Audiology Research

11 pages, 1251 KB

Open AccessArticle

Awareness of Noise-Induced Hearing Loss Related to Exposure to High-Noise Environments—Case Study: Young Adults 18 to 30 in Greece

by Nikolaos Trimmis, Melina Kaparou, Theodoros Tsoukalas, Panagiotis Plotas and Voula Chris Georgopoulos

Audiol. Res. 2025, 15(6), 171; https://doi.org/10.3390/audiolres15060171 - 5 Dec 2025

Abstract

Background: Noise-induced hearing loss (NIHL) is one of the most common types of hearing impairment, even though it is preventable. However, awareness and protective behaviors among young adults remain limited. This study explored the knowledge, attitudes, and behaviors of young adults in Greece [...] Read more.

Background: Noise-induced hearing loss (NIHL) is one of the most common types of hearing impairment, even though it is preventable. However, awareness and protective behaviors among young adults remain limited. This study explored the knowledge, attitudes, and behaviors of young adults in Greece regarding exposure to high-noise environments and the risk of NIHL. Methods: A cross-sectional survey was conducted with 104 participants aged 18–30 years in Patras, Greece. A 27-item questionnaire was used to collect data on demographics, patterns of noise exposure, use of personal listening devices, auditory symptoms, and preventive behaviors. Descriptive statistics and chi-square tests were used to examine relationships between demographic variables and participants’ responses. Results: Most participants (93.3%) recognized that prolonged exposure to high noise levels can harm hearing. However, only 6.7% reported having regular hearing checks, and almost half (45.2%) had never been tested. Remarkably, 19.2% of participants experienced tinnitus, while more than half (54.8%) reported fatigue after exposure to loud sounds. Younger participants (aged 18–22 years) were significantly more likely to listen at high volumes compared to older groups (p < 0.05). Males reported higher rates of tinnitus and ear discomfort, whereas females more often experienced headaches. Although general awareness of NIHL was high, preventive behaviors such as using hearing protection were rarely practiced. Conclusions: These findings highlight the need for targeted educational campaigns and preventive screening programs to promote safe listening practices and reduce the overall prevalence of NIHL. Full article

(This article belongs to the Section Hearing)

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12 pages, 439 KB

Open AccessArticle

Hearing Abilities in Children with Perinatally Acquired HIV, Children Perinatally Exposed to HIV but Uninfected, and Children Unexposed to HIV

by Peter Torre III, Haley Elliott, Zhongli J. Zhang, Tzy-Jyun Yao and Barbara Laughton

Audiol. Res. 2025, 15(6), 170; https://doi.org/10.3390/audiolres15060170 - 5 Dec 2025

Abstract

Background/Objectives: Children with perinatal HIV (PHIV) are more at risk for hearing loss than HIV-unexposed (HU) children. Due to medical advances maternal HIV transmission to newborns is decreasing, but in children with perinatal HIV exposure, uninfected (PHEU) is increasing. The objectives were [...] Read more.

Background/Objectives: Children with perinatal HIV (PHIV) are more at risk for hearing loss than HIV-unexposed (HU) children. Due to medical advances maternal HIV transmission to newborns is decreasing, but in children with perinatal HIV exposure, uninfected (PHEU) is increasing. The objectives were to evaluate (1) pure-tone audiometry and cochlear and auditory neural function in children with perinatally acquired HIV (PHIV), children with perinatal HIV exposure but uninfected (PHEU), and HIV-unexposed (HU) children and (2) differences in hearing measures for children with PHIV according to HIV disease severity. Methods: Three hundred and thirty-three children (105 PHIV [58 girls, 47 boys], 101 PHEU [51 girls, 50 boys], and 127 HU [65 girls, 62 boys]), aged 11–14 years, completed a hearing assessment that included a hearing-related questionnaire, otoscopy, tympanometry, pure-tone thresholds, distortion product otoacoustic emissions (DPOAEs) for cochlear function, and auditory brainstem responses (ABRs) for neural function. Results: Pure-tone thresholds, DPOAE, and ABR measures were similar in the three groups. Children with PHIV had a higher prevalence of hearing loss compared to children with PHEU and HU children. Children with PHIV and greater historical HIV disease severity had similar hearing, DPOAEs, and ABRs to those with lesser HIV disease severity. Conclusions: In utero HIV acquisition or HIV exposure might not affect the cochlear and neural function up to the level of the brainstem. Children with PHIV had a higher prevalence of hearing loss; it is possible there is a difference in central auditory processing across the three groups of children. Hearing loss identification is important since it may impact social and educational development. Full article

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14 pages, 2267 KB

Open AccessArticle

Listening Effort and Its Relation to Spatial Localization, and Vestibular and Visual Impairment in Usher Syndrome—Our Experience

by Tiziana Di Cesare, Paola Michieletto, Maria Teresa Bonati, Federica De Caro, Pietro Cossu, Francesco Torelli and Eva Orzan

Audiol. Res. 2025, 15(6), 169; https://doi.org/10.3390/audiolres15060169 - 5 Dec 2025

Abstract

Background/Objectives: Children with hearing loss (HL) could experience significant fatigue which compromises their performance. The effort related to the combination of HL and visual impairment in children affected by Usher syndrome (USH) could compromise mental health, socio-emotional behavior and academic achievement. The aim [...] Read more.

Background/Objectives: Children with hearing loss (HL) could experience significant fatigue which compromises their performance. The effort related to the combination of HL and visual impairment in children affected by Usher syndrome (USH) could compromise mental health, socio-emotional behavior and academic achievement. The aim of the present study was to analyse the listening effort in USH cases types 1 and 2 and its relation to age, molecular diagnosis, visual field, visual acuity, degree of HL, vestibular impairment and spatial orientation. Methods: This was a retrospective monocentric study. Twenty children with genetically confirmed USH (USH2 in 15/20–75% and USH1 in 5/20–25%), age range 3–17 years (mean 9.6 ± 4.7), underwent: the Vanderbilt fatigue scale questionnaire (VFS), audiological and vestibular assessment including the Oldenburg Matrix test in Italian and video head impulse test (VHIT), sound localization test and ophthalmologic examination. Results: We observed a more pronounced HL and deteriorated vestibular function in those with USH1. They also employed significantly more time and head movements to localize sounds compared to USH2 and had the worst visual field on eye examination. The VFS did not show significant differences between the two groups, with the exception of the physical fatigue reported by parents. Mean VFS was linearly related to age, the hearing threshold of the worse ear, data logging hours of hearing device, time and head movements of the localization test, VHIT asymmetry and balance problems referred by parents and the visual field. USH type 1 had no greater risk of fatigue than USH2. Profound hearing loss, data logging of hearing device < 8 h a day, difficult localization test, balance problems and low retinal sensitivity represented risk factors for listening effort measured with VFS. Conclusions: Listening effort in difficult environments such as school rooms in USH patients is not only associated to hearing function but also to the spatial awareness determined in part by vestibular and visual function. Teachers should be informed and made aware of multiple comorbidities in order to facilitate learning. Full article

(This article belongs to the Section Hearing)

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22 pages, 338 KB

Open AccessReview

Multidisciplinary Management of Cerebellopontine Angle Tumors with Brainstem Involvement

by Concheri Stefano, Vito Pontillo, Alberto D’Amico, Stefano Di Girolamo, Francesco Signorelli, Elisabetta Zanoletti and Nicola Antonio Adolfo Quaranta

Audiol. Res. 2025, 15(6), 168; https://doi.org/10.3390/audiolres15060168 - 4 Dec 2025

Abstract

Background/Objectives: Tumors of the cerebellopontine angle (CPA) encompass a limited range of histologies, predominantly vestibular schwannomas (VSs), meningiomas, and paragangliomas (PGLs). Their growth region threatens the cranial nerves (V–XII), brainstem, and cerebellum, possibly causing functional deficits. This review aims to synthesize clinical features [...] Read more.

