Audiol. Res., Volume 15, Issue 2 (April 2025) – 27 articles

Background: Cochlear implants (CIs) are the gold standard intervention for severe-to-profound sensorineural hearing loss. Their success depends not only on technological advancements but also on the knowledge, attitudes, and practices (KAP) of otolaryngologists responsible for patient selection, counselling, and postoperative management. Objective: This study aimed to evaluate the KAP of otolaryngologists in the UAE towards CIs, identify gaps in training and decision-making, and assess adherence to global CI protocols. Methods: A cross-sectional study was conducted using a self-administered online questionnaire distributed to otolaryngologists across public and private healthcare institutions in the UAE. The survey assessed demographics, clinical knowledge, attitudes towards CIs, and clinical practices. Descriptive and inferential statistical analyses were performed to assess the relationships among knowledge levels, referral frequency, and institutional factors. Results: A total of 31 otolaryngologists participated. While 74% demonstrated moderate-to-high knowledge of CIs, 39% had low awareness of national guidelines. Most (61%) strongly supported CI integration into treatment protocols, but financial and institutional barriers were frequently cited as challenges. Knowledge levels significantly correlated with referral frequency (p < 0.001), indicating a gap between awareness and practice. Conclusions: This is the first study in the UAE assessing otolaryngologists’ KAP regarding CIs. Despite favourable attitudes, limited guideline awareness, financial barriers, and inconsistent multidisciplinary collaboration remain challenges. Targeted clinician education, standardised CI guidelines aligned with international benchmarks, and improved funding mechanisms are essential to enhance CI accessibility and optimise patient outcomes in the region. Full article

Background/Objectives: In the early stage of presbycusis, patients experience reduced speech perception in noisy environments despite normal audiometry, normally known as hidden hearing loss. Diagnostic indicators like the reduced amplitude of ABR wave I, elevated extended high-frequency threshold (EHT), and decreased middle ear muscle reflex (MEMR) amplitude aim to identify biomarkers of peripheral auditory pathology but remain inconsistent. Mismatch negativity (MMN) is a cortical auditory evoked potential generated when the brain detects sound changes. This study aimed to assess MMN as a diagnostic tool for hidden hearing loss in adults. Methods: Seventy-three subjects with normal hearing underwent an extended pure-tone audiogram examination ranging from 0.125 to 16 kHz and a subsequent MMN assessment with two different paradigms: a speech (ba/da) and a tone (1/2 kHz) paradigm. The MMN’s amplitude and latency were measured and analyzed. Results: The outcome shows a significant age-related effect on MMN amplitude in the speech condition (χ² = 13.0, p = 0.002). Specifically, the MMN amplitude in the 25–30-year-old group was significantly smaller than in the 20–25-year-old group (p = 0.0015, Cohen’s d = 0.63). Additionally, no further effects of age were observed on the cortical potentials examined. Also, neither tone nor speech paradigms showed a significant influence of EHT on the amplitude or latency of either MMN or P300. Conclusions: The application of MMN as an electrophysiological tool to diagnose hidden hearing loss in normal hearing adults has limitations. However, in contrast to MMN responses to tonal stimuli, the present study reveals that MMN amplitude obtained with speech stimuli may indicate early signs of central auditory deficits. Full article

Background: Vestibular function implements head position regulation and body spatial navigation. It matures during childhood and adolescence and integrates with the completion of an individual’s motor development. Nevertheless, vestibular impairment is associated with profound paediatric hearing loss and has a negative impact on the child’s motor proficiency. Cochlear implantation (CI) is the treatment of choice for severe hearing loss, where conservative treatment plans are not appropriate or fail. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation with respect to the hearing, speech, psychological, and balance development among CI users. Methods: This study focuses on the vestibular function and the appropriate methods for vestibular assessment. The results of two established vestibular test methods are explored: the video head impulse test (vHIT) and cervical/ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP) with air and bone conduction vibration stimulation. The results of vHIT, cVEMP, and oVEMP, per implanted ear and the relation to the aetiology of hearing loss are reported. An additional dynamic visual acuity (DVA) test was included to assess clinical oscillopsia. Results: Overall abnormal lateral canal testing was detected in 35/76 (46.1%) of the implanted ears. Bone-conducted cVEMP (BC cVEMP) was pathological in 33/76 (43.3%) and BC oVEMP in 42/76 (55.3%). Lateral canal impairment was associated with the background diagnosis of the hearing loss. Oscillopsia was related to bilateral canal impairment (sensitivity 73% specificity 100%). Conclusions: Lateral canal testing together with BC VEMPs were the most reproducible modules for vestibular testing The above tests were related to each other and complemented the overall vestibular assessment. DVA is a helpful tool to screen dynamic oscillopsia in patients with bilateral vestibular impairment. Full article

