Audiology Research doi: 10.3390/audiolres16040118

Authors: Lan Wang Qiong Li Bin Zhang Shaohan Wang Shanshan Tian Yu Han Wenbin Wang Zhaomin Fan Haibo Wang Yu Ai

Background/Objectives: The study was aiming to determine the test–retest repeatability of DEX or CH as single sedative agents on ABR indices by analyzing data from initial test and retest. We also preliminarily explored the correlation between sleep deprivation and onset time of sedation in group DEX and group CH, respectively. Methods: We collected data from two groups of children sedated with either DEX (n = 20, 40 ears) or CH (n = 20, 40 ears). Paired- samples t-tests and Bland–Altman plots were used to evaluate repeatability between the initial test and retest. Pearson correlation analysis was used to measure the relationship between the average onset time of sedation and the average duration of sleep deprivation in both groups. Results: Within each sedative group, no significant differences were observed in ABR indices between the initial test and retest. Additionally, in group DEX, the mean onset time was 12.15 ± 4.40 min and the mean sleep deprivation duration was 442.80 ± 85.91 min, with no correlation between them (r = 0.01, p = 0.96). In group CH, the mean onset time was 27.55 ± 15.70 min and the mean sleep deprivation duration was 455.10 ± 90.94 min, showing a significant negative correlation (r = −0.97, p = 0.00). Conclusions: ABR indices exhibited high repeatability when DEX and CH were used as a sedative in pediatric ABR examinations. The choice of sedative agent in clinical practice should be individualized, taking into account institutional protocols and clinical requirements.

Audiology Research doi: 10.3390/audiolres16040117

Authors: Joan Lorente-Piera Raquel Manrique-Huarte Nicolás Pérez-Fernández

Objective: To critically synthesize the available evidence on the pathophysiological variants of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) and to propose an integrative model based on otoconial location and cupular dynamics to explain their clinical presentation and therapeutic implications. Methods: A scoping review was conducted through a search of PubMed/MEDLINE, Scopus, and the Cochrane Library for studies published between January 1996 and May 2026. Studies describing pathophysiological variants, biomechanical mechanisms, nystagmus patterns, or therapeutic maneuvers in HSC-BPPV were included. A total of 26 studies met the inclusion criteria and underwent qualitative analysis. Results: Six principal mechanical configurations of horizontal canal positional vertigo were identified: long-arm canalolithiasis, short-arm canalolithiasis, canal-side cupulolithiasis, utricular-side cupulolithiasis, canalith jam, and light cupula. The available evidence suggests that these variants represent different mechanical states determined by otoconial location, otoconia–cupula interaction, canal obstruction, or alterations in cupula–endolymph density. This model explains the direction, intensity, and duration of positional nystagmus, the findings observed during the supine roll test and the bow and lean test, as well as the variability in response to repositioning maneuvers. A practical classification integrating pathophysiology, clinical findings, and treatment is proposed. Conclusions: HSC-BPPV may be more appropriately understood as a spectrum of mechanical states in which the configuration of otoconial debris and its interaction with the cupula influence the nystagmus pattern, clinical presentation, and therapeutic response. This integrative model may improve diagnostic accuracy and guide treatment selection, although prospective validation is required.

Audiology Research doi: 10.3390/audiolres16040116

Authors: Angela Babuci Laila Ashkar Zinovia Zorina Svetlana Capcelea Silvia Stratulat Ilia Catereniuc Lora Gitu Doina Botnaru Marin Buracovschi Igor Cemortan Nicolae Chele Andrei Mostovei Gabriela Motelica Ion Dabija Stanislav Strisca Mihaela Dandara Liliana Nastas Sergiu Beliniuc Elena Stepco Svetlana Lozovanu Olga Cheptanaru Sofia Lehtman

Background/Objectives: The variability of the internal acoustic meatus (IAM) and its morphological peculiarities are of high clinical significance in otologic interventions and neurosurgery. Considering the complexity of the neurovascular structures housed by the IAM, including passage of the facial nerve, the aim of the study was to highlight the morphological peculiarities of the IAM and their clinical significance. Methods: The age peculiarities of the IAM course were studied on 18 serially, transversely sectioned human embryos and fetuses, as well as on 20 newborn and 20 adult formalin-fixed hemiheads. The morphometric parameters of the IAM (width, height, length, and angles between the anterior and posterior walls of the IAM and the longitudinal axis of the petrous ridge (LAPR) were evaluated on 82 dry temporal bones. Results: In embryos and early fetal stages of development, the course of the IAM formed an acute, posteromedially open angle with the longitudinal axis of the petrous part of the temporal bone (LAP); in newborns, it was a right angle; in adults, it was an acute, anteromedially open angle. Various shapes of the IAO, such as oval (51.2%), semioval (23.2%), quadrangular (13.4%), heart-like (3.7%), and triangular (8.5%), were highlighted. The mean width of the internal acoustic opening (IAO) was 7.7 ± 2.11 mm (right/left—8.2 ± 2.22 mm/7.2 ± 1.89 mm), with a statistically significant difference (p = 0.031). The mean height of the IAO was 5.3 ± 1.43 mm (right/left—5.6 ± 1.58 mm/5.0 ± 1.22 mm), p = 0.082. The mean length of the IAM was 10.1 ± 2.83 (right/left—10.5 ± 2.96 mm/9.7 ± 2.67 mm), p = 0.214. A partial septum was revealed in 3.6% of cases, while total septation of the IAM was observed in 2.4%. The mean angle between the anterior wall of the IAM and the longitudinal axis of the petrous ridge (AWIAM/LAPR) was 21.4 ± 13.67° (right/left—22.2 ± 14.62°/20.5 ± 12.78°), p = 0.564. The mean angle between the posterior wall of the IAM and the longitudinal axis of the petrous ridge (PWIAM/LAPR) was 82.4 ± 8.02° (right/left—84.3 ± 7.93°/80.5 ± 7.76°); p = 0.032. Conclusions: In the initial stages of an individual’s ontogenesis, the IAM forms an acute, posteromedially open angle with the LAP; in newborns—a right angle; in adults—an acute, anteromedially open angle. Both morphological characteristics and morphometric parameters of the IAO and IAM vary bilaterally. The oval, semioval, quadrangular, heart-like, and triangular shapes of the IAO were highlighted. Partial and total septation of the IAM were revealed. Only the TDAIO and PWIAM/LAPR angle were statistically significant, p < 0.05, while the bilateral correlation was negligible. The established morphological variants of the IAM could predispose to facial and vestibulocochlear nerve impairments.

Audiology Research doi: 10.3390/audiolres16040115

Authors: Athena Eliana Arsie Carlotta Muneretto Matteo Seno Marta Gaffeo Luca Sacchetto Daniele Monzani Silvia Palma

Background/Objectives: Diabetes mellitus (DM) has been proposed as a potential risk factor for vestibular dysfunction, although the evidence remains heterogeneous. This review was prompted by the increasing recognition in clinical practice of a frequent coexistence between DM and recurrent vestibular disorders. It aims to examine the most recent available literature investigating the association between DM and the most common causes of recurrent vestibular disorders, thereby providing clinicians with additional insights for early diagnosis and risk stratification. Methods: A systematic review was conducted according to PRISMA guidelines with SWiM-based narrative synthesis. PubMed, Scopus, and Google Scholar were searched for studies (2016–2026) including adult diabetic patients with vestibular disorders. Risk of bias was assessed using NOS, RoB2, and JBI tools. Results: Twenty-nine studies met the inclusion criteria, but only nineteen were focused explicitly on recurrent vestibular disease. Diabetes was consistently associated with higher prevalence and recurrence of benign paroxysmal positional vertigo (BPPV), more persistent vestibular symptoms, and worse balance outcomes. Associations with other recurrent vestibular disorders was scarce and high heterogeneity limited quantitative synthesis. Conclusions: The available literature suggests that DM increases the vulnerability of the vestibular system in BPPV cases while data regarding other vestibular disorders, including VM and MD, are still limited. More prospective studies investigating the link between diabetes and recurrent vestibular disorders are needed, particularly through specific indicators of evolutionary picture of diabetes.

Audiology Research doi: 10.3390/audiolres16040114

Authors: Eman A. Hajr Haifa H. Allahem Aroob M. Alromih Amal A. Alghtani Abdullah Z. Alshalan Faisal N. Almhesen Abdulrahman A. Hagr

Background/Objectives: Age-related hearing loss (ARHL) is a major and growing public health concern, yet awareness of its nature, consequences, and management options remains inadequately studied in the Middle Eastern context. In Saudi Arabia, cochlear implantation is provided free of charge through the public healthcare system; however, adult uptake remains critically low, suggesting that awareness—rather than access—constitutes the primary barrier to timely intervention. In collective healthcare cultures, family members play a central role in healthcare decision-making for older individuals, making family-level awareness a critical determinant of early identification and treatment. This study aimed to assess public awareness, beliefs, and attitudes toward ARHL and its management options among adults in Saudi Arabia, applying the Health Belief Model (HBM) as a theoretical framework. Methods: A cross-sectional descriptive study was conducted using a structured questionnaire adapted from a previously validated survey, with cultural modifications for the Saudi context. The questionnaire was distributed electronically to adults aged 18 years and above across Saudi Arabia. A total of 506 consenting responses were included in the final analysis. Descriptive statistics were used to analyse frequencies, percentages, means, and standard deviations. Results: The majority of participants correctly identified hearing loss as a reduction in the ability to hear (84.6%), and 95.3% regarded good hearing as personally important. However, significant knowledge gaps were observed, with 53.8% believing hearing loss can be cured and 50.4% believing it can be halted. Notably, 34.2% believed cochlear implants benefit children exclusively. Doctors and the internet were the primary sources of medical information, yet 39.3% reported no preventive healthcare visits and 23.9% did not seek any information about hearing problems. When faced with a hypothetical hearing loss, 75.3% indicated they would consult an ENT specialist. Conclusions: Adults in Saudi Arabia demonstrate good awareness of the signs and consequences of hearing loss but exhibit significant knowledge gaps regarding its clinical course and available management options, most notably the belief that cochlear implantation is exclusively a pediatric intervention. These findings highlight the urgent need for culturally adapted awareness campaigns targeting family members of older adults, and support the development of community-based hearing health promotion strategies in Saudi Arabia and comparable collective healthcare societies.

