Hello and welcome back to Sounding It Out. As we always say, a podcast dedicated to audiology and hearing health, brought to you by Signia UK and Ireland. I'm Julia van Huyssteen, your host, and I'm so happy to be back with a second of two new episodes in series four. I'm the head of audiology at Signia UK and Ireland and hearing health is really a very great passion of mine. I'm really happy to say that these podcasts are Signia- neutral, so that everybody with an interest in hearing health or audiology can benefit and enjoy them. For this series, we are going beyond the audiogram and we are exploring individual experiences of hearing. My guest speaker is Professor Andrew Hugill, who is the deputy director at the Institute for Digital Culture at the University of Leicester, where he has also founded the Creative Computing program. His background is in music, in which he is a professor and he's an active composer and musicologist. Throughout his career, he worked across artistic and scientific disciplines. As I said on our previous episode, Professor Hugill has three invisible disabilities and he uses these as a platform to work actively in these three areas to improve lives for others with the same or similar conditions. He's autistic, which includes social and sensory issues, but absolutely no learning difficulties. He has severe hearing loss, including tinnitus and diplacusis and he also has Ménière's disease, a balance disorder, which caused the hearing loss in the first instance. And these all contribute to his passion for aural diversity and hearing differences that we introduced in our first episode. So to summarize, in our first episode, we introduced things like the auditory system, animal hearing and also technology. Today, we will explore how invisible hearing disabilities or difficulties may affect people's hearing experiences and how we can influence the perception and appreciation of these difficulties and therefore, ultimately, providing appropriate support. Professor Hugill, welcome back and thank you once again for joining me for this podcast.

Hello and welcome back to Sounding It Out. As we always say, a podcast dedicated to audiology and hearing health, brought to you by Signia UK and Ireland. I'm Julia van Huyssteen, your host, and I'm so happy to be back with a second of two new episodes in series four. I'm the head of audiology at Signia UK and Ireland and hearing health is really a very great passion of mine. I'm really happy to say that these podcasts are Signia- neutral, so that everybody with an interest in hearing health or audiology can benefit and enjoy them. For this series, we are going beyond the audiogram and we are exploring individual experiences of hearing. My guest speaker is Professor Andrew Hugill, who is the deputy director at the Institute for Digital Culture at the University of Leicester, where he has also founded the Creative Computing program. His background is in music, in which he is a professor and he's an active composer and musicologist. Throughout his career, he worked across artistic and scientific disciplines. As I said on our previous episode, Professor Hugill has three invisible disabilities and he uses these as a platform to work actively in these three areas to improve lives for others with the same or similar conditions. He's autistic, which includes social and sensory issues, but absolutely no learning difficulties. He has severe hearing loss, including tinnitus and diplacusis and he also has Ménière's disease, a balance disorder, which caused the hearing loss in the first instance. And these all contribute to his passion for aural diversity and hearing differences that we introduced in our first episode. So to summarize, in our first episode, we introduced things like the auditory system, animal hearing and also technology. Today, we will explore how invisible hearing disabilities or difficulties may affect people's hearing experiences and how we can influence the perception and appreciation of these difficulties and therefore, ultimately, providing appropriate support. Professor Hugill, welcome back and thank you once again for joining me for this podcast.

Thank you. It's a pleasure.

Thank you. It's a pleasure.

Professor Hugill, here is my first question to you. Let's start by asking you to once again explain the terms neurodivergent, which you've already done during the first episode, but also aural divergent, because I think this will tee us up quite nicely for the rest of the episode. We introduced aural diversity in our previous episode, but I feel we are ready to do a bit more of a deep dive into those terms.

Professor Hugill, here is my first question to you. Let's start by asking you to once again explain the terms neurodivergent, which you've already done during the first episode, but also aural divergent, because I think this will tee us up quite nicely for the rest of the episode. We introduced aural diversity in our previous episode, but I feel we are ready to do a bit more of a deep dive into those terms.

So aural divergence and neurodivergence both refer to deviations from a predominant type. So in the case of neurodivergence, it would be a deviation from the predominant neurotype. So the majority of people are neurotypical. That's to say their brains are different, but they follow a broadly similar pattern. And then you have groups who have a marked difference, a neurodivergence, which is basically something you're born with. It's something that characterizes you and makes you who you are. In my case, you've mentioned autism. Autism is a difference in brain type. It's a different way of wiring the brain, if I can put it like that. The analogy I often use, it's like the difference between a Windows operating system and a Mac operating system. They both do the job of computing, but they do it in very different ways and things that work on a Windows computer will not necessarily work on a Mac computer and vice versa. So it's a bit like that. You see the world, you experience the world differently. And the same goes for are aural divergence. You hear the world differently. And this underpins a lot of the terms that you've used. The differences that are the result of some kind of brain or neurological processing.

So aural divergence and neurodivergence both refer to deviations from a predominant type. So in the case of neurodivergence, it would be a deviation from the predominant neurotype. So the majority of people are neurotypical. That's to say their brains are different, but they follow a broadly similar pattern. And then you have groups who have a marked difference, a neurodivergence, which is basically something you're born with. It's something that characterizes you and makes you who you are. In my case, you've mentioned autism. Autism is a difference in brain type. It's a different way of wiring the brain, if I can put it like that. The analogy I often use, it's like the difference between a Windows operating system and a Mac operating system. They both do the job of computing, but they do it in very different ways and things that work on a Windows computer will not necessarily work on a Mac computer and vice versa. So it's a bit like that. You see the world, you experience the world differently. And the same goes for are aural divergence. You hear the world differently. And this underpins a lot of the terms that you've used. The differences that are the result of some kind of brain or neurological processing.

I love that analogy and that's definitely something that I will use moving forward when I'm talking to colleagues and patients. That's brilliant. It's fantastic, because it just makes sense. It really does make sense if you put it that way. We're probably ready at this point to delve a little bit more into this neurodivergent and aural divergent factors or conditions or hearing differences and I think it's probably best for us to start with something that most people will have heard about before and that is, of course, tinnitus, which of course, you've shared you also have. We briefly touched on it and obviously, that coexists with your Ménière's disease as well. And I think for our listeners, for those that are not in the hearing industry and that are just enjoying hearing about hearing and aural diversity, the shortest possible definition I have really is that tinnitus is a sound or a perception of sound internally that isn't delivered externally. So the sound that you hear isn't present from the outside or externally. And it often involves sounds like clicking or buzzing, roaring, whooshing, or whistling. Of course, we have to acknowledge people's frustration with tinnitus. We've got to acknowledge how hopeless people can feel, the anxiety that goes with it, sleeping problems and we've got to support people through those two in terms of their experience with tinnitus. In addition to that, we can also have a bit of a different perspective when we talk about tinnitus in terms of where hearing and sound is important to the career and the hobbies and things like music. So I think from both yourself and the people that you talk to through Aural Diversity and through your music experiences, I'm wondering how tinnitus impacts musicians where pitch and tone and timbre and volume, all of that is so important. And then yet, you've also got this sound inside your head that is going on at the same time while you're trying to deal with the external sounds so specifically. What's your thoughts on that?

