Audiologic Rehabilitation

All of our senses are important but the ability to hear strongly impacts many areas of life. Particularly for infants and children, the ability to hear is the key to normal development of an array of skills: language and speech, obviously, but also emotional, social and intellectual. Hearing loss that is diagnosed and treated from an early age will have minimum impact on the development of these children’s skills. You should know that audiologic rehabilitation should begin in infants once hearing loss has been diagnosed – there is no need to wait.

Has your child been diagnosed with hearing loss? Audiologic rehabilitation will be specifically adapted to every case and will include:

Hearing aids

Hearing aids are the most common method in audiologic rehabilitation at any age. The aids are small electronic devices that are positioned on or in the ear and amplify the volume of sounds made in the environment.

How hearing aids work

The devices pick up sound waves made in the environment through a built-in microphone, which relays it through a tiny amplifier. The elevated sounds return to the outer ear, where the normal hearing process takes place.

Device fitting

Once the child has been diagnosed and the level of hearing loss determined, that child must be referred to an ear nose and throat (ENT) physician, who will determine whether the hearing loss requires medical intervention or rehabilitative intervention, and will subsequently refer the child to a speech pathologist for a consultation and adaptation of the hearing aid.

Hearing aids will be fitted in one of the pediatric audiologic rehabilitation centers (Hebrew) that are recognized by the Ministry of Health (in accordance with Circular 05/2016) for the adjustment and recommendation of hearing aids, or from age of 6 in one of the audiologic institutes of licensed Ministry of Health suppliers (Hebrew).

The fitting of the devices includes mounting the devices on the ears, separately calibrating the devices for each ear, experimenting and explaining the daily operation, as well as a trial and adjustment period of at least 4 weeks, in exchange for a deposit.

Once the devices have been fitted, you must submit an application on the Ministry of Health website for approval of eligibility for assistance in funding the hearing aid for children under the age of 18. The Ministry of Health subsidizes the payment for hearing aids up to a (payment ceiling) of NIS 6,000.

Options for financing hearing aids

• Ministry of Health financing: the Ministry of Health subsidizes the funding of hearing aids for infants and children under the age of 18 up to a limit (payment ceiling) of NIS 6,000. If the child is fitted with a hearing aid the price of which exceeds this amount, the family will be subject to a deductible for the difference. For more information about options and the amount of financing, visit the Ministry of Health website.
• Ministry of Welfare and Social Affairs financing: there is a possibility of financing of hearing aids by contacting the Ministry of Welfare’s Committee for Individual Assistance, to receive a basic needs grant for disadvantaged people.

Implants

Implants are hearing aids designed for people with severe hearing loss when hearing aids are unable to provide sufficient auditory accessibility. Implants perform the action of the inner ear, relaying the stimuli directly to the nerve ends. Implants are largely composed of two parts – internal and external, with the internal part surgically implanted in the inner ear and the external part fitted behind the ear.

How does it work? The microphone that is located on the exterior (processor) picks up sounds from the environment, transforms them into electrical signals and relays them to the internal part implanted in the ear, to the electrodes, and from there to the auditory nerve fibers.

Implants today can be adapted to a variety of auditory needs and hearing impairments.

Types of implants

• Internal ear implants include several types:
  
  • Cochlear implant: the cochlear implant is composed of internal and external parts. The external part includes: a speech processor, the function of which is to turn the received sounds into electrical signals, a transmitter designed to transmit the electrical signals to the internal receiver, and a magnet the function of which is to attach the external transmitter to an internal magnet located under the skin. These parts are placed in the inner part: a magnet, a receiver and an arc of electrodes that are implanted in the cochlea of the inner ear that does not function, and actually bypasses it transmitting the signals directly to the area of the brain responsible for hearing.
  • Electric Acoustic Stimulation (EAS) implant: the implant is designed for people with auditory nerve damage typified by high-frequency hearing loss and a milder hearing loss at lower frequencies. They are suitable for situations in which no additional deterioration in hearing is expected.
    
    
• Middle ear implants include several types:
  
  • VSB implants: the implant is designed for moderate to severe conductive hearing loss, in other words, where there is a mechanical problem with the transmission of sounds. The implant is activated by mechanical energy, through which it directly stimulates the organs of the middle ear.
  • Bone conduction implants such as BAHI – bone anchored hearing implants: a bone conduction implant is implanted in the skull and is intended for cases of conductive hearing loss, which impedes the use of standard hearing aids. It is also suitable for cases of deep damage to one ear, as a means of transmitting the sound to the hearing side.
    
    
• Auditory brainstem implant (ABI): the implant is designed for situations in which there is no evidence of auditory nerve disorder or when the cochlear is not developed. The implant directly stimulates the auditory nerve fibers located in the brainstem.

Auditory learning

The fitting of hearing aids or an implant for a child is just the beginning of the audiologic rehabilitation process. In fact, the amount of auditory information that reaches the auditory system from this moment is enormous, making it necessary to adapt to both the hearing aids and how the information is deciphered. To maximize the capabilities of the hearing aids, it is important to undergo auditory learning or auditory training. The HMOs subsidize auditory training of children with cochlear implants, based on the conditions of each HMO.

Audiologic rehabilitation involves training of the brain. In fact, through gradual exposure, the brain is taught to distinguish between different frequencies, between different decibels and between sounds of different durations, thus responding and deciphering sounds like speech, and understanding messages. The process is carried out with the help of a speech pathologist in quiet and comfortable conditions as well as in more challenging and noisy conditions (such as a multi-participant conversation), to gain experience and improve speech comprehension in any environment.

Language and speech therapy

After the device or implant has been fitted, it is especially important to teach language and speech skills, especially when dealing with infants and young children who have not yet acquired these skills. Acquiring language and speech skills is a process that takes time even for hearing babies. In their first year of life, babies are exposed to sounds and speech sounds in their environment and slowly begin to develop language. Hearing loss may be an obstacle to the baby’s development in other areas as well.

In the initial period after the hearing aid has been fitted, the adjustment period will begin. Until use of the hearing aid, the child may have heard certain components of the language differently, so it is possible that not all consonants ("consonants" are sounds that, during their production, have a complete or partial stoppage of the air in the oral cavity, such as: "pa", "ma", "ga") and intonation of speech have been acquired.