Background/Objectives: Electrode impedance is crucial for optimizing cochlear implant (CI) stimulation and hearing outcomes. While typically stable, some patients experience unexplained impedance fluctuations. This study used electrode impedance subcomponent analysis to identify the subcomponents contributing to these impedance fluctuations. Methods: This study analyzed clinical electrode impedances and transimpedance matrix (TIM) measurements in 10 CI patients with Nucleus devices (CI422, CI522, or CI622 electrode arrays) who exhibited fluctuating or rising electrode impedances. TIM measurements used a cathodic-leading biphasic pulse (110 CLs, 75 µs/phase, 7 µs interphase interval). Electrode impedances were determined at 6, 12, 18, 24, and 75 µs, and subcomponents (access resistance [near-field/far-field] and polarization impedance [Warburg capacitance/Faraday resistance]) were calculated. Results: Both access resistance and polarization impedance changes contributed to impedance fluctuations. Large changes in near-field resistance compared to far-field resistance were associated with increased resistance to current flow closer to the surface of the electrode. The decreased double-layer capacitance and slightly increased Faraday resistance further suggested increased resistance to charge transfer at the electrode–electrolyte interface. Conclusions: Electrode impedance subcomponent analysis reveals changes in the electrochemical reaction at the electrode surface that cause fluctuating or rising CI electrode impedances. Full article

Background/Objectives: This study investigated whether exposure to various types of information online can influence adults aged 40 and above in their likelihood to purchase hearing aids (HAs). Specifically, it examined the effects of price anchoring, using high or low HA prices in advertisements, and attribute framing, using product descriptions that highlighted lifestyle appeal or technological capabilities. Methods: In a 2 × 2 experimental design, 271 participants browsed a website simulating an online search for hearing health information. Participants then rated their likelihood of purchasing three fictitious HAs as well as their likelihood of not purchasing any device. Results: Two-way ANCOVAs indicated no significant main effects of anchoring or framing on purchase likelihood for the fictitious devices (covariates included self-rated hearing ability, trust in online health information, and HA knowledge and importance). No significant interaction effects emerged. However, exploratory analyses revealed significant anchoring effects for two of the three devices among participants with below-median self-rated hearing. Additionally, self-rated knowledge was a significant covariate in the model for all devices (p < 0.001), positively correlating with purchase likelihood. Participants with above-median self-rated knowledge showed significantly higher purchase likelihood for all devices (p < 0.001, d ≥ 0.572 for all comparisons), while those with below-median knowledge displayed a significant anchoring effect for two outcomes. Conclusions: Enhanced HA knowledge may increase HA purchase likelihood and reduce the potential anchoring effects of online advertising. Further research is needed to determine the impact of exposure to high or low prices on HA purchase decisions, especially among those with poorer hearing. Full article

Background/Objectives: Hearing aid fitting is critical for hearing loss rehabilitation but involves complex, interdependent parameters, while AI-based technologies offer promise, their reliance on large datasets and cloud infrastructure limits their use in low-resource settings. In such cases, expert knowledge, manufacturer guidelines, and research findings become the primary sources of information. This study introduces DHAFES (Dynamic Hearing Aid Fitting Expert System), a personalized, ontology-based system for hearing aid fitting. Methods: A dataset of common patient complaints was analyzed to identify typical auditory issues. A multilingual self-assessment questionnaire was developed to efficiently collect user-reported complaints. With expert input, complaints were categorized and mapped to corresponding hearing aid solutions. An ontology, the Hearing Aid Fitting Ontology (HAFO), was developed using OWL 2. DHAFES, a decision support system, was then implemented to process inputs and generate fitting recommendations. Results: DHAFES supports 33 core complaint classes and ensures transparency and traceability. It operates offline and remotely, improving accessibility in resource-limited environments. Conclusions: DHAFES is a scalable, explainable, and clinically relevant solution for hearing aid fitting. Its ontology-based design enables adaptation to diverse clinical contexts and provides a foundation for future AI integration. Full article