I love that analogy and that's definitely something that I will use moving forward when I'm talking to colleagues and patients. That's brilliant. It's fantastic, because it just makes sense. It really does make sense if you put it that way. We're probably ready at this point to delve a little bit more into this neurodivergent and aural divergent factors or conditions or hearing differences and I think it's probably best for us to start with something that most people will have heard about before and that is, of course, tinnitus, which of course, you've shared you also have. We briefly touched on it and obviously, that coexists with your Ménière's disease as well. And I think for our listeners, for those that are not in the hearing industry and that are just enjoying hearing about hearing and aural diversity, the shortest possible definition I have really is that tinnitus is a sound or a perception of sound internally that isn't delivered externally. So the sound that you hear isn't present from the outside or externally. And it often involves sounds like clicking or buzzing, roaring, whooshing, or whistling. Of course, we have to acknowledge people's frustration with tinnitus. We've got to acknowledge how hopeless people can feel, the anxiety that goes with it, sleeping problems and we've got to support people through those two in terms of their experience with tinnitus. In addition to that, we can also have a bit of a different perspective when we talk about tinnitus in terms of where hearing and sound is important to the career and the hobbies and things like music. So I think from both yourself and the people that you talk to through Aural Diversity and through your music experiences, I'm wondering how tinnitus impacts musicians where pitch and tone and timbre and volume, all of that is so important. And then yet, you've also got this sound inside your head that is going on at the same time while you're trying to deal with the external sounds so specifically. What's your thoughts on that?

Well, I think for musicians, it can be extremely debilitating and there are quite a lot of prominent examples in all fields of music actually, of musicians who've had to basically give up their careers because of tinnitus. And those who've managed to find ways of carrying on often do so in ways that make adjustments for the tinnitus that themselves affect the musical production. I think it's incredibly common in the music industry. Interestingly, as much in the classical music industry as in the rock and pop, people tend to assume that if you're exposed to loud noises for long periods, that will give you tinnitus, which it certainly will, but they tend to think that, "Oh, the rockers are going to have the worst tinnitus, because they make the loudest music." But actually, if you think about an instrument like a violin or a piccolo, where the sound is being produced very close to your ear and is often connected to your body with a physical connection, so you have the vibration, the bone conduction, as well as the sound. And the sounds are intense, so it's not just the volume of the sound. It's the intensity of the sound. These people often experience great problems with tinnitus. This is my crude understanding of tinnitus. I'm very aware that there's a lot of research and it's still very active. This is, I think, what's happening and this is why it's triggered not just by physical input. Loud noises and so on will trigger tinnitus, but it's also very much affected by your psychological condition at the time. So if you are tired, if you've consumed a lot of alcohol, if it's the middle of the night and you've woken up, these are the times when tinnitus really intrudes in a major way. So perceptually, it seems louder, it seems more insistent, more prominent. One other interesting thing about tinnitus that many people in the network have talked about is that if you use the word tinnitus, it makes your tinnitus worse. In fact, we published a book called Aural Diversity a few years ago, which contained essays by people from the network. And Patrick Farmer wrote an essay about tinnitus, which he experiences, but rather than use the word tinnitus, he used a wavy line. So it's like a symbol, like a tilde. I thought that was a really clever idea, to avoid the actual word.

Well, I think for musicians, it can be extremely debilitating and there are quite a lot of prominent examples in all fields of music actually, of musicians who've had to basically give up their careers because of tinnitus. And those who've managed to find ways of carrying on often do so in ways that make adjustments for the tinnitus that themselves affect the musical production. I think it's incredibly common in the music industry. Interestingly, as much in the classical music industry as in the rock and pop, people tend to assume that if you're exposed to loud noises for long periods, that will give you tinnitus, which it certainly will, but they tend to think that, "Oh, the rockers are going to have the worst tinnitus, because they make the loudest music." But actually, if you think about an instrument like a violin or a piccolo, where the sound is being produced very close to your ear and is often connected to your body with a physical connection, so you have the vibration, the bone conduction, as well as the sound. And the sounds are intense, so it's not just the volume of the sound. It's the intensity of the sound. These people often experience great problems with tinnitus. This is my crude understanding of tinnitus. I'm very aware that there's a lot of research and it's still very active. This is, I think, what's happening and this is why it's triggered not just by physical input. Loud noises and so on will trigger tinnitus, but it's also very much affected by your psychological condition at the time. So if you are tired, if you've consumed a lot of alcohol, if it's the middle of the night and you've woken up, these are the times when tinnitus really intrudes in a major way. So perceptually, it seems louder, it seems more insistent, more prominent. One other interesting thing about tinnitus that many people in the network have talked about is that if you use the word tinnitus, it makes your tinnitus worse. In fact, we published a book called Aural Diversity a few years ago, which contained essays by people from the network. And Patrick Farmer wrote an essay about tinnitus, which he experiences, but rather than use the word tinnitus, he used a wavy line. So it's like a symbol, like a tilde. I thought that was a really clever idea, to avoid the actual word.

So that's really interesting. I think from my point of view, I'm probably going to say something that isn't achievable, but we want to promote healthy hearing behaviors as much as possible within our industry for musicians, for everybody. Musicians in particular. And I don't know how realistic it is to talk about ear protection, but I do know that nowadays, we've got some really advanced, different types of protection that will attenuate sounds very specifically in terms of both the frequency response that it attenuates and also the amount of gain that is reduced by.

So that's really interesting. I think from my point of view, I'm probably going to say something that isn't achievable, but we want to promote healthy hearing behaviors as much as possible within our industry for musicians, for everybody. Musicians in particular. And I don't know how realistic it is to talk about ear protection, but I do know that nowadays, we've got some really advanced, different types of protection that will attenuate sounds very specifically in terms of both the frequency response that it attenuates and also the amount of gain that is reduced by.