Audiology Research doi: 10.3390/audiolres16040113

Authors: Stephanie Fowler-Brookman Andrea D. Warner-Czyz

Background/Objectives: Even with the use of hearing aid or cochlear implant technologies, adults who are deaf or hard of hearing (DHH) exhibit difficulty perceiving musical characteristics compared to peers with typical hearing, but do not necessarily report a consistent decrease in appreciation of musical activities. This study addresses a gap in the literature by examining the effect of both hearing status (i.e., DHH versus typical hearing) and hearing technology (i.e., hearing aids versus cochlear implants) on both behavioral and subjective music abilities and ratings of music importance. Methods: Adults with typical hearing (n = 20), hearing aids (n = 10), or cochlear implants (n = 10) completed tasks on (a) behavioral measures of music perception including pitch perception, melody recognition, and timbre recognition; and (b) the Music-related Quality of Life questionnaire to assess subjective ratings of music abilities and music importance. Results: Adults with typical hearing outperformed the cochlear implant group on all behavioral music perception tasks, but they performed similarly to the hearing aid group. Although the two DHH groups subjectively rated their musical abilities less positively than adults with typical hearing, all three groups appraised the importance of music in their lives similarly. Conclusions: Music importance and appreciation do not depend on music abilities, implying that clinicians and researchers should incorporate metrics of subjective music quality of life to comprehensively assess and treat adults who are DHH to foster more positive quality of life.

Audiology Research doi: 10.3390/audiolres16040112

Authors: Giuseppe Santopietro Luigi Califano Iacopo Cangiano Cataldo Latorre Maria Grazia Melillo Roberto Teggi

Background: Positional torsional downbeating nystagmus elicited during diagnostic maneuvers for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) may indicate either ipsilateral apogeotropic PSC-BPPV or contralateral anterior canal BPPV, making differential diagnosis challenging. This retrospective study evaluated whether ipsilateral 100 Hz mastoid vibration could facilitate conversion to a geotropic nystagmus pattern, thereby supporting both diagnosis and treatment. Materials and Methods: Ten patients with apogeotropic PSC-BPPV underwent standard diagnostic and therapeutic maneuvers combined with ipsilateral 100 Hz mastoid vibration. The primary outcome was the rate of nystagmus geotropization. Secondary outcomes included the number of repositioning maneuvers required to achieve complete symptom resolution. Outcomes were compared with those of two control groups: one consisting of patients with apogeotropic PSC-BPPV treated without mastoid vibration and another consisting of patients with typical PSC-BPPV treated using standard repositioning maneuvers alone. Results: Mastoid vibration induced geotropization in 7 out of 10 patients (70%). The mean number of liberatory maneuvers required for symptom resolution was lower in vibration-responsive patients than in vibration-non-responsive patients (1.7 ± 0.49 vs. 3.0 ± 1.41;). Compared with patients with apogeotropic PSC-BPPV treated without mastoid vibration, vibration-responsive patients required significantly fewer maneuvers (2.1 ± 0.87 vs. 2.9 ± 0.74; p = 0.036). No significant difference was observed when compared with patients with typical PSC-BPPV (2.1 ± 0.87 vs. 2.1 ± 0.52; p = 0.82). Conclusions: Mastoid vibration may represent a useful adjunctive tool in the management of apogeotropic PSC-BPPV by facilitating conversion to the typical geotropic pattern. This conversion may provide useful diagnostic information, and potentially reduce the number of repositioning maneuvers required to achieve symptom resolution.

Audiology Research doi: 10.3390/audiolres16040111

Authors: Peizheng Wang Changgeng Mo Shangqiguo Wang

Background/Objectives: The four-frequency better-ear pure-tone average (PTA4; 0.5–4 kHz) is the dominant population definition of hearing impairment but underweights frequencies above 4 kHz and ignores interaural asymmetry. We quantified, in two independent adult samples, the proportion of PTA4-normal adults with elevated high-frequency or asymmetric profiles and whether this has a self-report correlate. Methods: Cross-sectional secondary analysis of two public datasets: the German HÖRSTAT/Aalen sample (2008–2012; N = 3105) and pooled US NHANES (2011–March 2020; N = 10,575; adults ≥ 20 years). The primary outcome, PTA4-discordant high-frequency loss, was defined a priori as better-ear PTA4 ≤ 25 dB HL with a better-ear 6–8 kHz mean (PTA68) > 25 dB HL, reported as the conditional proportion among PTA4-normal adults. Secondary outcomes were interaural asymmetry ≥ 15 dB and self-rated hearing trouble (NHANES AUQ054 ≥ 3). Results: Among PTA4-normal adults, 34.3% (95% CI 32.5–36.2) of the German sample and a survey-weighted 28.2% (25.9–30.5) of the NHANES sample had PTA68 > 25 dB HL. Prevalence rose with age (≈three-fold odds per decade; two-fold for male sex; all p < 0.001). Of those with PTA68 asymmetry ≥ 15 dB, 75–85% remained PTA4-normal, although the more stringent unilateral-like pattern was rare (1.5–1.7%). Self-reported trouble was elevated in PTA4-discordant mild (OR 2.56) and strong (OR 3.50) groups (OR 1.43 per 10 dB PTA68). Conclusions: Although disagreement between the two classifications is arithmetically expected, since they cover different frequencies, its magnitude is substantial and reproducible: roughly a quarter to a third of PTA4-normal adults (28–34%) carry an elevated PTA68, with a graded self-report correlate consistent with early high-frequency presbyacusis, and the same age structure emerges in two samples measured with different equipment and procedures. Because the 25 dB HL criterion is not age-referenced, an increasing share of the discordance at older ages represents expected presbyacusis rather than pathology, so the older-age figures should be read as counts above a fixed public-health threshold. Reporting a high-frequency companion metric (PTA68 or PTA346) alongside PTA4 would make this information visible without displacing the existing system.

Audiology Research doi: 10.3390/audiolres16040110

Authors: Mohammed A. Shajeri Abdullah N. Alkhunfur Saeed M. Alqahtani Omar S. Abdullah Alnmasi Hussam J. Alshehri Norah H. Aldawsari Atheer M. Alshammakhi Ahmed H. Alkhaldi Ahmed A. Alessa Tawfiq Khurayzi

Objective: This review aimed to evaluate the existing literature to determine the incidence and associated risk factors of cochlear implant complications. Data Sources: A comprehensive literature search was conducted across PubMed, Web of Science, Embase, and Scopus up to 12 April 2025. Methods: The review protocol was registered on PROSPERO (ID: CRD420251012225) on 15 March 2025, and the systematic review was performed according to PRISMA guidelines. Results: We included a total of 100 records based on 81 studies with 42,167 patients. The overall incidence was 13.7%. Major complications occurred in 5.2%, with device failure being the most common at 2.8%. Minor complications affected 7.8%, with superficial wound infections being most frequent at 2.3%. Vestibular complications (vertigo/dizziness) were prevalent at 12.4%. Adults had significantly higher overall and major complication rates compared to pediatric patients. The mastoidectomy with posterior tympanotomy approach (MPTA) was associated with lower rates (5.4%) than the suprameatal approach (SMA) (7.8%). A significant temporal trend showed decreased complication rates from 8.9% in the early era (1991–2010) to 4.1% in the recent era (2011–2025). Significant risk factors were identified including older age at implantation, inner ear malformations, chronic otitis media, previous otologic surgery, and longer surgery duration. A substantial heterogeneity was present across the included studies (I2 up to 93.6%), and the evidence base was predominantly retrospective in nature, which limits the certainty of these estimates. Conclusions: Cochlear implantation appears to be a generally safe procedure. However, these findings should be interpreted with caution. The high heterogeneity, predominantly retrospective study designs, inconsistent complication definitions, and detected publication bias collectively limit the certainty of the pooled estimates. Standardized complication reporting, prospective multicenter designs, and consensus-based outcome definitions are essential to strengthen the evidence base and guide safer clinical practice.

Audiology Research doi: 10.3390/audiolres16040109

Authors: William J. Bologna Courtney King Katie Esser Elaine V. Shaw Karina M. Ball

Background/Objectives: A listener’s physical position in a realistic environment influences the intensity of speech and noise that arrives at the two ears as well as the binaural cues available for the segregation of target signals from background noise. The purpose of this paper was to evaluate how listener position influences speech recognition in a simulated multitalker environment and to determine the extent to which strategic positioning can be leveraged to improve communication in the real world. Methods: Virtual acoustics were used to generate a realistic simulation of a restaurant with 12 different listener positions, which were distributed across four different tables. Speech recognition in each simulated position was measured in 64 listeners separated into two age groups (younger and older) with varying degrees of hearing sensitivity represented in both groups. Results: Significant differences in speech recognition were observed between tables and between seats at each table, indicating that even subtle changes in listener position can yield meaningful effects on speech recognition. The best positions tended to contain asymmetric distributions of maskers on either side of the listener, and they afforded access to spatial cues for segregation of the target from nearby maskers. Age and hearing sensitivity also contributed to speech recognition thresholds and interacted with the effects of listener position. Conclusions: Manipulations of listener position may be an effective way to improve communication in realistic environments. Future work is needed to develop generalizable strategies to guide patients on how to identify positions that are optimal for speech understanding in any given environment.

Audiology Research doi: 10.3390/audiolres16040108

Authors: Nirmal Srinivasan

Background/Objectives: Spatial hearing enables listeners to segregate competing sound sources in complex acoustic environments. Two key components of spatial hearing are localization acuity and spatial release from masking (SRM). Although both rely on similar binaural cue processing, their relationship remains unclear. The present study aimed to investigate localization acuity using frequency-specific and broadband stimuli and to determine how these measures relate to SRM in young normal-hearing listeners. Methods: Forty-five normal-hearing participants completed free-field localization and speech identification tasks using a multi-loudspeaker array. Localization acuity was assessed using one-third octave low-frequency (500 Hz), high-frequency (5000 Hz), and broadband noise stimuli. SRM was measured using a Coordinate Response Measure (CRM) speech task under colocated and spatially separated conditions (±30°). Localization performance was quantified using percent correct and root-mean-square (RMS) error, and relationships between localization acuity and SRM were examined using correlation analyses. Results: Localization performance varied significantly with stimulus bandwidth, with broadband stimuli yielding the highest accuracy, followed by low- and high-frequency conditions. Listeners demonstrated robust SRM (~5.6 dB). Moderate negative correlations were observed between RMS error and SRM across all stimulus conditions. Although the broadband condition yielded numerically larger correlation coefficients, differences among correlations were not statistically significant. Conclusions: Localization acuity was moderately associated with SRM across stimulus conditions. Although numerically larger correlations were observed for broadband stimuli, these differences were not statistically significant. The findings suggest that localization acuity represents one of several factors contributing to spatial hearing performance in complex listening environments.

