The Auditory and Neurological Institute for the Assessment and Rehabilitation of Hearing

The Auditory and Neurological Institute for the Assessment and Rehabilitation of Hearing, located within the Interdisciplinary Clinical Center at Haifa University, provides the following services: assessment, consultation, auditory and rehabilitation consultation for all ages. The Institute has arrangements with most health organizations and agencies.
The Institute does not sell hearing aids. This is in order to remain objective and clear of all extraneous interests.
Institute staff is composed of senior speech therapists and audiologists with clinical experience acquired over many years. They are experts in the field of hearing. Some of them are members of the academic faculty at the Department of Communication Disorders, Haifa University. The Institute is fully equipped with the most innovative and advanced clinical instruments and has fully acoustically insulated testing rooms that meet the criteria for international standards as set by the American National Standard Institute (ANSI). The Institute also serves as an academic and research center in the field of hearing and collaborates closely with academic and medical establishments in Israel and abroad.
Hearing disorders are believed to be one of the most common health issues among children. Statistical findings show that one in every 1000 infants is born hard of hearing in both ears and approximately six out of every 1000 children develop some kind of hearing problem by the age of 6. Early identification and treatment of hearing problems are essential in order to (achieve) attain full speech and language development. Hearing disabilities can negatively influence many aspects of life, for example: language and speech development, cognitive and academic abilities, social skills, emotional development, and even choice of profession and career opportunities.

Director of the Institute: Dr. Rafi Shemesh
Head of the Department of Communication Disorders: Prof. Yossi Atias