Yes. Well, it's very important for musicians to use hearing protection. In rehearsals, in concerts, every musician should have flat frequency response earplugs that they use as a standard. And not just with amplified music. With acoustic music too. I've written about this. I wrote a book called The Digital Musician, which was first published in 2008. It's now in its third edition and it's a standard textbook in most music courses. In that book, I have a whole section on hearing protection. I think it's that important. And particularly in an era of in- ear buds, where people are listening to music with these inserts into the ear, I think it's generally accepted that it's roughly 40 minutes before the acoustic reflex gives up basically and you start to actually damage your hearing. So if you're playing for two hours, you are actually damaging your hearing at that point, or if you are listening to music for two hours, you are damaging your hearing. And initially, you won't notice that when you're young, but gradually, it will become more and more evident and it's cumulative and there's no going back. Once it's damaged, it's damaged. So that hearing protection is tremendously important for musicians. As for audiology and improving hearing health, I am aware that for audiologists, their worst patients are musicians, because musicians come in with a whole lot of assumptions and things, which the audiologist basically doesn't deal with or cannot deal with. It's not part of what they're there to do. But if I can just politely to my audiology colleagues say that from a musician's point of view, the experience of dealing with an audiologist is quite frustrating, because we know, for example, that the audiometric tests that you do do not cover even anything below middle C on the piano. Basically, you're already focusing on an area of hearing that doesn't include most of what I deal with as a musician. I know why you're doing that. It's because your focus is speech. The whole audiology and hearing aid industry is focused on speech, but actually, if you're a musician, that's not your primary focus. And we would probably argue that there are more richness in things that are not speech in life than in things that are just speech. Musical sounds are quite rich. I have actually suggested at an audiology conference once before that all audiology degrees should include a module on music and this was greeted with a fair degree of hostility. Someone said, " Does that mean opticians should all look at paintings?" And I said, " Well, yeah. I think it does." Just because I think people need to be aware of the full spectrum of hearing and music is one of those things that really, particularly classical music, deals with the complete range of audible frequencies, amplitudes and so on. It's not that you're necessarily going to change your audiometry radically for this, but in terms of supporting the patient and enhancing quality of life, having that awareness would be a great advantage, I think.

Yes. Well, it's very important for musicians to use hearing protection. In rehearsals, in concerts, every musician should have flat frequency response earplugs that they use as a standard. And not just with amplified music. With acoustic music too. I've written about this. I wrote a book called The Digital Musician, which was first published in 2008. It's now in its third edition and it's a standard textbook in most music courses. In that book, I have a whole section on hearing protection. I think it's that important. And particularly in an era of in- ear buds, where people are listening to music with these inserts into the ear, I think it's generally accepted that it's roughly 40 minutes before the acoustic reflex gives up basically and you start to actually damage your hearing. So if you're playing for two hours, you are actually damaging your hearing at that point, or if you are listening to music for two hours, you are damaging your hearing. And initially, you won't notice that when you're young, but gradually, it will become more and more evident and it's cumulative and there's no going back. Once it's damaged, it's damaged. So that hearing protection is tremendously important for musicians. As for audiology and improving hearing health, I am aware that for audiologists, their worst patients are musicians, because musicians come in with a whole lot of assumptions and things, which the audiologist basically doesn't deal with or cannot deal with. It's not part of what they're there to do. But if I can just politely to my audiology colleagues say that from a musician's point of view, the experience of dealing with an audiologist is quite frustrating, because we know, for example, that the audiometric tests that you do do not cover even anything below middle C on the piano. Basically, you're already focusing on an area of hearing that doesn't include most of what I deal with as a musician. I know why you're doing that. It's because your focus is speech. The whole audiology and hearing aid industry is focused on speech, but actually, if you're a musician, that's not your primary focus. And we would probably argue that there are more richness in things that are not speech in life than in things that are just speech. Musical sounds are quite rich. I have actually suggested at an audiology conference once before that all audiology degrees should include a module on music and this was greeted with a fair degree of hostility. Someone said, " Does that mean opticians should all look at paintings?" And I said, " Well, yeah. I think it does." Just because I think people need to be aware of the full spectrum of hearing and music is one of those things that really, particularly classical music, deals with the complete range of audible frequencies, amplitudes and so on. It's not that you're necessarily going to change your audiometry radically for this, but in terms of supporting the patient and enhancing quality of life, having that awareness would be a great advantage, I think.

Mm- hmm. Fully, fully, fully agree with you. I acknowledge these frustrations and I also understand that as an industry, we need to address those two.

Mm- hmm. Fully, fully, fully agree with you. I acknowledge these frustrations and I also understand that as an industry, we need to address those two.

There is a technical problem, of course, with lower frequencies, which is that hearing aids can't actually reproduce them, because apart from the fact there's a vent in a hearing aid, which means that no base frequencies are going to be contained, the wavelengths are just too long. So there's a technical reason why you wouldn't consider that, but my argument is not just about fitting hearing aids. My argument is about the whole patient and this is aural diversity in action. Yeah, hearing aids are hearing aids, but there are other forms of hearing, other forms of hearing device, other forms of hearing the world and I think an audiologist needs to take an interest in those as well as in the more traditional, " Let's fit a hearing aid, so that this person can hear speech better."

There is a technical problem, of course, with lower frequencies, which is that hearing aids can't actually reproduce them, because apart from the fact there's a vent in a hearing aid, which means that no base frequencies are going to be contained, the wavelengths are just too long. So there's a technical reason why you wouldn't consider that, but my argument is not just about fitting hearing aids. My argument is about the whole patient and this is aural diversity in action. Yeah, hearing aids are hearing aids, but there are other forms of hearing, other forms of hearing device, other forms of hearing the world and I think an audiologist needs to take an interest in those as well as in the more traditional, " Let's fit a hearing aid, so that this person can hear speech better."

No. Agreed. Agreed 100%. We're definitely aligned on that. So my next question is on a topic that I'm also extremely passionate about and that is auditory processing disorder, or short, APD, which is where individuals can't understand what they hear. And in the simplest way, it's because the ears and the brain don't fully coordinate. So you may have completely normal hearing, but the way that your brain is processing what's going in doesn't agree with each other, so to speak. And a lot of the time, people think it's just children that suffers from APD, but actually, there's a lot of adults that also suffer from APD. And a lot of the time, we could have people that come through the clinic that's got completely normal hearing and we do this audiogram, we've talked about this lots of times, and you say to them, even though they come to you and they say, " I really can't understand what people are saying to me, can't understand that background noise. It's just not clear. I have to really listen with effort and it's tiring. And even then, I get things wrong." And you do this hearing test and you say to them, " Actually, your hearing's fine." And don't think beyond that audiogram, because for APD, an audiogram will definitely not diagnose that. And I think my question to you is how often in the conversations that you've had within your network do you think that actually happens, where somebody says, a hearing care professional, whether it's an audiologist or a hearing dispenser, " Your hearing's fine," and then they don't get the help that they need?

No. Agreed. Agreed 100%. We're definitely aligned on that. So my next question is on a topic that I'm also extremely passionate about and that is auditory processing disorder, or short, APD, which is where individuals can't understand what they hear. And in the simplest way, it's because the ears and the brain don't fully coordinate. So you may have completely normal hearing, but the way that your brain is processing what's going in doesn't agree with each other, so to speak. And a lot of the time, people think it's just children that suffers from APD, but actually, there's a lot of adults that also suffer from APD. And a lot of the time, we could have people that come through the clinic that's got completely normal hearing and we do this audiogram, we've talked about this lots of times, and you say to them, even though they come to you and they say, " I really can't understand what people are saying to me, can't understand that background noise. It's just not clear. I have to really listen with effort and it's tiring. And even then, I get things wrong." And you do this hearing test and you say to them, " Actually, your hearing's fine." And don't think beyond that audiogram, because for APD, an audiogram will definitely not diagnose that. And I think my question to you is how often in the conversations that you've had within your network do you think that actually happens, where somebody says, a hearing care professional, whether it's an audiologist or a hearing dispenser, " Your hearing's fine," and then they don't get the help that they need?