Audiology Research doi: 10.3390/audiolres16040107

Authors: Johanna Müller-Diesing Thien An Duong Dinh Stephan Hackenberg Anna Klein Ariane Renson Justus Ilgner Julia Kristin Brach Markus Wirth Flurin Müller-Diesing

Background: Dizziness is a common symptom arising from disorders across multiple organ systems. Diagnostic pathways are often prolonged, and uncertainty may increase patients’ subjective burden. Aims/Objectives: This study describes the long-term course of functional impairment in patients with chronic, complex dizziness with delayed or inconclusive diagnostic classification using longitudinal DHI data. Material and Methods: This retrospective longitudinal study included patients presenting between 2009 and 2012 with persistent dizziness of at least one year and no definitive diagnosis at baseline. Initial DHI scores were compared with follow-up data collected 14–17 years later via structured telephone interviews. Changes in total and subdomain scores (functional, emotional, and physical) were analyzed, with subgroup analyses (sex, age, and diagnostic status). Results: Fifty-one patients were included. Median total DHI score decreased from 48.0 to 14.0 (Z = −6.13, p < 0.001). Median within-patient change was −28 (95% CI: −44 to −15). A total of 49/51 patients (96%) showed improvement. All DHI subdomains improved significantly, with the largest change observed in the functional domain (median −10, 95% CI: −15 to −4). Improvements were consistent across subgroups and largely independent of epidemiological and diagnostic factors. Conclusions and Significance: Patients with complex chronic dizziness show substantial long-term improvement in DHI scores. Further studies in larger cohorts are needed to determine whether a generalizable prognosis can be established.

Audiology Research doi: 10.3390/audiolres16040106

Authors: Bulent Mamikoglu Pankajavalli Ramakrishnan Fawaz Al-Mufti Gerard Gianoli

Background/Objectives: To critically evaluate the evidence on sigmoid sinus wall reconstruction (SSWR) for venous pulsatile tinnitus (PT), with emphasis on outcome durability, objective hemodynamic assessment, pressure-associated findings, and safety. Methods: A critical review with a structured literature search and reporting informed by PRISMA 2020 was performed using PubMed/MEDLINE and backward citation searching. Embase, Scopus, and the Cochrane Library were used to identify contextual secondary reviews and to cross-check the primary-study set. A descriptive study-level appraisal addressed design, cohort size, follow-up, outcome objectivity, hemodynamic measurements, and complication reporting. The manuscript is presented as a critical review because no prospective registration or formal risk-of-bias assessment was undertaken. Results: Thirty-four records were identified, two duplicates were removed, and 32 records were screened; 10 studies were included in the qualitative synthesis. These comprised dedicated SSWR/resurfacing outcome cohorts and clinical, imaging, or pressure/hemodynamic studies, with some studies contributing to more than one domain. The cohorts were small, heterogeneous, and predominantly retrospective, and only one cohort had mean follow-up exceeding 5 years. In that cohort, complete PT elimination was reported in 24/37 ears (64.9%), with significant partial improvement in 10 additional ears, yielding an initial satisfactory response in 34/37 ears (91.9%); after recurrence was considered, the source authors reported long-term success in 31/37 ears (83.8%). IIH (3/35), papilledema (5/35), and venous sinus stenting (2/35) were reported separately during follow-up and were not combined into a composite prevalence. Objective pre- and postoperative intracranial pressure or venous hemodynamic measurements were sparse, and complication reporting was inconsistent. Conclusions: This critical review suggests symptomatic benefit from SSWR in selected patients but finds insufficient evidence to determine whether the procedure normalizes intracranial pressure, corrects upstream venous hemodynamics, prevents recurrence, or modifies long-term disease. Comparative treatment recommendations cannot be supported. Prospective multicenter studies with standardized objective, patient-reported, and safety outcomes are required.

Audiology Research doi: 10.3390/audiolres16040105

Authors: Yongqing Liang Navid Shahnaz Valter Ciocca

Background/Objectives: Some individuals present with difficulty understanding speech in noise, tinnitus, or both, despite normal conventional audiometric hearing thresholds. This study evaluated whether acoustic stapedial reflex thresholds (ASRTs) could serve as a clinically useful indicator of auditory complaints not captured by conventional audiometry. Methods: ASRTs for pure tones and broadband noise (BBN) were measured in 146 ears (73 participants) from controls, music students, and symptomatic participants. Bayesian random-intercept linear regression models were used to compare ASRTs among groups, adjusting for age and sex. ASRT difference scores were also used for ROC analysis and to estimate the difference between pure-tone and BBN thresholds (“BBN advantage”). Results: Symptomatic ears showed higher ASRTs than control ears with BBN stimuli, after adjustment for age and sex. Symptomatic ears had a lower AvgDiff posterior mean (reduced BBN advantage) than control ears. ASRTs for music students were directionally consistent with an intermediate pattern, but with wider credible intervals and greater uncertainty. Exploratory ROC analysis showed moderate separation between symptomatic and non-symptomatic ears with AvgDiff; however, symptom status was not independently validated against any diagnostic reference standard. Conclusions: The study suggests that a reduced BBN advantage may be associated with auditory complaints in individuals with normal hearing at conventional audiometric frequencies. However, these findings should be interpreted with caution and not used for specific diagnostic purposes, as the symptomatic group was substantially older and symptom status was not independently validated against any diagnostic reference standard.

Audiology Research doi: 10.3390/audiolres16040104

Authors: Zhadra Bukenova Galiya Orazova Aigerim Baimagambetova Zhadyra Karashutova Aisulu Talgatova Zulfiya Zholdybayeva Sauran Yerdessov Gulnara Kulkayeva

Background: Hearing health in Kazakhstan is documented through parallel administrative systems whose indicators are often conflated. We examined three administrative layers of hearing health during 2020–2025: dispensary registration of ear and hearing-loss diagnoses, disability certification as a severe administrative endpoint, and cochlear implantation (CI) as the specialised treatment response, with reference to Global Burden of Disease (GBD) 2021 estimates. Methods: We conducted a national ecological, region-year, multi-source administrative registry study across all 20 regions of Kazakhstan from 2020 to 2025. The dataset included 114 region-year observations and integrated Dispensary Report Form No. 12, the State Register of Persons with Disabilities, and the Electronic Register of Inpatient Patients. Dispensary indicators were interpreted as registered healthcare-utilisation measures, not population prevalence or incidence. Trends were assessed using Mann–Kendall tests with Benjamini–Hochberg false-discovery-rate correction. Regional patterns were examined using Spearman correlation, inequality metrics, and exploratory clustering. Results: Among adults, registered H60–H95 annual morbidity increased from 231,209 to 278,897 cases (CAGR +3.8%; FDR p = 0.016), and first-time registrations rose from 126,513 to 167,674 (CAGR +5.8%; FDR p = 0.016). Active dispensary observation declined modestly from 21,840 to 19,881. H65–H66 chronic otitis first-time registration remained stable, while active observation declined sharply. Paediatric H90–H91 registration was stable. In 2025, 31,560 persons were registered with hearing impairment-related disability, including 26,522 adults. CI procedures increased from 285 to 523. Adult CI activity was intermittent between 2012 and 2018 (peak 140 in 2013), ceased in 2019–2020, and was re-established from 2021 (14 → 129 procedures in 2025), reaching 24.7% of all CI. Most procedures were concentrated in Almaty and Astana. Compared with the GBD-2021 estimate of 17,212 per 100,000, administrative indicators captured much narrower service-utilisation and severe-certification layers. Conclusions: Kazakhstan’s administrative data describe distinct hearing-health layers rather than competing prevalence estimates. Adult screening, regional audiology capacity, post-CI rehabilitation, and longitudinal outcome registries are priority areas.

Audiology Research doi: 10.3390/audiolres16040103

Authors: Carrie A. Davenport Elaine R. Smolen Derek M. Houston

Background: Language outcomes among DHH children are widely variable. Equally variable is the diversity of factors involved in fostering healthy language development in this population. Some DHH children use cochlear implants and hearing aids and reach expected milestones. Others exhibit delays, ranging from mild to severe. Regardless of how “success” is defined for individual children who use these technologies, recognizing the ecological contexts in which DHH children develop language, and the relationships among those contexts, can support the identification of contextual predictors and points of intervention that lie beyond the individual DHH child. Purpose: The purpose of this article is to articulate Bronfenbrenner’s Ecological Systems Theory and how it relates to language development in this population of children. We discuss the original conceptualization of the theory, portraying the levels of ecosystems depicted as nested, and explore how a networked version of the theory might provide a complementary lens for elucidating the ecological variables associated with language development. Implications for research: We describe implications for research including expanding the ecological variables examined, examining interactions between ecosystems, use of diverse methodologies, and shifting beyond a deficit model towards an ecological perspective.

Audiology Research doi: 10.3390/audiolres16040102

Authors: Alexandra Rousset Sylvia Tari Rod Hollow Raoul Wills Richard C. Dowell

Objectives: To collate subjective and objective outcome measures from cochlear implant recipients with asymmetric hearing loss. Methods: Forty-one CI recipients with asymmetrical hearing loss completed spatially separated speech in noise testing, speech in quiet testing, localisation testing, and tinnitus and quality of life questionnaires (SSQ and IOI-HA) pre-operatively and at 3, 12 and 24 months post-operatively. The results were used to generate a tool to help clinicians guide potential recipients through the counselling process. Results: Significant improvements in spatially separated SRT, localisation, tinnitus and the SSQ were observed for the group, with significant individual variability. CVC phoneme scores were not significantly different from those observed for CI recipients with bilateral hearing loss. The rates of non-use were consistent with those in the literature and were higher than for recipients with bilateral hearing loss. There was a significant correlation between PTA in the contralateral ear and localisation, and those recipients with a shorter duration of hearing loss were more likely to be satisfied with their CI. Discussion: Cochlear implantation for patients with asymmetrical hearing loss has the potential to offer improvements in head-shadow effects, localisation and tinnitus, with subjective measures also showing significant improvements post-operatively. There exists a large amount of individual variability across the group, however, which makes pre-operative counselling problematic for this patient cohort. Conclusions: The use of the study-generated counselling tool by clinicians may help patients make a more educated decision to proceed with implantation based upon realistic expectations of possible post-operative outcomes.

