Audiology Research

18 pages, 872 KB

Open AccessArticle

Identifying Hearing Loss and Audiological Rehabilitation Candidacy Through Self-Perceived Hearing Handicap Using the Croatian Version of the Hearing Handicap Inventory for the Elderly—Screening (HHIE-S-CRO)

by Luka Bonetti, Ana Bonetti and Tea Krišto

Audiol. Res. 2025, 15(5), 116; https://doi.org/10.3390/audiolres15050116 - 12 Sep 2025

Abstract

Background/Objectives: This study aimed to: (1) evaluate the effectiveness of the Croatian version of the Hearing Handicap Inventory for the Elderly—Screening Version (HHIE-S-CRO) in screening for hearing loss greater than 20 dB HL in the better-hearing ear among adults aged ≥ 60 years; [...] Read more.

Background/Objectives: This study aimed to: (1) evaluate the effectiveness of the Croatian version of the Hearing Handicap Inventory for the Elderly—Screening Version (HHIE-S-CRO) in screening for hearing loss greater than 20 dB HL in the better-hearing ear among adults aged ≥ 60 years; (2) assess its utility in identifying individuals with hearing loss ≥ 40 dB HL in the better-hearing ear, meeting current Croatian eligibility criteria for state-funded hearing aid rehabilitation; and (3) determine whether the emotional and social components of perceived hearing handicap can be meaningfully distinguished. Methods: Validity of the HHIE-S-CRO was analyzed using Spearman’s correlation coefficient, the Mann–Whitney test and the factor analysis, while reliability was assessed via Cronbach’s alpha and the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curve analysis was calculated to determine sensitivity, specificity, and positive and negative predictive values (PPV and NPV) at various cut-off scores of the HHIE-S-CRO total for specified audiometric criteria (better ear pure-tone average > 20 dB HL and ≥40 dB HL). The nonparametric Wilcoxon Matched Pairs Test was used to compare scores on the emotional and social subscales of the HHIE-S-CRO. Results: The HHIE-S-CRO demonstrated excellent internal consistency (Cronbach’s alpha = 0.92) and high repeatability of the results (ICC = 0.92). Discriminant, convergent, construct and predictive validity were confirmed. The area under the curve (AUC) for detecting hearing loss > 20 dB HL in the better ear was 0.95, with a sensitivity of 90.67% and specificity of 94.65% at a cut-off score of 6. For the Croatian threshold for state-supported hearing aid rehabilitation (≥40 dB HL in the better-hearing ear), similarly favorable screening characteristics were found at a cut-off score of 10. Conclusions: Based on these findings, the HHIE-S-CRO appears to offer sufficient sensitivity and specificity to support two key clinical applications: (1) screening for hearing loss > 20 dB HL in individuals aged 60 and older, and (2) identifying individuals within this age group who may be eligible for state-supported hearing aid-based rehabilitation. Full article

(This article belongs to the Section Hearing)

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15 pages, 756 KB

Open AccessOpinion

A Critique of the Stenger Test

by Andrew Bell, Myriam Westcott and W. Wiktor Jedrzejczak

Audiol. Res. 2025, 15(5), 115; https://doi.org/10.3390/audiolres15050115 - 9 Sep 2025

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Abstract

Introduction: Most audiometers have an in-built “Stenger test” setting. The test is sometimes applied in cases of single-sided deafness as an indicator of malingering. Although textbooks have been written about it, the underlying conditions remain enigmatic. The literature usually points to psychological problems, [...] Read more.

Introduction: Most audiometers have an in-built “Stenger test” setting. The test is sometimes applied in cases of single-sided deafness as an indicator of malingering. Although textbooks have been written about it, the underlying conditions remain enigmatic. The literature usually points to psychological problems, pointing to the patient as having “nonorganic hearing loss”, “malingering”, “false and exaggerated hearing loss”, “hysterical hearing loss”, or “pseudohypoacusis”. These are all non-objective features without a sound scientific base, and the test tends to blame the patient for providing non-repeatable hearing thresholds. Methods: This opinion piece looks at the literature surrounding the Stenger test and the factors that might cause hearing threshold variability and concludes that the test has a subjective basis that makes it unscientific. In our opinion, we also think it is ethically questionable to blame the patient for malingering when there are non-repeatable findings. In order to make the test scientifically valid, we frame a testable hypothesis: that the Stenger effect could be due to unrecognised contraction of the middle ear muscles in response to stimulation of the contralateral (worse-hearing) ear. That is, we suppose that bilateral contraction impairs thresholds in both the good and poor ear, so the subject can no longer hear a tone in their good ear which they previously could when their audiogram was established monaurally. Thus, we make the case that the subject is not malingering—they genuinely cannot hear the test tones in either ear. Discussion and Conclusions: We believe it is incorrect to blame the patient when the problem may lie with incomplete understanding of how the auditory system functions bilaterally. The test needs to be objectively investigated and perhaps reinterpreted in terms of hearing sensitivity in one ear being reduced by sound levels in the contralateral ear. If this is not possible, we suggest it would be better if the Stenger test were abolished. Full article

