Audiol. Res., Volume 15, Issue 3 (June 2025) – 17 articles

Vestibular atelectasis (VA) is a rare clinical entity characterized by a collapse of the endolymphatic space resulting in vestibular loss with the possible onset of positional and/or sound/pressure-induced vertigo. It could be idiopathic or secondary to other inner-ear diseases including Meniere’s disease (MD). A collapse of the membranous labyrinth involving the semicircular canals (SCs) and the utricle represents its distinctive histopathological feature. While specific radiological patterns consistent with VA have been described on contrast-enhanced MRI with delayed acquisitions, an impairment of the blood–labyrinthine barrier (BLB) could be detected in several disorders leading to vestibular loss. We conducted a narrative review of the literature on VA focusing on the putative pathomechanisms accounting for positional and sound/pressure-induced nystagmus despite unilateral vestibular loss (UVL) in this condition, providing two novel cases of VA. Both patients presented with a clinical picture consistent with unilateral MD that rapidly turned into progressive UVL and positional and/or sound/pressure-induced vertigo. In both cases, the posterior SC was initially impaired at the video-head impulse test (vHIT) and both cervical and ocular VEMPs were initially reduced. Progressively, they developed unsteadiness with paretic spontaneous nystagmus, an impairment also for the lateral and anterior SCs, caloric hypo/areflexia and VEMPs areflexia. They both exhibited ipsilesional nystagmus to sound/pressure stimuli and in one case a persistent geotropic direction-changing positional nystagmus consistent with a “light cupula” mechanism involving the lateral SC of the affected side. A collapse of the membranous labyrinthine walls resulting in contact between the vestibular sensors and the stapes footplate could explain the onset of nystagmus to loud sounds and/or pressure changes despite no responses to high- and low-frequency inputs as detected by caloric irrigations, vHIT and VEMPs. On the other hand, the onset of positional nystagmus despite UVL could be explained with the theory of the “floating labyrinth”. Both patients received contrast-enhanced brain MRI with delayed acquisition exhibiting increased contrast uptake in the pars superior of the labyrinth, suggesting an impairment of the BLB likely resulting in secondary VA. A small intralabyrinthine schwannoma was detected in one case. VA should always be considered in case of positional and/or sound/pressure-induced vertigo despite UVL. Full article

Background: Auditory steady-state responses (ASSRs) are sustained potentials used to assess the physiological integrity of the auditory pathway and objectively estimate hearing thresholds. ASSRs are typically analyzed using statistical procedures to remove the subjective bias of human operators. Knowing when to terminate signal averaging in ASSR testing is critical for making efficient clinical decisions and obtaining high-quality data in empirical research. Here, we report on stimulus-specific (frequency, level) properties and operating ranges of a novel ASSR detection metric based on mutual information (MI). Methods: ASSRs were measured in n = 10 normal-hearing listeners exposed to various stimuli varying in modulation rate (40, 80 Hz) and level (80–20 dB SPL). Results: MI-based classifiers applied to ASSR recordings showed that the accuracy of ASSR detection ranged from ~75 to 99% and was better for 40 compared to 80 Hz responses and for higher compared to lower stimulus levels. Receiver operating characteristics (ROCs) were used to establish normative ranges for MI for reliable ASSR detection across levels and rates (MI = 0.9–1.6). Relative to current statistics for ASSR identification (F-test), MI was a more efficient metric for determining the stopping criterion for signal averaging. Conclusions: Our results confirm that MI can be applied across a broad range of ASSR stimuli and might offer improvements to conventional objective techniques for ASSR detection. Full article

