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Clinical diagnostics and hearing loss treatment

Hearing loss doesn’t have to be a burden to you! All you need to do is choose an appropriate regeneration program and you can start enjoying your great hearing again!

Hearing loss

Which medical test is necessary to check if my child hears properly?

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.

What kind of ABR hearing test is the Best for our child and how much it costs?

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.

What examination is required to diagnose inflammation of the inner ear?

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.

Do children hear in the same way as adults?

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.

What it means when my child faces hearing problems, but test result are perfectly correct?

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.

What if a test result will show lesser memory capacity?

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.

What kind of examination should be done to select a hearing aid for my child?

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.

What’s the most important in child’s diagnostics?

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.

Hearing loss testing for adults and children

In our clinics we have an access to the latest advanced technologies of hearing tests, such as high frequency audiometry test up to 20 kHz (used to examine activity range of inner and outer auditory cells), 3D Tympanometry (for advanced diagnostics of inner ear and the range of conducting frequencies by auditory ossicles), Otoacoustic emission and ABR (threshold, training, neurodiagnostics). Last two are used to examine structure of nervous system from ribbon synapses to lateral lemniscus (midbrain fibers concentration). Using ASSR technology, we are able to activity and eurhythmics of neuron oscillation in the auditory cortex. In our clinics you will find any medical test needed to answer all questions concerning tinnitus and the process of nervous system development in both adults and children. Additionally, we perform diagnostics of cognitive processes with use of (BATERIA TESTU). Thanks to this system we can evaluate children’s memory from sensory memory, short-term audio-visual memory in relation to dynamics and independence of cerebral hemispheres. Due to diagnostics of cognitive skills based on individual parameters, we select speech processor or hearing aid technology. We aim at getting the best possible effects of auditory cortex regeneration after hearing loss.

Hearing aids

Does hearing aid help in hearing better?

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.

Why is it wrong to wear single hearing aid when having bilateral hearing loss?

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.

Do I have to buy an expensive hearing aid for good speech understanding?

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.

Should I continue to wear my hearing aid if its quality is poor?

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.

Should I wear a hearing aid in a situation when only one ear is burden with a disorder?

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.

Can I hear as good as I used to?

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.

Does use of wide enhancement range in devices of 14 kHz give something? Can we even hear it?

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.

Do I have to wear a hearing aid all day long for better results?

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.

Hearing aids

In our clinic we also perform the very first and advanced rehabilitation program of the nervous system after long-term hearing loss, selection and regulation of hearing aids and rehabilitation of speech recognition in noise for patients whose hearing aids haven’t brought any results. During hearing loss, we observe reorganization and loss of the big part of the auditory cortex which is filled with neurons. If  hearing loss sustains for a longer time, neurons from the auditory cortex start to migrate to the visual cortex or they empower other sensory regions. The auditory cortex thereby looses neurons important and necessary in speech understanding. A patient who purchases a hearing aid in one of our clinics, will be provided with an additional, 6-month rehabilitation of neurons from the auditory cortex. Normally, it takes 10 000 hours of wearing a hearing aid to rebuild the structure of the auditory cortex. Musical and multisensory training shortens this time to around 5 000 hours. Brain Volts Laboratory of University in Northwestern proves in their studies the influence and effectiveness  of implementing training to everyday hearing rehabilitation of children and adults. Below, you can access all necessary information and research studies about this program.

Rehabilitation

Is musical training neccessary? Do I have to sign up for this?

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.

Who teaches how to play an instrument?

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.

How does a musical training look like?

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.

How does multi-sensory training look like?

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.

Rehabilitation

Except hearing aid devices, our clinics provide patients with specialized program of rehabilitation and reconstruction of hearing region, which may last from 6 to 12  months. It consists of musical and multisesnsory traning

 

Musical training is a program created exclusively for implant and prosthetic patients in order to improve their speech perception and speech recognition in noisy environment. Despite using technology of hearing aids and implants, a patient faces a problem of hearing speech in noise and among many interlocutors. Meeting patients’ needs, we created a special program with School of Communication in Northwestern (USA), which is based on playing an instrument and practicing frequency discrimination. Somatosensory stimulation (fingers movement on a keyboard) and stimulation of the auditory cortex with diverged tonal combination of octaves, create a possibility of double stimulation of the auditory  region. As a result, it leads to two-fold development of the auditory cortex. After six months of even short-term musical training, medical imaging research showed an increase of hampering neurons population in the auditory cortex of patients with very serious hearing losses. Hampering neurons are responsible for sound clearance; therefore, the more we have, the better we are able to hear. As test results show, musical training speeds up reorganization of regions responsible for hearing, improves our memory, concentration, perception and sending information between cerebral hemispheres. It fosters creative development and improves speech recognition in noise and among many interlocutors of 70%.