(This article belongs to the Special Issue Perspectives on Audiology as an Interdisciplinary and Multilevel Science)

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10 pages, 697 KB

Open AccessArticle

Somatosensory Intervention Targeting Temporomandibular Disorders and Awake Bruxism Positively Impacts Subjective Tinnitus

by Eric Bousema, Pieter U. Dijkstra and Pim van Dijk

Audiol. Res. 2025, 15(5), 114; https://doi.org/10.3390/audiolres15050114 - 9 Sep 2025

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Abstract

Objective: To analyze the effects of a somatosensory education intervention targeting temporomandibular disorders (TMD) and awake bruxism on subjective tinnitus. Methods: This study had a pre-post-design in a primary care practice for orofacial physical therapy. Twenty-eight participants with the presence of TMD and [...] Read more.

Objective: To analyze the effects of a somatosensory education intervention targeting temporomandibular disorders (TMD) and awake bruxism on subjective tinnitus. Methods: This study had a pre-post-design in a primary care practice for orofacial physical therapy. Twenty-eight participants with the presence of TMD and suffering from moderate to severe subjective tinnitus, for at least 3 months, received the following treatments: (a) comprehensive information about tinnitus and the factors influencing it; (b) bruxism reversal training via a smartphone application; and (c) treatment for TMD. The primary outcome was the Tinnitus Functional Index (TFI). Secondary outcomes were awake bruxism frequency and the TMD pain screener. The study was approved by the Ethics Committee of the University of Groningen, the Netherlands. Results: The mean (95% CI) reduction in TFI scores and awake bruxism frequency were 18.4 (13.2–23.5) and 16.6% (2.0–31.2%), respectively. A clinically relevant reduction of 13 points on the TFI was observed in 63% of the participants. Regression analysis revealed that factors associated with TFI change included the TFI initial score at T0 (0.3, 95% CI 0.0–0.6), the presence of daytime clenching (21.0, 95% CI 8.7–33.4), and stiffness or pain around the TMJ (10.6, 95% CI −1.9–23.0) at baseline. Conclusions: The findings suggest that tinnitus education, TMD treatment, combined with decreasing awake bruxism, can reduce tinnitus in a primary care setting. Full article

(This article belongs to the Special Issue Perspectives on Audiology as an Interdisciplinary and Multilevel Science)

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24 pages, 1808 KB

Open AccessArticle

Relationships Between Self-Report Hearing Scales, Listening Effort, and Speech Perception in Cocktail Party Noise in Hearing-Aided Patients

by Annie Moulin, Pierre-Emmanuel Aguera and Mathieu Ferschneider

Audiol. Res. 2025, 15(5), 113; https://doi.org/10.3390/audiolres15050113 - 8 Sep 2025

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Abstract

Background/Objectives: Potential correlations between the scores of self-report questionnaires and speech perception in noise abilities vary widely among studies and have been little explored in patients with conventional hearing aids (HAs). This study aimed to analyse the interrelations between (1) self-report auditory scales [...] Read more.

Background/Objectives: Potential correlations between the scores of self-report questionnaires and speech perception in noise abilities vary widely among studies and have been little explored in patients with conventional hearing aids (HAs). This study aimed to analyse the interrelations between (1) self-report auditory scales (the 15-item short-form of the Speech Spatial and Qualities of Hearing Scale (15iSSQ) and the Extended Listening Effort Assessment Scale (EEAS); (2) speech perception in cocktail party noise, measured with and without HAs; and (3) a self-assessment of the listening effort perceived during the speech in a noise-perception task (TLE) in hearing-aid wearers. Material and Methods: –Thirty-two patients, aged of 77.5 years (SD = 12) with a mean HA experience of 5.6 years, completed the 15iSSQ and EEAS. Their speech-in-babble-noise perception thresholds (SPIN) were assessed with (HA_SPIN) and without their HAs (UA_SPIN), using a four-alternative forced-choice test in free field, with several fixed Signal to Noise ratios (SNR). They were asked to self-assess their listening effort at each of those SNRs, allowing us to define a task-related listening-effort threshold with (HA_TLE) and without HAs (UA_TLE), i.e., the SNR for which they self-evaluated their listening effort as 5 out of 10. Results: 15iSSQ decreased as both HA_SPIN (r = −0.47, p < 0.01) and HA_TLE increased (r = −0.36, p < 0.05). The relationship between 15iSSQSpeech and UA_SPIN (and UA_TLE) showed a strong moderating influence by HA experience and HA daily wear (HADW), explaining up to 31% of the variance. 15iSSQQuality depended on HA SPIN and HA_TLE (r = −0.50, p < 0.01), and the relationship between 15iSSQQuality and UA_TLE was moderated by HADW. EEAS scores depended on both HA experience and UA_SPIN, with a strong moderating influence by HADW. Conclusions: Relationships between auditory questionnaires and SPIN are strongly moderated by both HA experience and HADW, even in experienced HA users, showing the need to account for these variables when analysing relationships between questionnaires and hearing-in-noise tests in experienced HA wearers. Full article