Background/Objectives: Previous research has shown that listeners may use acoustic cues for speech processing that are perceived during brief segments in the noise when there is an optimal signal-to-noise ratio (SNR). This “glimpsing” effect requires higher cognitive skills than the speech tasks used in typical audiometric evaluations. Purpose: The aim of this study was to investigate the use of an online test of speech processing in noise in listeners with typical hearing sensitivity (TH, defined as thresholds ≤ 25 dB HL) who were asked to determine the gender of the subject in sentences that were presented in increasing levels of continuous and interrupted noise. Methods: This was a repeated-measures design with three factors (SNR, noise type, and syntactic complexity). Study Sample: Participants with self-reported TH (N = 153, ages 18–39 years, mean age = 20.7 years) who passed an online hearing screening were invited to complete an online questionnaire. Data Collection and Analysis: Participants completed a sentence recognition task under four SNRs (−6, −9, −12, and −15 dB), two syntactic complexity settings (subjective-relative and objective-relative center-embedded), and two noise types (interrupted and continuous). They were asked to listen to 64 sentences through their own headphones/earphones that were presented in an online format at a user-selected comfortable listening level. Their task was to identify the gender of the person performing the action in each sentence. Results: Significant main effects of all three factors as well as the SNR by noise-type two-way interaction were identified (p < 0.05). This interaction indicated that the effect of SNR on sentence comprehension was more pronounced in the continuous noise compared to the interrupted noise condition. Conclusions: Listeners with self-reported TH benefited from the glimpsing effect in the interrupted noise even under low SNRs (i.e., −15 dB). The evaluation of glimpsing may be a sensitive measure of auditory processing beyond the traditional word recognition used in clinical evaluations in persons who report hearing challenges and may hold promise for the development of auditory training programs. Full article

Objectives: This study investigates Greek teenagers’ general knowledge and perception of hearing loss, hearing aid accessibility, and the challenges associated with hearing impairment. Methods: A 27-item self-reported questionnaire was developed and distributed to 152 participants (aged 12–18) to assess their familiarity with hearing loss, amplification availability, communication strategies, and perceptions of hearing loss. Results: While 94.7% of participants recognized that hearing loss affects communication, only 10.5% correctly identified how hearing aids are accessed. Additionally, 42.1% reported having temporarily experienced some form of hearing loss. Most participants (94.7%) acknowledged communication difficulties faced by individuals with hearing loss, and only 3.4% reported being unable to communicate effectively with someone affected. Among those aware of bullying incidents involving individuals with hearing loss, 78.1% identified classmates as the primary source. Conclusions: These findings are consistent with international research and highlight the need for targeted education, awareness initiatives, and clearer access pathways to hearing technology. Improving adolescent hearing health literacy may facilitate early intervention, reduce stigma, and promote inclusion for peers affected by hearing impairment. Full article

Background/Objectives: The ability of young adults to control their balance is generally effortless and can occur automatically with minimal cognitive involvement. However, this ability may be compromised when integration conflicts arise due to impairments in vestibular, visual, or somatosensory functions. Hence, psychomotor symptoms linked to emotional states can also influence postural control. The purpose of this study was to understand the effects of anxiety and depression on balance in young adults. Methods: Our study included 50 young adults (21.86 ± 2.63 years), consisting of 13 males and 37 females. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS), while balance was assessed through the Modified Clinical Test for the Sensory Interaction on Balance (mCTSIB). Data analysis was conducted using Pearson’s correlation coefficient test and the Kruskal–Wallis test. Results: Pearson’s correlation analysis indicated that young adults exhibited stable postural control. However, a positive correlation (0.259, p < 0.1) was observed between anxiety levels and the sway index. Additionally, positive correlations were found between anxiety and both somatosensory (0.281, p < 0.05) and visual (0.276, p < 0.1) ratios. Conclusions: The results suggest that higher anxiety levels are associated with reduced postural balance, with sensory inputs, particularly visual and somatosensory, playing a key role in this decreased stability. Full article