Background/Objectives: Tumors of the cerebellopontine angle (CPA) encompass a limited range of histologies, predominantly vestibular schwannomas (VSs), meningiomas, and paragangliomas (PGLs). Their growth region threatens the cranial nerves (V–XII), brainstem, and cerebellum, possibly causing functional deficits. This review aims to synthesize clinical features and multidisciplinary treatment strategies for CPA tumors with brainstem involvement, emphasizing functional preservation alongside tumor control. Methods: A systematic PubMed search identified studies on VSs, CPA meningiomas, and intradural PGLs. Eligibility criteria included studies reporting tumor management and cranial nerve outcomes. Data extraction focused on tumor size, neurological presentation, surgical approach, adjunctive therapies, and postoperative cranial nerve function. Multidisciplinary involvement and rehabilitation strategies were noted. Results: Twenty studies (3311 patients) analyzed large VSs, showing facial nerve dysfunction in 8–53%, trigeminal neuropathy in 20–77%, and cerebellar signs in up to 79%. Microsurgery (MS) achieved variable gross total resection, while stereotactic radiosurgery (SRS) preserved facial nerve function but carried trigeminal and hydrocephalus risks. CPA meningiomas demonstrated cranial nerve displacement patterns critical for surgical planning, with transient deficits common and recovery linked to baseline function. In 388 intradural PGL cases, staged surgery combined with preoperative embolization was standard; functional preservation of lower cranial nerves was often limited. Across all histologies, multidisciplinary management and targeted rehabilitation were essential. Conclusions: Optimal CPA tumor management balances tumor control with functional preservation. VSs benefit from individualized MS or SRS based on size and mass effect. Meningioma surgery prioritizes cranial nerve preservation over radical resection. Intradural PGLs require staged vascular-conscious approaches. Multidisciplinary care and structured rehabilitation are pivotal to improving outcomes and quality of life. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

17 pages, 809 KB

Open AccessArticle

Impact of Hearing Aid Amplification on Subjective Tonal Tinnitus in Patients with Gently Sloping and Ski-Slope Hearing Loss: A Retrospective Cohort Study

by Daniele Portelli, Sabrina Loteta, Cosimo Galletti, Mariangela D’Angelo, Leonard Freni, Pietro Salvago, Francesco Ciodaro and Giuseppe Alberti

Audiol. Res. 2025, 15(6), 167; https://doi.org/10.3390/audiolres15060167 - 3 Dec 2025

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Abstract

Background/Objectives: This study aims to evaluate the effectiveness of hearing aid amplification in reducing self-perceived tinnitus handicap in individuals with ski-slope hearing loss—a population seldom addressed in previous research. In addition, a correlation analysis was performed to examine the relationship between tinnitus [...] Read more.

Background/Objectives: This study aims to evaluate the effectiveness of hearing aid amplification in reducing self-perceived tinnitus handicap in individuals with ski-slope hearing loss—a population seldom addressed in previous research. In addition, a correlation analysis was performed to examine the relationship between tinnitus duration, pitch, loudness, and THI scores. The results are then compared with those of patients with high-frequency gently sloping hearing loss. Methods: 38 patients with bilateral sensorineural hearing loss and chronic tonal tinnitus were retrospectively evaluated and divided into two equal groups: high-frequency gently sloping and ski-slope hearing loss (n = 19 each). Tinnitus pitch, loudness, and edge frequency were assessed. The Mann–Whitney test compared tinnitus characteristics between groups, while the Wilcoxon signed-rank test evaluated pre- and post-treatment THI scores. Spearman correlation was used to explore associations between tinnitus duration, intensity, pitch, and THI outcomes. Results: The Mann–Whitney test showed significant differences in tinnitus pitch, and edge frequency between both groups; no statistically significant differences were found for the tinnitus level. Tinnitus frequency was higher in the high-frequency gently sloping group. The Wilcoxon test confirmed significant improvements in THI scores post-treatment for both groups (p < 0.001). No significant correlations were found between tinnitus duration, level, pitch, and post-treatment THI scores. Conclusions: Hearing aids effectively reduce tinnitus severity in patients with ski-slope and gently sloping hearing loss, supporting their use as a therapeutic option. Larger, multicentric studies are recommended to validate these findings and explore specific auditory profiles and processing strategies. Full article

(This article belongs to the Special Issue Emerging Technologies in Audiology: Advancing Assessment, Intervention, and Accessibility)

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15 pages, 967 KB

Open AccessArticle

Cochlear Implants and Adult Patient Experiences, Adaptation and Challenges: A Survey

by Sahar Bin Dehaish, Abdulmalik Bin Marouq, Abdulaziz Almalki, Medhat Yousef, Fida Almuhawas, Abdulrahman Hagr, Jad Mony, Mohammad Albaqeyah, Hala Alferaih, Haifa Alqahtani, Sara Alghuraibi, Deepthi Poovayya, Hassan Yalcouy and Dalal Alrushaydan

Audiol. Res. 2025, 15(6), 166; https://doi.org/10.3390/audiolres15060166 - 30 Nov 2025

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Abstract

Background: Cochlear implants (CIs) are a life-changing treatment for individuals with severe to profound hearing loss, yet adult CI uptake remains low despite high clinical and economic effectiveness. This study investigates adult patient experiences, adaptation, and barriers to CI access in Saudi Arabia. [...] Read more.

Background: Cochlear implants (CIs) are a life-changing treatment for individuals with severe to profound hearing loss, yet adult CI uptake remains low despite high clinical and economic effectiveness. This study investigates adult patient experiences, adaptation, and barriers to CI access in Saudi Arabia. Methods: A survey of 89 adult CI recipients was conducted across three major CI centers in Saudi Arabia. The electronic questionnaire explored pre- and post-implant experiences, including referral pathways, device choice, adaptation, and satisfaction. Descriptive statistics, ranked correlations, and inferential tests were used to analyze associations between demographic and clinical variables. Results: The median time between hearing loss diagnosis and implantation was 17 years, with most patients using hearing aids beforehand. Healthcare professionals were the primary source of CI interest for 48% of respondents, though younger recipients were more often influenced by peers. Longer daily device use was linked to faster acclimatization (ρ = −0.26, p < 0.05); however, age, wait time, and initial attitude did not affect adaptation. Outcomes exceeded expectations for 54% of participants. Major barriers included lack of awareness (23%) and fear of surgery (18%). Only 4% learned about CI through social media. Advice for future candidates emphasized confidence and proactive action. Conclusions: Despite expanded CI availability in Saudi Arabia, structural and societal barriers persist. Empowering healthcare professionals and utilizing social media for awareness may enhance adult CI uptake and improve hearing health outcomes. Full article

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6 pages, 160 KB

Open AccessArticle

Does Superior Semicircular Canal Dehiscence Surgery Resolve or Exacerbate Positional Vertigo?

by Gerard Joseph Gianoli

Audiol. Res. 2025, 15(6), 165; https://doi.org/10.3390/audiolres15060165 - 28 Nov 2025

Viewed by 146

Abstract

Does Superior Semicircular Canal Dehiscence Surgery Resolve or Exacerbate BPPV? Background/Objectives: BPPV is commonly found to be associated with other inner ear disorders. It has been found to occur with Superior Semicircular Canal Dehiscence (SSCD) as well as postoperatively following SSCD surgical repair. [...] Read more.

