Tests · Hearing
Central auditory processing: assessment and therapy
Some children and adults hear well on audiometry and still do not understand properly, particularly in noisy settings. Central auditory processing assessment investigates how the brain organises and interprets incoming sound. Where it identifies difficulties, it guides auditory training delivered in sessions by a speech-language pathologist.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
What is central auditory processing?
Hearing and understanding are different stages. The ear captures sound and sends it to the brain; central auditory processing is what the brain does with that signal once it arrives.
That work involves several skills at once:
- Separating speech from background noise.
- Locating where a sound comes from.
- Ordering sounds in sequence, which underpins the perception of speech.
- Detecting very brief gaps between sounds.
- Integrating what arrives at each ear.
When one of those skills does not work well, a person hears and still does not understand — especially when the environment does not help.
Which complaints bring the patient in?
In children:
- Frequently asking for repetition, even when close to the speaker.
- Not following long instructions or instructions with several steps.
- Confusing similar sounds in speech or writing.
- Appearing inattentive in the classroom, but concentrating well in quiet.
- Difficulty with reading and writing without another evident explanation.
- A history of recurrent ear infections in early childhood.
In adults:
- Not following conversation in a restaurant, meeting or place with music.
- A normal audiogram and the persistent sense that “everyone speaks too quietly”.
What must come first
Auditory processing assessment only makes sense with peripheral hearing within normal limits. Before it, audiometry and tympanometry are required, because an unrecognised hearing loss produces exactly the same complaints — and in that case the path is a different one.
How is the assessment carried out?
It takes place in an acoustic room, with headphones, and brings together a set of tests:
| Skill assessed | What the task asks |
|---|---|
| Listening in noise | Understanding speech with competing background noise |
| Dichotic listening | Processing different information arriving at each ear |
| Temporal ordering | Recognising the sequence of sounds differing in duration or pitch |
| Temporal resolution | Detecting very brief silent gaps between sounds |
The assessment takes an hour to an hour and a half and is tiring, because it demands attention throughout. This is why timing and prior rest make a difference to the result.
And the therapy?
Where assessment identifies affected skills, the path is auditory training: sessions delivered by a speech-language pathologist, with activities directed at the specific skills in each case. The work is reviewed as it goes on, and the number of sessions varies.
Alongside therapy, practical guidance for school and home usually comes in — seating position in the classroom, reducing noise, how to give instructions. That part often makes a difference in daily life straight away, in parallel with the training.
Where it is carried out
At Clínica Rhinus, in the Renascença district of São Luís. Assessment and therapy are delivered by the speech-language pathologists on our team, and the case is followed alongside the ENT specialist.
How should I prepare for this test?
- Bring the medical request: it is required for all tests, whether under insurance or self-pay.
- Have audiometry and tympanometry beforehand: the assessment depends on their results.
- Avoid exposure to loud noise for 14 hours before.
- Come rested — the assessment is long and requires sustained attention.
- Bring reports from school, speech therapy or neuropsychology, if available.
- If you wear glasses or a hearing aid, bring them.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about hearing
My child hears well but seems not to understand. Does that exist?
It does, and it is exactly what this assessment investigates. Audiometry measures whether sound reaches the brain; auditory processing concerns what the brain does with it — separating speech from noise, locating where it comes from, ordering sounds in sequence. A child may have a normal audiogram and difficulty at that later stage.
From what age can it be done?
Generally from age 7. The tasks require sustained attention and understanding of instructions, and below that age results are difficult to interpret. In younger children, the approach is to investigate peripheral hearing, treat any otitis or obstruction, and monitor language development.
Which complaints usually lead to this assessment?
Difficulty understanding in noisy settings, frequently asking for repetition, confusing similar sounds, inattention in the classroom, difficulty following long instructions, and reading and writing difficulties. In adults, the commonest complaint is not following conversation in a restaurant or meeting, despite a normal audiogram.
What does the therapy involve?
Auditory training delivered by a speech-language pathologist, in sessions, with activities targeting the skills identified as affected in the assessment — selective attention, temporal ordering, listening in noise. The number of sessions and the response vary from person to person and are reviewed as the process goes on.