We choose a test with regard of child’s age. If a child is under five years old, we won’t be able to perform a standard hearing test which requires reaction to sounds. We have an access to many different tests which don’t require neither child’s reaction nor alertness. Therefore, for such a young child we recommend Tympanometry test, Otoacoustic emission test, Auditory Brainstream Response test (ABR) or neurodiagnostics. All those examinations should be performed together in order to obtain reliable results and diagnosis. If a child is five years old or older, we can perform a standard tonal audiometry test, but there’s still a need for an additional test to confirm the results of a previous one.

If we suspect hearing loss on the grounds of previous hearing tests, for ex ample otoacoustic emission, we have to be very precise in our selection. We choose ABR test which not only shows our child’s hearing threshold for 500 Hz, 1,2,4 kHz, but also gives out information about the number of synapses and neurons in each range of intensity at each cell from 90 dB to 20 dB. It gives us a complete view on how developed a child’s nervous system is also in dynamics of hearing. If we, as parents, suspect that our child doesn’t respond properly, we should make sure everything’s fine, by performing ABR test or using neurodiagnostics. Those test are cheaper, they take less time and examine all frequencies. If a test shows a normal hearing range and complete development of nerves, no further testing is required. If opposite, we need to run ABR test.

Tympanometry is the most suitable medical test in such case. It shows pressure level of the inner ear, level of the ossicles tension and airway of the Eustachian tube. The examination also presents if the structure of our inner ear transmits sounds worse towards the inner ear as a result of the previous inflammation or exudation. It’s necessary to run this test before any other hearing examination we will perform, because lack of airway or exudate is a serious contraindication for further diagnostics such as ABR.

Unfortunately, no. We have to remember that until we are 12, the whole structure of inner ear (auricle and auditory cortex) is still being developed. The nervous system, meaning fibers with synaptic connections, connect with new cells and create new connections all the time. Until the age of 2, a range of auditory cells responsible for high frequencies reception is still in the process of development. Until the age of 10, apical structure is being developed in the cochlea and its task is reception of medium and low ranges where most of the speech aspects occurs. Thus, our child hears a little more quiet than we do and it’s a natural process of the auditory cortex development.

Tonal audiometry isn’t an indicator of hearing. We need to remember that in addition to cells, we have connections between a cell and neurons, called synapses, and fibers of the nervous system. Among school-age children we often observe damage of a significant part of the fibers transmitting sounds of medium intensity. If a child doesn’t struggle with hearing loss, and audiogram will show a normal hearing threshold, because fibers of this particular range transmit low intensities really well. Although a cell works properly, sound intensity above 30-50 dB is transmitted by synapses and fibers more poorly. Cognitive processes play a prominent role in speech understanding; therefore, it’s worth to run tests on memory and auditory perception.

Both capacity and effectiveness of cognitive processes in our brain depends on how big environmental stress our child is exposed to, and how is prevented from it. In the nervous system, mental and physical stress is considered as oxidative stress. If our child’s diet is of poor quality and physical activity is low; therefore, stress resistance in the nervous system is lower, neurons are susceptible to damage. The more damaged neurons we have, the lesser our memory becomes, because the number of nerve cells influences how long information can be stored in neurons. We need to bear in mind the difference in memory capacity according to a sex. Women have two auditory cortexes equipped with quickly analyzing neurons, a quickly changing signal within time, namely speech and two verbal memories. Men, on the contrary, have only one auditory cortex specialized with quick speech signal analysis and one verbal memory. The other cerebral of men’s brain specializes in analysis of sound localization, eurhythmics, syllables and simple signals, such as music. If we aim at reconstructing neurons, improving memory and concentration, a child should be more active physically and willing to keep a balanced diet. Those are the strongest correlations regarding production of neurotrophic proteins BDNF which are responsible for creating new neurons and protecting existing ones from damage.

Age is the main indicator. If a child doesn’t cooperate, we choose ABR, ASSR, Otoacoustic emission, 3D Tympanometry or absorption tests which will inform us at which hearing threshold a hearing aid should be selected. If a child is 5 or older, we can perform high frequency audiometry to evaluate which range of frequency can be effectively enhanced and to develop the auditory cortex even more.

Consistency and repetitiveness of tests. Sometimes tests are unsuccessful because a child’s natural process of the auditory nerve myelinogenesis hasn’t been completed yet due to an individual, delayed factor of certain fibers. After two months, test results might appear normal and it might turn out that everything is correctly developed.

Yes, it does, provided it’s properly selected to a hearing loss type and taking into consideration its unilateralness or bilateralness. Most of the auditory prosthetists tends to .. what is connected with patient’s disapproval of the price for two hearing aids, as a result of which, they don’t buy it at all. If we know that a patient has two-sided hearing loss but wants to purchase only one device, we refuse further treatment, because it would be a conscious medical mistake. Thus, if we can’t afford to buy a dual hearing aid, it’s better not to wear it at all.

