# Retrocochlear Auditory Dysfunctions (RADs) and Their Treatment: A Narrative Review

## TL;DR

This review discusses retrocochlear auditory dysfunctions like auditory neuropathy and auditory processing disorders, focusing on their diagnosis, causes, and treatment strategies to improve communication and quality of life.

## Contribution

The paper provides a comprehensive synthesis of recent advances in understanding and managing retrocochlear auditory dysfunctions.

## Key findings

- ANSD is marked by neural desynchronization and poor speech discrimination despite normal outer hair cell function.
- APD involves central processing deficits with normal peripheral hearing and varied symptoms affecting speech perception.
- Combined bottom-up and top-down rehabilitation strategies may offer better outcomes for patients with RADs.

## Abstract

Background/Objectives: Retrocochlear auditory dysfunctions (RADs), including auditory neuropathy (AN) and auditory processing disorders (APD), encompass disorders characterized by impaired auditory processing beyond the cochlea. This narrative review critically examines their distinguishing features, synthesizing recent advances in classification, pathophysiology, clinical presentation, and treatment. Methods: This narrative review involved a comprehensive literature search across major electronic databases (e.g., PubMed, Scopus) to identify and synthesize relevant studies on the classification, diagnosis, and management of AN and APD. The goal was to update the view on etiologies (genetic/non-genetic) and individualized rehabilitative strategies. Diagnosis relies on a comprehensive assessment, including behavioral, electrophysiological, and imaging tests. Rehabilitation is categorized into bottom-up and top-down approaches. Results: ANSD is defined by neural desynchronization with preserved outer hair cell function, resulting in abnormal auditory brainstem responses and poor speech discrimination. The etiologies (distal/proximal) influence the prognosis for interventions, particularly cochlear implants (CI). APD involves central processing deficits, often with normal peripheral hearing and heterogeneous symptoms affecting speech perception and localization. Rehabilitation is multidisciplinary, utilizing bottom-up strategies (e.g., auditory training, CI) and compensatory top-down approaches. Remote microphone systems are highly effective in improving the signal-to-noise ratio. Conclusions: Accurate diagnosis and personalized, multidisciplinary management are crucial for optimizing communication and quality of life. Evidence suggests that combined bottom-up and top-down interventions may yield superior outcomes. However, methodological heterogeneity limits the generalizability of protocols, highlighting the need for further targeted research.