Audiology Research

Background/Objectives: with the aim of describing how students and their teachers perceive and define their hearing and auditory experience in the classroom, we present the results of a questionnaire that examined the listening challenges faced by students and teachers at the University of Perugia and in four secondary schools in Friuli-Venezia Giulia, Italy. Methods: A survey was developed as part of the A.Ba.Co. project (Overcoming Communication Barriers). Closed or open-ended questions were used to analyze the responses of students and teachers regarding diagnosed or only perceived hearing difficulties in daily life and the quality of listening in school classes. Results: Hearing difficulties, either clinically diagnosed or only perceived, were reported by 8–9% of students. Between teachers, the reported hearing difficulties were 27.1% in high school and 12% at university (p < 0.001). The most frequent reason for less-than-optimal ease of listening in class differed between the two educational levels; 45.8% of high school students blamed it on the noise in the room compared to 18.2% of university students (p < 0.001). Inversely, 40.9% of university students connected listening difficulty with their place in class compared to 9.5% (101/1065) of high school students (p < 0.001). Conclusions: Although the minimum acoustic requirements for educational facilities have been established by the UNI 11532-2 standard, it is speculated that the majority of high school and university classrooms in Italy do not meet optimal listening conditions. Furthermore, the reasons for students’ poor listening quality appear to not be fully understood, neither by students nor by teachers. In addition to the need for greater attention to physical learning spaces (advocating the universal design principles), effective change will also need to involve a greater awareness of what the barriers to listening are and how much they influence both teaching and learning quality and effectiveness. Full article

Background/Objectives: As vestibular paroxysmia (VP) has recently been described in children, with an incidence of up to 4% of vertigo, and a promising therapeutic response to sodium-channel-blocking drugs has also been reported, the aim of this paper is to review the available literature on this topic and to provide the best possible guidance for diagnosis and treatment. Methods: PubMed, Medline, Cochrane, and Crossref databases were searched, and all studies on VP in children and sodium channel blockers were selected. Results: Only five articles reporting small case series or single case reports were identified. To date, oxcarbazepine (OXC) and carbamazepine (CBZ) are the only two molecules prescribed. The recommended doses were 300 to 360 mg/day and 50 to 200 mg/day for OXC and CBZ, respectively, for a total duration of 6 weeks. Fast efficacy (one week) was reported. Conclusions: VP has been identified in pediatric patients and appears to respond to sodium channel blockers in a manner similar to adults. Only a limited number of cases have been reported to date; thus, there is a need to raise awareness about this treatable cause of episodic vertigo in children. Full article

Background/Objectives: Subterranean mole-rats live in an intricate system of underground tunnels, a unique acoustic environment that has led to adaptations to their hearing. Most experimenters have concluded that mole-rats have poor hearing thresholds, perhaps 20–40 dB less sensitive than rodents living on the surface. The potential problem identified here is that mole-rat thresholds have all been measured in air, whereas there is some evidence—theoretical and observational—to suggest that these animals may hear more sensitively via bone conduction. Methods: A wide-ranging review of the literature surrounding mole-rat hearing is undertaken and then interpreted in terms of the ways air conduction and bone conduction thresholds are measured. The important factor, often overlooked, is that the detection of an acoustic signal is most sensitive when there are matching impedances all along the transmission path, and the argument is made that, for subterranean mole-rats, more energy may be transmitted to their cochlea when the head is directly in contact with the earth than when an acoustic signal must propagate from the earth to the air and then reach the cochlea via the external and middle ear. Results: Based on observational evidence, theoretical considerations, and inferences from related species, the suggestion is made that, for African mole-rats, high bone conduction sensitivity could make up for their relatively poor air conduction thresholds. Conclusions: Bone conduction audiograms are needed for mole-rats, similar to those for other animals sensitive to substrate vibration such as snakes or amphibians. It is possible that the hearing thresholds of mole-rats may, when measured appropriately, be comparable to those of other rodents. Full article

Introduction: Masseter vestibular evoked myogenic potentials (M-VEMPs) are a recent tool for assessing a vestibulo-trigeminal pathway departing from the saccule, similarly to cervical VEMPs (C-VEMPs), that evaluate saccular function via the sternocleidomastoid muscle. M-VEMPs may offer a complementary diagnostic value in vestibular neuritis (VN). Methods: This retrospective study analysed M-VEMPs and C-VEMPs in 28 monolateral patients and 1 bilateral (30 ears) diagnosed with VN between 2023 and 2024. Diagnostic evaluation included video head impulse tests (VHIT), caloric tests, ocular VEMPs, and, in a few cases, electromyography (EMG) of the sternocleidomastoid muscle. M-VEMPs were elicited using 500 Hz tone bursts at 97 dB nHL. Results were compared based on the topography of vestibular involvement and muscle response concordance. Results: M-VEMPs were always present in patients with superior VN and intact saccular function, showing consistent results with normal C-VEMPs. In some cases, with saccular dysfunction, M-VEMPs were preserved despite the absence of C-VEMPs, suggesting greater robustness. One patient with herpes zoster (HZ) involving both the VIII and trigeminal nerves showed absent M-VEMPs, indicating trigeminal pathway involvement. Edentulous patients showed reduced or absent M-VEMPs due to compromised masseter muscle electromyography activity. Conclusions: M-VEMPs are reliable and often concordant with C-VEMPs in VN but may reveal additional diagnostic information in discordant or complex cases. They are particularly useful in identifying trigeminal involvement but are limited in patients with poor masseter muscle function. Further studies are needed to clarify their full diagnostic potential. Full article

Background/Objectives: Hearing loss represents an important communication barrier which can lead to social isolation and can be a challenge for mental health status. It is generally accepted that hearing aid (HA) users can develop a stigma related to hearing loss despite the perceived benefits due to most modern technologies. Nevertheless, stigma toward HAs may persist even when patients have been well acclimatized to their use. This study aims to evaluate their experiences in everyday life, the underlying social aspects and the utility of psychometric multidimensional approach in skilled HA users. Methods: In total, 96 HA users and 85 normally hearing subjects were enrolled and asked to complete three psychometric questionnaires that investigated social functioning, body image perception, and psychological distress. HA users were additionally asked to fulfill a disease-specific survey, the International Outcome Inventory for Hearing Aids. The performance of the devices was also investigated by HA’s functional gain through free-field audiometry. Results: Even if auditory devices help with compensating the sensorial deprivation, patients often suffer from social anxiety, social phobia and body image concerns about their appearance while wearing HAs. Conclusions: This study discloses psychopathological factors associated with the HA experience that are surprisingly present after long satisfying HA use. Despite the benefits, the satisfaction and the daily use, HA users continue to be worried about body image and report more psychopathological distress in comparison to their normal hearing peers. Full article

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

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

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

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

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

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

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

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

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

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

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

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

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

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