Background/Objectives: Cochlear implantation is an advantageous procedure for individuals with severe to profound hearing loss in many aspects related to auditory performance, social communication and quality of life. As machine learning applications have been used in the field of Otorhinolaryngology and Audiology in recent years, signal processing, speech perception and personalised optimisation of cochlear implantation are discussed. Methods: A comprehensive literature review was conducted in accordance with the PRISMA guidelines. PubMed, Scopus, Web of Science, Google Scholar and IEEE databases were searched for studies published between 2010 and 2025. We analyzed 59 articles that met the inclusion criteria. Rayyan AI software was used to classify the studies so that the risk of bias was reduced. Study design, machine learning algorithms, and audiological measurements were evaluated in the data analysis. Results: Machine learning applications were classified as preoperative evaluation, speech perception, and speech understanding in noise and other studies. The success rates of the articles are presented together with the number of articles changing over the years. It was observed that Random Forest, Decision Trees (96%), Bayesian Linear Regression (96.2%) and Extreme machine learning (99%) algorithms reached high accuracy rates. Conclusions: In cochlear implantation applications in the field of audiology, it has been observed that studies have been carried out with a variable number of people and data sets in different subfields. In machine learning applications, it is seen that a high amount of data, data diversity and long training times contribute to achieving high performance. However, more research is needed on deep learning applications in complex problems such as comprehension in noise that require time series processing. Funding and other resources: This study was not funded by any institution or organization. No registration was performed for this study. Full article

Background: Benign paroxysmal positional vertigo is the most common cause of dizziness over the lifespan. Management is complicated by both a diagnostic burden (correctly interpreting specific ocular motor findings) and a therapeutic burden (selecting appropriately targeted treatment maneuvers). Purpose: Devise a canalith repositioning maneuver to treat simultaneously benign paroxysmal positional vertigo affecting any combination of semicircular canals on one side. If clinically verified, then this will simplify management. Research design: After analyzing the results of a computer simulator applied to several published maneuvers for treating benign paroxysmal positional vertigo, we used basic principles to design a maneuver that simultaneously, for all three semicircular canals on one side, advances otoliths toward the crus of each canal and prevents retreat toward the ampule of each canal and then tested the maneuver in computer simulation. Study sample: Not applicable. Intervention: Not applicable. Data collection and analysis: Not applicable. Results: We developed a maneuver that computer simulation predicts will successfully treat simultaneously benign paroxysmal positional vertigo affecting any combination of semicircular canals on one side. Conclusions: This maneuver should be tested empirically as a standalone maneuver and compared to other maneuvers. Clinical relevance statement: If the efficacy of this maneuver is clinically verified, then it will simplify management by diminishing the diagnostic burden (of determining affected canals) and treatment burden (of selecting the appropriately targeted maneuvers). Full article

Background and objective: Currently, there is no universal newborn hearing (UNHS) screening in the Democratic Republic of Congo (DRC), partly due to financial and organizational reasons. The aim of this study was to adapt the LittlEARS^® Auditory Questionnaire (LEAQ) into the Kiswahili and Lingala languages for use as a screening tool for auditory development in children less than two years of age, as objective hearing screening cannot be performed nationwide. Methods: For this purpose, norm data were collected from n = 723 infants (Lingala) and n = 648 infants (Kiswahili) aged between 0 and 24 months in a random selection of four out of seven health zones with pediatric services in the DRC. A non-linear regression model was derived for total scores by age. Pearson correlations were performed to determine whether there were differences between total scores of the questionnaire by region (urban/rural areas). A Mann–Whitney U-test was calculated to determine if there were differences depending on who completed the questionnaire (mother/other caregiver). In addition, a one-way ANOVA was used to determine whether there were differences in the total scores of the questionnaires according to the educational background of the person completing the questionnaire. Results: The Pearson correlation coefficient between total scores and age was 0.81 for Kiswahili and 0.77 for Lingala. There were no significant differences in total scores for all conditions tested (total scores by age, language, region, person who completed the questionnaire, educational background). Conclusions: The LEAQ can be used effectively in a large region such as the DRC, regardless of the region, respondent, and the educational background. Full article

Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease affecting both upper and lower motor neurons, with bulbar dysfunction manifesting in up to 80% of patients. Dysarthria, characterized by impaired speech production, is common in ALS and often correlates with disease severity. Voice analysis has emerged as a promising tool for detecting disease progression and monitoring functional status. Methods: This study investigates acoustic and biomechanical voice alterations in ALS patients and their association with clinical measures of functional independence. A descriptive observational case series study was conducted, involving 43 ALS patients and 43 age and sex matched controls with non-neurological voice disorders. Sustained vowel /a/ recordings were obtained and analyzed using Voice Clinical Systems^® and Praat software (version 6.2.22). Biomechanical and acoustic parameters were correlated with ALS Functional Rating Scale-Revised (ALSFRS-R) and Barthel Index scores. Results: Significant differences were observed between ALS and control groups (elevated muscle force and tension and interedge distance in non-ALS individuals). Between bulbar and spinal ALS subtypes, elevated values were observed in certain parameters in Bulbar ALS patients, indicating irregular vocal fold contact and weakened phonatory control, while spinal ALS exhibited increased values, suggesting higher phonatory muscle tension. Elevated biomechanical parameters were significantly correlated with low ALSFRS-R scores, suggesting a possible relationship between voice measures and functional decline. However, acoustic measurements showed no relationship with performance status. Conclusions: These results highlight the potential of voice analysis as a non-invasive, objective tool for monitoring ALS stage and differentiating between subtypes. Further research is needed to validate these findings and explore their clinical applications. Full article

Objective: This paper reviews the current research on hearing device technology, outlines key challenges, and identifies priorities for future investigation. Method: This paper presents an informal narrative review of the current literature on hearing technology, supplemented by expert insights to identify key challenges and future directions. Results: The proliferation of direct-to-consumer (DTC) hearing devices with varied features and prices underscores the need to assess whether advanced technologies offer meaningful improvements. Understanding these incremental benefits is critical for determining the minimum technology required for optimal outcomes. The paper highlights the limitations in current clinical trials, which often suffer from selection bias, and the inadequacies of existing hearing aid outcome measures that may not capture real-life benefits. It emphasizes the need for real-world evidence and the development of assessment tools that better reflect everyday experiences. While existing research provides some insights into the potential benefits of incremental advances in hearing device technology, the evidence remains inconclusive. Conclusions: Addressing the cost, accessibility, and technological diversity of hearing devices is crucial to advancing hearing healthcare. Future research should prioritize the development of affordable, high-quality devices and establish comprehensive outcome measures that capture real-world benefits. A deeper understanding of these factors can lead to more accessible and effective hearing care, ultimately improving quality of life for individuals with hearing loss. Full article

Background: This study examined the relationship between hearing device price and sound quality. Method: A novel consumer-centric metric of sound quality (“SoundScore”) was used to assess hearing devices’ audio performance. Each hearing device is tested with two fittings. The “Initial Fit” is designed to approximate the most likely fitting for an individual with a mild-to-moderate sloping sensorineural hearing loss. The “Tuned Fit” includes adjusting parameters optimized to hit prescriptive fitting targets (NAL NL2) on an acoustic manikin. Each fitting is evaluated across five dimensions. Both fittings are combined using a weighted average to create a single number from 0 to 5 representative of a device’s overall audio performance. Seventy-one hearing devices were tested. Results: A strong positive correlation was found between hearing device price and SoundScore. The average SoundScore increased dramatically as the price approached USD 1000, with marginal improvements beyond this point. SoundScore was consistently poor for devices under USD 500, highly variable between USD 500–1000, and consistently good over USD 1000. Conclusions: There is a strong but nonlinear relationship between hearing device price and sound quality. This information can aid consumers in making informed decisions while also assisting hearing healthcare professionals in providing comprehensive guidance to their patients. Full article