Well, I think that's far more common than people realize and I think the people who are on the receiving end, as it were, the people with APD tend to just then go quiet, confronted with the factual evidence that their hearing is normal. There's a tyranny of otological normalcy, if I can put it like that, which drives people away. You can observe similar tendencies in some of the other areas I know we're coming on to like neurodivergence as well, where there's just this awareness that there's no support anyway. If you say, " Well, my hearing's normal, but I can't make sense of what I hear," what are you going to do about that? What are the therapies? This kind of APD can be caused by all sorts of things. Often childhood trauma of some kind, birth trauma, so physical problems that then have consequences for hearing. And I know quite a few people who are in that category with what you would call classical APD as opposed to the kind of processing difference that you would find with autism, let's say. But there's some overlap between them, I think. There are some situations where you've got people with normal hearing who can't make sense of what they hear, where there isn't a physical cause either and it's probably more widespread than we realize. It would still be classified as rare, I think, but by the medical profession. But as soon as someone says, " Oh, something's rare," I think back to when I was a child, almost nobody was diagnosed autistic and now, how many autistic people are there in the UK? Over a million, I would say and the number of diagnoses is growing all the time. So this is about, I think, awareness of the problem and an ability to understand what's happening and I think audiology can really help there if people can listen. I'm not sure what an audiologist can offer somebody other than perhaps a reference to someone who might be able to help. I think in terms of classical audiology, there's probably not much that can be done, but it's important to be aware of this kind of issue and to acknowledge it when it appears.

Well, I think that's far more common than people realize and I think the people who are on the receiving end, as it were, the people with APD tend to just then go quiet, confronted with the factual evidence that their hearing is normal. There's a tyranny of otological normalcy, if I can put it like that, which drives people away. You can observe similar tendencies in some of the other areas I know we're coming on to like neurodivergence as well, where there's just this awareness that there's no support anyway. If you say, " Well, my hearing's normal, but I can't make sense of what I hear," what are you going to do about that? What are the therapies? This kind of APD can be caused by all sorts of things. Often childhood trauma of some kind, birth trauma, so physical problems that then have consequences for hearing. And I know quite a few people who are in that category with what you would call classical APD as opposed to the kind of processing difference that you would find with autism, let's say. But there's some overlap between them, I think. There are some situations where you've got people with normal hearing who can't make sense of what they hear, where there isn't a physical cause either and it's probably more widespread than we realize. It would still be classified as rare, I think, but by the medical profession. But as soon as someone says, " Oh, something's rare," I think back to when I was a child, almost nobody was diagnosed autistic and now, how many autistic people are there in the UK? Over a million, I would say and the number of diagnoses is growing all the time. So this is about, I think, awareness of the problem and an ability to understand what's happening and I think audiology can really help there if people can listen. I'm not sure what an audiologist can offer somebody other than perhaps a reference to someone who might be able to help. I think in terms of classical audiology, there's probably not much that can be done, but it's important to be aware of this kind of issue and to acknowledge it when it appears.

Yeah. I think although there isn't a cure for APD, obviously, we need to go beyond thinking about our normal clinic routine and obviously, have the initiative to understand when somebody presents with a normal audiogram to do some further screening, because there is some tests where you can actually screen for APD. And then there are some activities where you can help improve their listening and concentration, so it's called auditory training. So there is research, although new, that backs up that auditory training can help improve. Not for everybody. A bell curve is in there for people that it works for, people that it doesn't and people that does really well. But you are right, so your standard audiology practice may not do these extra steps and this auditory training, because they focus on the usual patient pathway. And of course, one thing I can say from personal experience with APD clinics, in pediatrics, granted, is that reducing background noise is a big thing for people with APD. And if you can do that in any way, whether that is with an assistive listening device of some sort helps, you've got to go the extra steps to identify that this is a thing and then be able to implement the rehabilitation thereof. Now, I want to go to some more slightly unfamiliar topics like misophonia and diplacusis. You mentioned that some of these are really, really new, so in the last 20 years, only we became aware of it. I think we already talked a little bit about misophonia before, which is, of course, a neurological difference and you defined it quite nicely previously, but for the sake of those people that may not have listened to the first episode, do you want to just explain it again for us?

Yeah. I think although there isn't a cure for APD, obviously, we need to go beyond thinking about our normal clinic routine and obviously, have the initiative to understand when somebody presents with a normal audiogram to do some further screening, because there is some tests where you can actually screen for APD. And then there are some activities where you can help improve their listening and concentration, so it's called auditory training. So there is research, although new, that backs up that auditory training can help improve. Not for everybody. A bell curve is in there for people that it works for, people that it doesn't and people that does really well. But you are right, so your standard audiology practice may not do these extra steps and this auditory training, because they focus on the usual patient pathway. And of course, one thing I can say from personal experience with APD clinics, in pediatrics, granted, is that reducing background noise is a big thing for people with APD. And if you can do that in any way, whether that is with an assistive listening device of some sort helps, you've got to go the extra steps to identify that this is a thing and then be able to implement the rehabilitation thereof. Now, I want to go to some more slightly unfamiliar topics like misophonia and diplacusis. You mentioned that some of these are really, really new, so in the last 20 years, only we became aware of it. I think we already talked a little bit about misophonia before, which is, of course, a neurological difference and you defined it quite nicely previously, but for the sake of those people that may not have listened to the first episode, do you want to just explain it again for us?

Yeah. So misophonia is basically a negative reaction to a sound. It's one of those things that most people will recognise to some extent. Classically, fingers being dragged down a blackboard causes a lot of people to have it. There you go. You've just reacted.

Yeah. So misophonia is basically a negative reaction to a sound. It's one of those things that most people will recognise to some extent. Classically, fingers being dragged down a blackboard causes a lot of people to have it. There you go. You've just reacted.

Cringing.

Cringing.

Cringing. So that's a kind of misophonia in the sense that you hate that sound. That's what the word means. Literally, a hating of certain sounds. But people with misophonia, identified as such medically, are people for whom sounds are not just unpleasant. They are really physically painful and completely intolerable. A lot of the sounds tend to be sounds produced by other people. Sound of eating and crunching and I heard a BBC documentary about this the other day and they actually played some of the sounds as part of the documentary and you think, "No. That is not the way to go if you want misophonics to listen to your broadcast. Don't play them the sounds that they have a problem with."

