Audiol. Res., Volume 14, Issue 6 (December 2024) – 10 articles

Despite the significant advancements in hearing aid technology, their adoption rates remain low, with stigma continuing to be a major barrier for many. This review aims to assess the origins and current state of hearing aid stigma, as well as explore potential strategies for alleviating it. This review examines the societal perceptions, psychological impacts, and recent technological advancements that can influence hearing aid adoption and reduce stigma. Methods: A narrative-focused review of the literature from peer-reviewed journals and reputable sources was conducted, analyzing papers on hearing aid stigma, adoption rates, and technological solutions. The research works were categorized based on their focus on the drivers and alleviation strategies for the stigma of hearing aids. Results: This review identifies stigma as a complex, multifaceted issue driven primarily by ageism, disability perception, and the association of hearing aids with aging and incapability. Despite technological improvements, the studies surveyed listed stigma as a major factor in non-adoption. Technological advancements such as artificial intelligence in sound processing, multifunctional features, and innovative design have shown potential in reducing stigma and improving user experience. Conclusions: Alleviating the stigma of hearing aids requires a multi-pronged approach, combining improvements in technology with changes in societal perceptions. Multifunctional devices including both health and communications functions, advanced signal processing, and esthetic improvements can drive their adoption, but broader public health awareness and education are also essential to changing societal attitudes and fostering greater acceptance of hearing aids. Full article

Background: We present a feasibility study on the development of a 3D-printed (3DP) model of benign paroxysmal positional vertigo (BPPV) and its validation as an educational tool for training in therapeutic maneuvers. Methods: A 1.5:1 3DP model of the human labyrinth, supplemented by a 1:1 3DP model of the skull, was obtained from a computed tomography scan. We presented the model to 15 Emergency Medicine residents, 15 medical students, 15 Otolaryngology residents, and 15 Otolaryngology practitioners from two academic referral centers. Participants performed the Semont and Epley maneuvers on the model twice, once before and once after observing the biomechanics of BPPV using this tool. A specific survey was then administered to assess both performance improvement and satisfaction. Results: All the trainees demonstrated an improving trend on the second attempt. The medical students ameliorated significantly after the training in both Epley (p = 0.007) and Semont maneuvers (p = 0.0134). The Emergency Medicine residents improved significantly in Semont maneuvers (p = 0.0134). Self-reported understanding of the BPPV mechanics improved significantly after training in all the groups (p < 0.05). Conclusions: The preliminary data highlighted the potential benefits of training on the 3DP model for practitioners involved in the first-line management of BPPV. Full article

Background/Objectives: Understanding speech in background noise is a challenging task for listeners with normal hearing and even more so for individuals with hearing impairments. The primary objective of this study was to develop Romanian speech material in noise to assess speech perception in diverse auditory populations, including individuals with normal hearing and those with various types of hearing loss. The goal was to create a versatile tool that can be used in different configurations and expanded for future studies examining auditory performance across various populations and rehabilitation methods. Methods: This study outlines the development of Romanian speech material for speech-in-noise testing, initially presented to normal-hearing listeners to establish baseline data. The material consisted of unpredictable sentences, each with a fixed syntactic structure, generated using speech synthesis from all Romanian phonemes. A total of 50 words were selected and organized into 15 lists, each containing 10 sentences, with five words per sentence. Two evaluation methods were applied in two sessions to 20 normal-hearing volunteers. The first method was an adaptive speech-in-noise recognition test designed to assess the speech recognition threshold (SRT) by adjusting the signal-to-noise ratio (SNR) based on individual performance. The intelligibility of the lists was further assessed at the sentence level to evaluate the training effect. The second method was used to obtain normative data for the SRT, defined as the SNR at which a subject correctly recognizes 50% of the speech material, as well as for the slope, which refers to the steepness of the psychometric function derived from threshold recognition scores measured at three fixed SNRs (−10 dB, −7 dB, and −4 dB) during the measurement phase. Results: The adaptive method showed that the training effect was established after two lists and remained consistent across both sessions. During the measurement phase, the fixed SNR method yielded a mean SRT50 of −7.38 dB with a slope of 11.39%. These results provide reliable and comparable data, supporting the validity of the material for both general population testing and future clinical applications. Conclusions: This study demonstrates that the newly developed Romanian speech material is effective for evaluating speech recognition abilities in noise. The training phase successfully mitigated initial unfamiliarity with the material, ensuring that the results reflect realistic auditory performance. The obtained SRT and slope values provide valuable normative data for future auditory assessments. Due to its flexible design, the material can be further developed and extended to accommodate various auditory rehabilitation methods and diverse populations in future studies. Full article