Does Superior Semicircular Canal Dehiscence Surgery Resolve or Exacerbate BPPV? Background/Objectives: BPPV is commonly found to be associated with other inner ear disorders. It has been found to occur with Superior Semicircular Canal Dehiscence (SSCD) as well as postoperatively following SSCD surgical repair. This paper will analyze the preoperative and postoperative incidence of positional vertigo in patients undergoing SSCD surgery. Methods: This is a retrospective chart review of 50 consecutive patients with SSCD undergoing surgical repair. They were evaluated preoperatively, at 1 week postoperative, at 6 weeks postoperative, and at 12 weeks postoperative for evidence of BPPV. Information collected included demographics, the semicircular canal involved, type of BPPV, and whether the patient required canalith repositioning. Results: Preoperatively, 33 (66%) patients reported symptoms of positionally induced vertigo with confirmation during VNG testing. No patient was treated for BPPV prior to surgery. At one week postoperative, 17 (35%) patients continued to have symptoms of positionally induced vertigo; at 6 weeks postoperative, 9 (18%), and at 12 weeks postoperative, 5 (10%) patients had positional vertigo requiring canalith repositioning (p < 0.05). Three patients (6%) had no evidence of BPPV preoperatively but had positional vertigo at the one-week postoperative evaluation. At the 6-week post-op visit, only one of the patients had new-onset postoperative positional vertigo. At the 3-month visit, no patient had new-onset postoperative positional vertigo. Conclusions: BPPV and positional vertigo symptoms were found commonly prior to SSCD surgery and in the week after SSCD surgery. However, BPPV resolved by 6 weeks after SSCD surgery without additional intervention for most of these patients, while the others underwent canalith repositioning. A small percentage developed BPPV after surgery who had none preoperatively and in the contralateral ear. Full article

(This article belongs to the Special Issue A Tribute to John M. Epley)

15 pages, 1410 KB

Open AccessArticle

by Anusha Yellamsetty, Gianmaris Fortuna, Egbe-Etu Etu and Shaowen Bao

Audiol. Res. 2025, 15(6), 164; https://doi.org/10.3390/audiolres15060164 - 26 Nov 2025

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Abstract

Background: Tinnitus has been increasingly reported during the COVID-19 pandemic, following both infection and vaccination. While these reports suggest that pandemic-related factors may influence the onset or worsening of tinnitus, the perceptual characteristics and functional consequences of such cases remain poorly understood. This [...] Read more.

Background: Tinnitus has been increasingly reported during the COVID-19 pandemic, following both infection and vaccination. While these reports suggest that pandemic-related factors may influence the onset or worsening of tinnitus, the perceptual characteristics and functional consequences of such cases remain poorly understood. This study examined the nature, severity, and communication-related impact of self-reported tinnitus following COVID-19 vaccination. Methods: A total of 770 adults who self-reported new or worsened tinnitus after vaccination completed a structured online survey between August 2021 and May 2023. Standardized instruments included the Tinnitus Functional Index (TFI), the Speech, Spatial and Qualities of Hearing Scale (SSQ), and visual analog scales assessing loudness discomfort and hyperacusis-related symptoms. Analyses included descriptive statistics, chi-square tests, t-tests, and correlation matrices. Results: Respondents reported moderate to severe tinnitus-related distress, with the greatest impacts on emotional control, sleep, and relaxation. Many described communication difficulties in noisy or multi-talker environments, despite relatively preserved spatial hearing and sound quality. A substantial subset endorsed hyperacusis symptoms, including sound-induced annoyance, fear, and intolerance. Correlation analyses revealed strong associations between emotional, cognitive, and auditory domains, underscoring the multidimensional burden of tinnitus in this population. Conclusions: Self-reported tinnitus after COVID-19 vaccination was associated with distress, sleep disruption, and communication difficulties, mirroring patterns commonly observed in tinnitus more broadly. Although causality cannot be determined, these findings highlight the importance of comprehensive audiological and psychological assessment for individuals reporting auditory complaints after vaccination and support the inclusion of functional hearing outcomes in tinnitus evaluation protocols. Full article

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14 pages, 788 KB

Open AccessArticle

Binaural Localization Development and the Effect of SmartSound iQ with SCAN in Children with Cochlear Implants

by Abdulaziz Alasmi, Mada Aljabr, Dalal Alrushaydan, Hassan Yalcouy and Fida Almuhawas

Audiol. Res. 2025, 15(6), 163; https://doi.org/10.3390/audiolres15060163 - 24 Nov 2025

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Abstract

Background: Binaural hearing is crucial for spatial auditory perception, including sound localization. Cochlear implants (CIs) are commonly used in children with congenital deafness to support binaural auditory development, but the extent to which they facilitate effective localization remains unclear. Objective: This study evaluates [...] Read more.

Background: Binaural hearing is crucial for spatial auditory perception, including sound localization. Cochlear implants (CIs) are commonly used in children with congenital deafness to support binaural auditory development, but the extent to which they facilitate effective localization remains unclear. Objective: This study evaluates the impact of CIs on binaural functional auditory development and sound localization in children with congenital deafness, considering factors such as age at implantation, hearing experience, and CI laterality. Methods: Thirty-eight CI-assisted children (aged 4–9 years) underwent directional hearing assessments using the “Erfassung des Richtungshörens bei Kindern (ERKI)” device. Localization accuracy was analyzed across various noise stimuli, and correlations with audiometric parameters and CI history were examined. Results: Localization accuracy improved with age and CI experience. Bilateral CI users outperformed unilateral users, particularly with pulse pink noise stimuli. The use of SmartSound iQ with SCAN technology enhanced localization, especially in younger children. Conclusion: CIs support binaural functional auditory development in children with congenital deafness, with localization skills improving over time. Bilateral implantation and early intervention may further enhance outcomes, warranting continued research. Full article

(This article belongs to the Section Hearing)

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9 pages, 633 KB

Open AccessArticle

A Concept for MRI-Based Cholesteatoma Detection in Cochlear Implant Recipients

by Lukas Woltersdorf, Rayoung Kim, Alexander Rempen, Christoph Pfeiffer, Lars-Uwe Scholtz, Christiane Schimmack, Daniela Eickenjäger, Rüdiger Steinbach and Ingo Todt

Audiol. Res. 2025, 15(6), 162; https://doi.org/10.3390/audiolres15060162 - 21 Nov 2025

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Abstract

Introduction: Cochlear implantation is the treatment of choice for severe hearing loss and deafness. Cholesteatomas can cause this deafness. A frequently used procedure in the course of surgical rehabilitation is a subtotal petrosectomy combined with a cochlear implant. The clinical follow-up of residual [...] Read more.