Audiology Research doi: 10.3390/audiolres16040101

Authors: Abdulrahman Ali Otaif Musleh Hussain Mubarki Khalid Talat Ardi Abdulelah A. Otaif Dhiyaa A. H. Otayf Ghala S. Al Ahmari Danah M. Al Mutib Razan M. Althumali Tif A. Jawahi Najla M. Al Yami Abdullah M. Algarni

Background/Objectives: Tinnitus is a significant global health concern with substantial geographic variation in prevalence. However, data on tinnitus epidemiology in southern Saudi Arabia remain limited, despite emerging evidence suggesting a relatively high regional burden. Therefore, this study aimed to estimate the prevalence of tinnitus and identify its epidemiological determinants among adults in southern Saudi Arabia. Methods: A community-based cross-sectional study was conducted among 501 adults from four regions in southern Saudi Arabia (Jazan, Aseer, Najran, and Al-Baha). Data were collected on sociodemographic characteristics, chronic medical conditions, noise exposure patterns, and clinical features of tinnitus. Multivariable logistic regression analysis was used to identify factors independently associated with tinnitus. Results: The overall tinnitus prevalence was 31.1% (156/501). The mean age of participants was 30 ± 11 years, and 61.7% were female. Bilateral tinnitus was the most common (47.4%). Symptom duration was reported as <3 months in 31.4% of cases and between 3 months and 1 year in another 31.4%. The mean severity score was 3.7 ± 1.9. Most affected individuals (76.9%) did not seek medical care. Primary exacerbating factors included sleep deprivation (41.7%), noise exposure (41.0%), and stress (39.1%). Multivariable analysis identified two significant independent predictors: weekly noise exposure exceeding 5 h (odds ratio [OR] = 2.14; 95% confidence interval [CI]: 1.34–3.42; p = 0.001) and higher body mass index (BMI) (OR = 1.06; 95% CI: 1.02–1.10; p = 0.005). The most commonly associated underlying conditions were ear infections (25.6%) and hearing loss (24.4%). Conclusions: Tinnitus prevalence in southern Saudi Arabia (31.1%) substantially exceeds global estimates. Noise exposure and elevated BMI are key modifiable factors associated with tinnitus. The substantial healthcare gap, with most affected individuals not seeking treatment, represents a critical public health challenge requiring targeted prevention programs, provider education, and improved access to evidence-based care.

Audiology Research doi: 10.3390/audiolres16040100

Authors: Giacinto Asprella-Libonati

With profound sorrow, I announce the passing of Prof [...]

Audiology Research doi: 10.3390/audiolres16040099

Authors: Merve Savaş Göknur Miray Ceyhan Tasin Senanur Kahraman Beğen Melis Buse Arslan Ayşe Nur Koçak Tutku Altıntaş

Background: Prosodic cues play a critical role in marking syntactic boundaries and guiding sentence interpretation. However, Turkish clinical language batteries lack dedicated measures targeting linguistic prosody and the syntax–prosody interface. Consequently, subtle auditory–prosodic comprehension difficulties may go undetected in stroke populations who perform within normal limits on standard aphasia assessments. This study presents the development and initial psychometric evaluation of the Prosodic Comprehension Test (PCT), a Turkish sentence–picture matching tool designed to isolate prosodic contributions to meaning under controlled syntactic conditions. Methods: A total of 440 neurologically healthy native Turkish-speaking adults participated. An initial pool of 80 sentences (40 minimal pairs), identical in segmental and syntactic structure but differing in interpretation through prosodic boundary placement, was created. Audio stimuli were recorded by a professional actor, and corresponding visual stimuli represented alternative interpretations. Following expert review, 32 sentences (16 pairs) were retained and organized into three subcomponents: In situ Prosody, Focus–Topic Marking, and Pragmatic Disambiguation. Administration included fixed-intensity auditory presentation and a structured learning phase. Results: Internal consistency was acceptable (Cronbach’s α = 0.73). Principal component analysis was consistent with the theoretically proposed three-component structure (KMO = 0.74; Bartlett’s test significant, p < 0.001), with the three components collectively accounting for 28.2% of the total variance. Convergent validity was supported by a significant positive correlation with MoCA-TR (r = 0.23, p < 0.001, 95% CI [0.14, 0.32]). Conclusions: The PCT appears to be a linguistically grounded and psychometrically promising tool for assessing prosodic comprehension in Turkish. The present findings are based on a healthy adult sample and should be interpreted as preliminary normative evidence. Further research should address test–retest reliability, confirmatory factor analyses, and validation in clinical populations.

Audiology Research doi: 10.3390/audiolres16040098

Authors: Zsuzsanna Piros Szilárd Gyula Rezes Rita Kiss Beáta Lelesz Gyula Ujlaki Béla Juhász Zoltán Szilvássy

Background/Objectives: This study evaluated the intra-session repeatability, reliability, and clinical consistency of resonance frequency derived from pressure-less acoustic immittance (PLAI), and compared the results with those obtained using conventional multifrequency tympanometry under identical clinical conditions. Methods: In this pilot methodological comparison study, resonance frequency (RF) measurements were obtained in 15 subjects (30 ears) using multifrequency tympanometry (MFT) and pressure-less acoustic immittance (PLAI). Three consecutive measurements were performed for each ear using both methods. Agreement between methods was evaluated using Bland–Altman analysis. Within-method repeatability was assessed using range, coefficient of variation, repeatability coefficient, and intraclass correlation coefficients. Results: PLAI demonstrated lower intra-session variability than MFT. The mean within-series SD was 96.6 Hz for MFT and 10.5 Hz for PLAI. The coefficient of variation was 9.3% for MFT and 3.2% for PLAI, while intraclass correlation coefficients were 0.60 and 0.83, respectively. The repeatability coefficient was ±367 Hz for MFT and ±47 Hz for PLAI. Bland–Altman analysis revealed a systematic difference between the two methods, with a mean bias of 580.7 Hz and 95% limits of agreement between 247.5 Hz and 913.9 Hz, indicating that the two methods are not interchangeable. Conclusions: PLAI demonstrated higher repeatability than MFT. Its lower variability may support a more consistent clinical interpretation; PLAI-derived RF may therefore represent a stable method-specific parameter for middle ear assessment. However, RF values should be interpreted within method-specific frameworks.

Audiology Research doi: 10.3390/audiolres16040097

Authors: Danielle S. Powell Carrie L. Nieman Per Thorsell Natalie A. Phillips Ingrid Ekström

Background/Objectives: Age-related hearing loss is one of the most prevalent chronic conditions in older adults and has emerged as a potentially modifiable risk factor for cognitive decline and dementia. Increasing evidence from epidemiological, neurobiological, and interventional studies has improved our understanding of the complex relationships between auditory dysfunction and cognitive aging. By highlighting findings in these areas, this review aims to aid clinicians and researchers gain a better understanding of the association between hearing loss, cognitive decline and dementia, and the importance of considering sensory decline during cognitive screening. Methods: This narrative review summarizes and integrates findings from epidemiological, neurobiological, and clinical studies examining relationships between hearing loss, cognitive decline, and dementia. Particular focus was placed on epidemiological associations, proposed mechanistic pathways, implications for screening and diagnostic assessment, and evidence regarding hearing rehabilitation interventions. Results: Accumulating evidence indicates that hearing loss is associated with accelerated cognitive decline and increased dementia risk. Proposed mechanisms include increased cognitive load, reduced sensory input, social isolation, depression, and shared neurodegenerative or vascular pathology, although causal pathways remain incompletely understood. Emerging evidence suggests that hearing rehabilitation may help preserve cognitive function in some groups, but findings remain heterogeneous. Clinical studies further support the importance of considering auditory function during cognitive assessment, as unrecognized hearing impairment may influence test performance, communication, and diagnostic accuracy. Conclusions: Current evidence supports hearing loss as an important factor in cognitive aging and dementia research and highlights the potential value of integrating hearing assessment and management into clinical and research settings.

Audiology Research doi: 10.3390/audiolres16040096

Authors: Leonardo Manzari

Background: The vestibular system has traditionally been interpreted within a reflex-based framework, mainly centered on gaze stabilization, vestibulo-ocular reflex pathways, and peripheral vestibular deficits. This model remains essential, but it is insufficient to explain the full spectrum of postural, perceptual, visual-motion, and self-motion complaints observed in contemporary clinical otoneurology. Objective: This conceptual narrative review examines selected representative works by Kathleen E. Cullen as landmarks in a broader transition from reflex physiology to predictive, multimodal, context-dependent, body-centered self-motion control. Methods: This is not a systematic or bibliometric review. Papers were selected because they mark distinct conceptual steps in Cullen’s work: neural encoding of self-motion, peripheral and central coding strategies, multimodal integration, active versus passive self-motion, reafference suppression, body-centered encoding, proprioceptive prediction, vestibular cerebellar internal models, sensory reweighting, and clinical translation. Synthesis: Angelaki and Cullen’s 2008 synthesis and Cullen’s subsequent work demonstrate that vestibular processing is inherently multimodal from the earliest central stages and that neural representations of self-motion depend on behavioral context. Vestibular nuclei, visual-vestibular networks, and vestibular cerebellar circuits integrate labyrinthine signals with optic flow, proprioceptive, oculomotor, motor, cerebellar, cortical, and contextual information. This architecture enables the brain to distinguish expected from unexpected motion, suppress predictable vestibular reafference during voluntary action, compute internal estimates of body motion, adapt to altered sensory reliability, and reweight sensory inputs according to task demands. Conclusions: The clinical relevance of this trajectory is substantial. Patients may show preserved high-acceleration vestibulo-ocular reflex responses while experiencing persistent instability, visually induced dizziness, defective self-motion perception, or abnormal sustained vestibular processing. Such dissociations are not paradoxical when the vestibular system is understood as a predictive, distributed, body-centered control system. Cullen’s long lesson offers a neurophysiological foundation for a modern vestibular grammar in which clinical findings are interpreted across the reflexive, perceptual, postural, visual-vestibular, sustained, and predictive domains.

Audiology Research doi: 10.3390/audiolres16040095

Authors: Douglas M. Bennion Alicia Williams Claire Perrin Joshua Lee Peter Eckard Philipp Verpukhovskiy Madeline Gibson Rick A. Friedman Marc S. Schwartz

Background/Objectives: For patients with profound deafness resulting from auditory nerve pathology, as in Neurofibromatosis type 2, auditory brainstem implantation (ABI) can restore meaningful acoustic input. The literature reporting real-world results for ABI users is limited, especially regarding patients with bilateral implants. Here, we provide an updated report on the audiologic outcomes among all ABI patients treated at a tertiary institution, including high-performing bilateral ABI users. Methods: In this updated and expanded retrospective case series, audiologic outcomes were reviewed in sixteen consecutive patients who underwent ABI placement by a single neurosurgeon-neurotologist team at our center since 2018. Implantation in four of these patients was on their second side after having undergone first side implantation prior to receiving care at our hospital. Main outcome measures were sound awareness (sound-field threshold testing) and speech understanding (pattern perception, spondee, open-set speech testing). Results: Sound awareness was achieved in 100% of patients (16/16) using an average of 12 electrodes (range 7–20). Persistent non-auditory sensations were reported by 12.5% (2/16). Postoperative speech differentiation (with or without lip-reading) was experienced in 87.5% (14/16). Two second-sided ABI recipients experienced exceptional outcomes as high-performing outliers: one achieved 57% audio only and 86% audio + visual hearing in noise test (HINT) sentence scores; the second bilateral user scored 92% with auditory-only input. Conclusions: ABI represents a viable option for patients who are at risk of developing bilateral profound deafness resulting from auditory nerve disruption. Second sided device implantation is safe and has the potential to significantly improve auditory outcomes.