Cringing. So that's a kind of misophonia in the sense that you hate that sound. That's what the word means. Literally, a hating of certain sounds. But people with misophonia, identified as such medically, are people for whom sounds are not just unpleasant. They are really physically painful and completely intolerable. A lot of the sounds tend to be sounds produced by other people. Sound of eating and crunching and I heard a BBC documentary about this the other day and they actually played some of the sounds as part of the documentary and you think, "No. That is not the way to go if you want misophonics to listen to your broadcast. Don't play them the sounds that they have a problem with."

Oh, dear.

Oh, dear.

But misophonia, I think, is one of those things that has become a very hot topic right now, because I think, again, people are realizing that it's far more extensive than has previously been acknowledged. The misophonic community overlaps somewhat with the autistic community and with the hyperacusis community, but they are distinct from one another. Misophonia and hyperacusis are not the same thing. So I think with misophonia, it's much more about a psychological state, a reactive state to the meaning of the sound to you than about necessarily the loudness of the sound or some other inherent audio property. It's an emotional and psychological reaction, misophonia.

But misophonia, I think, is one of those things that has become a very hot topic right now, because I think, again, people are realizing that it's far more extensive than has previously been acknowledged. The misophonic community overlaps somewhat with the autistic community and with the hyperacusis community, but they are distinct from one another. Misophonia and hyperacusis are not the same thing. So I think with misophonia, it's much more about a psychological state, a reactive state to the meaning of the sound to you than about necessarily the loudness of the sound or some other inherent audio property. It's an emotional and psychological reaction, misophonia.

This is interesting, because you've really described how distressing this can be. Well, actually misophonia was first recognized in 2001, actually, officially, but you know what? It's still not in a DSM- 5 or any other similar manual. Now, that, to me, is bonkers. So they call it the neglected disorder. As we just said, it can cause problems in school, work, your social life, your family. I, for example, had an ex- work colleague that had misophonia and back then, we didn't label it as misophonia and I'm talking my early 2000 careers. And she really struggled with people repetitively clicking their pens, click, click, click, click, click, click, so we had to replace all of the pens in the department with just your standard big pens, but we had to make it a rule throughout the office that we didn't have that, because you could see that it hurt her ear when somebody was clicking the pens. Now, that is an example of how it can affect somebody and everybody else around them as well, because all of us in the office had to adjust to help her with this particular response that she had. That is how impactful it can be.

This is interesting, because you've really described how distressing this can be. Well, actually misophonia was first recognized in 2001, actually, officially, but you know what? It's still not in a DSM- 5 or any other similar manual. Now, that, to me, is bonkers. So they call it the neglected disorder. As we just said, it can cause problems in school, work, your social life, your family. I, for example, had an ex- work colleague that had misophonia and back then, we didn't label it as misophonia and I'm talking my early 2000 careers. And she really struggled with people repetitively clicking their pens, click, click, click, click, click, click, so we had to replace all of the pens in the department with just your standard big pens, but we had to make it a rule throughout the office that we didn't have that, because you could see that it hurt her ear when somebody was clicking the pens. Now, that is an example of how it can affect somebody and everybody else around them as well, because all of us in the office had to adjust to help her with this particular response that she had. That is how impactful it can be.

Well, I think in terms of the Equality Act of 2010, what that will be called is a reasonable adjustment, replacing all the pens. It's a reasonable adjustment. It's not expensive, it's easily achieved and it doesn't impact on people in any significant way. You're still able to use a pen. But it obviously impacts on your colleague very profoundly, because it is the difference between being able to work and not being able to work. We're going to see more and more of this as people become aware that misophonia is a recognized condition and start to be more open about their own misophonia. Because I think it takes quite a bit of courage to say that you have a misophonia. Rather like your colleague, I imagine that there's a mixture of, " Yeah. Well, I have to say about this, because it's a real thing," but at the same time, aware of the likely reaction, which is, " Oh, come on. Clicking a pen? Why are you bothered about that?" That's what you're frightened of is that response and so it does take courage to admit to these things.

Well, I think in terms of the Equality Act of 2010, what that will be called is a reasonable adjustment, replacing all the pens. It's a reasonable adjustment. It's not expensive, it's easily achieved and it doesn't impact on people in any significant way. You're still able to use a pen. But it obviously impacts on your colleague very profoundly, because it is the difference between being able to work and not being able to work. We're going to see more and more of this as people become aware that misophonia is a recognized condition and start to be more open about their own misophonia. Because I think it takes quite a bit of courage to say that you have a misophonia. Rather like your colleague, I imagine that there's a mixture of, " Yeah. Well, I have to say about this, because it's a real thing," but at the same time, aware of the likely reaction, which is, " Oh, come on. Clicking a pen? Why are you bothered about that?" That's what you're frightened of is that response and so it does take courage to admit to these things.

There are also not so embedded, I guess, treatment methods that people try, but I think the first thing is, like you say, to recognize that that is a thing. And then I think working on from that is to either make this reasonable adjustment or to help people, if possible, with some coping strategies. I know that there's a majority of smaller studies done on the subject that are focused on the use of maybe something like tinnitus retraining therapy or cognitive, CBT, behavioral therapy. Some even tried exposure therapy. There's no real substance in terms of what definitely works and what we should do moving forward and that's because it's so new. But it is worth mentioning that people are starting to realize this is a thing and we need to try and not just make some adjustments ourselves, but also think about how we approach helping people with it.

There are also not so embedded, I guess, treatment methods that people try, but I think the first thing is, like you say, to recognize that that is a thing. And then I think working on from that is to either make this reasonable adjustment or to help people, if possible, with some coping strategies. I know that there's a majority of smaller studies done on the subject that are focused on the use of maybe something like tinnitus retraining therapy or cognitive, CBT, behavioral therapy. Some even tried exposure therapy. There's no real substance in terms of what definitely works and what we should do moving forward and that's because it's so new. But it is worth mentioning that people are starting to realize this is a thing and we need to try and not just make some adjustments ourselves, but also think about how we approach helping people with it.

I think all the therapeutic support and interventions potentially are valuable, but of course, only to the extent that they work for that person. Talking personally, I've many times have been advised to try mindfulness and have found it a absolute nightmare from an autistic perspective, because what it asks you to do is to become aware of your situation, intensely aware of the moment, living in the moment. And of course, for an autistic person who already has sensory overload to become even more aware of what's happening to your body and the senses and the environment around you is basically a instant shutdown. But that's not to say that I think mindfulness is bad. It's just it doesn't work for me and I think that is the key, is to find the therapies that work for the people concerned. I think, yes, tinnitus therapies, some of them help, some of them don't. If it helps, use it. Why not? But I would be wary of something that masked a problem that then stored up a bigger problem later on, if that makes sense.