Background: Hearing-related disease is a significant cause of disability worldwide. In resource-limited settings, prevention and early detection are critical for preventing severe disease. Understanding what a population knows and believes with regards to hearing health can be critical in identifying knowledge gaps and developing targeted interventions. Objective: To assess community awareness of hearing health and otitis media (OM) treatment, both modern and traditional, to inform educational programs. Methods: A retrospective review of clinical records from 52 patients (aged 1–79 years) diagnosed with OM during a 3-day hearing health clinic in Kasungu district, Malawi was conducted. Patients diagnosed with OM during the clinic were invited to provide additional details about their hearing health. Surveys contained open-ended questions to assess knowledge and beliefs regarding the cause of their infection and therapies they had previously used for treatment, including home remedies and prescribed medications from allopathic providers or traditional healers. A WHO adapted survey on hearing knowledge was also administered. Results: Hearing loss was identified in 60% of participants. Otoscopy revealed either bilateral or unilateral drainage in 69% of participants and perforation in 73%. Confidence in understanding the causes and treatments of OM was voiced by 60% of participants and 54% had used home remedies as treatment. Of the 11 home remedies used, none aligned with modern medical practice, and only two were recommended by local herbalists. Conclusions: Hearing-related disease contributes significantly to global disability, particularly in resource-limited settings. Educational campaigns to improve hearing health knowledge offer low-cost yet impactful solutions and implementation via partnerships with community leaders and traditional healers can be critical to addressing hearing health challenges. The use of nonantibiotic antimicrobials should be explored further, as these are low-cost and readily available. However, therapeutic alliance between patients and healthcare providers remains crucial. Full article

Background/Objectives: Unilateral hearing loss (UHL) is a relatively common disability condition comprising around 20–50% of all congenital hearing loss (HL). The adverse effects of UHL affect the typical development of auditory function with implications for communication, speech and language acquisition, academic development and quality of life. Current literature suggests an early intervention treatment in order to avoid developmental delays, but there is a lack of evidence about the effectiveness and use of hearing devices. The purpose of the present study was to evaluate the benefits of rehabilitative strategies such as hearing aid (HA) and cochlear implant (CI) in UHL children by exploring audiological and parent-reported outcomes. Methods: A total of 18 UHL children, between the ages of 3 and 17, were enrolled in the study designed as a prospective longitudinal study from July 2023 to July 2024. All children were evaluated for speech perception in quiet and noise and subjective benefits before and after rehabilitative treatment with HA in 15 (83.3%) children and with CI in 3 (16.7%) children. Results: The evaluation of audiological outcomes in children with UHL, based on assessment of aided sound field thresholds and speech perception scores assessment versus unaided, shows improvements in audiometric thresholds and how the hearing devices adequately support listening and spoken language. Scores with hearing devices were significantly higher than baseline-only scores when averaging both SSQ and CHILD questionnaires, pointing to an overall rehabilitative benefit. Conclusions: Rehabilitative interventions, particularly HA and CI, offer notable benefits when introduced early, but achieving optimal outcomes requires a multidisciplinary and individualized approach. Full article

Background/Objectives: A crucial factor for a successful cochlear implant (CI) outcome is an intact auditory nerve (AN). The integrity of the AN can be tested during implantation by measuring electrical auditory brainstem responses (eABR) via the CI. A method that does not require a CI is the use of the auditory nerve test stimulator (ANTS) from MED-EL (Innsbruck, Austria). The aim of the current study was to investigate the cases tested with the ANTS at our clinic and to describe the hearing results following CI for the cases who were implanted with a CI. Methods: All patients underwent preoperative magnetic resonance imaging (MRI) and high-resolution computed tomography (HRCT) to rule out cochlear malformation or retrocochlear pathology. In this study, we described all cases from when we began using the ANTS in 2011. Results: Five patients were tested intraoperatively: three adults with long-term deafness prior to CI and two children with no detectable AN. Three of the five patients were implanted with a CI. All implanted patients in this study could hear with their CIs, even though the speech perception results were limited. Conclusions: The ANTS can be used as a method to assess cochlear nerve function during implantation. The eABR results from the ANTS and the implanted CI were comparable for all cases in our study. Minor changes in waveform latencies were found between ANTS and CI stimulation and may be explained by the insertion depth of the electrode used for stimulation. Full article