Audiology Research doi: 10.3390/audiolres16030094

Authors: Nawaf Khayal Alkhayal Mohammed Sherif Yousef Fares Shata Leen Z. Alotaibi Fayez A. Alhabib Hesham Saleh Almofada

Purpose: This study aimed to map publication trends, topical focus, study designs, and institutional concentration in otology research in Saudi Arabia from 1978 to 2024 to deduce any topical, regional, institutional, or funding disparities in the field of otology in the country. Methods: We conducted a scoping review of studies on human ear diseases in Saudi Arabia, searching PubMed and the Cochrane Library from inception to 31 December 2024. Bibliometric characteristics were charted, topics were mapped to ICD-11 chapters, and temporal trends were modelled using negative binomial regression with a single data-driven breakpoint. Results: Of 2227 records identified, 510 studies were included. Annual output increased by 9.28% (95% CI 7.05–11.55). An inflection occurred around 2017, with slower growth before 2017 (7.2%/year, 95% CI 5.3–9.1) and faster growth from 2018 onward (23.9%/year, 95% CI 18.6–29.4). The institutional affiliation of first authors was concentrated in a small number of organizations, led by King Saud University. Observational studies predominated (441/510), whereas experimental studies were limited (16/510). ICD-11 mapping showed the greatest concentration in “Ear and mastoid” (189/510, 37.1%) and “Factors influencing health status or contact with health services” (179/510, 35.1%) chapters. Funding was reported in 75 studies. Conclusions: PubMed- and Cochrane-indexed otology and hearing health research output in Saudi Arabia has grown substantially, particularly since 2017, but remains concentrated by institution, region, study design, and topic. The dominance of cochlear implant and hearing impairment research, together with limited multicenter, experimental, vestibular, tinnitus, and rehabilitation-focused studies, identifies priorities for future audiology and neurotology research planning.

Audiology Research doi: 10.3390/audiolres16030093

Authors: Matija Švagan

Background/Objectives: Recurrent acute otitis media (AOM) in children is known to cause cumulative cochlear and vestibular injury. Whether a single fulminant episode severe enough to require surgical intervention produces an analogous long-term audiovestibular signature, and whether infection severity contributes to outcome independently of cumulative episode count, is unclear. The present study addressed this gap. Methods: In this single-centre retrospective cohort study, 65 paediatric patients who had undergone surgical treatment for acute mastoiditis—the fulminant form of AOM—between July 2001 and March 2021 were assessed a median of 11.5 years after surgery. Of these, 35 had undergone mastoidectomy with tympanostomy and 30 had undergone tympanostomy alone because their episode had not been severe enough to require mastoidectomy. Thirty-two age-matched healthy volunteers (one ear each) formed the control group, yielding 97 ears in three groups (Group TM, 35 ears; Group T, 30 ears; Group C, 32 ears). Extended high-frequency pure-tone audiometry (125–20 kHz), distortion-product otoacoustic emissions (DPOAEs), single-frequency and wideband tympanometry, ipsilateral acoustic reflex thresholds, and lateral-canal vestibulo-ocular reflex gain were measured. Results: Both operated groups showed significantly elevated audiometric thresholds in the high- and extended high-frequency ranges compared with controls (HTA: χ2 = 24.25, p < 0.001), with corresponding reductions in DPOAE amplitudes (HTA: χ2 = 25.04, p < 0.001). Group TM did not differ significantly from Group T at any frequency band, indicating a negligible additional contribution of mastoidectomy itself. Acoustic reflex thresholds were elevated in Group TM. Vestibulo-ocular reflex gain was within reference ranges in all groups. Conclusions: A single fulminant episode of acute middle-ear infection in childhood—whether severe enough to require mastoidectomy or treated by tympanostomy alone—was associated, more than a decade later, with significantly elevated audiometric thresholds closely resembling those reported after multiple recurrent infections, supporting an effect of infection severity independent of cumulative episode count. Long-term audiological follow-up with extended high-frequency audiometry and otoacoustic emission testing is warranted, irrespective of whether mastoidectomy was required.

Audiology Research doi: 10.3390/audiolres16030092

Authors: John Williams Alex Elkins Alp Sarigul Mary Frances Johnson Charles E. Bishop

Introduction: Teprotumumab (Tepezza®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols.

Audiology Research doi: 10.3390/audiolres16030091

Authors: Matthew Mavandi Jack Hyler Eric Lee Ramanjot Singh De Wet Swanepoel Ashley M. Nassiri Vinaya Manchaiah

Background/Objectives: Sensorineural hearing loss (SNHL) is a chronic condition with no established pharmacological treatment. Recent advances in drug-based therapies offer promising opportunities to prevent or treat SNHL. This scoping review summarizes the current landscape of pharmacotherapeutics for SNHL. Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A literature search of PubMed, Google Scholar, Embase, Scopus, and Web of Science was conducted in 2024 using keywords related to SNHL and pharmacotherapeutics. A review protocol was preregistered on the Open Science Framework. A systematic search of five electronic databases identified published studies from 2004 to 2024 on pharmacological treatments for SNHL in human participants, as well as ongoing clinical trials. Interventions were categorized by mechanism of action: antioxidant therapy, steroid-based combination therapy, hematologic-based therapy, pathway modulator therapy, regenerative therapy, and gene therapy. A narrative synthesis approach was used to map key trends across treatment types, study designs, and outcomes. Results: Sixty-six records met the inclusion criteria, including 48 published studies and 18 ongoing or recently completed clinical trial records. Antioxidants, corticosteroids, hematologic agents, and pathway modulators have demonstrated potential in preventing or treating SNHL caused by cisplatin, aminoglycosides, noise-induced ototoxicity, and intraoperative cochlear implantation trauma. Emerging regenerative and gene therapies show promise as future pharmacologic treatment options. Conclusions: Pharmacologic therapies for SNHL are promising but remain constrained by small sample sizes, heterogeneous study designs, and drug delivery challenges across the blood–labyrinth barrier. Future research should prioritize multicenter randomized trials, optimized delivery strategies, and integration of precision medicine approaches.

Audiology Research doi: 10.3390/audiolres16030090

Authors: Mitra Britton Peter A. Hosick

Background/Objectives: Tinnitus is a prevalent auditory condition associated with significant psychological burden and limited treatment efficacy. While physical activity confers broad health benefits, its relationship with tinnitus remains understudied. This study examined associations between domain-specific physical activity and tinnitus in a nationally representative sample of U.S. adults. Methods: Data from NHANES 2015–2018 were analyzed. The final analytic sample comprised 4301 adults aged 20 years and older. Tinnitus was assessed via the NHANES audiometry questionnaire. Physical activity was categorized as low, moderate, and high (MET-min/week) separately for work-related (WORK) and non-work-related (NW) domains. Survey-weighted multivariable logistic regression models, adjusted for age, sex, race, BMI, poverty–income ratio, sedentary time, smoking, education, noise exposure, hypertension, diabetes, and depressive symptoms, were used to examine associations. Linear trends across ordered physical activity categories were evaluated using ordinal trend analyses. Results: The weighted prevalence of tinnitus was 17.3%. High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488–0.995, p = 0.0475), while high WORK PA was associated with significantly higher odds (OR = 1.30, 95% CI: 1.06–1.60, p = 0.018). Trend analyses confirmed opposing linear trends across ordered categories: inverse for NW PA (OR = 0.83 per category, p-trend = 0.0406) and positive for WORK PA (OR = 1.14 per category, p-trend = 0.017). Noise exposure and depressive symptoms were independently associated with tinnitus across both models. Conclusions: These findings suggest a domain-specific paradox: NW PA was associated with lower odds of tinnitus, whereas WORK PA was associated with higher odds. These results highlight the importance of domain-specific assessment and identify recreational activity as a potential modifiable factor warranting further investigation. Given the cross-sectional design, these associations should not be interpreted as causal.

Audiology Research doi: 10.3390/audiolres16030089

Authors: Guangwei Zhou Kaitlyn Butler

Background/Objectives: Auditory neuropathy spectrum disorder (ANSD) is a well-established hearing disorder in the pediatric population and is estimated to account for at least 10% of children with sensorineural hearing loss. Compared to auditory function, vestibular function in children with ANSD has not been well described in the past. The purpose of this study is to examine vestibular testing results in children with ANSD and to better characterize vestibular dysfunction in these children. Methods: A retrospective review of vestibular laboratory testing results was conducted in pediatric patients diagnosed with ANSD. Vestibular evaluation included vestibular evoked myogenic potential (VEMP), rotary chair test, video head impulse test (vHIT), and videonystagmography (VNG). Results: A total of 30 pediatric patients with ANSD were identified, including 18 boys and 12 girls, with a mean age of 4.5 years. Bilateral ANSD was found in 24 cases, while 6 cases were unilateral. Etiologies of ANSD included a history of hyperbilirubinemia in infancy, cochlear nerve dysplasia, genetic-related conditions, etc. Vestibular dysfunction was found in 12 cases, as indicated by at least one abnormal outcome in VEMP, vHIT, or rotary chair testing. Nineteen children were cochlear implant candidates and eventually underwent unilateral or bilateral implantation. Conclusions: Vestibular dysfunction is significant in pediatric patients with ANSD, and vestibular outcomes appear to be related to underlying etiologies. Formal vestibular evaluation is necessary to identify such vestibular losses, and these findings will be helpful to guide clinical management and rehabilitation strategies for these children.