Background/Objectives: The conventional strategy for addressing age-related hearing loss is hearing aid (HA) use, yet many individuals underutilize their devices. Despite the positive effects of HA use, adherence remains low, highlighting the importance of studying associated variables. We hypothesize that better unaided speech perception in noise (SPiN) would be associated with greater perceived benefit from HAs, which, in turn, would be linked to increased HA use. Methods: A cross-sectional study design was used, including 114 older adults (≥65 years) who were HA users. HA use and perceived benefit were assessed using questions 1 and 2 of the International Outcome Inventory for Hearing Aids (IOI-HAs), while unaided SPiN performance was measured monaurally with a speech-in-noise test. In the mediation analysis, SPiN performance was the predictor, perceived benefit the mediator, and HA use the outcome. Direct and indirect effects were evaluated using generalized structural equation modeling. Results: No significant total effect was found for the right ear. For the left ear, there was a significant indirect effect of SPiN performance on HA use through perceived benefit (OR = 1.26, 95% CI 1.06–1.57, p = 0.019) but no direct effect (p = 0.563). In addition, a significant total effect of left ear SPiN performance on HA use was observed (p = 0.041). Conclusions: The findings suggest that unaided SPiN performance—particularly in the left ear—may be indirectly associated with HA use through its effect on perceived benefit. These results underscore the potential value of including SPiN assessments in the HA fitting process and counseling strategies for older adults. Full article

Background: Single-sided deafness (SSD) and asymmetric hearing loss (AHL) impair spatial hearing and speech perception, often reducing quality of life. Cochlear implants (CIs) and bone conduction implants (BCIs) are rehabilitation options used in SSD and AHL to improve auditory perception and support functional integration in daily life. Objective: We aimed to evaluate hearing outcomes after auditory implantation in SSD and AHL patients, focusing on localization accuracy, speech-in-noise understanding, tinnitus relief, and perceived benefit. Methods: In this longitudinal observational study, 37 patients (adults and children) received a CI or a BCI according to clinical indications. Outcomes included localization and spatial speech-in-noise assessment, tinnitus ratings, and SSQ12 scores. Statistical analyses used parametric and non-parametric tests (p < 0.05). Results: In adult CI users, localization error significantly decreased from 81.9° ± 15.8° to 43.7° ± 13.5° (p < 0.001). In children, regardless of the implant type (CI or BCI), localization error improved from 74.3° to 44.8°, indicating a consistent spatial benefit. In adult BCI users, localization error decreased from 74.6° to 69.2°, but the improvement did not reach statistical significance. Tinnitus severity, measured on a 10-point VAS scale, decreased significantly in CI users (mean reduction: 2.8 ± 2.0, p < 0.001), while changes in BCI users were small and of limited clinical relevance. SSQ12B/C scores improved in all adult groups, with the largest gains observed in spatial hearing for CI users (2.1 ± 1.2) and in speech understanding for BCI users (1.6 ± 0.9); children reported high benefits across all domains. Head shadow yielded the most consistent benefit across all groups (up to 4.9 dB in adult CI users, 3.8 dB in adult BCI users, and 4.6 dB in children). Although binaural effects were smaller in BCI users, positive gains were observed, especially in pediatric cases. Correlation analysis showed that daily device use positively predicted SSQ12 improvement (r = 0.57) and tinnitus relief (r = 0.42), while longer deafness duration was associated with poorer localization outcomes (r = –0.48). Conclusions: CIs and BCIs provide measurable benefits in SSD and AHL rehabilitation. Outcomes vary with age, device, and deafness duration, underscoring the need for early intervention and consistent auditory input. Full article

Background: Transparency mode in hearables aims to maintain environmental awareness by transmitting external sounds through built-in microphones and speakers. While technical assessments have documented acoustic alterations in these devices, their impact on spatial hearing abilities under realistic listening conditions remains unclear. This study aimed to evaluate how transparency mode affects sound localization performance with and without background noise. Methods: Ten normal-hearing adults completed sound localization tasks across azimuth (±90°) and elevation (±30°) with and without background noise. Performance was assessed with and without AirPods Pro in transparency mode. Sound localization performance was evaluated through linear regression analysis and mean absolute errors. Head-Related Transfer Function measurements quantified changes in binaural and spectral cues. Results: While interaural time differences were largely preserved, transparency mode introduced systematic alterations in level differences (up to 8 dB) and eliminated spectral cues above 5 kHz. These modifications resulted in increased localization errors, particularly for elevation perception and in noise. Mean absolute errors increased from 6.81° to 19.6° in azimuth and from 6.79° to 19.4° in elevation without background noise, with further degradation at lower SNRs (p < 0.05). Response times were affected by background noise (p < 0.001) but not by device use. Conclusions: Current transparency mode implementation significantly compromises spatial hearing abilities, particularly in noisy environments typical of everyday listening situations. These findings highlight the need for technological improvements in maintaining natural spatial cues through transparency mode, as current limitations may impact user safety and communication in real-world environments. Full article