Introduction: Cochlear implantation is the treatment of choice for severe hearing loss and deafness. Cholesteatomas can cause this deafness. A frequently used procedure in the course of surgical rehabilitation is a subtotal petrosectomy combined with a cochlear implant. The clinical follow-up of residual cholesteatomas is related to the blind sac closure difficult. Cholesteatoma MRI sequence-related CI magnet artefacts make follow-up challenging. Recent developments in combining cochlear implants and necessary MRI examinations enable the assessment of the internal auditory canal and cochlea. The study aimed to develop a procedure for detecting cholesteatomas in patients with cochlear implants using magnetic resonance imaging (MRI). Methods: Ex vivo MRI examinations were performed on five volunteers with fixed cochlear implants (Medel Synchrony) and swim caps. MRI examinations were performed at 1.5 T and 3 T using EPI, HASTE, and RESOLVE sequences (Siemens). The position of the implant was 12 cm distal to the external auditory canal, with anteversional head position of the volunteers in the MRI. Results: Due to artefact effects, assessment of the ipsilateral and contralateral mastoid is not possible with EPI sequences and a cochlear implant. The combination of cholesteatoma-detecting MARS sequences (HASTE, RESOLVE), a distal implant position, and a specific head position allows the assessment of the ipsilateral mastoid. Conclusions: Postoperative cholesteatoma assessment after CI implantation and subtotal petrosectomy appears to be possible under 1.5 T and 3 T, considering the MRI sequence, implant position, and head position. Full article

(This article belongs to the Section Hearing)

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14 pages, 1377 KB

Open AccessArticle

Machine Learning Versus Simple Clinical Models for Cochlear Implant Outcome Prediction

by Rieke Ollermann, Nils Strodthoff, Andreas Radeloff and Robert Böscke

Audiol. Res. 2025, 15(6), 161; https://doi.org/10.3390/audiolres15060161 - 21 Nov 2025

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Abstract

Background/Objectives: Cochlear implantation is the most widely used treatment option for patients with severe to profound hearing loss. Despite being a relatively standardized surgical procedure, cochlear implant (CI) outcomes vary considerably among patients. Several studies have attempted to develop predictive models for CI [...] Read more.

Background/Objectives: Cochlear implantation is the most widely used treatment option for patients with severe to profound hearing loss. Despite being a relatively standardized surgical procedure, cochlear implant (CI) outcomes vary considerably among patients. Several studies have attempted to develop predictive models for CI outcomes but achieving accurate and generalizable predictions remains challenging. The present study aimed to evaluate whether simple and complex statistical and machine learning models could outperform the Null model based on various pre-CI implantation variables. Methods: We conducted a retrospective analysis of 236 ears with postlingual profound sensorineural hearing loss (SNHL) and measurable residual hearing (WRS_max > 0%) at the time of implantation. The median postoperative word recognition score with CI (WRS₆₅(CI)) was 75% [Q1: 55%, Q3: 80%]. The dataset was divided using a 70:15:15 split into training (n = 165), validation (n = 35) and test (n = 36) cohorts. We evaluated multiple modeling approaches: different Generalized Linear Model (GLM) approaches, Elastic Net, XGBoost, Random Forest, ensemble methods, and a Null model baseline. Results: All models demonstrated similar predictive performance, with root mean squared errors ranging from 26.28 percentage points (pp) to 30.74 and mean absolute errors ranging from 20.62 pp to 23.75 pp. Coefficients of determination (R²) ranged from −0.468 to −0.073. Bland–Altman analyses revealed wide limits of agreement and consistent negative bias, while Passing–Bablok regression indicated calibration errors. Nonetheless, all models incorporating predictors significantly outperformed the Null model. Conclusions: Increasing model complexity yielded only marginal improvements in predictive accuracy compared with simpler statistical models. Pre-implantation clinical variables showed limited evidence of predictive validity for CI outcomes, although further research is needed. Full article

(This article belongs to the Section Hearing)

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13 pages, 3138 KB

Open AccessArticle

Reuniting and Endolymphatic Duct Macrophages: Localization and Possible Roles

by Elisa Vivado, Daniele Cossellu and Paola Perin

Audiol. Res. 2025, 15(6), 160; https://doi.org/10.3390/audiolres15060160 - 20 Nov 2025

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Abstract

Background: The inner ear hosts several macrophage populations. Endolymphatic sac macrophages can phagocytose otoconia, and spiral limbus macrophages express genes for fluid shear stress sensing and bone remodeling. Obstruction of endolymph flow by saccular otoconia could be linked to endolymphatic hydrops. Since [...] Read more.

Background: The inner ear hosts several macrophage populations. Endolymphatic sac macrophages can phagocytose otoconia, and spiral limbus macrophages express genes for fluid shear stress sensing and bone remodeling. Obstruction of endolymph flow by saccular otoconia could be linked to endolymphatic hydrops. Since macrophages are strongly affected by inflammatory status, a role for them in otolith removal could provide a link between inflammation and hydrops. However, the distribution of macrophages around the reuniting duct (RD) and endolymphatic duct (ED), which are narrow structures likely prone to blockage, remains unexplored. Methods: We performed tissue clearing and light-sheet imaging on rat temporal bones. Autofluorescence and immunolabeling for collagen IV, smooth muscle actin, and Iba1 were used to visualize inner ear structures, blood vessels, and macrophages. Results: The connective tissue layer underlying the RD extended from the cochlear spiral limbus. The RD and spiral limbus hosted a continuous microvascular network and macrophage population, comprising both ameboid and ramified cells; macrophages also surrounded the underlying vestibulocochlear artery (VCA). A separate macrophage population, continuous with that of the saccular connective tissue, was found around the endolymphatic sinus and utriculo–endolymphatic (Bast’s) valve; macrophage patterns changed in the vestibular aqueduct and endolymphatic sac. Conclusions: Macrophages are observed in positions consistent with potential roles in sensing luminal changes and in the clearance of obstructive material from the RD and ED; functional confirmation will require targeted experiments. Full article

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14 pages, 394 KB

Open AccessReview

Trigeminal Nerve and Vestibular System: Update on Pathophysiological and Clinical Links

by Mario Faralli, Giuseppe Santopietro, Francesco Frati and Luigi Califano

Audiol. Res. 2025, 15(6), 159; https://doi.org/10.3390/audiolres15060159 - 19 Nov 2025

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Abstract

The points of contact between the vestibular system and the trigeminal nerve remain an active area of research. Anatomically, several connections have been clearly identified, and these may play a role in the development of various disorders. Understanding these connections also proves to [...] Read more.

The points of contact between the vestibular system and the trigeminal nerve remain an active area of research. Anatomically, several connections have been clearly identified, and these may play a role in the development of various disorders. Understanding these connections also proves to be extremely valuable from a clinical perspective. It is increasingly evident that the etiopathogenesis of various vestibular disorders is multifactorial. Therefore, knowledge of the points of interaction between the two systems can assist clinicians in patient assessment and, most importantly, in selecting the most appropriate therapeutic approach. This study is presented as a narrative review. A literature search was conducted to identify studies investigating the correlation between the trigeminal system and the vestibular system, as well as their respective characteristics, to provide a comprehensive overview. Since this is a narrative rather than a systematic review, no specific inclusion or exclusion criteria were applied. So, the aim of this study is to analyze these connections through a comprehensive review of the literature, trying to present a multidisciplinary approach to the topic, one that can involve both the neurologist and the otologist, in order to achieve a more refined management of clinical cases. To better understand their anatomical relationships, we begin by examining the embryological development of both the vestibular system and the trigeminal nerve. Finally, we present current knowledge on the trigeminal influence in certain vestibular disorders—particularly vestibular migraine—and, conversely, the vestibular system’s potential impact on trigeminal-related conditions. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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14 pages, 1737 KB

Open AccessArticle

Classification of Speech and Associated EEG Responses from Normal-Hearing and Cochlear Implant Talkers Using Support Vector Machines

by Shruthi Raghavendra, Sungmin Lee and Chin-Tuan Tan

Audiol. Res. 2025, 15(6), 158; https://doi.org/10.3390/audiolres15060158 - 18 Nov 2025

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Abstract

Background/Objectives: Speech produced by individuals with hearing loss differs notably from that of normal-hearing (NH) individuals. Although cochlear implants (CIs) provide sufficient auditory input to support speech acquisition and control, there remains considerable variability in speech intelligibility among CI users. As a [...] Read more.