Objectives: Evaluating middle ear function is essential for interpreting screening results and prioritizing diagnostic referrals for infants with hearing impairments. Wideband Acoustic Immittance (WAI) technology offers a comprehensive approach by utilizing sound stimuli across various frequencies, providing a deeper understanding of ear physiology. However, current clinical practices often restrict WAI data analysis to peak information at specific frequencies, limiting its comprehensiveness. Design: In this study, we developed five machine learning models—feedforward neural network, convolutional neural network, kernel density estimation, random forest, and support vector machine—to extract features from wideband acoustic immittance data collected from newborns aged 2–6 months. These models were trained to predict and assess the normalcy of middle ear function in the samples. Results: The integrated machine learning models achieved an average accuracy exceeding 90% in the test set, with various classification performance metrics (accuracy, precision, recall, F1 score, MCC) surpassing 0.8. Furthermore, we developed a program based on ML models with an interactive GUI interface. The software is available for free download. Conclusions: This study showcases the capability to automatically diagnose middle ear function in infants based on WAI data. While not intended for diagnosing specific pathologies, the approach provides valuable insights to guide follow-up testing and clinical decision-making, supporting the early identification and management of auditory conditions in newborns. Full article

Background/Objectives: Although newborn hearing screening (NHS) programs have been successfully implemented in many countries worldwide, challenges to these programs have been reported in the literature, such as a lack of awareness among families and healthcare professionals and limited funding. Challenges to the NHS programs in Saudi Arabia have not been systematically reported. This study aimed to assess the level and quality of evidence supporting the existing challenges of the NHS programs in Saudi Arabia. Methods: A systematic review of all peer-reviewed literature on Saudi NHS programs published between 2016 and 2024 was conducted according to the PRISMA guidelines. Search strategies were executed in seven databases. Data were collected from studies that met the inclusion criteria. Results: A total of 37 records were reviewed, and 13 peer-reviewed publications met the inclusion criteria. Characteristics of included studies were classified by study language, study sample, sample size, location of the study sample, study purpose, and study method via evidence tables. Each study was critically appraised according to the quality. Results revealed that cross-sectional prospective description was the main research design with low strength of evidence. Six main challenges were identified and described: lack of awareness and gaps in knowledge, lost to follow-up, inadequate data entry, management, and tracking system, limited or absence of services in some residential areas, insufficient training and frequent changes of NHS personnel, and absence of a standardized NHS protocol. Conclusions: This review may assist in overcoming these challenges and improving the NHS programs in Saudi Arabia. There is a need to establish national education campaigns about the NHS programs, improve documentation by using database management and tracking systems, and expand the early hearing detection and intervention (EHDI) services for children in all Saudi regions. Full article

Background/Objectives: Aural toilet using microsuction is a common procedure in ENT clinics, and vertigo is a frequent complaint during this procedure. This study aimed to investigate the characteristics and incidence of microsuction-induced nystagmus and vertigo based on the appearance of the tympanic membrane (TM). Methods: In 85 patients with various TM appearances, microsuction-induced vertigo and nystagmus were assessed. Results: Microsuction elicited nystagmus in 95% (81 of 85) of patients and vertigo in 36% (31 of 85). The nystagmus direction was towards the ipsilateral ear in a bowing position and towards the contralateral ear in a leaning position. The proportion of patients who complained of rotatory vertigo was significantly higher in those with TM perforation, open cavity mastoidectomy, and adhesive otitis media (74%, 26 of 35) compared to those without TM perforation (10%, 5 of 50) (p < 0.001, X² test). Conclusions: Aural toilet using microsuction commonly induces vertigo due to convection in the lateral semicircular canal endolymph caused by the cooling effect. While microsuction-induced nystagmus was observed in most patients, the incidence of vertigo varied depending on the TM condition. Clinicians should closely monitor patients for vertigo during the procedure, and methods to prevent microsuction-induced vertigo should be explored. Full article

Objectives: This study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of the Persian version of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA) in elderly Iranian adults. Methods and Materials: This cross-sectional study was conducted in Tehran, 2021. Following translation and cross-cultural adaptation, the face validity, content validity, and reliability of the questionnaire were assessed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire was used to assess concurrent validity. Study participants included 300 hearing-aid users aged 60 years and older who completed the research instruments. Data were analyzed using Confirmatory Factor Analysis (CFA), Cronbach’s alpha coefficient, Pearson correlation coefficient, independent t-tests, and analysis of variance (ANOVA) in SPSS and AMOS version 24. The significance level was set at p ≤ 0.05 for all tests. Results: The mean (SD) age of the participants was 71.38 (8.05) years. The face and content validity of the questionnaire were confirmed by ten experts (CVI > 0.91). The CFA supported the four-factor structure of the questionnaire, and the goodness-of-fit indices indicated that the final model had a good fit. The Cronbach’s alpha for the total questionnaire was 0.93, and for the subscales, it ranged between 0.83 and 0.93. The Pearson’s correlation analysis results showed a positive and significant correlation between MARS-HA and SADL scores (r = 0.61, p < 0.05), supporting criterion validity. Conclusions: The P-MARS-HA questionnaire demonstrates good validity and reliability and can be used as an appropriate tool for assessing self-efficacy in hearing-aid use among elderly Iranian adults. Full article