Background/Objectives: This study aimed to evaluate the progress in auditory speech perception in a group of children with cochlear implants and additional disabilities, whose implants were implanted at a public hospital in southern Chile between 2013 and 2019. This population has historically been excluded from research due to uncertainties regarding their outcomes. Methods: All pediatric patients who received cochlear implants between 2013 and 2019 were considered for inclusion. After obtaining informed consent, relevant data were collected from their medical records. A total of 18 children met the inclusion criteria. Data analysis was performed using Jamovi software. Results: The minimum age at cochlear implant activation was 2 years, and the maximum was 16.1 years. The median Category of Auditory Performance (CAP) score was 0 pre-implantation and increased to 2 to 12 months post-implantation. Conclusions: Cochlear implantation provides clear benefits for children with additional disabilities. Although gains in auditory perception may be limited in some cases, implantation enables access to the world of sound. Even when oral language development is not fully achieved, parents frequently report positive changes in their children’s interaction with their environment, suggesting an overall improvement in quality of life. Full article

Background/Objectives: Hearing loss (HL) is a prevalent condition that can lead to social exclusion. This review explores the epidemiological, cultural, and social dimensions of HL and examines the barriers to accessibility that individuals with HL encounter. Methods: This research employs a narrative review approach to provide a comprehensive overview of HL, focusing on stigma, gender disparities, cultural and social differences, and accessibility challenges. Results: The review highlights pervasive prejudices surrounding HL and hearing devices. Gender disparities are evident, with Deaf women facing compounded challenges. Cultural perspectives on HL differ widely, ranging from the medical model, which emphasizes treatment using hearing devices, to the Deaf community’s social model, which views deafness as a cultural identity. Socioeconomic disparities further restrict access to modern technologies, particularly in low-income settings, while intersectional discrimination affects marginalized groups within the Deaf community. Public spaces also present significant barriers related to communication, architecture, and technology, which hinder accessibility for individuals with HL. Conclusions: A cultural shift is essential to dismantle societal stereotypes and reduce discrimination associated with HL. Moreover, improving accessibility for individuals with HL necessitates a multifaceted approach, including accessible design, staff training, and the integration of assistive technologies. Full article

Background/Objectives: Hearing loss, particularly in older adults, is associated with reduced physical functioning; increased fall risk; and altered gait patterns, including slower walking speed and shorter step length. While the underlying mechanisms are not fully understood, one possibility is that these gait changes result from an additional cognitive load due to hearing difficulties. Prior research suggests that hearing aids may improve balance; however, their impact on gait remains less well explored. Methods: This study investigated gait parameters in individuals with hearing loss as they walked with and without hearing aid amplification under different dual-task conditions. Additionally, we showed the potential of ear-worn sensors for detecting relevant gait changes. To achieve this, we used a hearing-aid-integrated accelerometer and our open-source EarGait framework comprising gait-related algorithms specifically developed for ear-worn sensors. Results: Our findings revealed no significant differences in gait velocity or step length between the unaided and aided conditions. For stride time, we observed a significant interaction effect; however, the effect size was negligible. The dual-task costs were lower than in previous reports, indicating that the applied dual-task paradigm did not induce the expected cognitive demand. The ear-worn gait analysis system showed strong performance compared to foot-worn sensors. Conclusions: Our findings indicate that in controlled, low-cognitive-demand settings, hearing aid amplification does not affect gait performance and, therefore, neither hinders nor improves walking performance. Additionally, the high accuracy of the ear-worn gait analysis system highlights the strong potential of ear-mounted wearable devices (“earables”) for real-world mobility assessments. Future research should explore more complex real-world conditions to better understand the impact of hearing aids on walking behavior. Our proposed earable-based system offers a promising tool for continuous, unobtrusive gait monitoring in everyday environments. Full article