Audiology Research doi: 10.3390/audiolres16030088

Authors: Luigi Falchetta Alfonso Scarpa Mario Carucci Matteo Calvanese Luisa Savignano Antonella Bisogno Carla De Santis Arianna Montanino Caterina Criscuoli Francesco Antonio Salzano

Background: Hearing loss is highly prevalent among older adults and represents a growing public health burden. Increasing attention has been given to the associations between hearing loss, cognitive decline, and dementia risk. Cochlear implantation is an established intervention for adults with severe-to-profound sensorineural hearing loss who obtain limited benefit from conventional amplification, but its potential cognitive effects remain debated. Objective: This narrative review summarizes current evidence on cognitive outcomes after cochlear implantation in adults and older adults, with particular attention to cognitive domains, long-term trajectories, methodological limitations, and clinical implications. Main findings: Available evidence suggests that cochlear implantation may be associated with improvement or stabilization of selected cognitive domains, particularly attention, executive function, working memory, and memory. However, findings are heterogeneous across studies, cognitive tools, and follow-up durations. Prospective longitudinal studies using hearing-adapted or visually presented cognitive batteries support the possibility of postoperative cognitive benefit, but the magnitude and durability of this effect vary between individuals and domains. Long-term studies suggest that cognitive improvement may be strongest during the first postoperative years and may later stabilize or attenuate, whereas auditory and quality-of-life benefits appear more consistently sustained. Conclusions: Cochlear implantation should be regarded as an established hearing rehabilitation strategy with robust benefits for auditory performance and quality of life, and as a potentially cognition-supportive intervention in selected older adults with severe-to-profound hearing loss. Current evidence does not yet prove that cochlear implantation prevents dementia. Future studies should use standardized hearing-adapted cognitive protocols, longer follow-up, adequate comparison groups, and clinically meaningful cognitive endpoints.

Audiology Research doi: 10.3390/audiolres16030087

Authors: Gudambe Nellithaya Spoorthi Usha Shastri Kaushlendra Kumar Mohan Kumar Kalaiah

Background/Objectives: The present study aimed to verify the importance of different components of aural rehabilitation and evaluate their relevance and acceptability among the Kannada-speaking population in India. This evaluation is intended to inform the development of a tailored aural rehabilitation module for this population. Methods: A thorough literature review was conducted to gain insights into the components of aural rehabilitation in the Western context. The insights gathered from this review served as foundational information for a focus group discussion. The focus group discussion consisted of 15 participants, including audiologists, adults with hearing loss, and their significant others. The data were transcribed and analyzed using inductive thematic analysis. Results: The audiologists in our study confirmed that the components of aural rehabilitation presented in the literature are essential, including sensory management, informational counseling, perceptual training, and personal adjustment counseling. Perspectives of significant others are the highlight of this study as they are less explored in the context of aural rehabilitation in India. Other themes identified from the FGDs included the involvement of family, the impact of hearing loss, awareness of various management options, and challenges/barriers related to aural rehabilitation. Furthermore, most of the adults with hearing loss and their significant others primarily viewed hearing aids as the sole solution. Conclusions: This study highlights the importance of a comprehensive aural rehabilitation program for adults with hearing loss and their significant others in the Kannada speaking population. It emphasizes the importance of informational counseling, communication strategies, and psychosocial support. Involving significant others might foster understanding and support, aiding in the acceptance of hearing loss and its rehabilitation, ultimately improving everyday communication and addressing functional challenges.

Audiology Research doi: 10.3390/audiolres16030086

Authors: Akmaral Izbassarova Assel Imangaliyeva Vigen Bakhshinyan Rimma Suatbayeva Zilola Mavlyanova Assel Izbassarova Murat Auyelbayev Kanat Kumar Aizhan Aidaralieva

Background/Objectives: Hearing loss is a leading cause of disability worldwide, with speech perception representing a key functional outcome of auditory rehabilitation. While hearing aids improve audibility, outcomes vary substantially across clinical subgroups. This study aimed to compare speech perception outcomes after hearing aid fitting in adults with conductive and sensorineural hearing loss and to identify determinants of variability in rehabilitation outcomes. Methods: This prospective longitudinal observational study included 250 adults with clinically confirmed bilateral conductive or sensorineural hearing loss who underwent standardized audiological assessment, bilateral hearing-aid fitting, immediate post-fitting evaluation, and 3-month follow-up in Kazakhstan between January 2023 and December 2024. Participants were classified as having conductive (n = 100) or sensorineural hearing loss (n = 150) based on audiometric criteria. Speech perception was assessed using a Kazakh-language open-set speech audiometry test. Multivariable linear regression models were used to estimate differences in 3-month aided speech perception after adjustment for the corresponding immediate post-fitting aided score and prespecified demographic, clinical, and audiometric covariates. Linear mixed-effects models were used separately to assess change in aided speech perception from immediate post-fitting to 3 months and to test whether this change differed by hearing-loss type. Propensity score matching was performed as a secondary sensitivity analysis. Results: Patients with conductive hearing loss demonstrated consistently higher speech perception scores than those with sensorineural hearing loss across all conditions. At 3 months, adjusted analyses showed no significant difference between groups for aided speech perception in quiet at 60 dB SPL, whereas sensorineural hearing loss remained associated with lower aided speech perception in noise at 60 dB SPL with SNR +3 dB (β = −1.73; 95% CI: −3.10 to −0.36; p = 0.014). In mixed-effects models assessing repeated aided scores from immediate post-fitting to 3 months, sensorineural hearing loss was associated with lower overall aided speech perception in both quiet and noise conditions. A modest improvement over time was observed only for speech perception in noise, and the group-by-time interaction was not statistically significant. Increasing age, higher tonal thresholds, advanced hearing loss stage, and living alone were independently associated with poorer outcomes. Conclusions: Aided speech perception scores were high after hearing-aid fitting in both conductive and sensorineural hearing loss; however, patients with sensorineural hearing loss showed persistently poorer outcomes, particularly in noise. These findings highlight the importance of incorporating speech-in-noise assessment and addressing clinical and social determinants to support hearing rehabilitation.

Audiology Research doi: 10.3390/audiolres16030085

Authors: Tomáš Mimra Martin Augustynek Marek Penhaker Lukáš Klein

Additional Affiliation [...]

Audiology Research doi: 10.3390/audiolres16030084

Authors: Amina Asif Siddiqui Cila Umat Farheen Naz Anis Ayesha Butt Kehkashan Kanwal

Background and Aims: Accuracy in speech perception in bilingual children is influenced by two phonological systems. This study compares phonological development in bilingual Urdu–English (UE) children with CIs with their hearing-age-matched peers with normal hearing (NH), by investigating whether bilingualism or any spectral limitations of CI impact perception of UE phonemes. Method and Procedures: Children (n = 57) aged 3; 0–6; 11 years (28 CI, 29 NH) were assessed for speech perception using a custom-designed UE Speech Perception Test (UE-SPT), in quiet and noise (+5 dB SNR). Responses were analysed using confusion matrices, across phonological parameters of place, manner, and voicing to determine error patterns. Outcomes and Results: Significant deficits in CI children were found across all features, with voicing discrimination showing the largest errors (effect sizes d > 6), exacerbated by noise, especially for Urdu aspirated stops. CIs mastered only 8.3% Urdu-aspirated consonants at 6; 11 years compared to 91.7% mastered by NH peers, indicating critical language-specific vulnerabilities. Backing and substitutions errors were particularly seen in CI’s speech, whilst manner was preserved. Conclusion and Implications: UE bilingual phonological complexity compounded by inadequate speech processing abilities in CIs challenges them, underscoring urgent need for targeted speech therapy interventions focusing voicing contrasts and aspirated consonants, as well as environmental accommodations that reduce noise interference and enhance listening through CI, to optimise educational outcomes. This research contributes vital clinical guidance for supporting bilingual children with cochlear implants, addressing both environmental, technological and linguistic challenges.

Audiology Research doi: 10.3390/audiolres16030083

Authors: Kadriye Guney Ozlem Topcu Patrizia Mancini Hilal Dincer D’Alessandro

Background/Objectives: This study investigated auditory perception and psychosocial well-being in long-term cochlear implant (CI) users, with a particular focus on the effects of auditory (re)habilitation on learned helplessness and speech-in-noise perception, representing everyday listening performance. Methods: Thirty CI users and thirty peers with typical hearing (TH) participated in the study. Speech perception was assessed using the Hearing in Noise Test (HINT) and the Matrix Test in both quiet and noisy listening conditions. Psychosocial status was evaluated using the Learned Helplessness Scale (LHS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Perceived hearing quality was evaluated using the Hearing Implant Sound Quality Index (HISQUI). Results: CI users showed significantly poorer speech perception performance than TH participants (p < 0.05), whereas between-group psychosocial outcomes, including LHS, BDI, and BAI scores, did not differ significantly (p > 0.05). Positive correlations were observed between Matrix and HINT scores in quiet and noisy conditions. Positive associations were also observed between CI hearing thresholds and HINT/Matrix results in noisy conditions. Within the prelingually deaf CI subgroup, age at implantation was correlated with CI thresholds, as well as with speech perception performance across both tests (p < 0.05). Conclusions: Although CI users showed significantly poorer speech perception performance, their levels of learned helplessness, depression, and anxiety were comparable to those of their TH peers. These results suggest auditory benefits following long-term CI rehabilitation, while psychosocial status appears to be within a typical range despite persistent listening difficulties in daily life.

Audiology Research doi: 10.3390/audiolres16030082

Authors: Raisa Chowdhury Angelina Tohme Daniel Lelli Darren Tse

Background/Objectives: Vestibular migraine is a common but often underrecognized cause of dizziness in otolaryngology practice. Although awareness has increased, variation in clinician training and management may contribute to inconsistent care. This study evaluated current diagnostic and treatment practices of Canadian otolaryngologists for vestibular migraine, including familiarity with diagnostic criteria, therapeutic approaches, perceived barriers, and educational needs. Methods: A national cross-sectional electronic survey was distributed to practicing and emeritus members of the Canadian Society of Otolaryngology–Head and Neck Surgery from February to April 2025. The 14-item survey assessed demographics, clinical exposure to dizzy patients, residency training, diagnostic familiarity, treatment patterns, referral practices, barriers to care, and preferred educational resources. Responses were anonymized and analyzed using descriptive statistics. Results: Forty-four otolaryngologists completed the survey (response rate: 7.4%). Most respondents reported being very familiar (59.1%) or moderately familiar (38.6%) with vestibular migraine diagnostic criteria, and 97.7% reported currently diagnosing and/or treating these patients. However, only 15.9% had received extensive residency training specific to migraine or vestibular migraine. Common treatments included lifestyle and dietary modification (90.9%), nutraceutical supplements (59.1%), tricyclic antidepressants (54.5%), and analgesics (52.3%). Vestibular rehabilitation therapy (29.5%) and calcitonin gene-related peptide-targeted therapies (<10%) were used less frequently. Major barriers were clinical time constraints (65.9%), lack of training or knowledge (54.5%), and diagnostic complexity (47.7%). Clinical guidelines (70.5%) and continuing medical education courses (65.9%) were identified as the most valuable supports. Conclusions: Among surveyed Canadian otolaryngologists engaged in dizziness and vestibular migraine care, substantial heterogeneity existed in training and management practices. Standardized guidance, enhanced education, and interdisciplinary collaboration may improve consistency of care and patient outcomes.