(This article belongs to the Section Hearing)

11 pages, 4288 KB

Open AccessCase Report

Use of the FLEX 28 Dexamethasone-Eluting Cochlear Implant Electrode in Electric–Acoustic Stimulation: A Case Report

by Shin-ichi Usami, Yutaka Takumi, Hidekane Yoshimura and Shin-ya Nishio

Audiol. Res. 2025, 15(5), 112; https://doi.org/10.3390/audiolres15050112 - 8 Sep 2025

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Abstract

Background/Objectives: During and after electric–acoustic stimulation (EAS) surgery (as well as regular cochlear implant surgery), the oral and/or intravenous administration of steroids is recommended to prevent acute inflammatory reactions and subsequent fibrosis. However, the effect does not last long. Therefore, with the [...] Read more.

Background/Objectives: During and after electric–acoustic stimulation (EAS) surgery (as well as regular cochlear implant surgery), the oral and/or intravenous administration of steroids is recommended to prevent acute inflammatory reactions and subsequent fibrosis. However, the effect does not last long. Therefore, with the hope of providing a sustained effect, a new dexamethasone (DEX)-eluting electrode (FLEX28 DEX) has recently been developed. Methods: A case study was performed at Shinshu University in February 2024 in which a DEX-eluting electrode array was utilized for a patient presenting with high-frequency hearing loss with a defined etiology (hearing loss due to a mitochondrial m.1555A > G variant). Results: Residual hearing was well preserved after EAS surgery, and post-operative impedance field telemetry was maintained at a very low level in contrast with a historical/retrospective control group (FLEX28 electrodes without DEX); therefore, it is expected that post-operative fibrosis will be minimized. Further, it was shown that the DEX-eluting electrode can also be applied to EAS. Conclusions: The DEX-eluting electrode was useful in maintaining post-operative impedance at a very low level, indicating that post-operative fibrosis could be minimized even after EAS surgery. Full article

(This article belongs to the Section Hearing)

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10 pages, 1467 KB

Open AccessCase Report

A Novel 1259 bp Intragenic Deletion in the GJB2 Gene in a Mexican Family with Congenital Profound Hearing Loss

by David Oaxaca-Castillo, Laura Taño-Portuondo, Montserrat Rodríguez-Ballesteros, Gerardo Pérez-Mendoza, Igrid García-González, Jorge Canto-Herrera, María Domínguez-Ruiz, Doris Pinto-Escalante, Orlando Vargas-Sierra, Damaris Estrella-Castillo, Paola López-González, Javier E. Sosa-Escalante, Ignacio del Castillo and Lizbeth González-Herrera

Audiol. Res. 2025, 15(5), 111; https://doi.org/10.3390/audiolres15050111 - 2 Sep 2025

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Abstract

Hearing loss is a genetically heterogeneous sensory defect for which biallelic pathogenic variants in the GJB2 gene are a frequent cause. Here, we report a novel intragenic large deletion in GJB2 in a Mayan family with several members affected by congenital non-syndromic hearing [...] Read more.

Hearing loss is a genetically heterogeneous sensory defect for which biallelic pathogenic variants in the GJB2 gene are a frequent cause. Here, we report a novel intragenic large deletion in GJB2 in a Mayan family with several members affected by congenital non-syndromic hearing loss. The analysis of the GJB2 gene in the proband was performed through Sanger sequencing. A novel homozygous 1259 bp deletion in GJB2 was identified, starting at nucleotide 248 of the coding region and ending at nucleotide 825 of the 3′-UTR (g.20188077_20189335del). Bioinformatic tools were used to predict the structural impact of the variant. This deletion would result in a truncated protein of 86 amino acids, p.(Phe83Cysfs*5), disrupting several critical domains of the connexin-26 protein. We developed an endpoint-PCR assay to test for the deletion. It was present homozygously in all affected siblings and was absent in 153 ethnically matched controls with normal hearing. Both parents and two unaffected siblings were heterozygous carriers, consistent with an autosomal recessive inheritance pattern. The identification of this novel large deletion expands the spectrum of GJB2 pathogenic variants causing non-syndromic hearing loss, and it is of concern to GJB2 screening methods that rely primarily on Sanger sequencing for its coding region. Full article