I think all the therapeutic support and interventions potentially are valuable, but of course, only to the extent that they work for that person. Talking personally, I've many times have been advised to try mindfulness and have found it a absolute nightmare from an autistic perspective, because what it asks you to do is to become aware of your situation, intensely aware of the moment, living in the moment. And of course, for an autistic person who already has sensory overload to become even more aware of what's happening to your body and the senses and the environment around you is basically a instant shutdown. But that's not to say that I think mindfulness is bad. It's just it doesn't work for me and I think that is the key, is to find the therapies that work for the people concerned. I think, yes, tinnitus therapies, some of them help, some of them don't. If it helps, use it. Why not? But I would be wary of something that masked a problem that then stored up a bigger problem later on, if that makes sense.

Agreed. And many individuals can't isolate exactly one hearing difference. It's often more than one thing that is neurodivergent. You mentioned it before that somebody with autism might also struggle with misophonia and how do you separate that? It's almost very tricky to actually do that, so I think we need to understand these mechanisms a bit better, but we're having the right conversations at the moment, but you know what it's like. These things unfortunately take time and tinnitus is a good example in terms of research. There's so much around tinnitus available and potential causes and potential therapies, yet the NICE guidelines, they only endorse a hearing aid if there's a hearing loss. And CBT, yet you've just talked about the fact that there's other sound therapies available, for example, but it's not supported by the National Institute of Excellence guidelines, because there's not enough evidence to actually all come together and say, " This works." And that's the issue, so we've got people-

Agreed. And many individuals can't isolate exactly one hearing difference. It's often more than one thing that is neurodivergent. You mentioned it before that somebody with autism might also struggle with misophonia and how do you separate that? It's almost very tricky to actually do that, so I think we need to understand these mechanisms a bit better, but we're having the right conversations at the moment, but you know what it's like. These things unfortunately take time and tinnitus is a good example in terms of research. There's so much around tinnitus available and potential causes and potential therapies, yet the NICE guidelines, they only endorse a hearing aid if there's a hearing loss. And CBT, yet you've just talked about the fact that there's other sound therapies available, for example, but it's not supported by the National Institute of Excellence guidelines, because there's not enough evidence to actually all come together and say, " This works." And that's the issue, so we've got people-

Well, yeah, I agree, but also the problem they have is it's not generalizable. This is back to aural diversity again. This idea that there's a one- size- fits- all solution in the hearing domain seems to be very problematic and hearing is such a unique thing to each person. And so whatever we're talking about, there's always going to be an element of individual adjustment that goes on. And this applies even in the most common differences. There's always this component of individual adjustment. And in some senses, audiology does recognize that, because you can adjust your hearing aids now in a way that 15, 20 years ago, you couldn't. You could maybe turn up the volume or adjust the treble. That was about it. But now, you can actually do a lot of personalizing. So there's obviously a recognition of this, but I think when it comes to conditions like misophonia, yeah, I think it's very hard for NICE to issue a set of standards for something that's so variable and so personal.

Well, yeah, I agree, but also the problem they have is it's not generalizable. This is back to aural diversity again. This idea that there's a one- size- fits- all solution in the hearing domain seems to be very problematic and hearing is such a unique thing to each person. And so whatever we're talking about, there's always going to be an element of individual adjustment that goes on. And this applies even in the most common differences. There's always this component of individual adjustment. And in some senses, audiology does recognize that, because you can adjust your hearing aids now in a way that 15, 20 years ago, you couldn't. You could maybe turn up the volume or adjust the treble. That was about it. But now, you can actually do a lot of personalizing. So there's obviously a recognition of this, but I think when it comes to conditions like misophonia, yeah, I think it's very hard for NICE to issue a set of standards for something that's so variable and so personal.

Thought provoking, hey?

Thought provoking, hey?

Yeah.

Yeah.

So the next question is actually on something that's probably even more rare or unknown of and probably will be something that a lot of our listeners will never have heard of and it's something that you have yourself and that's diplacusis, which of course, is a hearing disorder whereby a single auditory stimulus is perceived as different pitches between two ears, important For musicians, and it's typically experienced usually as a symptom of sensorineural hearing loss or tinnitus, but not necessarily. I just want to confirm, I guess, for our listeners that this is different to a cochlear dead region. So with a cochlear dead region, which is the area in the cochlea where there's no function whatsoever, sometimes going back to the audiogram, you can get a response in different frequencies, but actually, you can't discriminate between the pitch of those frequencies, because you have a cochlear dead region. This is different, because talking about interaural differences.

So the next question is actually on something that's probably even more rare or unknown of and probably will be something that a lot of our listeners will never have heard of and it's something that you have yourself and that's diplacusis, which of course, is a hearing disorder whereby a single auditory stimulus is perceived as different pitches between two ears, important For musicians, and it's typically experienced usually as a symptom of sensorineural hearing loss or tinnitus, but not necessarily. I just want to confirm, I guess, for our listeners that this is different to a cochlear dead region. So with a cochlear dead region, which is the area in the cochlea where there's no function whatsoever, sometimes going back to the audiogram, you can get a response in different frequencies, but actually, you can't discriminate between the pitch of those frequencies, because you have a cochlear dead region. This is different, because talking about interaural differences.

So again, this is another one of these ones that is classified as rare, but I think it's far more common than people realize. And I think part of the reason why people don't realize how common it is is because most people are not trained musicians, so not used to listening in that way. If you've got diplacusis and you're hearing two different pitches from a single pitch source, you tend to just ignore that and try and work past it, but if you're a musician, that becomes very debilitating. So for me, the differences between the two ears vary in terms of pitch and so the intervallic difference, as we say in music, anything up to a minor third of detuning between the two ears, but note by note, it varies. And I actually built an instrument that reproduces what I hear when a normal piano is played and I did this in quite a crude way, which will abuse audiologists. I blocked up one ear and then played notes and sang them into a pitch meter and with my good ear, which is my left ear, my pitch was pretty well exact. And then when I blocked up my good ear and did the same exercise with my bad ear and there was all this detuning in the way that I sang and I was able then to take those measurements and transfer them into a digital instrument, which I call the diplacusis piano and I wrote a set of studies for diplacusis piano so that people could hear what I would hear if a normal piano is played. So I think this is a phenomenon that does apparently affect musicians more than the rest of the population, but actually, I suspect affects the rest of the population just as much. And I think certainly with Ménière's, there are four standard symptoms that you have to have to be diagnosed with Ménière's. Balance issue, tinnitus, hearing loss and aural fullness, so it's the sensation of pressure of fullness in the ear, but actually, diplacusis should be the fifth one, because I think everybody who has Ménière's also has diplacusis to some extent. And I did confirm this with my wonderful consultant, Professor Peter Ray, who very casually said, " Oh, yeah. Diplacusis is something else that people get with Ménière's." It's like, " That's the most important thing. Why isn't that part of the diagnostic criteria?" It's another one of those conditions that I think needs more research and again, I think we're becoming more aware of it now, partly thanks to the efforts of the Aural Diversity network.