Audiology Research doi: 10.3390/audiolres16030081

Authors: Anna Morgan Paolo Gasparini Giorgia Girotto

Presbycusis, or age-related hearing loss (ARHL), is a multifactorial disorder characterized by a gradual, bilateral sensorineural decline in hearing sensitivity, predominantly affecting high-frequency sounds. It is one of the most common chronic conditions in the aging population and represents a major public health concern due to its high prevalence and progressive nature. Presbycusis significantly impairs speech perception, especially in noisy environments, leading to communication difficulties, reduced social participation, increased risk of social isolation, and a decline in quality of life. Moreover, growing evidence highlights a strong association between ARHL and cognitive impairment, dementia, depression, and increased frailty in older adults. The etiology of presbycusis is complex and involves the interplay between genetic predisposition and cumulative environmental and lifestyle-related factors. Genetic susceptibility influences cochlear aging, neural degeneration, and vulnerability to external insults. Non-genetic contributors include chronic noise exposure, cardiovascular and metabolic disorders such as diabetes and dyslipidemia, ototoxic medications, smoking, and other lifestyle factors that may accelerate cochlear damage through oxidative stress and microvascular dysfunction. This narrative review aims to provide an updated overview of the genetic and environmental determinants involved in the development and progression of presbycusis. Furthermore, it discusses the clinical implications of these factors for early identification, audiological evaluation, prevention strategies, and personalized management approaches. A better understanding of the multifactorial nature of presbycusis may support the development of targeted interventions to preserve hearing function and improve overall health outcomes in the aging population.

Audiology Research doi: 10.3390/audiolres16030080

Authors: Isil Cakmak Karaer Erdinc Sarıdogan

Background/Objectives: Pregnancy involves significant hormonal, cardiovascular, and physiological shifts that may potentially affect the vestibular system. The utricle and saccule, the two primary otolith organs, are responsible for detecting linear acceleration and maintaining equilibrium. This study aims to objectively evaluate the functional status of these organs throughout the three trimesters of pregnancy using Vestibular Evoked Myogenic Potentials (VEMPs). Methods: A prospective cross-sectional study was conducted with 64 healthy primigravida women (mean age 29.4 ± 2.3 years). Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests were performed at three distinct time points: the first (8–9 weeks), second (20–21 weeks), and third (33–34 weeks) trimesters. Latencies (p13 and n23 for cVEMP; n10 and p15 for oVEMP) and peak-to-peak amplitudes were recorded and statistically compared across trimesters. Results: No statistically significant differences were found in cVEMP p13 and n23 latencies or amplitudes across the three trimesters (p > 0.05). Similarly, oVEMP p15 latencies and amplitudes remained stable throughout the pregnancy (p = 0.43 and p = 0.95, respectively). While a slight numerical increase in certain latencies was observed in the third trimester, and the oVEMP n10 latency was found to be consistently prolonged compared to non-pregnant norms, these values remained stable between trimesters. The inter-aural asymmetry showed no significant deviations, indicating a balanced vestibular adaptation. Conclusions: The functional integrity of the saccule and utricle is preserved during a healthy pregnancy. Despite the dramatic increase in gestational hormones such as estrogen and progesterone, the otolith-dependent reflex pathways (vestibulocollic and vestibulo-ocular) remain resilient. These results provide a clinical baseline for evaluating vestibular symptoms in pregnant populations, suggesting that significant VEMP abnormalities should prompt investigation into underlying vestibular pathologies rather than being attributed to normal pregnancy changes.

Audiology Research doi: 10.3390/audiolres16030079

Authors: Augusto Pietro Casani Nicola Ducci Luigi Califano Mauro Gufoni

Background: Vestibular migraine (VM) is a common cause of episodic vertigo, yet its diagnosis remains primarily clinical and is often complicated by the absence of reliable objective biomarkers. Pupillary nystagmus, reflecting spontaneous oscillations of pupil diameter, has been proposed as a potential clinical sign of VM, but its quantitative characterization remains limited. Objective: The objective of this study is to evaluate the diagnostic value of pupillary nystagmus in VM and to provide a quantitative assessment using infrared pupillometry. Methods: In this case–control study, 137 patients with vestibular migraine and 102 healthy controls underwent comprehensive neuro-otological evaluation, including vestibular testing and pupillometric assessment. Pupillary activity was recorded using a dedicated infrared pupillometer, and oscillatory dynamics were quantified using the Pupillary Unrest Activity Level (PUAL), which was derived through spectral analysis (Larson–Neice algorithm). Statistical comparisons were performed using non-parametric methods. Results: PUAL values differed significantly between VM patients and controls (Mann–Whitney test p < 0.001), demonstrating a clear separation between groups. A cut-off value of 0.325 was identified as the upper limit of normality, suggesting that elevated PUAL values may indicate vestibular migraine. Conclusions: Pupillary nystagmus represents a clinically accessible sign that can be objectively quantified through infrared pupillometry. The PUAL index provides a measurable parameter reflecting altered vestibulo–autonomic dynamics in VM and may serve as a promising neuro-otological biomarker. The integration of pupillometric analysis with clinical evaluation may improve diagnostic accuracy and support the development of objective diagnostic tools in vestibular migraine.

Audiology Research doi: 10.3390/audiolres16030078

Authors: András Molnár Panayiota Mavrogeni Stefani Maihoub

Objectives: This study aimed to analyse the effects of educational levels, sex, and residence on tinnitus-related distress, as well as the severity of depression and anxiety. Material and methods: A total of 235 patients with primary subjective tinnitus participated in the study. These patients underwent thorough evaluations in otorhinolaryngology and audiology. Additionally, all patients completed the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and the Generalised Anxiety Disorder-7 (GAD-7) questionnaires. Results: Patients with a primary school education scored significantly higher on the functional (F) subscale of the THI. When examining depression and anxiety levels, it was observed that patients with a primary school education exhibited the highest levels of anxiety, whereas those with a university education displayed the highest levels of depression. When analysing the effects of residency, slightly lower total THI scores were observed in individuals living in metropolitan areas. When comparing the subscale results of the THI, patients residing in metropolitan areas exhibited significantly lower scores on the F subscale. In terms of the total BDI and GAD-7 scores, there were no statistically significant differences observed. Women had slightly higher scores on the BDI and GAD-7, without statistical differences. However, women had significantly higher total THI scores. Additionally, women exhibited statistically significantly higher scores on the catastrophic (C) subscale. However, the results for the F and emotional (E) subscales did not show any statistically significant differences. There was no correlation between age and the THI, BDI, or GAD-7 scores. Conclusions: The results of this study reveal significant differences in tinnitus distress based on sex, educational levels, and residence locations, along with the presence of psychiatric symptoms, which should also be considered in tinnitus management.

Audiology Research doi: 10.3390/audiolres16030077

Authors: Hailey A. Kingsbury Sarah E. Kingsbury Michael J. Cevette Jan Stepanek Edwar Habr Hussein Itawi Gaurav N. Pradhan

Background/Objectives: Hearing loss is frequently misunderstood by communication partners and healthcare providers of patients with hearing loss alike, leading to gaps in counseling, medical adherence, and empathy. Hearing loss simulation is a technique that can clarify patient experience by illustrating how hearing loss affects daily listening and speech discrimination. The current research explores the influences of a web-based hearing loss simulator on how hearing loss is understood by communication partners, audiologists, and medical providers/students. Methods: Using a convergent parallel mixed-methods design, 72 participants (communication partners, audiologists, and medical providers/residents) completed a guided trial with the hearing simulator, either one-on-one or in group settings, and subsequently completed a questionnaire regarding their experiences. The simulation trial included demonstrations of hearing loss and amplification across four listening environments: speech in quiet, in noise, at a distance, as well as listening to instrumental music. Results: Communication partners reported that they gained a better understanding of their partner’s hearing loss, with all expressing increased feelings of empathy towards their partner and individuals with hearing loss. When compared to audiologists, communication partners were significantly more surprised by the impact of hearing loss on speech understanding. Medical providers and students emphasized the value of the simulator as a counseling tool and highly recommended that other providers use the simulator with their patients. Conclusions: Simulating hearing loss can be beneficial for counseling purposes and medical training. These findings suggest that hearing loss simulation can enhance empathy and communication across clinical and educational contexts.

Audiology Research doi: 10.3390/audiolres16030076

Authors: Wenyue Xue Nolan Sun Emily Wood Jason Xie Xiuping Liu Jun Yan

Background: Prolonged exposure to moderate and loud noise is known to impair hearing; however, the safety of long-duration exposure to low-level sound, such as that encountered during everyday conversation, remains unclear. This study aimed to determine the effect of continuous exposure to sound at a 65 dB sound pressure level (SPL) on auditory processing. Methods: Auditory brainstem responses (ABRs) were recorded in C57BL/6 mice before and after a 1 h exposure to a continuous pure tone at 65 dB SPL. Changes in ABR thresholds, wave amplitudes, and latencies were analyzed across frequencies and time points. Correlations between amplitude and latency changes across ABR waves were also assessed. Results: Tone exposure induced a significant, frequency-specific increase in ABR thresholds, with a mean elevation of approximately 6 dB and a maximum shift of 15 dB. Significant reductions in amplitudes and prolongations of latencies were observed in Waves I–III, while Wave V amplitude remained relatively stable. A strong negative correlation between amplitude reduction and latency increase was found in Wave I, which progressively weakened from Wave II to Wave V. These functional changes persisted for up to three hours following exposure before gradually returning to baseline. Conclusions: Prolonged exposure to low-level sound at intensities typical of conversational speech can transiently impair auditory function and alter early neural processing in the auditory pathway. These findings suggest that sound levels commonly considered safe may still pose a risk when exposure is sustained, with implications for understanding hidden hearing loss and improving early diagnostic approaches.

