Audiology Research

The Adaptive Auditory Speech Test (AAST) was developed to record the Speech Recognition Threshold (SRT) in children in quiet or with background noise. AAST is an interlingually valid and reliable standardised tool with speech material developed in several languages. The Maltese version of the Adaptive Auditory Speech Test (AAST) was developed to examine the speech recognition skills of 208 children and 40 Maltese-speaking adults in quiet, noise and high frequency. The aims were to determine the norms in these three settings in adults and children aged 4 years and older. The Maltese version of AAST confirms an age dependent norm threshold with a significant improvement in threshold being observed as children grow older, similar to other AAST versions. This was evident across the three test settings. An approximate difference of 10 dB was also noted between 4-year-old and 10-year-old children in AAST in quiet. Thresholds of 10-year-olds and adults were similar in both the quiet and high frequency versions. Implications for post Universal Newborn Hearing Screening using these tools are addressed. Full article

The Weber tuning fork test is a standard otologic examination tool in patients with unilateral hearing loss. Sound should typically lateralize to the contralateral side in unilateral sensorineural hearing loss. The observation that the Weber test does not lateralize in some patients with longstanding unilateral deafness has been previously described but remains poorly understood. In the present study, we conducted a retrospective analysis of the medical records of patients with unilateral profound hearing loss (single-sided deafness or asymmetric hearing loss) for at least ten years. In this patient cohort, childhood-onset unilateral profound hearing loss was significantly associated with the lack of lateralization of the Weber tuning fork test (Fisher’s exact test, p < 0.05) and the absence of tinnitus in the affected ear (Fisher’s exact test, p < 0.001). The findings may imply a central adaptation process due to chronic unilateral auditory deprivation starting before the critical period of auditory maturation. This notion may partially explain the poor outcome of adult cochlear implantation in longstanding single-sided deafness. The findings may suggest a role for the Weber test as a simple, quick, and economical tool for screening poor cochlear implant candidates, thus potentially supporting the decision-making and counseling of patients with longstanding single-sided deafness. Full article

Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that causes dizziness. The incidence of horizontal semicircular canal (HSC) BPPV ranges from 5% to 40.5% of the total number of BPPV cases diagnosed. Several studies have focused on establishing methods to treat BPPV caused by the apogeotropic variant of the HSC, namely, the Appiani maneuver (App). In 2016, a new maneuver was proposed: the Zuma e Maia maneuver (ZeM), based on inertia and gravity. The aim of this study is to analyze the efficacy of App versus ZeM in the resolution of episodes of BPPV produced by an affectation of the horizontal semicircular canal with apogeotropic nystagmus (Apo-HSC). A retrospective, quasi-experimental study was conducted. Patients attended in office (November 2014–February 2019) at a third-level hospital and underwent a vestibular otoneurology assessment. Those who were diagnosed with Apo-HSC, treated with App or ZeM, were included. To consider the efficacy of the maneuvers, the presence of symptoms and/or nystagmus at the first follow up was studied. Patients classified as “A” were those with no symptoms, no nystagmus; “A/N+”: no symptoms, nystagmus present during supine roll test; “S”: symptoms present. Previous history of BPPV and/or otic pathology and calcium levels were also compiled. From the 54 patients included, 74% were women. The average age was 69. Mean follow-up: 52.51 days. In those patients without previous history of BPPV (n = 35), the probability of being group “A” was 63% and 56% (p = 0.687) when treated with App and ZeM, respectively, while being “A/N+” was 79% and 87% for App and ZeM (p = 0.508). Of the 19 patients who had previous history of BPPV, 13% and 64% were group “A” when treated with App and ZeM (p = 0.043), and 25% and 82% were “A/N+” after App and ZeM, respectively (p = 0.021). In conclusion, for HSC cupulolithiasis, ZeM is more effective than App in those cases in which there is a history of previous episodes of BPPV (“A”: 64% (p = 0.043); “A/N+”: 82% (p = 0.021)). Full article