(This article belongs to the Section Hearing)

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13 pages, 1441 KB

Open AccessArticle

The Predictive Role of Video Head Impulse Testing Patterns of Anti-Compensatory Saccades Using the Suppression Head Impulse Paradigm for the Diagnosis of Mild Acute Unilateral Vestibular Loss

by Cristiano Balzanelli, Fabio Pontara and Luca Oscar Redaelli de Zinis

Audiol. Res. 2025, 15(5), 110; https://doi.org/10.3390/audiolres15050110 - 30 Aug 2025

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Abstract

Background/Objectives: To evaluate the predictive role of anti-compensatory saccades in diagnosing mild acute unilateral vestibular loss. Methods: Consecutive patients with vertigo who underwent a bedside vestibular evaluation and video head impulse testing of the horizontal semicircular canal at the San Bernardino Outpatient Clinic [...] Read more.

Background/Objectives: To evaluate the predictive role of anti-compensatory saccades in diagnosing mild acute unilateral vestibular loss. Methods: Consecutive patients with vertigo who underwent a bedside vestibular evaluation and video head impulse testing of the horizontal semicircular canal at the San Bernardino Outpatient Clinic in Salò, Italy, between 1 January and 30 June 2024 were examined (Group 1). Two control groups were considered: patients with severe unilateral acute vestibular loss (Group 2) and healthy subjects (Group 3). The video head impulse testing patterns of anti-compensatory saccades (amplitude, scattered pattern, and latency) using the suppression head impulse paradigm were analyzed to evaluate their predictive role in identifying horizontal canal dysfunction, even when borderline gain values of the canal’s vestibulo-ocular reflex were present. Results: Group 1 included 74 patients, Group 2 included 20 patients, and Group 3 included 20 healthy, voluntary subjects. The anti-compensatory saccades revealed significant differences in the amplitudes and scattered patterns between the two ears, exclusively in Groups 1 and 2. Conclusions: The anti-compensatory saccades alterations using the suppression head impulse paradigm can predict mild acute unilateral vestibular loss, even when the horizontal semicircular canal’s vestibulo-ocular reflex gain values are mild (lower borderline). Conversely, a borderline asymmetry of the horizontal semicircular canal’s vestibulo-ocular reflex using the classic head impulse paradigm should not be considered a marker of mild acute unilateral vestibular loss when the saccadic pattern is symmetrical using the suppression head impulse paradigm. Further meticulous differential diagnostic investigations are necessary in such cases to effectively diagnose horizontal semicircular canal dysfunction. Full article

(This article belongs to the Section Balance)

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16 pages, 302 KB

Open AccessArticle

The Influence of Auditory Dysfunction on Ergonomic Workplace Design for Aging Employees

by Matjaž Maletič, Albin Kotnik and Zvone Balantič

Audiol. Res. 2025, 15(5), 109; https://doi.org/10.3390/audiolres15050109 - 29 Aug 2025

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Abstract

Background/Objectives: This research focuses on the increasing presence of older workers in the labor market, a group particularly vulnerable to hearing problems due to age-related changes and prolonged noise exposure. Methods: The research combines theoretical and empirical approaches to investigate the [...] Read more.

Background/Objectives: This research focuses on the increasing presence of older workers in the labor market, a group particularly vulnerable to hearing problems due to age-related changes and prolonged noise exposure. Methods: The research combines theoretical and empirical approaches to investigate the impact of noise on the workplaces of older employees. The empirical component is based on two primary methods: a survey and audiometric testing to assess participants’ hearing abilities. The study included a sample of 50 older workers, all with diagnosed hearing loss. Results: The results of the survey showed that most older workers are regularly exposed to noise at work, which has long-term negative effects on their hearing. This highlights the need to introduce appropriate protective measures such as personal protective equipment, insulation of noise sources, and raising awareness about the dangers of noise. In addition to the questionnaire survey, the analysis of hearing measurements revealed that all respondents had significant bilateral hearing loss, with sensorineural hearing loss being the most prevalent type. Conclusions: This study highlights the negative impact of chronic noise exposure in the workplace on the hearing, communication and productivity of older workers and emphasizes the importance of combining preventive measures, hearing protection and workplace adaptations to promote their well-being and performance. Full article

(This article belongs to the Section Hearing)

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Audiol. Res., Volume 15, Issue 5 (October 2025) – 8 articles

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