Background/Objectives: Speech produced by individuals with hearing loss differs notably from that of normal-hearing (NH) individuals. Although cochlear implants (CIs) provide sufficient auditory input to support speech acquisition and control, there remains considerable variability in speech intelligibility among CI users. As a result, speech produced by CI talkers often exhibits distinct acoustic characteristics compared to that of NH individuals. Methods: Speech data were obtained from eight cochlear-implant (CI) and eight normal-hearing (NH) talkers, while electroencephalogram (EEG) responses were recorded from 11 NH listeners exposed to the same speech stimuli. Support Vector Machine (SVM) classifiers employing 3-fold cross-validation were evaluated using classification accuracy as the performance metric. This study evaluated the efficacy of Support Vector Machine (SVM) algorithms using four kernel functions (Linear, Polynomial, Gaussian, and Radial Basis Function) to classify speech produced by NH and CI talkers. Six acoustic features—Log Energy, Zero-Crossing Rate (ZCR), Pitch, Linear Predictive Coefficients (LPC), Mel-Frequency Cepstral Coefficients (MFCCs), and Perceptual Linear Predictive Cepstral Coefficients (PLP-CC)—were extracted. These same features were also extracted from electroencephalogram (EEG) recordings of NH listeners who were exposed to the speech stimuli. The EEG analysis leveraged the assumption of quasi-stationarity over short time windows. Results: Classification of speech signals using SVMs yielded the highest accuracies of 100% and 94% for the Energy and MFCC features, respectively, using Gaussian and RBF kernels. EEG responses to speech achieved classification accuracies exceeding 70% for ZCR and Pitch features using the same kernels. Other features such as LPC and PLP-CC yielded moderate to low classification performance. Conclusions: The results indicate that both speech-derived and EEG-derived features can effectively differentiate between CI and NH talkers. Among the tested kernels, Gaussian and RBF provided superior performance, particularly when using Energy and MFCC features. These findings support the application of SVMs for multimodal classification in hearing research, with potential applications in improving CI speech processing and auditory rehabilitation. Full article

(This article belongs to the Section Hearing)

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17 pages, 943 KB

Open AccessReview

What’s in an App? Scoping Review and Quality Assessment of Clinically Available Hearing-Aid-Connected Apps

by Kate Pfingstgraef, Robin O’Hagan, Jana N. Bataineh and Danielle Glista

Audiol. Res. 2025, 15(6), 157; https://doi.org/10.3390/audiolres15060157 - 13 Nov 2025

Viewed by 410

Abstract

Background/Objectives: Mobile health (mHealth) tools, such as smartphone apps, support person-centred care for persons with hearing loss engaging in the hearing aid management process. Hearing-aid-connected apps are increasingly common in audiological care, making it important to evaluate their availability and quality for clinicians, [...] Read more.

Background/Objectives: Mobile health (mHealth) tools, such as smartphone apps, support person-centred care for persons with hearing loss engaging in the hearing aid management process. Hearing-aid-connected apps are increasingly common in audiological care, making it important to evaluate their availability and quality for clinicians, developers, and end-users. This scoping review aimed to identify, summarize, and synthesize information on clinically available hearing-aid-connected apps and evaluate their quality. Methods: A search of the Apple App Store (Canada) was conducted in August 2024 to identify current hearing-aid-connected apps that support hearing aid management. Metadata and features were extracted, and app quality was assessed using the Mobile Application Rating Scale (MARS). Quality was assessed across four objective domains (engagement, functionality, aesthetics, and information) and one subjective domain. Results: Apps had varying levels of metadata detail, including updates, compatibility, and target populations. All apps included common hearing aid controls (e.g., volume adjustment, microphone directionality), while more specialized features (tinnitus management, health tracking, remote clinician support) varied. High-performing apps scored significantly higher in engagement, functionality, aesthetics, and subjective quality, and all apps scored low in information quality, particularly for evidence and credibility. Conclusions: Findings highlight the need for transparent and informative metadata reporting and patient-centred design to improve clinical awareness, usability, and uptake of hearing-aid-connected apps. Full article

(This article belongs to the Special Issue Emerging Technologies in Audiology: Advancing Assessment, Intervention, and Accessibility)

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23 pages, 502 KB

Open AccessReview

Brainstem Stroke and Dysphagia Treatment: A Narrative Review on the Role of Neuromodulation, Skill-Based Swallowing Training and Transient Receptor Potential Agonists

by Ivy Cheng, Wan-Qi Li, Shaheen Hamdy, Emilia Michou, Maggie-Lee Huckabee, Noemí Tomsen, Pere Clavé and Rainer Dziewas

Audiol. Res. 2025, 15(6), 156; https://doi.org/10.3390/audiolres15060156 - 12 Nov 2025

Viewed by 1322

Abstract

Swallowing is mediated by the central nervous system, including cortical and subcortical structures, the cerebellum, and the brainstem. The brainstem contains the swallowing centre that is crucial for initiating and coordinating swallowing. Consequently, brainstem damage due to stroke often leads to severe and [...] Read more.

Swallowing is mediated by the central nervous system, including cortical and subcortical structures, the cerebellum, and the brainstem. The brainstem contains the swallowing centre that is crucial for initiating and coordinating swallowing. Consequently, brainstem damage due to stroke often leads to severe and persistent dysphagia. The aim of the present narrative review is to provide an overview of dysphagia following brainstem stroke and its management. It summarizes the physiology and pathophysiology of dysphagia following brainstem stroke and the available therapeutic options, and evaluate their effectiveness for dysphagia following brainstem stroke, which would promote the development of therapeutic protocols. Neuromodulatory techniques, including pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), modulate the excitability of corticobulbar circuits. These techniques promote neuroplasticity through peripheral or cortical electrical or electromagnetic inputs. Skill-based swallowing training emphasizes cortical involvement in enhancing swallowing skill, offering a targeted approach to behavioural rehabilitation. Finally, transient receptor potential (TRP) agonists increase sensory inputs to the swallowing system by stimulating the sensory receptors in the oropharynx, potentially activating the swallowing network. While these options have shown promise in dysphagia rehabilitation following stroke, most the available data comes from patients with mixed stroke lesions, with limited data focused specifically on brainstem lesions. Therefore, the evidence for their efficacy in patients with brainstem stroke remains underexplored. Therefore, treatment decisions should rely on the understanding of swallowing physiology, neuroplasticity, and clinical evidence from related stroke populations. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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12 pages, 1113 KB

Open AccessReview

Management of Facial Paralysis Following Skull Base Surgery: A Comprehensive Narrative Review

by Laura Maria De Luca, Sergio Cannova, Sebastiana Lai, Marco Accolla, Alice Barbazza, Lea Calò, Davide Rizzo, Pierangela Tramaloni, Marco Bonali, Ignacio Javier Fernandez and Francesco Bussu

Audiol. Res. 2025, 15(6), 155; https://doi.org/10.3390/audiolres15060155 - 12 Nov 2025

Viewed by 484

Abstract

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, [...] Read more.

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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8 pages, 513 KB

Open AccessArticle

Mechanisms of VOR Suppression in Brainstem Pathology: Insights from the Absence of Anti-Compensatory Saccades Despite Normal VOR Gain

by Marco Tramontano, Laura Casagrande Conti, Nicola Ferri and Leonardo Manzari

Audiol. Res. 2025, 15(6), 154; https://doi.org/10.3390/audiolres15060154 - 12 Nov 2025

Viewed by 283

Abstract

Background/Objective: The Suppression Head Impulse Paradigm (SHIMP) is a specialized variant of the Head Impulse Test (HIT), designed to evaluate the suppression of the angular Vestibulo-Ocular Reflex (aVOR) by central mechanisms. These mechanisms are primarily mediated by brainstem structures, including the vestibular [...] Read more.