Right ear stimulates left part of the midbrain and left auditory cortex in our brain. Left ear stimulates right part of the midbrain and right auditory cortex. Activity of one cerebral hemisphere determines activity of the other one. Thus, if we stimulate only the right side, it will undergo the process of deprivation and worsening of hearing. That’s why a patient can see no difference when wearing a single hearing aid; quite the opposite, he/she may even experience worse hearing. It’s connected with the fact that the nervous system notices the development of only one side, consequently, it takes the neurons from the opposite side and places them at the side equipped with a hearing aid. It makes unstimulated structure weak, leads to its fast worsening of hearing and weakening of the auditory cortex. When the auditory cortex becomes weak, it will make the other cortex weak as well, due to a rule of mutual dependence.

Speech understanding doesn’t depend upon what kind of hearing aid we have, but if we wear it at all. It’s impossible for neurons to develop and reconstruct without stimulation, so unless we buy a device we won’t be able to understand speech. Speech isn’t something we gain, neurons learn to understand speech signals and if hearing loss disturbs it, they will lack this ability. It requires 10 000 hours of wearing a hearing aid to teach them how to understand again. The most important factor in speech understanding is for hearing aid to have at least one amplification bandwidth which would cover speech range up to 10 kHz. RIC hearing aids offer good quality of sound and they are technologically more discreet in comparison with BTE devices. The brands offer products of the same shelf price, so the choice should be easy.

When buying a hearing aid, one of the many important factors is we should pay our attention to sound quality and whether or not it’s suitable for us. The speech itself doesn’t indicate good quality of a device, because speech depends upon a reconstruction stage of neurons in the auditory cortex, namely how long we’ve been wearing a device. Neither auditory prosthetists nor audiologists wear those devices, but patients themselves; therefore, they need to select hearing aids to meet their expectations in terms of first impression (sound quality and clearance, patient’s reaction to loud and quiet sounds). Please note that a brand-new hearing aid will sound different on its first and last day of use. It’s connected with the fact that some components burn out. Likewise, the longer the cable and processor of other audiophiliac devices work, the better sound we get, because the path between microphone and headphones has already been paved.

Of course, you should. Again, we’re facing a phenomenon of disproportion on the subject of access to stimulation of both cerebral hemispheres of the nervous system. Although one ear is perfectly healthy, at some point it will begin to weaken due to the ongoing process of weakening a well-hearing auditory cortex. Activity of one auditory cortex depends upon the other. Therefore, if one of them is weaker, the other one, despite perfect hearing, will be gradually moving into the stage of deprivation and weakness. It’s possible to stop this process by stimulating disabled side. Everything will return to normal state and capacity.

An elder person’s brain is plasticible. While hearing loss causes a decrease of neural populations in the auditory cortex, wearing a hearing aid activates auditory cells, which change vibrations into information as electromagnetic pulse, to work again. If electricity is sent to our neurons, they develop and create new populations which makes us understand speech more precisely. Thus, our nervous system can be in a good or even better condition it was before hearing loss. It’s responsible for sound analysis and creating sound impression regardless hearing loss level.

Our clinics, as one of the few, perform audiometry in high range up to 20 kHz. Contrary to popular belief, the majority of people isn’t able to hear sounds in those ranges. The range above 10 kHz is responsible for sound localization and its understanding in noisy environment, not for speech recognition. For clear understanding in noisy environment, our nervous system hears the widest range of high and low frequencies. When in noise, it’s able to distinguish sounds of similar range and deriving from the same direction on the grounds of differences in high and low sounds. In neurobiology, this process is called sound segregation and grouping in space.

Before hearing loss emerged, did you hear better when your interlocutor joined a conversation? Did your nervous system stop working without speech and you became deaf? I believe none of those happened. As we have already mentioned, our nervous system works all the time and it needs stimulation (silence is considered as stimulation as well). While sitting and reading a book, you don’t need hearing better, but your nervous system is stimulated by quiet sounds of the environment, which causes development of neurons at low sound intensity level; it makes you understand better and hear more. Thus, we should wear the devices from morning till evening, when the auditory system is of high activity. We need to remember that hearing aids should be worn 10 000 hours in total; therefore, the longer we wear it each day, the faster the time will pass. Similarly, if we put it off, 10 000 hours will extend up to 5 years.

You are provided with an opportunity to attend musical training sessions when you purchase hearing aids in our clinics. It’s not necessary, but strongly recommended. This program brings forward effectiveness and faster neurons rebuild; therefore, if we demand more rapid effects, we choose this particular therapy. Musical training is a must for children whose cognitive skills have to develop before they begin education. It generates necessity to support child’s nervous system by multi-sensory and musical training.

A music teacher with specialized knowledge of audiology. The moment a teacher sees an audiogram, he/ she knows with which instruments a patient should work most frequently in order for a reconstruction to be successful and effective.

A musical training is divided into two parts. In the first part, a patient practices the very basic skills of playing the instrument and in the second, focuses on frequency discrimination (learns how to distinguish octaves and closer sounds). It might seem easy, but once we start doing those exercises, it becomes the most difficult part.

A patient is in a special room where different audio-visual exercises are presented. The patient’s task, for instance, is to understand a sequence of sentences in sound pressure. The better the score is, the higher sound pressure becomes. We focus on practicing speech recognition in noisy environments, memory and dynamic audio-visual attention. A training session lasts approximately an hour.