Background/Objectives: Hearing loss in childhood is associated with significant challenges in linguistic and cognitive development, particularly affecting language skills such as syntax, semantics, and pragmatics, which are essential for effective communication and social integration. This study aimed to analyze how different types and degrees of hearing loss impact linguistic development in children, and to identify clinical factors—such as age at diagnosis and years of language intervention—that may predict language performance. Methods: This study included a sample of 140 children aged 6 to 12, categorized into seven groups based on their hearing condition: unilateral and bilateral conductive, unilateral and bilateral sensorineural, unilateral and bilateral mixed hearing loss, and a control group with no hearing loss. Linguistic development was assessed using the Clinical Evaluation of Language Fundamentals-5 (CELF-5), a validated tool for diagnosing language disorders. Statistical analyses, including MANOVA and multiple regression, were conducted to evaluate differences in linguistic skills across groups and to determine the predictive value of clinical variables on total language performance. Results: The analysis revealed statistically significant differences across groups in all assessed linguistic domains (p < 0.001), with children with severe or bilateral hearing loss exhibiting notably lower scores compared to normohearing peers. The multiple regression analysis indicated that type of hearing loss was the strongest predictor of total linguistic performance (β = −0.674), followed by age at diagnosis (β = −0.285) and age of hearing device adaptation (β = −0.220). Years of language intervention also contributed significantly (β = 0.198) but to a lesser extent. Conclusions: This study highlights the critical impact of early and comprehensive auditory and language intervention on linguistic outcomes for children with hearing impairments. Early diagnosis and timely adaptation of hearing aids or cochlear implants are essential in mitigating language deficits, particularly in areas like syntax and pragmatic skills. These findings support the need for specialized, long-term interventions tailored to the severity and type of hearing loss to improve language development in this population. Full article

Background/Objectives: Tinnitus is a debilitating auditory disorder commonly described as a ringing in the ears in the absence of an external sound source. Sound trauma is considered a primary cause. Neuronal hyperactivity is one potential mechanism for the genesis of tinnitus and has been identified in the cochlear nucleus (CN) and the auditory cortex (AC), where there may be an imbalance of excitatory and inhibitory neurotransmissions. However, no study has directly correlated tinnitus with the extracellular levels of amino acids in the CN and the AC using microdialysis, which reflects the functions of these neurochemicals. In the present study, rats were exposed to acoustic trauma and then subjected to behavioural confirmation of tinnitus after one month, followed by microdialysis. Methods: Rats were divided into sham (aged, n = 6; young, n = 6); tinnitus-positive (aged, n = 7; young, n = 7); and tinnitus-negative (aged, n = 3; young, n = 3) groups. In vivo microdialysis was utilized to collect samples from the CN and the AC, simultaneously, in the same rat. Extracellular levels of amino acids were quantified using high-performance liquid chromatography (HPLC) coupled with an electrochemical detector (ECD). The effects of sound stimulation and age on neurochemical changes associated with tinnitus were also examined. Results: There were no significant differences in either the basal levels or the sound stimulation-evoked changes of any of the amino acids examined in the CN and the AC between the sham and tinnitus animals. However, the basal levels of serine and threonine exhibited age-related alterations in the AC, and significant differences in threonine and glycine levels were observed in the responses to 4 kHz and 16 kHz stimuli in the CN. Conclusions: These results demonstrate the lack of a direct link between extracellular levels of amino acids in the CN and the AC and tinnitus perception in a rat model of tinnitus. Full article

Background: Bilateral vestibulopathy (BVP) is a disabling condition characterized by a deficit in vestibular function on both sides. Current diagnostic criteria consider instrumental data only from horizontal canals, excluding vertical canals and otolithic function, with the possibility of not including some variants of BVP. This study aims to evaluate vestibular functions in people with chronic vestibular syndrome through a comprehensive battery of tests. Methods: This diagnostic accuracy study included patients who met criteria for probable BVP. The index test included a thorough evaluation of the vestibular system, using the video Head Impulse Test (vHIT) to measure the gain of the angular vestibulo-ocular reflex (aVOR) in all six semicircular canals and the cervical and ocular vestibular-evoked myogenic potentials (VEMPs) to assess otolith function. The diagnostic criteria established by the Barany Society were considered the standard reference, including only the horizontal vHIT as an instrumental assessment. Results: 78 patients (41 male, age 61.40 ± 12.99) were enrolled. The Barany criteria showed a low ability to rule out BPV (sensitivity = 46%). The median Dizziness Handicap Inventory (DHI) varied from 66 to 69 among the models studied, and a significant difference in DHI scores between positive and negative tests was observed for the Barany criteria and the six-canals vHIT model. Conclusions: Our findings highlight the potential to transform BPV diagnostic criteria. The identification of new bilateral vestibular dysfunction variants through improved diagnostic tools calls for revising current criteria, with promising implications for patient care and understanding of etiological and prognostic aspects. Full article