Background/Objective: The Suppression Head Impulse Paradigm (SHIMP) is a specialized variant of the Head Impulse Test (HIT), designed to evaluate the suppression of the angular Vestibulo-Ocular Reflex (aVOR) by central mechanisms. These mechanisms are primarily mediated by brainstem structures, including the vestibular nuclei, their projections to ocular motor nuclei, and modulatory inputs from the cerebellum. Damage to these areas can impair the generation of anti-compensatory saccades (ACs), even when the peripheral vestibular apparatus remains intact. The present study explores this phenomenon in a cohort of patients with neurological disorders known to potentially involve the brainstem, including multiple sclerosis, severe traumatic brain injury, stroke, and Parkinson’s disease. Methods: This cross-sectional study included 119 patients with multiple sclerosis (PwMS), severe traumatic brain injury (PwTBI), stroke (PwS), and Parkinson’s disease (PwPD). The video Head Impulse Test was performed to assess the aVOR gain across all semicircular canals using both the HIMP and SHIMP. The presence, absence, or delay of ACs was systematically recorded. Results: Among the 119 patients evaluated (238 semicircular canals), 24 (20%) demonstrated normal aVOR gain but failed to generate ACs during SHIMP. The absence of ACs was observed in seven PwMS, five with PwTBI, six with PwS, and six with PwPD. Conclusions: The absence of ACs despite normal aVOR gain suggests a potential impairment in the central pathways controlling saccadic responses, independently of peripheral vestibular function. These findings underscore the clinical relevance of integrating the SHIMP into vestibular assessments to improve the identification of central vestibular dysfunction in neurological disorders. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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15 pages, 732 KB

Open AccessReview

Pathophysiology and Etiology of Brainstem-Related Dysphagia

by Lucia D’Alatri, Maria Raffaella Marchese, Angelo Tizio and Jacopo Galli

Audiol. Res. 2025, 15(6), 153; https://doi.org/10.3390/audiolres15060153 - 11 Nov 2025

Viewed by 719

Abstract

Background: Brainstem-related dysphagia represents a complex and severe form of neurogenic dysphagia (ND) arising from lesions that disrupt the central pattern generator (CPG) for swallowing located in the medulla oblongata. Methods: This paper explores the physiological basis of swallowing and its disruption in [...] Read more.

Background: Brainstem-related dysphagia represents a complex and severe form of neurogenic dysphagia (ND) arising from lesions that disrupt the central pattern generator (CPG) for swallowing located in the medulla oblongata. Methods: This paper explores the physiological basis of swallowing and its disruption in various brainstem pathologies. Results: The clinical presentation and electrophysiological evaluation of dysphagia are discussed, with a focus on volitional and spontaneous swallowing (SS) and the use of electromyography (EMG)-based assessment techniques. Conclusions: Finally, therapeutic strategies are reviewed, including conventional rehabilitative methods, neuromuscular electrical stimulation, non-invasive brain stimulation, and invasive procedures such as neurobotulinum toxin-A (BoNT-A) injections, balloon dilation, and CP myotomy. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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15 pages, 1057 KB

Open AccessArticle

Acoustic Vowel Metrics as Correlates of Dysphagia and Dysarthria in Brainstem Neurodegenerative Diseases

by Silvia Capobianco, Luca Bastiani, Francesca Forli, Bruno Fattori, Francesco Stomeo, Maria Russo, Maria Rosaria Barillari and Andrea Nacci

Audiol. Res. 2025, 15(6), 152; https://doi.org/10.3390/audiolres15060152 - 8 Nov 2025

Viewed by 468

Abstract

Background/Objectives: Swallowing and speech rely on shared brainstem circuits coordinating oropharyngeal motor functions. In neurodegenerative diseases affecting the brainstem—such as progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA)—bulbar dysfunction often impairs tongue propulsion and motility, affecting both swallowing [...] Read more.

Background/Objectives: Swallowing and speech rely on shared brainstem circuits coordinating oropharyngeal motor functions. In neurodegenerative diseases affecting the brainstem—such as progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA)—bulbar dysfunction often impairs tongue propulsion and motility, affecting both swallowing (dysphagia) and phonation (dysarthria). This study aimed to investigate whether vowel-based acoustic features are associated with swallowing severity in brainstem-related disorders and to explore their potential as surrogate markers of bulbar involvement. Methods: This was a cross-sectional observational study. Thirty-one patients (13 PSP, 12 ALS, 6 MSA) underwent clinical dysarthria assessment, acoustic analysis of the first (F1) and second (F2) formants during sustained phonation of /a/, /i/, /e/, and /u/, and swallowing evaluation using standardized clinical scales (DOSS, FOIS, ASHA-NOMS) and fiberoptic endoscopic evaluation (Pooling Score, Penetration-Aspiration Scale). The vowel space area (tVSA, qVSA) and Formant Centralization Ratio (FCR) were computed. Results: Significant correlations emerged between acoustic vowel metrics and dysphagia severity, especially for liquids. The FCR showed strong correlations with DOSS (ρ = −0.660, p < 0.0001), FOIS (ρ = −0.531, p = 0.002), ASHA-NOMS (ρ = −0.604, p < 0.0001), and instrumental scores for liquids: the Pooling Score (ρ = 0.538, p = 0.002) and PAS (ρ = 0.630, p < 0.0001). VSA measures were also associated significantly with liquid swallowing impairment. F2u correlated with dysarthria severity and all liquid-related dysphagia scores. Conclusions: Vowel-based acoustic parameters, particularly FCR and F2u, reflect the shared neuromotor substrate of articulation and swallowing. Acoustic analysis may support early detection and monitoring of bulbar dysfunction, especially where instrumental assessments are limited. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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15 pages, 603 KB

Open AccessArticle

Music Sound Quality Assessment in Bimodal Cochlear Implant Users—Toward Improved Hearing Aid Fitting

by Khaled H. A. Abdellatif, Horst Hessel, Moritz Wächtler, Verena Müller, Martin Walger and Hartmut Meister

Audiol. Res. 2025, 15(6), 151; https://doi.org/10.3390/audiolres15060151 - 6 Nov 2025

Viewed by 515

Abstract

Background/Objectives: Cochlear implants (CIs) are a common treatment of severe-to-profound hearing loss and provide reasonable speech understanding, at least in quiet situations. However, their limited spectro-temporal resolution restricts sound quality, which is especially crucial for music appraisal. Many CI recipients wear a [...] Read more.