Family-centred early hearing detection and intervention (FC-EHDI) is an established framework globally recognized for its emphasis on family involvement in supporting children who are deaf and hard of hearing (DHH). In the African context, unique sociocultural and systemic challenges necessitate tailored approaches to ensure effective implementation. This narrative review explores the relevance of FC-EHDI in Africa, highlights barriers to its implementation, and offers recommendations for creating sustainable and culturally aligned interventions. A narrative review methodology synthesizing evidence from African countries to examine the intersection of FC-EHDI with cultural practices, systemic barriers, and opportunities for innovation was adopted. Databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed journal articles, books, and reports published between 2000 and 2024. Keywords included “family-centred care”, “EHDI”, “Africa”, “cultural responsiveness”, and “early hearing detection and intervention”. Studies were included if they addressed EHDI in African contexts, explored family-centred approaches, or provided barriers and recommendations specific to the region. Thematic analysis was employed to synthesize findings into barriers, evidence, and strategies for FC-EHDI implementation. Data were extracted and analysed thematically to identify patterns and gaps in knowledge. Key challenges identified include resource limitations, economic constraints, linguistic and cultural diversity, and fragmented healthcare systems. Evidence highlights the effectiveness of community-based care, linguistic inclusivity, and culturally tailored interventions in enhancing family engagement and programme outcomes. Recommendations focus on leveraging technology, interdisciplinary collaboration, and policy advocacy. FC-EHDI offers a transformative approach to addressing DHH African children by integrating family involvement, cultural responsiveness, and systemic innovations. Future efforts should emphasize technology, scalable models, and family empowerment to create sustainable and equitable services. Full article

Objectives: This study aimed to analyse the potential influence of abnormalities detected through carotid–vertebral ultrasonography and brain MRI on pure-tone averages (PTAs) and the frequency and intensity of tinnitus. Methods: 423 participants with subjective tinnitus were enrolled in this investigation. All patients underwent carotid– vertebral ultrasonography, brain MRI, and pure-tone audiometry, including tinnitus matching. Results: The median values for tinnitus onset indicated chronic tinnitus in most cases. Regarding tinnitus location, left-sided symptoms (32%) and bilateral symptoms (44%) were the most prevalent. In analysing the effects of abnormalities detected by carotid–vertebral ultrasonography on PTAs, a statistically significant difference was found between the groups (p = 0.0037). Specifically, individuals with intimal hyperplasia had significantly higher PTAs (p = 0.02), as did those with carotid artery plaques (p = 0.005). However, no significant differences in PTAs were noted in relation to carotid artery stenosis (p = 0.07). Similar trends emerged regarding tinnitus intensity (p = 0.013), with significantly higher values observed in the presence of any carotid–vertebral ultrasonography abnormalities. In contrast, tinnitus frequencies were not significantly affected (p = 0.401). Regarding brain MRI findings, Fazekas scores of 2 (p = 0.02) and 3 (p = 0.0052) significantly influenced PTAs. For tinnitus intensity, Fazekas scores of 2 (p = 0.0027) and 3 (p = 0.0005), and the presence of acoustic neuromas (p = 0.019), significantly impacted the intensity values. However, tinnitus frequencies were not significantly (p = 0.36) influenced by brain MRI abnormalities. Conclusions: The findings of this study show that carotid–vertebral ultrasonography and brain MRI abnormalities significantly influence PTAs and tinnitus intensities. Full article

Vestibular paroxysmia (VP) is a disabling medical condition characterized by a high recurrence rate of vertigo. VP is classically associated with the presence of contact between a vascular structure and the cochleovestibular nerve, a neurovascular cross compression (NVCC). Antiepileptic drugs are the first-line treatment for disabling symptoms. We conducted a systematic review to evaluate their efficacy in patients with VP, and whose imaging shows NVCC. All published studies in PubMed databases until October 2024 were included. A total of seven studies were selected. Carbamazepine and oxcarbazepine are by far the most widely used drugs, but there is still a lack of data showing the efficacy of antiepileptic drugs in a large sample of patients. This suggests that a future randomized controlled trial with a satisfactory sample size of VP patients with NVCC and comparing several drugs with neuroprotective properties is needed. Further, as imaging in some of the patients with obvious clinical signs does not always support this diagnosis, we discussed VP physiopathology and the different types of VP published in the literature, including those with no radiological support for NVCC. Full article