So again, this is another one of these ones that is classified as rare, but I think it's far more common than people realize. And I think part of the reason why people don't realize how common it is is because most people are not trained musicians, so not used to listening in that way. If you've got diplacusis and you're hearing two different pitches from a single pitch source, you tend to just ignore that and try and work past it, but if you're a musician, that becomes very debilitating. So for me, the differences between the two ears vary in terms of pitch and so the intervallic difference, as we say in music, anything up to a minor third of detuning between the two ears, but note by note, it varies. And I actually built an instrument that reproduces what I hear when a normal piano is played and I did this in quite a crude way, which will abuse audiologists. I blocked up one ear and then played notes and sang them into a pitch meter and with my good ear, which is my left ear, my pitch was pretty well exact. And then when I blocked up my good ear and did the same exercise with my bad ear and there was all this detuning in the way that I sang and I was able then to take those measurements and transfer them into a digital instrument, which I call the diplacusis piano and I wrote a set of studies for diplacusis piano so that people could hear what I would hear if a normal piano is played. So I think this is a phenomenon that does apparently affect musicians more than the rest of the population, but actually, I suspect affects the rest of the population just as much. And I think certainly with Ménière's, there are four standard symptoms that you have to have to be diagnosed with Ménière's. Balance issue, tinnitus, hearing loss and aural fullness, so it's the sensation of pressure of fullness in the ear, but actually, diplacusis should be the fifth one, because I think everybody who has Ménière's also has diplacusis to some extent. And I did confirm this with my wonderful consultant, Professor Peter Ray, who very casually said, " Oh, yeah. Diplacusis is something else that people get with Ménière's." It's like, " That's the most important thing. Why isn't that part of the diagnostic criteria?" It's another one of those conditions that I think needs more research and again, I think we're becoming more aware of it now, partly thanks to the efforts of the Aural Diversity network.

So let's campaign for it being the fifth symptom for diagnosis for Ménière's. Let's do that.

So let's campaign for it being the fifth symptom for diagnosis for Ménière's. Let's do that.

One other thing I should say is people have said to me, " If that's the problem, why didn't you just block up one ear and listen with one ear rather than listening with two ears?" And the weird thing is that if I do that, I still have the diplacusis. So you think that this is about the signal hitting the two ears and one ear being more damaged than the other and so that is what causes this perceptual difference and that probably is it, but I think what's going on, and this is very much amateur theory time, is that my brain has now understood the differences between the two and so even when I listen to music without the bad ear, I still hear the diplacusis.

One other thing I should say is people have said to me, " If that's the problem, why didn't you just block up one ear and listen with one ear rather than listening with two ears?" And the weird thing is that if I do that, I still have the diplacusis. So you think that this is about the signal hitting the two ears and one ear being more damaged than the other and so that is what causes this perceptual difference and that probably is it, but I think what's going on, and this is very much amateur theory time, is that my brain has now understood the differences between the two and so even when I listen to music without the bad ear, I still hear the diplacusis.

Yeah. That's interesting. That's really, really interesting. Oh, wow. So I think the last complicated one to end on, and a disclaimer here, I know you've said at the start you're not a hearing scientist, although, oh my goodness, you know so much about the topic, credit to you, so the last thing that I would like to talk about is palinacousis. I think I'm saying it right. I've only ever read it and that's where sounds repeat after inaudibility and that's in the simplest form. So I've got two parts to this question. Is this different to auditory hallucinations? That's part one. And part two is when I prepared for this podcast, I stumbled across quite a lot of different causes of palinacousis, so the majority being physiological, which I think we can probably tick that box off, but there was definitely some studies that also mentioned schizophrenia, so maybe linking in with the first question about auditory hallucinations. I know that you obviously know a bit on the topic, but what is your insights and your thoughts on the links of these and what it is.

Yeah. That's interesting. That's really, really interesting. Oh, wow. So I think the last complicated one to end on, and a disclaimer here, I know you've said at the start you're not a hearing scientist, although, oh my goodness, you know so much about the topic, credit to you, so the last thing that I would like to talk about is palinacousis. I think I'm saying it right. I've only ever read it and that's where sounds repeat after inaudibility and that's in the simplest form. So I've got two parts to this question. Is this different to auditory hallucinations? That's part one. And part two is when I prepared for this podcast, I stumbled across quite a lot of different causes of palinacousis, so the majority being physiological, which I think we can probably tick that box off, but there was definitely some studies that also mentioned schizophrenia, so maybe linking in with the first question about auditory hallucinations. I know that you obviously know a bit on the topic, but what is your insights and your thoughts on the links of these and what it is.

Yeah. Strictly speaking, it is a form of auditory hallucination in the sense that you're hearing sounds that aren't there. You're hallucinating sounds that aren't there. But the difference, as I understand it, is that in palinacousis, there was a sound and that it continues after the sound has actually stopped. Whereas in an auditory hallucination, there is no sound. You just believe there's a sound. There was nothing that preceded it. So a typical auditory or musical hallucination would be you think you hear a record playing and you believe you're hearing that and there is no record playing. Whereas with palinacousis, you might have listened to a record and the record's stopped, but you think it's continued. And I think that's the major difference, that the brain believes that it's hearing something continuing in palinacousis. Like you say, this, again, would be classified as rare. It's something that traditionally, is a result of lesions in the brain. Also, epilepsy, you get this phenomenon. As with all the other things, I'm going to suggest that it's a bit more common than people realize. I still wouldn't say it's common. I think it is very unusual, but I think in various kinds of psychological conditions, it does manifest as part of perhaps a suite of manifestations of that condition and probably gets overlooked, partly because it's muddled in with a load of other stuff, but I think it is a little more common than perhaps people realize.

Yeah. Strictly speaking, it is a form of auditory hallucination in the sense that you're hearing sounds that aren't there. You're hallucinating sounds that aren't there. But the difference, as I understand it, is that in palinacousis, there was a sound and that it continues after the sound has actually stopped. Whereas in an auditory hallucination, there is no sound. You just believe there's a sound. There was nothing that preceded it. So a typical auditory or musical hallucination would be you think you hear a record playing and you believe you're hearing that and there is no record playing. Whereas with palinacousis, you might have listened to a record and the record's stopped, but you think it's continued. And I think that's the major difference, that the brain believes that it's hearing something continuing in palinacousis. Like you say, this, again, would be classified as rare. It's something that traditionally, is a result of lesions in the brain. Also, epilepsy, you get this phenomenon. As with all the other things, I'm going to suggest that it's a bit more common than people realize. I still wouldn't say it's common. I think it is very unusual, but I think in various kinds of psychological conditions, it does manifest as part of perhaps a suite of manifestations of that condition and probably gets overlooked, partly because it's muddled in with a load of other stuff, but I think it is a little more common than perhaps people realize.

