Journal of Otorhinolaryngology, Hearing and Balance Medicine

Background/Objectives: This narrative review aims to evaluate the use of pupillometry as an objective measure of auditory perception and listening effort across the lifespan. Specifically, it synthesizes research examining pupillary responses in individuals with and without hearing impairment across pediatric, adult, and older adult populations. The review addresses methodological practices and clinical implications for integrating pupillometry into routine audiological assessment. Methods: 12 peer-reviewed studies published between 2010 and 2025 were selected through a systematic search of databases including PubMed, Scopus, Web of Science, and Google Scholar. Inclusion criteria required empirical use of pupillometry in auditory tasks involving human participants with normal hearing or hearing impairment. Studies were analyzed for population characteristics, experimental paradigms, pupillometric metrics (e.g., peak pupil dilation), level of evidence, and relevance to clinical audiology. This article uses a narrative review approach to organize and interpret findings. Results: Across age groups and hearing conditions, pupillometry consistently demonstrated sensitivity to cognitive load and listening effort, particularly in noisy environments or during complex auditory tasks. Pediatric studies revealed its potential as a non-invasive tool for preverbal children. Adult and older adult studies confirmed that pupillary responses reflect device performance (e.g., hearing aids, cochlear implants) and cognitive–linguistic demands. Methodological variability and individual differences in pupil response patterns were noted as limitations. Conclusions: The findings support the use of pupillometry as a valuable adjunct to behavioral audiometry, offering objective insight into auditory–cognitive load. Its application holds promise for pediatric diagnostics, hearing technology evaluation, and geriatric audiology. Standardization of measurement protocols and development of normative data are necessary to enhance clinical applicability and generalizability.

Background/Objectives: The high prevalence of benign paroxysmal positional vertigo (BPPV) poses a considerable burden on healthcare systems, with an estimated annual cost of 2 billion dollars per year in the United States. The results of previous network meta-analyses (NMAs) have been inconclusive regarding the efficacy of different treatment strategies for managing BPPV. This study aimed to provide updated evidence of the comparative efficacy and safety of different treatment strategies in patients with BPPV. Methods: The present study was divided into two subgroups. The first part was the posterior canal BPPV, and the second was the horizontal canal BPPV. This frequentist model-based NMA included randomized controlled trials (RCTs) of treatments for BPPV, either in the posterior or horizontal canal. Results: This NMA of 82 RCTs revealed that, regarding posterior canal BPPV, most maneuvers plus postmaneuver rehabilitation/self-treatments were ranked superior to the traditional maneuver with/without medication in terms of the resolution rate. Among them, the modified Epley maneuver + self-treatment at home [odds ratio (OR) = 33.70, 95% confidence intervals (95%CIs) = 6.45–176.13] was ranked to be associated with the highest resolution rate. Regarding horizontal canal BPPV, only the Gufoni maneuver was associated with a significantly better resolution rate (OR = 4.40, 95%CIs = 1.13–17.12) and a higher transition/conversion rate (OR = 3.55, 95%CIs = 1.20–10.57) than that of sham/control groups. Conclusions: This study provides evidence that treatment strategies consisting of maneuvers in combination with postmaneuver rehabilitation/self-treatment may be preferred for managing BPPV affecting the posterior canal. However, no effective treatment strategy for horizontal canal involvement has been identified.

Background and Objectives: Speech-in-noise testing is essential for evaluating functional hearing abilities in clinical practice. Although the Quick Speech-in-Noise test (QuickSIN) is widely used, no equivalent tool existed for European Portuguese. This study aimed to develop a Speech-in-Noise Test for European Portuguese (SiN-EP), linguistically adapted and calibrated for native speakers, to support clinical assessment of speech perception in realistic listening environments. Materials and Methods: The SiN-EP was developed through a multi-stage process. Sentences were drafted to reflect natural speech patterns and reviewed by native speakers for clarity and grammatical accuracy. Selected sentences were recorded by a female native speaker in a controlled acoustic environment and mixed with multi-talker babble at signal-to-noise ratios (SNR (dB)) from 25 to 0 SNR (dB). A pre-test in a free-field setting at 65 dB SPL was conducted with fifteen normal-hearing young adults. Participants repeated each sentence, and their responses were analyzed to refine list composition, adjust difficulty, and ensure phonetic balance. Results: Intelligibility decreased systematically as SNR (dB) worsened, with ceiling effects at 25 and 20 SNR (dB). At 5 SNR (dB), high variability was observed, with set 5 showing disproportionate difficulty and set 14 containing an incomplete sentence; both were removed. At 0 SNR (dB), all sets demonstrated expected low intelligibility. The final test comprises thirteen lists of six sentences, each maintaining stable intelligibility, phonetic representativeness, and consistent difficulty across SNRs (dB). Conclusions: The SiN-EP provides a linguistically appropriate, phonetically balanced, and SNR (dB) calibrated instrument for assessing speech-in-noise perception in European Portuguese. The refinement process improved reliability and list equivalence, supporting the test’s clinical and research applicability. The SiN-EP fills a critical gap in assessing speech-in-noise perception in European Portuguese speakers, providing a reliable tool for both clinical and research applications.