Institute Team Members

Dr. Rafi Shemesh

Mr. Eyal Goel

Ms. Inas Natur

Behavioral Hearing Tests:
These tests are carried out in soundproof rooms and with earphones or loud speakers for the purpose of clarifying the hearing threshold of the individual to sounds and spoken voices. The test assesses whether or not there is a hearing dysfunction, determines the kind of dysfunction and evaluates its seriousness.
Objective Hearing Tests:
Auditory Brainstem Response (ABR):
The test measures Auditory Brainstem Response (ABR), the electric potential registered in the brainstem.
The ABR provides a measure for the functioning of the auditory system at the cochlear level (inner ear) via the auditory nerve to the brainstem.
During the test, electrodes are placed next to the individual’s ears and a sound composed of a series of clicks are sounded for a few minutes. The test provides objective data concerning the neurological functioning of the auditory pathways and the estimated threshold of hearing.
In adults, the test is carried out in a sitting or reclining position, in a quiet room, and the person is asked to close his or her eyes and relax quietly. The test does not hurt and does not cause any discomfort.
In infants and young children, the test is carried out during spontaneous sleep or following light sedation under a doctor’s prescription.
Otoacoustic Emissions (OAE) Testing
Cochlear emissions are sound waves that are emitted from the cochlea (inner ear) in response to sound stimuli, a phenomenon characteristic of healthy functioning ear. This test is carried out by the delivery of sounds at a variety of frequencies with a small microphone placed at the opening of the outer ear canal and measuring the response to these stimuli of the outer hair cells found in the inner ear.
The test lasts a number of seconds to minutes, depending on the level of environmental noise and movements made by the individual being tested. The test is objective and does not require the cooperation of the individual. Receipt of sound emissions indicates healthy functioning of the outer hair cells in the inner ear and a high probability of normal or near-normal hearing (except some rare pathological conditions).
In situations in which a comprehensive central hearing test is required, or in cases in which there is evidence of the existence of only slight hearing ability, a combined behavioural, electroacoustical and electrophysiological test is conducted. This estimates hearing thresholds for various stimuli and auditory brain functioning.
Assessment for the Characteristics of Tinnitus
Tinnitus is the sensation of noise, sounds or voices in the ear or the head with no external sound stimulus. Tinnitus, a symptom of a number of pathological conditions and diseases, can result from a wide range of disorders, necessitating detailed assessments involving the head and neck.
The purpose of the test is to assess tinnitus frequency and intensity. During the test, the individual is presented with sounds at different frequencies and volumes and he or she is instructed to compare these sounds with those heard without any outside source. In this way, it is possible to determine the nature of the tinnitus so the patient could be fitted with tinnitus-maskers .
Testing for Central Auditory Processing Disorders (CAPD)– coming soon
Central Auditory Processing Disorder is a problem that may arise in children and adults with hearing within Normal Limits. They find it difficult to understand spoken language using the auditory pathways alone, have problems absorbing and synthesizing aural information, mainly when there are difficult circumstances, such as background noise, the speaker speaks too quickly, or there is competition from another speaker.
In some cases, CAPD results from injury sustained by the structure of the aural pathway or to processes connected with it. In other cases, the problem arises from broader dysfunction, such as attention disorders, learning disorders, cognitive difficulties, and more. There may also be cases in which the difficulties arise from a combination of factors. Audiological Assessments prior to performing CAP tests includes a test battery of behavioral tests (tests of aural processing of sound and voice stimuli) electroacoustical and electrophysiological tests.
Assessment of Middle Ear Functioning
In the case of suspected middle ear function disorders (infection, leakage, perforated tympanic membrane, etc.) the following objective tests are conducted:
Tympanometry is used to evaluate functioning of the ear drum and the middle ear. In this exam, movement in the eardrum and the chain of ear bones (ossicles) is measured in response to sound delivered at various air pressures.
The test is carried out using a special instrument called the tympanometer. During the test, a small earphone with three holes is inserted into the outer ear canal; the holes contain a loudspeaker (delivers sound to the ear), a microphone (absorbs the sound emitted by the ear), and an additional hole that varies the air pressure in the outer ear canal. Sound volume emitted by the ear drum is measured as a change in air pressure in the ear canal and the results are recorded on a graph called the tympogram. Tympanometry is not a hearing test but only an examination of the effectiveness of the mechanical apparatus of the middle ear in passing sound to the inner ear. Therefore, it is certainly possible that the results of the tympometry will show normal functioning of the middle ear in spite of the fact that there is hearing loss.
Tympometry is a short, quick, painless and very effective test for identifying pathology of the middle ear, such as presence of fluid, abnormal aeration of the middle ear cavity, excess vibration in the eardrum, disconnection or fixation of the ear bone chain and more. Our clinic possesses the equipment necessary for accurate tests for children and infants as well as adolescents and adults.
Acoustic Reflex
When the ear is exposed to high volume acoustic stimuli, the muscles in the middle ear (the stapedius muscle and the tensor tympany muscle) contract in order to protect the inner ear from harmful high intensity sound. This is called the acoustic reflex. Over exposure to intense prolonged sound stimuli, the muscle contraction can lead to hardening of the system and diminished vibrations in the middle ear mechanism in response to sound. Response is measured with the tympometer, the results of which, together with all the complete battery of tests, help identify a variety of hearing pathologies.
Functioning of the Eustachian Tube (ETF)
The Eustachian tube connects the nose cavity with the middle ear cavity and tests for its functioning is carried out when an individual complains of pressure and blockage in the ears.
Ultra High-Frequency Audiometry
A healthy human cochlear ear can detect sounds in the range of 20-20,000 Hertz. For understanding of speech, the range of 500-3000 Hertz is sufficient but hearing loss due to exposure to high volume sounds begins at the higher frequencies and if undetected in the higher ranges, irreversible damage may occur. The professional literature emphasizes the importance of conducting Ultra high-Frequency Audiometry among individuals exposed to harmful noise and monitoring the hearing threshold of those taking ototoxic drugs (i.e., drugs with side-effects harmful to the inner ear).
Ultra high-Frequency Audiometry tests the threshold of hearing in frequencies higher than 8000 Hertz. Together with tests of otoacoustic emissions, cochlear damage that is not revealed in standard audiometry can be identified.
Additional research points to the importance of investigating the threshold at ultra-high frequencies among adolescents who complain of difficulty hearing when there is noise competition in the room standard audiometry indicates apparently normal hearing.

The audiology team at the institute provides consultation and supervision in issues concerning peripheral and central hearing disorders and hearing rehabilitation for children and adults. Rehabilitation includes use of air conduction and bone anchored hearing aids as well as cochlear implants.

The Institute is involved in research on the topic of clinical audiology in collaboration with universities, medical institutions and international research centers. The purpose of the research is to understand the auditory processes and to improve assessment and auditory rehabilitation from birth to adulthood.


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