Yeah. I think, again, this refers back to the standard protocol that most GPs or ENTs or audiologists would follow. It's just not something that you would ask about specifically. It's just not part of the case history and like you say, actually, if we do, we might start to understand just how often this happens. And as you say, part of a complex amount of symptoms that manifest together. But yeah, I've not come across this personally in my career, but that's because I've never asked.

Yeah. I think, again, this refers back to the standard protocol that most GPs or ENTs or audiologists would follow. It's just not something that you would ask about specifically. It's just not part of the case history and like you say, actually, if we do, we might start to understand just how often this happens. And as you say, part of a complex amount of symptoms that manifest together. But yeah, I've not come across this personally in my career, but that's because I've never asked.

Yeah. I think for an audiologist, it's something you might have in the back of your mind and you may never ever encounter it, but on the day that you do encounter it, you need to be aware of it and you need to know what that is. And as you say, ask people, because often, if you ask people what their experiences is, you'll be surprised by the answers, because people will have these very unique experiences. If you look back, people like Oliver Sacks writing about amusia and these conditions that at one time were regarded as really unusual psychological phenomena. And then gradually, over time, as awareness grows, they start to become a little more prevalent than they were previously. They're still unusual. A genuine amusia is unusual, but it's probably more prominent than we previously thought.

Yeah. I think for an audiologist, it's something you might have in the back of your mind and you may never ever encounter it, but on the day that you do encounter it, you need to be aware of it and you need to know what that is. And as you say, ask people, because often, if you ask people what their experiences is, you'll be surprised by the answers, because people will have these very unique experiences. If you look back, people like Oliver Sacks writing about amusia and these conditions that at one time were regarded as really unusual psychological phenomena. And then gradually, over time, as awareness grows, they start to become a little more prevalent than they were previously. They're still unusual. A genuine amusia is unusual, but it's probably more prominent than we previously thought.

Mm- hmm. That's tone- deaf, right?

Mm- hmm. That's tone- deaf, right?

Yeah. Well, the colloquial thing is tone- deaf. Yeah. The inability to distinguish, for example, between high and low sounds. Again, that's a neurological, brain processing thing.

Yeah. Well, the colloquial thing is tone- deaf. Yeah. The inability to distinguish, for example, between high and low sounds. Again, that's a neurological, brain processing thing.

I wanted to probe a little bit about whether there's any treatment for palinacousis. And this is my word now, palinacousis. I've got to try and learn to say it properly, because obviously, if we identify it, if we ask about it, we identify that that's something that we need to think about within our clinics, then where do we go from there? What is-

I wanted to probe a little bit about whether there's any treatment for palinacousis. And this is my word now, palinacousis. I've got to try and learn to say it properly, because obviously, if we identify it, if we ask about it, we identify that that's something that we need to think about within our clinics, then where do we go from there? What is-

Well, I'm not aware of any specific treatment for palinacousis, but I'm hardly an expert on this, but I would imagine that it would form part of some general treatment for schizophrenia or for other psychological conditions. It's possible that it would be incorporated into other forms of treatment that are not aimed specifically at that condition, because those other aspects of the condition are not aural necessarily. They don't make their way into aural diversity, so palinacousis here is sort of sitting out of context. It should really be seen in terms of certain forms of mental issues and probably would make its way into the DSM under that banner, rather than under any particular aural banner. But for aural diversity, given what we're trying to show, it's important to include it, because I'm trying to show the range of hearing difference.

Well, I'm not aware of any specific treatment for palinacousis, but I'm hardly an expert on this, but I would imagine that it would form part of some general treatment for schizophrenia or for other psychological conditions. It's possible that it would be incorporated into other forms of treatment that are not aimed specifically at that condition, because those other aspects of the condition are not aural necessarily. They don't make their way into aural diversity, so palinacousis here is sort of sitting out of context. It should really be seen in terms of certain forms of mental issues and probably would make its way into the DSM under that banner, rather than under any particular aural banner. But for aural diversity, given what we're trying to show, it's important to include it, because I'm trying to show the range of hearing difference.

Exactly. Exactly. Exactly. And I think that's a really strong point for us to bring it all together. I am so thankful, again for you, Professor Hugill, for talking about aural diversity as passionately as you have been. It was perfect and it really got the message across. Today, we delved a little deeper into some of the complex hearing disorders that can influence our hearing experiences like tinnitus, auditory processing disorder, misophonia, diplacusis, et cetera and one of the main takeaways for me is that any industry associated with hearing in any way have a responsibility to raise awareness on neurodiversions and aural diversions for how they approach individuals with communication, music and environmental sounds. It is certainly clear that our hearing system is complex and that we need to have a patient- centered care approach that considers any of these hearing differences in order to give the most appropriate support. If you are interested in any further information on Aural Diversity, you can connect with the Aural Diversity family on their website, auraldiversity. org. If you found any of what you've heard today helpful, please tell your friends, family and colleagues, so as many people as possible can share the knowledge. And if there's a topic you think we should be covering, drop us an email to the address on the show page. If you are just discovering this series, we've already talked to legendary audiologist, Dr. Gus Mueller about hearing aid fitting standards. And for series two, we had four UK industry experts that talked about audiology- led wax removal here in the UK. We also had Dr. Barbara Weinstein talking about the audiologist's role in dementia. You can go back and download those previous episodes for free wherever you get your podcasts from and remember to follow, so you don't miss any future episodes. This is a Fresh Air Production by Oli Seymour for Signia UK and Ireland. Until next time, goodbye and thank you.

Exactly. Exactly. Exactly. And I think that's a really strong point for us to bring it all together. I am so thankful, again for you, Professor Hugill, for talking about aural diversity as passionately as you have been. It was perfect and it really got the message across. Today, we delved a little deeper into some of the complex hearing disorders that can influence our hearing experiences like tinnitus, auditory processing disorder, misophonia, diplacusis, et cetera and one of the main takeaways for me is that any industry associated with hearing in any way have a responsibility to raise awareness on neurodiversions and aural diversions for how they approach individuals with communication, music and environmental sounds. It is certainly clear that our hearing system is complex and that we need to have a patient- centered care approach that considers any of these hearing differences in order to give the most appropriate support. If you are interested in any further information on Aural Diversity, you can connect with the Aural Diversity family on their website, auraldiversity. org. If you found any of what you've heard today helpful, please tell your friends, family and colleagues, so as many people as possible can share the knowledge. And if there's a topic you think we should be covering, drop us an email to the address on the show page. If you are just discovering this series, we've already talked to legendary audiologist, Dr. Gus Mueller about hearing aid fitting standards. And for series two, we had four UK industry experts that talked about audiology- led wax removal here in the UK. We also had Dr. Barbara Weinstein talking about the audiologist's role in dementia. You can go back and download those previous episodes for free wherever you get your podcasts from and remember to follow, so you don't miss any future episodes. This is a Fresh Air Production by Oli Seymour for Signia UK and Ireland. Until next time, goodbye and thank you.