is an important factor in understanding speech in noise 6
• Cochlear implant users may have difficulty with stream segregation, which can impact their ability to understand speech in noise 6
• Psychoacoustic measures such as forward and backward masking can be correlated with phoneme identification measures in cochlear implant listeners 5