**4. Auditory neuronal plasticity**

memory, slower brain processing, and reduction in the ability to reduce the environmental

Factors such as working memory and speech processing speed influence speech recognition in noise. Studies have shown that the elderly who has a good cognitive performance obtained good results, which were better than those who had poorer performance, indicating that for

These cognitive changes associated with the decline in hearing thresholds and a worsening in hearing generates a change in perception and speech understanding in noise. These factors

Nowadays, we have the idea that there is a correlation between auditory processing tests and hearing loss and that the elderly performs worse than adults. Because of that, recent research includes study of the auditory processing and hearing loss, and look for a way to evaluate and

In the elderly, it is essential to consider the presence of peripheral hearing loss, but as it is a poor signal that reaches the cerebral cortex due to peripheral hearing loss, cognition of the elderly is fundamental for a better understanding of the message. Additionally, the auditory cortex of individuals in this portion of the population tends to atrophy, which causes a change in auditory processing, i.e., the sound that enters the system is already an altered sound, and

Studies show that seniors who have changes in auditory processing tend to perform a self‐ assessment of the hearing handicap worse than those who have no auditory processing disor‐

Some researches specify types of responses that can be obtained for each case. Individuals with low‐ and high‐frequency hearing loss show difficulty in monotonic tasks. In turn, the elderly with hearing loss in high frequency or normal hearing can perform well on these tests. Therefore, audiological characteristics of the hearing loss have to be taken into account to

Many factors have to be considered to assess auditory processing in the elderly. In addition to care in the test selection, it is important to consider the age of the assessed person. It is known that when comparing the performance of adults with the elderly performance, the elderly will have a lower performance than adults, those observed even in the presence of similar hearing loss. This occurs because there is a deterioration of the central auditory system, which gener‐ ates an auditory processing disorder in the elderly. This context interferes negatively with the hearing aids' fitting, reducing the satisfaction of the elderly in relation to these devices,

To evaluate how the elderly process this sound, or their listening skills, it can map out a more detailed and correct rehabilitation plan for each case. If there is the presence of periph‐ eral hearing loss, hearing aids must be fitted. However, with a broader look at the elderly's

der, showing that it is necessary for a better evaluation of each individual [32].

select the processing test and understand the results achieved [33].

processing the acoustic signal there is a cognitive interference condition [30].

result in a decline in the elderly quality of life and can lead to social isolation [31].

interference for speech understanding [6].

118 Advances in Clinical Audiology

**3.3. Auditory processing evaluation in the elderly**

it worsens because of the way this is processed [31].

intervene with this population.

resulting in a noneffective use [22].

The elderly with hearing loss suffer from the beginning of the hearing loss installation, sen‐ sory deprivation by having hearing restricted to some sounds. Thus, the introduction of sound stimuli, through the hearing aid, even after the privation period, can cause changes in the sensory system responsible for transmitting acoustic information.

The adaptation of hearing aids promotes neuronal plasticity. Neural networks are generated and areas of the brain that were not stimulated become stimulated, favoring the adaptation of the hearing aid and social reintegration of the elderly. In addition, the adaptation of the hear‐ ing aid can contribute to the stabilization of the hearing loss, namely, the reintroduction of certain sounds by the hearing aid can promote a positive plasticity (structural and functional reorganization of the central auditory system).

The longer an individual stays with hearing loss and without the use of hearing aids, the greater the negative effects on the perception of sound and performance in listening skills. The use of hearing aids favors amplification and modification of the sound stimulus so that it reaches the eardrum with quantity increase and quality, and promotes and stimulates the auditory skills.

Due to the improvement of the quality of sound that reaches the central auditory system, it is believed that after auditory stimulation for a certain period of time, the elderly tends to improve his auditory perception because there is a greater stimulation of the auditory cortex. This theory is grounded by the theory of brain plasticity, or because of high stimulation, which happens with the use of hearing aids: the brain region responsible for the understand‐ ing of the function and process the auditory information creates new neural network (plastic‐ ity), thus, generating a better performance of the individual. When this occurs, the elderly has a better hearing performance, because in fact there were positive brain changes.

In some cases, there is indication of auditory training, so that the auditory cortex can be poten‐ tially stimulated and thus there will be an improvement in hearing. Several surveys show that the auditory training is suitable for adults and the elderly with hearing loss, since this therapeutic resource improves perception and hearing in noisy or acoustically unfavorable environments.

Even with those seniors who have mild hearing loss, satisfaction with the use of hearing aids will not be great because of auditory processing disorders. Research claim that therein lies the impor‐ tance of ear training because it will occur with an improvement in electrophysiological response (latency wave III in ABR) in auditory localization and speech understanding in noise [41].

This training becomes complementary to the use of hearing aids. Thus, it will be through training that the individual with hearing loss will be able to hone your listening skills so there is a better understanding of speech [42].

The auditory training can assist in the recognition of sounds that were not already heard and others that can be modified by technology, such as the lowering frequency that seeks to dislo‐ cate a high‐frequency sound to a lower one.

The professional who will make the indication of the treatment must have concepts of neuro‐ science and aging, which should be considered at the time of the hearing aid selection and type of auditory training. Moreover, it is necessary to consider that there is brain reorganization and acclimatization with hearing aids and that these processes are closely related to cognition [43].

All this care and to look further, beyond the peripheral hearing loss, is essential for the individual with hearing aid, and notices an improvement in his understanding of speech. The presence of hearing loss can lead to changes in the mood of the elderly and social change, taking them into isolation. Because of this, it is important to evaluate the benefits of hearing aids and how the technology can change the life and the neurologic system of the elderly.
