LM204 - Cases from Mayo Clinic's Neuro-Audiology Clinic

Abstract: Led by two audiologists at Mayo Clinic in Arizona - a central auditory processing specialist and a central vestibular/balance specialist - this learning module is a collaborative review of neuro-audiology clinical cases, including elements of vestibular/balance diagnostics, behavioral evaluations of central auditory processing disorder (CAPD)/deficits, electrophysiology, and imaging. These cases highlight the vastly overlapping relationship between hearing and balance dysfunction in neurological patients. Information discussed whilst reviewing these cases will emphasize ways that central auditory and vestibular specialists can work together for improved problem solving, leaving our individual practice silos to join forces in elevating patient care, satisfaction, and outcomes.

Summary: As audiology is the study of hearing and balance, neuro-audiology is the study of the central system’s involvement in hearing and balance. Clinically, neuro-audiology specialty care focuses on the effects of neurological disorders and disease on hearing and balance. For many years, neurologically involved patients have sought audiologic care at Mayo Clinic related to dizziness and imbalance. In the early months of 2022, Mayo Clinic in Arizona’s Division of Audiology began offering services for evaluation and management of central auditory processing disorder (CAPD)/deficits. In the four years since, hundreds of patients have sought these services, including many with documented central auditory nervous system (CANS) lesions and who have also undergone vestibular and balance evaluations.

Both central auditory and vestibular/balance clinical subspecialties require extensive education and hands-on practical training that is often mutually exclusive regarding subject matter. Therefore, audiologists specializing in central auditory processing may not be aware or concerned of how their practice relates to central vestibular/balance practice and vice-versa. It is the presenters’ experiences that similarities in evaluation results between auditory and vestibular modalities are relatively common and may represent the norm rather than the exception. When similarities are lacking, the other modality could provide useful interpretive information to inform individualized care decisions.

Led by two audiologists at Mayo Clinic in Arizona - a central auditory processing specialist and a central vestibular/balance specialist - this learning module is a collaborative review of neuro-audiology clinical cases of patients who reported dizziness/imbalance and difficulty hearing, especially in complex listening environments (e.g., background noise, reverberation/echo, talkers at a distance, with reduced access to linguistic and/or situational context, etc.). This review of clinical cases includes elements of vestibular/balance diagnostics, behavioral evaluations of central auditory processing disorder (CAPD)/deficits, electrophysiology, and imaging. The selected cases highlight the vastly overlapping relationship between hearing and balance dysfunction in neurological patients. While acknowledgement of this relationship is important, understanding that clinicians can work their entire careers developing knowledge and skills in just one of these specialties is imperative, and it is unrealistic to expect neuro-audiologists to be experts in both. Information discussed whilst reviewing these cases will emphasize ways that central auditory and vestibular specialists can work together for improved problem solving as a team, leaving our individual clinical practice silos to join forces in elevating patient care, satisfaction, and outcomes.

Brief Summary of Clinical Takeaways: The clinical takeaway for this session is understanding of the benefits of collaboration between central auditory and central vestibular/balance specialists in the provision of neuro-audiology clinical care, gained through review of clinical cases of patients with neurological involvement, reported dizziness/imbalance, and difficulty hearing and understanding speech, especially in complex environments.

Assumptions: Knowledge and skills re: behavioral and electrophysiologic tests of central auditory processing function and vestibular/balance function.
Knowledge of central anatomy and physiology related to auditory and vestibular/balance systems.