Background: Early intervention approaches play a critical role in shaping the communication outcomes of children with hearing loss, influencing their language development and overall learning trajectory. Objectives: The main objective of this study was to compare the communication outcomes of children with hearing loss who received Listening and Spoken Language-South Africa (LSL-SA) with those who received Traditional Speech-Language Therapy (TSLT). Methods: A retrospective record review was conducted to gather data on communication outcomes from participants’ speech-language therapy records. Communication outcomes were measured using standardized assessments evaluating speech intelligibility, expressive vocabulary, receptive language, expressive language, audition, and cognitive–linguistic skills. The data were analyzed using quantitative statistics. Key statistical methods included measures to determine associations, identify statistical significance, determine outcomes, and compare differences between the two groups. Results: The study found that children in the LSL-SA group had statistically significant better communication outcomes, with 63% achieving age-appropriate speech intelligibility compared to 45% in the TSLT group (p = 0.046). Similar trends were observed for expressive vocabulary (LSL-SA: 58% vs. TSLT: 39%, p = 0.048) and receptive language (LSL-SA: 60% vs. TSLT: 39%, p = 0.043). Additionally, 66% of children in the LSL-SA group were recommended for mainstream schooling, compared to 39% in the TSLT group (p = 0.0023). These findings highlight the importance of early amplification and structured intervention in improving communication outcomes. The results also emphasize the importance of Early Hearing Detection and Intervention (EHDI) in decreasing the odds of delay in communication outcomes, irrespective of the type of communication approach, although a higher proportion of children in the LSL-SA approach group achieved age-appropriate communication outcomes than those in the TSLT group. Conclusions: This study highlights that communication intervention approaches aligned with the LSL-SA practice promote better communication development and enhance spoken language outcomes in children with hearing loss, facilitating successful transitions to mainstream schooling. Contribution: This study provides contextually relevant evidence for implementing an LSL-SA intervention approach for children with hearing loss. The implications of these findings for clinical practice and future research are discussed in detail. Full article

Background: The Music-Related Quality of Life (MuRQoL) was launched in 2017 as a valid psychometric measure of Cochlear Implant (CI) users’ music experience and its impact on Quality of Life (QoL). This scoping review aimed to explore the implementation and effectiveness of the instrument since its introduction. Methods: PubMed and Google Scholar databases were searched for publications written in English reporting a translation, validation or application of the MuRQoL. Results: Eleven publications were found, including three validated versions and eight studies that applied the MuRQoL in Italy, Turkey, Spain and the US in research and clinical settings for various purposes. The review showcases the reliability, validity and potential clinical utility of the tool underscoring its growing adoption and integration with other assessment tools. Based on the findings, we make recommendations and provide a roadmap for optimizing the use of MuRQoL globally, including naming and terminology conventions. Anecdotal evidence, such as forthcoming or non-English publications offer further insights into the tool’s future potential. Conclusions: The MuRQoL is currently available in four languages and applicable across diverse cultural contexts, populations and settings. It is a versatile, patient-centered tool providing a deep understanding of CI users’ music experiences. As research and validation efforts continue, the instrument has the potential to set a benchmark for assessing the broader impacts of CIs beyond speech perception, emphasizing the significance of music in enriching the lives of individuals with Hearing Loss (HL). Full article

Dr. Epley has been instrumental in defining the mechanisms and treatment of BPPV variants, including those of the horizontal canals. Cupulolithiasis is a horizontal canal BPPV variant usually defined as direction-changing apogeotropic nystagmus. In recent years, the favored cupulolithiasis mechanism of otoconia adhering persistently to the cupula has been called into question. Epley was the first to propose mechanistic theories which better match the most recent evidence. From the beginning, he has demonstrated mastery over the semicircular canal pathology and otoconial mechanics. Full article