The COVID-19 pandemic and the lockdown measures are both causes of psychological distress. The aim of the current study was to evaluate the psychological effects of lockdown measures on patients with subjective chronic tinnitus diagnosed before the COVID-19 pandemic. A sample of n = 77 patients with chronic tinnitus was contacted by mail/phone for a survey between June 2021 and September 2021. All patients filled out questionnaires on tinnitus distress (Tinnitus Handicap Inventory, THI), anxiety (Beck Anxiety Inventory, BAI) and depression (Beck Depression Inventory, BDI) and eight items of the Tinnitus Sample Case History (TSCH) about tinnitus history (i.e., loudness, pitch, perception, tinnitus location), stress, and related conditions (noise annoyance, vertigo/dizziness, headache). Forty patients with chronic tinnitus filled out the survey. No significant differences of total THI mean scores (p > 0.05) were found compared to the results obtained before the COVID-19 pandemic and after lockdown. Regarding depression and anxiety, the female population showed a significant increase in scores obtained from the BDI (p < 0.0170) and the BAI (p < 0.049). Only two patients (0.5%) were infected by COVID-19 (positive RT-PCR), and they did not report any worsening of tinnitus. According to the data of the literature, our patients experienced a heterogeneous course of tinnitus, and the severity of tinnitus was not significantly affected by lifestyle changes during the COVID-19 pandemic and lockdown. Full article

Objective: The skull vibration-induced-nystagmus test (SVINT) is a noninvasive and effective screening tool for the function of the otolith and canal structures in children. It can instantaneously assess vestibular asymmetry. This study aimed to analyze the SVINT results of healthy children vs. children with hearing loss (HL) and to correlate it with sensory organization test (SOT) results as a functional balance evaluation tool. Design: This case-controlled study compared the results of SVINT to the results of the SOT of the computerized dynamic posturography (CDP) in a control group of 120 healthy normal-hearing children (i.e., NH group) vs. hearing loss (HL) group of 60 children, including 30 children with hearing aids (HAs) and 30 children with a unilateral cochlear implant (CI). The SVINT results were compared to the caloric test (CaT) and video head impulse test (vHIT) and associated with SOT scores. Results: Thirty-one children in the HL group had normal SVINT and normal SOT results. A total of 21 children in the HL group had SVINT-negative and abnormal results in the SOT (possibly due to bilateral vestibular loss (BVL)). Eight children in the HL group had positive SVINT and abnormal SOT results. However, none of the children had only positive SVINT with normal SOT findings. Moreover, 52% of children had a normal result on both the SOT and CaT, whereas 27% had abnormal results on both tests (17% bilateral weakness and 10% unilateral), and 22% had the only result of the SOT suggesting a functional abnormality. Similarly, when associating the result to vHIT, 51% had normal results on both tests, and 25% had abnormal results (13% bilateral and 12% unilateral weakness). Conclusions: SVINT findings can be correlated with SOT findings in the case of the unilateral vestibular lesion (UVL), which adds a diagnostic value in these pediatric cases but may differ in the case of the bilateral vestibular lesion (BVL). However, SVINT findings need to be cautiously interpreted in light of other test findings such as the SOT, CaT, and vHIT. Full article

The course of COVID-19 infection may be complicated by a variety of neurological manifestations. Since the inner ear is vulnerable to viruses, sensorineural hearing loss (SNHL) has been reported to occur following the SARS-CoV-2 infection, often resulting in long-term morbidity and worsening the quality of life. The interest in how the virus affects the inner ear has gradually increased since the pandemic’s spread, but little is still known about the SNHL potentially caused by SARS-CoV-2. The aim of this paper is to evaluate the possible association between SNHL and COVID-19 infection, through a systematic literature review. Currently available data suggest that SARS-CoV-2 may hamper cochlear function; however, available reports are still limited. Large cohort and prospective studies are necessary to evaluate the long-term effects of this viral infection in the inner ear. Full article

This study aimed to translate and adapt the English version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) for children and for parents into the Italian language; validate SSQ for hearing children and their parents; and evaluate the discriminant validity of the instrument. A group of 102 normal-hearing Italian children, aged between 9 and 16 years, and their parents were included in this study. A group of 31 parents of normal-hearing Italian children aged between 6 and 8 years was also included. A group of 57 hearing-impaired Italian children aged between 9 and 16 years, and their parents were also included, as well as a group of 30 parents of hearing-impaired Italian children aged between 6 and 8 years. Cronbach’s alpha in the SSQ for parents was 0.92; it was 0.95 in the SSQ for children. Guttmann’s split-half coefficient in SSQ for children for both λ4 and λ6 was 0.98; in SSQ for parents in λ4 was 0.96 and λ6 was 0.95. These data provide evidence for the discriminant validity of the SSQ scale (p-value < 0.001). Italian SSQ scales for children and for parents are now available. Full article