Background/Objectives: Cochlear implants (CIs) are a common treatment of severe-to-profound hearing loss and provide reasonable speech understanding, at least in quiet situations. However, their limited spectro-temporal resolution restricts sound quality, which is especially crucial for music appraisal. Many CI recipients wear a hearing aid (HA) on the non-implanted ear (bimodal users), which may enhance music perception by adding acoustic fine structure cues. Since it is unclear how the HA should be fitted in conjunction with the CI to achieve optimal benefit, this study aimed to systematically vary HA fitting parameters and assess their impact on music sound quality in bimodal users. Methods: Thirteen bimodal CI recipients participated in a listening experiment using a master hearing aid that allowed controlled manipulation of HA settings. Participants evaluated three music excerpts (pop with vocals, pop without vocals, classical) using the multiple-stimulus with hidden reference and anchor (MUSHRA) test. To assess the reliability of individual judgments, each participant repeated the test, and responses were analyzed with the eGauge method. Results: Most participants provided reliable and consistent sound quality ratings. Compared to a standard DSL v5.0 prescriptive fitting, modifications in compression settings and low-frequency gain significantly influenced perceived music quality. The effect of low-frequency gain adjustments was especially pronounced for pop music with vocals, indicating stimulus-dependent benefits. Conclusions: The study demonstrates that HA fitting for bimodal CI users can be optimized beyond standard prescriptive rules to enhance music sound quality by increasing low-frequency gain, particularly for vocal-rich pieces. Additionally, the testing method shows promise for clinical application, enabling individualized HA adjustments based on patient-specific listening preferences, hence fostering personalized audiology care. Full article

(This article belongs to the Special Issue Hearing Beyond Words: Advancements in Music Perception and Enjoyment for the Hearing-Impaired Population)

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20 pages, 1714 KB

Open AccessReview

Oculomotor Abnormalities and Nystagmus in Brainstem Disease: A Mini Review

by Augusto Pietro Casani, Mauro Gufoni, Nicola Ducci, Giacinto Asprella Libonati and Giuseppe Chiarella

Audiol. Res. 2025, 15(6), 150; https://doi.org/10.3390/audiolres15060150 - 6 Nov 2025

Viewed by 1168

Abstract

The brainstem plays a pivotal role in the generation and control of eye movements—including saccades, smooth pursuit, the vestibulo-ocular reflex (VOR), vergence, and gaze holding. Beyond its vital physiological functions, it is also essential for the coordination of balance and movement. Consequently, eye [...] Read more.

The brainstem plays a pivotal role in the generation and control of eye movements—including saccades, smooth pursuit, the vestibulo-ocular reflex (VOR), vergence, and gaze holding. Beyond its vital physiological functions, it is also essential for the coordination of balance and movement. Consequently, eye movement disorders of brainstem origin are often accompanied by vertigo, imbalance, unsteady gait, and diplopia, particularly during changes in head or body position. A sound understanding of the neural structures involved in oculomotor and vestibular control is therefore crucial for accurately identifying and localizing a wide variety of brainstem syndromes. However, oculomotor abnormalities resulting from brainstem disease represent a major diagnostic challenge for the neurotologist, owing to the wide spectrum of possible etiologies (vascular, traumatic, degenerative, neoplastic), their variable severity and clinical course (acute, fluctuating, or progressive), and the frequent concomitant involvement of other central structures, particularly the cerebellum. This mini review summarizes the pathophysiological mechanisms and clinical features of oculomotor disorders and nystagmus associated with brainstem disease. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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20 pages, 972 KB

Open AccessSystematic Review

An Insight into Role of Auditory Brainstem in Tinnitus: A Systematic Review of Diagnostic Assessments

by Giovanni Freda, Andrea Ciorba, Nicola Serra, Rita Malesci, Francesco Stomeo, Chiara Bianchini, Stefano Pelucchi, Pasqualina Maria Picciotti, Luigi Maiolino, Giacinto Asprella Libonati and Anna Rita Fetoni

Audiol. Res. 2025, 15(6), 149; https://doi.org/10.3390/audiolres15060149 - 6 Nov 2025

Viewed by 625

Abstract

Background/Objectives: Tinnitus is a complex auditory phenomenon with multifactorial origins, often involving both peripheral and central auditory pathways. Given the multifactorial nature of tinnitus, this review specifically focuses on the auditory brainstem as it represents the first central relay for auditory input [...] Read more.

Background/Objectives: Tinnitus is a complex auditory phenomenon with multifactorial origins, often involving both peripheral and central auditory pathways. Given the multifactorial nature of tinnitus, this review specifically focuses on the auditory brainstem as it represents the first central relay for auditory input and a key site of abnormal synchrony and central gain, which may generate or modulate tinnitus even when peripheral hearing appears normal. Several studies suggest a potential role of brainstem dysfunction in its pathogenesis, even among patients with normal hearing thresholds. Although the physiopathological data provide evidence for the role of brainstem in the generation and magnification of tinnitus, the diagnostic tools are still unclear. This systematic review aimed to investigate the diagnostic relevance of brainstem-level abnormalities in individuals with tinnitus. Methods: Following PRISMA guidelines, a literature search was conducted using PubMed, Scopus, and Web of Science from January 2000 to June 2025. Studies were included if they addressed the diagnostic relationship between tinnitus and brainstem involvement. Data on auditory brainstem response (ABR), otoacoustic emissions (used to differentiate peripheral from central auditory abnormalities), neuroimaging, and electrophysiological markers were extracted. Results: Twenty studies were included. Most used ABR as a diagnostic tool, revealing significant amplitude and latency alterations in tinnitus patients compared to controls, particularly in wave V and V/I amplitude ratios. Imaging studies supported altered brainstem–cortical connectivity and localized changes in inferior colliculus (IC) activity. Additional techniques, such as middle-latency evoked potentials and gap-in-noise detection, showed potential but lacked consistent clinical utility. Conclusions: Evidence suggests that brainstem dysfunction may contribute to tinnitus generation or persistence. ABR and advanced imaging represent specific diagnostic tools, though standardization and high-quality studies are still needed to improve clinical applicability. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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10 pages, 353 KB

Open AccessReview

The Presence of Serotonin in the Vestibular System: Supporting the Use of SSRIs/SNRIs in the Treatment of Vestibular Disorders—A Narrative Review

by Roberto Teggi, Daniela Caldirola, Giampiero Neri, Iacopo Cangiano, Pasquale Viola and Giuseppe Chiarella

Audiol. Res. 2025, 15(6), 148; https://doi.org/10.3390/audiolres15060148 - 6 Nov 2025

Viewed by 1011

Abstract

Background: Serotonin (5-HT) is a neurotransmitter and a hormone that regulates various functions. Serotonin receptors have been studied in animal experiments in the vestibular system, beginning from the inner ear and vestibular nuclei. However, the role of serotonin in the vestibular system and [...] Read more.

Background: Serotonin (5-HT) is a neurotransmitter and a hormone that regulates various functions. Serotonin receptors have been studied in animal experiments in the vestibular system, beginning from the inner ear and vestibular nuclei. However, the role of serotonin in the vestibular system and disorders remains to be clarified. Methods: A review of the literature was performed on different databases according to the PRISMA guidelines. Only publications published on humans and in English have been included. A total of 41 articles were included in this review. Results: There are many publications regarding the use of SSRI/SNRI in vestibular disorders. Regarding persistent postural perceptual dizziness (PPPD) and chronic subjective dizziness (CSD) the available evidence supports multimodality treatment incorporating vestibular rehabilitation, serotonergic medications, and cognitive behavior therapy, although most studies have not included a placebo control group. As for vestibular migraine (VM), SNRI and SSRIs were proposed as preventive therapy and demonstrated a reduction in vertigo attacks in patients with Menière’s Disease (MD), especially when symptoms of anxiety disorder were present. Conclusions: Although SSRIs/SNRIs are considered an off-label therapy for vertigo, several studies have assessed their efficacy in vestibular disorders, as indicated in the data published on PPPD, MD, and VM above all. As some studies report that serotonin receptors are also present in the inner ear and vestibular nuclei, it can be postulated that in cases where the natural levels of serotonin are altered, such as in depression and anxiety, the change in serotonin levels may affect vestibular function and play a role in vestibular disorders. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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3 pages, 149 KB