In our clinical setting, we have identified a novel pattern of Trans-Impedance Matrix (TIM) measurement that we call “scatter”, a measure characterised by a loss of definition in the heat and line maps. Objective: the aim of this study was to describe the basic characteristics of the anomaly pattern. The secondary purpose is to evaluate correlations between the “scatter” pattern and normal TIM by considering different parameters. Methods: the experimental sample, therefore, consisted of 565 patients (81.1% of people with a checked TIM at follow-up; M: 279, F: 286 and mean age: 27 years (sd 26). The scatter pattern was found in 55 devices (9.7%). We classified this pattern as severe (20 devices) or mild (35 devices) according to the visual extent of the abnormality. We considered the visual extension of the pattern, device lifetime, type of internal part of the CI, and auditory performance (speech audiometry in quiet at 65 dB and in noise—Ita Matrix Sentence Test). We also analysed two quantitive parameters: Shannon entropy and exponential decay. Results: a difference was found in these two quantitative parameters between the severe scatter, mild scatter, and normal TIM groups (p-value < 0.0001). The severe scatter group seems to be related to the type of device (CI24RE and CI512) and long device life (average 133 months); it did not show differences in audiology performances compared to the other groups. Conclusions: this result gives a numerical validation to the more subjective visual inspection approach. The scatter pattern is a novel, previously undescribed abnormality of TIM. It can vary from moderate to severe. A numerical basis to validate the inspection approach is described here. Full article

Background/Objectives: Children with congenital or early onset sensorineural hearing loss (SNHL) are at a greater risk of vestibular dysfunction (VD), hypothesized to occur from the close embryological relationship between the cochlear and vestibular systems. Even with increasing focus on early detection and rehabilitation through Universal Newborn Hearing Screening (UNHS) programmes in many countries, few studies have focused on the prevalence and feasibility of vestibular assessment in infant populations. The objectives of this review are to 1. identify the prevalence of VD infants with congenital or early onset (<12 months old) SNHL, 2. identify which vestibular assessment tests/protocols are conducted on this population, 3. report sensitivity and specificity values for identified vestibular assessment tests/protocols. Methods: Studies that included infants aged 0–12 months, with congenital or early onset SNHL of any laterality, degree, or configuration, and who underwent any method of vestibular assessment were included. The review adhered to the Joanna Briggs Institute (JBI) guidance and the PRISMA-ScR extension statement. Results: A total of 18 studies were included in the review. All articles reported that infants with congenital or early onset SNHL are at a greater risk of VD, particularly those with bilateral severe–profound SNHL. The cervical vestibular-evoked myogenic potentials (cVEMP) test was the most frequently identified vestibular assessment tool for this age demographic. Conclusions: Results from the included articles coincide with results from literature assessing older paediatric populations. cVEMPs have been reported to be a feasible, sensitive, and specific screening tool in infants with congenital or early onset SNHL. The prevalence of VD in infants with congenital or early onset SNHL justify further investigation on the feasibility of establishing a pathway for vestibular assessment for all infants referred by UNHS programmes. Full article

Background: Cisplatin, a widely used chemotherapeutic agent, is associated with significant ototoxicity, leading to progressive and irreversible sensorineural hearing loss in up to 93% of patients. Cisplatin generates reactive oxygen species (ROS) in the cochlea, activating apoptotic and necroptotic pathways that result in hair cell death. Inflammatory processes and nitrative stress also contribute to cochlear damage. Methods: This literature review was conducted to explore the mechanisms underlying cisplatin-induced ototoxicity and evaluate protective strategies, including both current and emerging approaches. A structured search was performed in multiple scientific databases, including PubMed and ScienceDirect, for articles published up to November 2024. Results: Current otoprotective strategies include systemic interventions such as antioxidants, anti-inflammatory agents, and apoptosis inhibitors, as well as localized delivery methods like intratympanic injection and nanoparticle-based systems. However, these approaches have limitations, including potential interference with cisplatin’s antitumor efficacy and systemic side effects. Emerging strategies focus on genetic and biomarker-based risk stratification, novel otoprotective agents targeting alternative pathways, and combination therapies. Repurposed drugs like pravastatin also show promise in reducing cisplatin-induced ototoxicity. Conclusions: Despite these advancements, significant research gaps remain in translating preclinical findings to clinical applications and developing selective otoprotective agents that do not compromise cisplatin’s efficacy. This review examines the mechanisms of cisplatin-induced ototoxicity, current otoprotective strategies, and emerging approaches to mitigate this adverse effect. Full article