Background: Though osteomas can commonly arise in the cranial bones, an extra canalicular mastoid bone location is a rare entity with less than 200 cases described to date. We present three cases of cortical mastoid bone osteomas and compare them with cases presented in the literature. Methods: In this study, we used a retrospective chart analysis. Results: All three patients presented after years of progressively increasing postauricular swelling without symptoms. Temporal bone non-contrast CT allowed accurate preoperative diagnosis. Surgical treatment was performed for cosmetic issues with minimal postoperative morbidity. Complete excision was achieved in all cases, and to date, there is no evidence of recurrence. Conclusions: Mastoid osteomas are rare benign slow-growing tumors. They usually present as a painless cosmetic disfigurement and are otherwise asymptomatic. Surgical excision is the treatment of choice when they cause esthetic discomfort or are symptomatic. Recurrences are infrequently reported. Full article

Tinnitus is generally defined as the perception of sound in the absence of vibration of an external elastic body. If this definition appears useful to differentiate tinnitus from somatosounds, it is not suitable for distinguishing it from psychiatric hallucinations. Nor does this solution define a temporal limit of duration of the perception, which is important for distinguishing pathological tinnitus from those occasional noises that we all perceive from time to time. A complete definition appears necessary not only to achieve homogeneity in epidemiological studies but also to set up correct and personalized therapeutic schemes. An analogy with neuropsychiatric studies and, in particular, the concept of auditory hallucinosis are proposed by the authors to define tinnitus. According to the authors, tinnitus is auditory hallucinosis, and similarly, vertigo is spatial hallucinosis. Full article

Translational research moves promising primary research results from the laboratory to practical application. The transition from basic science to clinical research and from clinical research to routine healthcare applications presents many challenges, including ethical. This paper addresses issues in the ethics of translational audiology and discusses the ethical principles that should guide research involving people with hearing loss. Four major ethical principles are defined and explained, which are as follows: beneficence, nonmaleficence, autonomy, and justice. In addition, the authors discuss issues of discrimination and equal access to medical services among people with hearing loss. Despite audiology’s broad field of interest, which includes evaluation and treatment of auditory disorders (e.g., deafness, tinnitus, misophonia, or hyperacusis) and balance disorders, this study focuses primarily on deafness and its therapies. Full article

Otoacoustic emissions (OAE) that were sound-induced, current-induced, or spontaneous have been measured in non-mammalian land vertebrates, including in amphibians, reptiles, and birds. There are no forms of emissions known from mammals that have not also been observed in non-mammals. In each group and species, the emission frequencies clearly lie in the range known to be processed by the hair cells of the respective hearing organs. With some notable exceptions, the patterns underlying the measured spectra, input-output functions, suppression threshold curves, etc., show strong similarities to OAE measured in mammals. These profound similarities are presumably traceable to the fact that emissions are produced by active hair-cell mechanisms that are themselves dependent upon comparable nonlinear cellular processes. The differences observed—for example, in the width of spontaneous emission peaks and delay times in interactions between peaks—should provide insights into how hair-cell activity is coupled within the organ and thus partially routed out into the middle ear. Full article

Aim of the Study: in humans, spatial orientation consists of the ability to move around the environment through memorized and pre-programmed movements, according to the afferent sensory information of the body and environmental analysis of the Central Nervous System (CNS). The purpose of this study is to analyze the abilities of professional athletes, such as footballers, to use mental navigation systems, cognitive maps, and memorized motor patterns in order to obtain better physical performance and to obtain useful information for training both non-sports subjects and vestibular patients for rehabilitation purposes. Materials and Methods: all the motor performances of sportsmen, healthy non-sporting subjects, or vestibular patients are based on the acquisition of visual–spatial and training information. In this study, we analyzed the visual–spatial performance of 60 trained sportsmen (professional footballers), 60 healthy non-sports subjects, and 48 patients affected by chronic unilateral vestibular loss by means of the Navigation Ability Test 2.0. A score based on the number of targets correctly reached in the various tests quantifies the degree of performance of the subjects. Results: NAT 2.0 scores progressively improve from vestibular subjects to healthy non-sporting subjects to footballers. NAT 2.0 scores improve in all three subject groups as the number of tasks performed in all patient groups increases, regardless of gender and age. Conclusions: the analysis of performance data through NAT 2.0 in athletes (footballers) opens new perspectives for rehabilitation purposes, regardless of age, sex, and training conditions, both in healthy non-sporting subjects to improve their sporting potential and in patients affected by chronic vestibular dysfunction, in order to optimize their motor skills and prevent falls. Full article