Background/Objectives: An air–bone gap (ABG) on audiometry is usually secondary to a conductive hearing loss. However, persistent and repeatable ABGs on audiometry in the absence of external or middle ear pathology is thought to arise from inner ear disorders including Meniere’s Disease (MD). In this paper, we aim to showcase this interesting finding occurring in MD with an associated literature review. Methods: Using retrospective review and analysis of case notes, we describe eight cases of persistent ABG on audiometry in MD. All other causes for the ABG were explored and excluded with the aid of objective audiological testing. Results: ABG can occur in a small sub-set of the MD population. In our case series, the ABG was typically found to affect the low frequencies. Higher frequencies appear to be spared. However, a detailed history, examination and battery of objective tests are required to ensure that all other causes of the ABG are reliably considered and excluded prior to attributing it to the inner ear. The finding of an ABG in MD may be dependent on the stage of the disease. Further research is required to determine the underlying cause of the ABG and its potential applications to help guide treatment. Full article

Background: Vestibular Neuritis (VN) can induce unilateral acute vestibular syndrome (AVS). This study aimed to identify predictive factors of recovery from vestibular neuritis considering total restitution and/or compensation. Methods: In this longitudinal study, 40 patients were included. The initial assessment, performed within 36 to 72 h from the onset (T0), included medical history taking (general and specific), including screening for cardiovascular risk factors (CVRFs), and a battery of diagnostic vestibular tests, comprising the bithermal caloric test (BCT), video head impulse test (VHIT), and skull vibration-induced nystagmus (SVIN) test. All patients also completed a Dizziness Handicap Inventory (DHI). All assessments were repeated 90 ± 15 days later (T3). Subjective compensation criteria were based on the DHI total score, and objective compensation criteria were based on laboratory test results. Four groups of patients (A, B, C, D) were delineated by combining patients with normal vs. abnormal vestibular tests and patients with normal vs. abnormal DHI. Results: CVRFs (but not age or body mass index (BMI)) were associated with a poorer recovery of symptoms. The BCT (lateral semicircular canal paresis %), VHIT (lateral semicircular canal gain), and SVINT (nystagmus slow phase velocity) recovered to normal values in 20%, 20%, and 27% of patients, respectively, at T3. Conclusions: Vascular risk factors (hypercholesterolemia) are correlated with patients who do not recover their symptoms via either total restitution or compensation. There was no significant difference between high- and low-frequency vestibular tests in patients recovering from their symptoms. Some patients with objective recovery may continue to have persistent subjective symptoms. Full article

(1) Background: Surgery for Chiari I malformation (CMI) is indicated when typical clinic-radiological features (syringomyelia, exertional headaches, sleep apnea syndrome, and tetraparesis) are present. Sometimes, patients have atypical complaints suggestive of otolaryngological (ENT) involvement, and it is sometimes difficult for the neurosurgeon to determine if these complaints are related to the CMI. Our aim was to describe postural control patterns in children with CMI using computerized dynamic posturography. To our knowledge, this is the first study addressing postural instability in pediatric CMI patients. (2) Methods: Twenty-eight children aged 6 to 17 years with both radiologically confirmed CMI and clinical ENT complaints were included. The children were separated into two groups, operated and non-operated patients, based on neurosurgical indication. Epidemiologic and posturographic results (CDP—Equitest^®) were compared between both groups, as well as pre- and postoperatively in Group 2. (3) Results: In Group 2 patients, significant improvement of global SOT was found after intervention. When the three sensorial aspects of postural control calculated by the system were independently assessed, the greatest improvement was in the vestibular ratio. We also observed an altered CoG pattern (“lateral deviation”) in the Group 2 patients, which significantly differed from those in Group 1. Lateral deviation was significantly reduced postoperatively in the Group 2 patients. A correspondence between preoperative MRI and the side of lateralization on posturography was found in four children, but this cannot be regarded as significant due to the low number of patients. (4) Conclusions: Postural control seems to improve after surgery for CMI in children, mostly due to the improvement in vestibular function. There is a correspondence between the side of lateral deviation and the side of greatest tonsillar descent on MRI and perioperatively. Further studies are needed to support these results and to confirm the utility of CDP in CMI patients. Full article

Objectives: Sensitivity to the gliding of ripples in rippled-spectrum signals was measured in both normal-hearing and hearing-impaired listeners. Methods: The test signal was a 2 oct wide rippled noise centered at 2 kHz, with the ripples gliding downward along the frequency scale. Both the gliding velocity and ripple density were frequency-proportional across the signal band. Ripple density was specified in ripples/oct and velocity was specified in oct/s. The listener’s task was to discriminate between the signal with gliding ripples and the non-rippled signal. Results: In all listener groups, increasing the ripple density decreased the maximal velocity of detectable ripple gliding. The velocity limit of ripple gliding decreased with hearing loss. Conclusions: The results can be explained by deteriorated temporal resolution in hearing-impaired listeners. Full article