Background/Objectives: This study aims to evaluate the feasibility of the angular vestibulo-ocular reflex (aVOR) function assessment in children with cerebral palsy (CP) using the video Head Impulse Test (vHIT) and to investigate how vestibular impairments correlate with functional motor ability. Methods: This cross-sectional study included children diagnosed with CP who attempted a vestibular function assessment with the vHIT. Descriptive statistics and a subgroup analysis based on clinical expression were performed. Finally, the correlation between aVOR gain and functional motor ability was investigated. Results: Thirteen children underwent assessments of the horizontal semicircular canals. Six out of thirteen children presented at least one dysfunctional canal; overall, eight out of twenty-six horizontal semicircular canals were dysfunctional in the HIMP paradigm. A subgroup analysis revealed a dysfunctional aVOR gain in all the children presenting ataxia. The correlation analysis demonstrated a strong negative association between aVOR gain and the Gross Motor Function Classification System (−0.73 and −0.68 for the left and right horizontal canal, respectively; p < 0.05). Conclusions: Vestibular dysfunctions are prevalent in children with CP and strongly correlate with motor function. An instrumental vestibular assessment in children with cognitive-motor disability seems feasible, in particular for horizontal canals and the HIMP paradigm. This could be important for better framing a child’s function and enhancing the management of balance and motor impairments with more specific strategies for children with CP. Full article

Bilateral vestibulopathy (BV) is a known cause of chronic vestibular syndrome. With the video head impulse test (VHIT), we can now evaluate all six semicircular canals independently and establish BV subgroups based on canal gain patterns. Background/objectives: To assess canal gain patterns for BV with VHIT, and evaluate subgroups with regard to sex, age, and hearing loss. Methods: A retrospective chart review was performed of all patients who underwent a VHIT between January 2021 and July 2024. Patients with decreased lateral canal gains, bilaterally, were included. Results of canal gains, VHIT patterns, audiometry, and videonystagmography (VNG) results were reviewed. Results: 101 cases were included. Patients were 75.5 ± 13.1 years old and 64.4% were women. Various VHIT patterns were observed; the most frequent being decreased canal gains across all six canals (44.6%), followed by a mix of canals with decreased gains with no clear pattern (34.7%). Decreased gains limited to the lateral canals were rare. We did not observe any significant difference between subgroups with regard to gender or age. Concomitant hearing loss was common (89.6%). A trend was noted, suggesting that severity of hearing loss increased with the number of affected canals. An abnormal VNG test was common (73.3%). Conclusions: Various patterns of canal gains were observed for patients with BV. Audiometry and VNG should be considered as part of BV studies since abnormalities are commonly found. Further research is needed to understand VHIT patterns in BV. Full article

Purpose: The purpose of this study was to evaluate the clinical and audiological outcomes in long-term cochlear implant (CI) users, focusing on hearing performance and device failures. Methods: A retrospective study was conducted on patients who underwent CI surgery, with a minimum follow-up of 10 years. Device survival was analyzed using Kaplan–Meier curves, and failure rates were classified as device failure explants or medical-related explants. The time to revision and causes of reimplantation were assessed. Statistical analyses included Pearson correlation for audiological outcomes, Student’s t-test for group comparisons, and the log-rank test for survival comparisons among implant brands. Results: In this study, data from a total of 211 CIs were collected. Fourteen major postoperative complications were reported in this series, resulting in a global major complication rate of 6.6%: 5.2% due to hard failure and 1.4% due to medical problems and soft failure. The revision rate was 4.1% for the children’s group and 10% for the adult group. The overall device survival rates were more than 96% at 10 years and 91% at 20 years. The median postoperative follow-up was 16.3 years. Moreover, a highly significant correlation was observed (r = 0.669, p < 0.0001) between pure tone average (PTA) thresholds at implant activation and those at the last follow-up, as analyzed using Pearson’s correlation coefficient. Conclusions: The CI is a lifelong device; however, the technology is constantly evolving. Therefore, careful patient counseling (or counseling of parents in the case of pediatric patients) is necessary. The device may wear out over time, requiring revision surgery. These data are essential for audiologists and ENT specialists when selecting patients and determining surgical indications. Full article

Introduction: This edition of the Audiology Research journal is dedicated to Dr. John Epley. For this reason, we would like to present a very unusual case involving the development of a bilateral abnormality of the otolith organs. The otoliths are the structures from which calcium particles detach to induce benign paroxysmal positional vertigo, the disorder for which Dr. Epley is famous for managing. Case report: This case report outlines an unusual presentation of vestibular pathology involving the otoliths. Discussion: We suggest that the atypical presentation may be related to a bilaterally asymmetrical insult to the otoliths. Conclusions: The central insult suffered by this patient resulted in bilateral peripheral otolithic pathology. Full article