(1) Background: The purpose of this article is to review pharmacological treatments for COVID-19 (currently approved by the EMA (European Medical Agency) and FDA (Food and Drug Administration)) and highlight their potential audio-vestibular side-effects as an ototoxic adverse reaction. (2) Methods: Review of the available literature in the scientific databases PubMed, ResearchGate, Scopus, and ScienceDirect, and in summaries of product data sheets. (3) Results: In accordance with EBM (evidence-based medicine) the treatment of COVID-19 by using lopinavir/ritonavir, chloroquine and hydroxychloroquine, azithromycin, favipiravir, amantadine, oseltamivir, and ivermectin is no longer recommended for patients suffering from COVID-19 due to a lack of clinical data, publications, and recommendations. There were 39 publications and 15 summaries of product characteristics (as other sources of data) which were also used in this analysis. Adverse events could be permanent or disappear over time. Following treatment for COVID-19, the most frequent adverse audio-vestibular reactions reported in clinical trials and publications in the area of audiology and otorhinolaryngology were: dizziness, blurry vision with dizziness, nasopharyngitis, dysgeusia, and tinnitus. As far as vaccines are concerned, dizziness as an ototoxic effect was uncommon and occurs only in hypersensitive people who experience anaphylactic shock. (4) Conclusions: The ototoxicity of the drugs discussed here does not have as severe symptoms as the drugs used in the treatment of COVID-19 in 2020 (e.g., hydroxychloroquine), and relates mainly to disorders of the vestibulocochlear system. However, there is still a need to monitor ototoxic side-effects because of potential interactions with other ototoxic drugs. Many of the drugs approved by EMA and FDA are new, and not every side-effect is known. Full article

The SARS-CoV-2 vaccination campaign is probably one of the most historic public hygiene measures in modern medicine. The drama of the pandemic has forced the scientific community to accelerate the development and commercialization of vaccines, thereby enhancing the phases of active surveillance. Among the adverse events following immunization (AEFI) reported, those of an audiovestibular interest, such as sudden sensorineural hearing loss (SSNHL), tinnitus, dizziness, and vertigo, constitute a very small percentage. There are many plausible etiological hypotheses, and scientific research needs to pay more attention to the correct collection of data, which up until now have often been inadequate and fragmented, on which to base future studies. SSNHL, new onset tinnitus, vertigo, and dizziness require a prompt evaluation, while the proposed treatment is the same as it is for events unrelated to vaccination. These are uncommon adverse events, and the risk rates for these diseases have not increased in conjunction with the COVID-19 vaccinations, therefore there is no justification of any hesitation towards the vaccination campaign. Full article

Background: Although diagnostic criteria have been established for superior canal dehiscence syndrome, cases in which the diagnosis is not easy are frequent. On those occasions, some tests such as vibration-induced nystagmus or vestibular-evoked myogenic potentials can offer invaluable help due to their high sensitivity and specificity. Methods: We studied 30 patients showing superior canal dehiscence or “near-dehiscence” in a CT scan. Skull vibration-induced nystagmus and high frequency ocular vestibular-evoked myogenic potentials are performed in each patient. The aim of the study is to determine how useful both tests are for detection of superior canal dehiscence or near-dehiscence. Results: Of the 60 temporal bones studied, no dehiscence was the result in 22, near-dehiscence in 17 and a definite finding in 21. In 10/30 patients, there was no SVIN (Skull vibration induced nystagmus) during otoneurological testing, while in 6/30, induced nystagmus was mainly horizontal, and in 14/30 there was vertical up-beating. All patients had a positive oVEMP (Ocular vestibular evoked myiogenic potentials) at 0.5 kHz in both ears and the HFoVEMP (High frequency ocular vestibular evoked myiogenic potentials) response was positive in 25/60 (41.6%) of the ears studied and in 19/30 of the patients evaluated (in 6 it was positive in both ears). Up-beat SVIN will point to a SCD (Superior Canal Dehiscence) mainly when HFoVEMP are present, and when this is negative there is a high probability that it is not a SCD. Conclusions: When SVIN and HFoVEMP results are added (or combined), they not only improve the possibilities of detecting SCD, but also the affected side. Full article