Open AccessReply

Comorbid Anxiety and Depression in Hyperacusis and Misophonia. Reply to Jastreboff, P.J. Comment on “Rodrigues, A.L.M.; Aazh, H. Psychiatric Comorbidities in Hyperacusis and Misophonia: A Systematic Review. Audiol. Res. 2025, 15, 101”

by Hashir Aazh and Ana Luísa Moura Rodrigues

Audiol. Res. 2025, 15(6), 147; https://doi.org/10.3390/audiolres15060147 - 31 Oct 2025

Viewed by 408

Abstract

This systematic review found that depression was reported in 8–80% of patients with hyperacusis and 1 [...] Full article

(This article belongs to the Section Hearing)

2 pages, 139 KB

Open AccessComment

Comment on Rodrigues, A.L.M.; Aazh, H. Psychiatric Comorbidities in Hyperacusis and Misophonia: A Systematic Review. Audiol. Res. 2025, 15, 101

by Pawel J. Jastreboff

Audiol. Res. 2025, 15(6), 146; https://doi.org/10.3390/audiolres15060146 - 30 Oct 2025

Viewed by 315

Abstract

I am writing with concerns about an interesting recent publication by Rodrigues and Aazh [...] Full article

(This article belongs to the Section Hearing)

11 pages, 243 KB

Open AccessArticle

Association Between Shift Work and Auditory–Cognitive Processing in Middle-Aged Healthcare Workers

by Margarida Roque, Tatiana Marques and Margarida Serrano

Audiol. Res. 2025, 15(6), 145; https://doi.org/10.3390/audiolres15060145 - 25 Oct 2025

Viewed by 448

Abstract

Background/Objectives: Shift work in healthcare professionals affects performance in high cognitive processing, especially in complex environments. However, the beneficial effects that working in complex environments may have on auditory–cognitive processing remain unknown. These professionals face increased challenges in decision-making due to factors such [...] Read more.

Background/Objectives: Shift work in healthcare professionals affects performance in high cognitive processing, especially in complex environments. However, the beneficial effects that working in complex environments may have on auditory–cognitive processing remain unknown. These professionals face increased challenges in decision-making due to factors such as noise exposure and sleep disturbances, which may lead to the development of enhanced auditory–cognitive resources. This study aims to investigate the associations between shift work and auditory–cognitive processing in middle-aged healthcare workers. Methods: Thirty middle-aged healthcare workers were equally allocated to a shift worker (SW) or a fixed-schedule worker (FSW) group. Performance on a cognitive test, and in pure-tone audiometry, speech in quiet and noise, and listening effort were used to explore whether correlations were specific to shift work. Results: Exploratory analyses indicated that shift workers tended to perform better in visuospatial/executive function, memory recall, memory index, orientation, and total MoCA score domains compared to fixed-schedule workers. In the SW group, hearing thresholds correlated with memory recall and memory index. In the FSW group, hearing thresholds correlated with orientation, memory index, and total MoCA score, while listening effort correlated with naming, and speech intelligibility in quiet correlated with total MoCA scores. Conclusions: These exploratory findings suggest that shift work may be linked to distinct auditory–cognitive patterns, with potential compensatory mechanisms in visuospatial/executive functions and memory among middle-aged healthcare workers. Larger, longitudinal studies are warranted to confirm whether these patterns reflect true adaptive mechanisms. Full article

(This article belongs to the Special Issue The Aging Ear)

10 pages, 481 KB

Open AccessArticle

Everyday Auditory Environment Among Elderly Cochlear Implant Users

by Ulrika Larsson, Ulrika Löfkvist and Karin Hallin

Audiol. Res. 2025, 15(6), 144; https://doi.org/10.3390/audiolres15060144 - 22 Oct 2025

Viewed by 396

Abstract

Background/Objectives: For most adults receiving a cochlear implant (CI), the primary goal is to enhance their oral communication with others. The aim of this study was to investigate the total CI usage time per day among retired CI users and to characterize [...] Read more.

Background/Objectives: For most adults receiving a cochlear implant (CI), the primary goal is to enhance their oral communication with others. The aim of this study was to investigate the total CI usage time per day among retired CI users and to characterize in which auditory environments they were using their CI. One additional aim was to analyze whether usage time, auditory environment, or social factors influenced CI speech perception. Methods: Participants completed a questionnaire addressing retirement status, whether they lived with another adult, educational level, and participation in social activities. Speech perception scores were obtained from medical records, and CI datalogging was extracted from the CI programming software. Results: Seventy-three CI users aged >65 years were included. The average usage was 12.9 h/day. No statistically significant correlations were found between total usage time or time spent listening to speech and CI speech perception. CI users who regularly met with family or friends had statistically significantly higher CI speech perception than those who did not (p = 0.003). Conclusions: Social interaction may play a crucial role in supporting speech perception among elderly CI users. Opportunities for communication and participation in social life appear to be important for maximizing benefit. Full article

(This article belongs to the Collection Cochlear Implants: Challenges and Opportunities in Hearing Rehabilitation)

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17 pages, 1943 KB

Open AccessArticle

Hearing Aid Amplification Schemes Adjusted to Tinnitus Pitch: A Randomized Controlled Trial

by Jose L. Santacruz, Emile de Kleine and Pim van Dijk

Audiol. Res. 2025, 15(6), 143; https://doi.org/10.3390/audiolres15060143 - 22 Oct 2025

Viewed by 1186

Abstract

Background/Objectives: Hearing aids can be used as a treatment for tinnitus. There are indications that this treatment is most effective when the tinnitus pitch falls in the frequency range of amplification of the hearing aid. Then, the hearing aid provides masking of [...] Read more.

Background/Objectives: Hearing aids can be used as a treatment for tinnitus. There are indications that this treatment is most effective when the tinnitus pitch falls in the frequency range of amplification of the hearing aid. Then, the hearing aid provides masking of the tinnitus. Alternatively, it has been suggested that a gap in the amplification around the tinnitus pitch would engage lateral inhibition and thereby reduce the tinnitus. Methods: To test these ideas, we conducted a randomized controlled trial. Patients were fitted with hearing aids using three different amplification schemes: (1) standard amplification according to the NAL-NL2 prescription procedure, (2) boosted amplification at the tinnitus frequency to enhance tinnitus masking, and (3) notch-filtered amplification at the tinnitus frequency to engage lateral inhibition and suppress tinnitus. The goal was to compare the boosted and notched amplification schemes to standard amplification. The primary outcome measure was tinnitus handicap as measured by the Tinnitus Functional Index (TFI). The trial was designed as a double-blind Latin square balanced crossover study. Eighteen tinnitus patients with moderate hearing loss were included. All of them were experienced hearing aid users. After two weeks of initial adaptation to the new hearing aids with standard settings, each setting was tried for four weeks. Results: There was an average reduction of 6.9 points on the TFI score after the adaptation phase, possibly due to a placebo effect. The TFI score did not differ significantly from the standard setting after using the notched or the boosted settings. Although notched amplification performed better than boosted amplification, this difference did not reach the clinical significance level. Regardless of the TFI outcomes, most participants had an individual preference for a particular setting. This preference was approximately uniformly distributed across the three amplification schemes. Conclusions: Notch-filtered and boosted amplification did not provide better tinnitus suppression than standard amplification. The individual preferences highlighted the importance of tailor-made approaches to hearing aid amplification in clinical practice. Further studies should explore the differences among patient’s tinnitus and their preference for a hearing aid setting. Full article

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

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Audiol. Res., Volume 15, Issue 6 (December 2025) – 29 articles

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