Objectives: To adapt the LittlEARS^® Auditory Questionnaire into the Maltese language and evaluate the psychometric properties of the Maltese version of the questionnaire for hearing children. Methods: The English version of LittlEARS^® Auditory Questionnaire was adapted into Maltese using a translation/back translation procedure. In this cross-sectional study, a total of 398 parents of normal hearing children aged between 5 days and 36 months completed the Maltese version of LittlEARS^®. Psychometric validation was performed through scale analysis, item analysis, and analysis of reliability and validity. A non-linear regression model was derived to obtain normative data for expected and minimum values of total scores from the questionnaire according to age. Results: Predictive accuracy (Guttman’s lambda) was 0.921, the Cronbach’s alpha coefficient value was 0.921, and the split-half reliability coefficient was 0.949. The Pearson correlation coefficient between scores and age was 0.903. The regression analysis showed that 82% of the variance in the total scores can be explained by age. Norm curves were comparable to the original German data. Conclusion: This study confirmed that the Maltese version of LittlEARS^® is a valid and reliable tool to evaluate auditory development in children less than two years of age. Full article

Background: An early hearing detection and intervention program (EHDI) is the first step for the habilitation of children with permanent hearing impairment (PHI). Actually, early intervention programs have increasingly shifted toward family involvement, emphasizing that the child’s family should take an active role in the habilitation process. Therefore, familiar empowerment is the best way to improve a child’s emerging abilities. The aim of this study was to investigate parental self-efficacy beliefs and involvement as well as the language skills of deaf or hard of hearing DHH children who were habilitated with hearing aids and followed using the T.A.T.A web app (NeonaTal Assisted TelerehAbilitation), an example of asynchronous telepractice. Methods: The study describes the early stages of the habilitation program of 15 PHI children followed through the T.A.T.A. web app, which empowers families through a weekly questionnaire submitted during the first 270 to 360 days of their child’s life, for 14 weeks. The family involvement rate scale (FIRS) was used to evaluate parental compliance, and all children received in-person visits at the beginning and at the end of the training period. Results: The children showed greater auditory perceptual skills at the end of the training period on the basis of both the Infant Listening Progress Profile (ILiP) score and the Categories of Auditory Performance (CAP) and FIRS scales. In other words, the auditory skills improved with age as well as with parental participation. Conclusions: The T.A.T.A. web app promotes a proactive management and a tailored habilitation through an active familiar involvement, easily achieved in clinical routine and in emergency settings without additional costs. Full article

Ethical standards in audiology have been continuously improved and discussed, leading to the elaboration of specific regulatory guidelines for the profession. However, in the field of auditory rehabilitation, audiologists are still faced with circumstances that question their ethical principles, usually associated with the support of the hearing aids industry. The study explores the decision-making process and ethical concerns in auditory rehabilitation as they relate to the practice of audiology in Portugal. An online questionnaire constructed by the authors was used and sent to the email addresses of a list of audiologists, registered with the Portuguese Association of Audiologists. The questionnaire was answered by 93 audiologists with clinical experience in auditory rehabilitation for more than one year. The collected data demonstrated that audiometric results and clinical experience are the most important factors for decision-making in auditory rehabilitation practice. Moreover, incentives from the employers or manufacturers were identified as the main cause of ethical dilemmas. This study highlights the ethical concerns regarding the clinical practice of auditory rehabilitation in Portugal, revealing that the decision-making process is complex and, specifically in this field, the current practice may not be adequate for effective compliance with professional ethical standards. Full article

Objectives: (1) To analyze the preferential pathways of sound transmission and sound waves travelling properties in the skull and (2) to identify the location(s) on the skull where bone conduction to the cochlea is optimal. Study design: Basic research Methods: Nine cadaveric heads were placed in an anechoic chamber and equipped with six Bone Anchored Hearing Aids (BAHA™) implants (Cochlear™, Sydney, NSW, Australia) and fifteen accelerometers. A laser velocimeter was used to measure cochlear response by placing a reflector on the round window. Different frequency sweeps were applied to each implant, and measurements were recorded simultaneously by the laser velocimeter and accelerometers. Results: Low-frequency sound waves mostly travel the frontal transmission pathways, and there is no clear predominant pattern for the high frequencies. The mean inter-aural time lag is 0.1 ms. Optimal sound transmission to the cochlea occurs between 1000 and 2500 Hz with a contralateral 5 to 10 dB attenuation. The implant location does not influence mean transmission to the cochlea. Conclusion: There is a pattern of transmission for low frequencies through a frontal pathway but none for high frequencies. We were also able to demonstrate that the localization of the BAHA™ implant on the skull had no significant impact on the sound transmission, either ipsi or contralaterally. Full article