Audiology Research doi: 10.3390/audiolres16030075

Authors: Abigail Anne Kressner Kirsten Maria Jensen-Rico Anja Kofoed Pedersen Lars Bramsløw Brent Kirkwood

Background/Objectives: This study describes the development and validation of the Danish Sentence Test (DAST), a Danish-language, adaptive speech-in-noise test constructed from a linguistically balanced corpus using a template-based method. This approach enables controlled linguistic variation while maintaining lexical consistency and may serve as a model for developing similar speech materials in other languages. Methods: Sentences spoken by one female talker from the DAST corpus were sorted into 44 balanced lists of 20 sentences using a psychometric optimization procedure. Speech reception thresholds (SRTs) were measured in 20 normal-hearing participants using headphone playback with speech-shaped noise. Results: Across the 44 sentence lists, the mean SRT was −5.3 dB SNR, with list means within ±0.5 dB of the grand average under the tested configuration. The average within-subject standard deviation was 0.7 dB, and the grand-average psychometric slope was 18.5%/dB. A statistically significant within-session training effect of approximately 0.02 dB per measurement. Conclusions: This study provides normative speech reception threshold (SRT) data for the adaptive Danish Sentence Test (DAST) in normal-hearing listeners under a defined headphone-based speech-in-noise paradigm and demonstrates that the resulting sentence lists yield comparable performance across lists. The template-based construction and optimization approach offers a framework for developing linguistically rich sentence-in-noise tests in other languages.

Audiology Research doi: 10.3390/audiolres16030074

Authors: Nienke Streefkerk Franciscus A. Diepstraten Evangeline A. Huis in ’t Veld Antoinette am Zehnhoff-Dinnesen Martine van Grotel Katrin Neumann Annelot J. M. Meijer Frédéric Amant Ross Parfitt L’udmila Verešpejová Penelope R. Brock Lisa L. Hunter Hiske W. Helleman Beth Brooks Kaukab M. Rajput Kristin Knight Marry M. van den Heuvel-Eibrink Alexander E. Hoetink

Background/Objectives: Cisplatin-exposed pediatric cancer patients are at increased risk of ototoxicity, particularly those under 5 years of age. In this group, audiological monitoring is challenging, as interpretation of otoacoustic emissions (OAEs) and tympanometry, used to supplement behavioral audiometry, is subject to interindividual variability. This study aimed to identify key challenges and establish an international consensus on optimal testing procedures and interpretation criteria for assessing early cochlear damage. Methods: Audiological data from 11 children (<5 years) exposed to cisplatin in utero were evaluated. An international panel of 10 pediatric oncology audiology experts reviewed tympanometry, transient evoked OAEs (TEOAEs), and distortion product OAEs (DPOAEs). Areas of disagreement were analyzed, and consensus was sought regarding testing conditions, interpretation, and clinical application. Results: Agreement on cochlear status was good in 10/22 ears, moderate in 3/22 ears, and poor in 9/22 ears, highlighting substantial variability in interpretation. Consensus was achieved on minimal technical and interpretative requirements for OAE testing in this population. The panel proposes a classification framework integrating OAEs and tympanometry to guide clinical follow-up. Importantly, normal OAE results were not considered sufficient to exclude ototoxic damage or mild hearing loss. Conclusions: OAEs, particularly DPOAEs, are valuable as a screening tool in ototoxicity monitoring programs for young children, provided that testing conditions and interpretation are standardized. However, OAEs alone are insufficient for definitive assessment. Longitudinal monitoring and confirmatory testing with behavioral audiometry or ABR/ASSR remain essential. Further validation of the proposed classification system is warranted.

Audiology Research doi: 10.3390/audiolres16030073

Authors: Chi Yhun Lo Valerie Looi

Background/Objectives: Spectral resolution is strongly associated with speech perception for adult cochlear implant users, but the developmental trajectory of spectral resolution in childhood is more complex and far less understood. Music-based training presents a unique opportunity to address this gap, as musical stimuli feature spectral complexity and fine frequency cues which map to spectral resolution. This study explored if a 12-week music-based intervention could support better spectral resolution in children with cochlear implants. Methods: Twelve children with cochlear implants participated in this longitudinal, repeated-measures study. The music training intervention consisted of group-based in-person music therapy and a take-home music app. Participants (six boys, six girls; M age = 7.3 years) were pseudo-randomized into an immediate training group (n = 4) or delayed-start waitlisted group (n = 8). Inclusion criteria required bilateral moderate-to-profound sensorineural hearing loss, prelingual device fitting, and consistent bilateral device use. Eight children had bilateral CIs and four were bimodal listeners. Results: Spectral resolution perception was significantly enhanced after participating in the music intervention with a mean increase of 2 rpo, F(3, 10.7) = 3.859, p = 0.017. Previous engagement with music and age were not associated with spectral resolution. Conclusions: Despite the known limitations of CIs on spectral resolution, the results of this study indicate that music training can improve spectral resolution perception in children using CIs.

Audiology Research doi: 10.3390/audiolres16030072

Authors: Neil S. Longridge Arthur I. Mallinson

Background/Objectives: In a recent article we outlined how the vestibular efferent system connects the stereo/kinociliary complex at the apex of the macular vestibular hair cells of the inner ear and coordinates movement so that planned body movements are precisely timed to coordinate with the expected otoconial movement that the body movement induces. Methods: Our present article proposes an extension of this concept with details about how a sailor develops “sea legs.” The rocking motion of a boat in rough seas requires sailors to sway in order to remain vertical. This causes fluctuation in the gravity-referenced otoconial signal. Results: As a sailor develops sea legs, it is necessary that the routine vestibular efferent system activity (based on gravity-referenced orientation on land) is disrupted as the otoconia move with this rocking process in order to re-coordinate with the new otoconial movement. As a result, the cerebral cortex must reconfigure vestibular efferent activity so that the stereo/kinociliary complex moves in conjunction with the otoconial movement. This process is carried out via the striated organelle (STO) and is one that takes several days. Those who are unfortunate and have severe motion sickness, become extremely unwell with nausea, vomiting, severe unsteadiness, and anorexia during this time. Conclusions: The present article describes how “sea legs” develop and discusses why an unpleasant symptom set can accompany it. We will also outline how a new medication, a calcitonin gene-related peptide (CGRP) inhibitor, which is presently used for the treatment of vestibular dysfunction, has been shown to suppress vestibular efferent activity and may be an effective therapy for these overly symptomatic individuals.

Audiology Research doi: 10.3390/audiolres16030071

Authors: Isil Cakmak Karaer Irem Pembegul

Background/Objectives: To determine the effect of single-dose hemodialysis treatment on the inner ear in patients with normal hearing functions using the Distortion product otoacoustic emissions (DPOAE) test. Methods: A total of twenty-four (24) patients with end-stage renal disease were included in the study. For all patients, the DPOAE test was performed immediately before hemodialysis and 3 h after hemodialysis. Both amplitude and signal-to-noise ratio (SNR) values were compared. Results: Compared to pre-dialysis values, the DPOAE test showed a statistically significant decrease in both amplitude and SNR values at all frequencies (1000, 2000, 4000 and 6000 Hz) in patients’ post-dialysis measurements. Conclusions: A single hemodialysis treatment has been found to have an adverse effect on cochlear function at both low and high frequencies.

Audiology Research doi: 10.3390/audiolres16030070

Authors: Sofia Anastasiadou Petros Karkos Jannis Constantinidis George Psillas

Background: Eustachian Tube Dysfunction (ETD) presents significant diagnostic challenges, particularly in patients with chronic nasal disease, which often mimic or complicate ETD symptoms. Tubomanometry (TMM) is emerging as an objective tool for diagnosing ETD, but its application in patients with concurrent nasal pathologies remains underexplored. Methods: One hundred patients with concurrent ETD and chronic nasal disease were recruited. They were categorized into three groups: chronic rhinitis (35 patients, group A), nasal septal deviation (31 patients, group B) and chronic rhinosinusitis with polyps (34 patients, group C). Treatments included nasal irrigation, septoplasty, and nasal polypectomy with functional endoscopic sinus surgery, respectively. The TMM parameters (R, C2 and C2–C1 scores) were assessed before and after interventions. The patient reported outcome measures (ETDQ-7 and NOSE scores) were also recorded and statistically correlated with TMM measures. Results: Group A showed improvements in R, C2 and C2–C1 scores and mild post-treatment reductions in ETDQ-7 and NOSE scores. Similar improvements were observed in Group B, with significant symptom reduction post-septoplasty, particularly on the side of the nasal septal deviation. Group C demonstrated the greatest improvement, with significant improvements in TMM values and substantial reductions in both ETDQ-7 and NOSE scores. The statistical results revealed correlations between the treatment of nasal pathologies and ETDQ-7 and NOSE scores. Conclusions: All TMM parameters improved in each group following the nasal intervention. This study highlights the utility of TMM in evaluating ETD in the context of chronic nasal disease and suggests that treating underlying nasal conditions can significantly alleviate ETD symptoms.

Audiology Research doi: 10.3390/audiolres16030069

Authors: Mohammed F. Alharbi Ahmad A. Alanazi

Background: Speech-language pathology (SLP) and audiology services are essential components of multidisciplinary rehabilitation, particularly for individuals with developmental, neurological, and communication-related disorders. National-level data describing the distribution and utilization of these services in Saudi Arabia remain limited. This study aimed to examine national patterns of rehabilitation service utilization, with a focus on SLP and audiology services in comparison to other rehabilitation specialties. Methods: A retrospective cross-sectional analysis was conducted using publicly available national open data released by the Saudi Ministry of Health (MOH). Aggregated rehabilitation service encounters (n = 1,872,328 to 1,930,695) from 2023–2024 were analyzed by specialty, geographic region, sector (MOH clusters versus private sector), and pediatric age groups. Descriptive statistics were used to characterize utilization patterns and regional variation. Results: Rehabilitation services were widely delivered across both public and private sectors, with physiotherapy representing the largest share of encounters. SLP and audiology services contributed a smaller proportion of total rehabilitation encounters compared to other specialties. Service distribution varied regionally, with higher volumes concentrated in major urban areas including Riyadh, Makkah, and the Eastern Region. Pediatric service encounters were highest in early childhood (ages 3–7), with SLP and audiology services forming a consistent component of rehabilitation during this period. Conclusions: This study provides a descriptive overview of rehabilitation service utilization in Saudi Arabia, highlighting the distribution of SLP and audiology services relative to other specialties and across regions. Findings emphasize the importance of addressing regional variation, supporting workforce development, and enhancing national rehabilitation data systems to inform planning and ensure comprehensive access to communication and hearing services.

Audiology Research doi: 10.3390/audiolres16030068

Authors: Mareike Rutenkröger Lasse Dührsen Maximilian Scheer Sandro M. Krieg Jannik Walter Andrea Baehr Bastian Baselt Alexander Huber Isabelle Scholl

Vestibular schwannomas (VSs) are benign tumors of the vestibulocochlear nerve that often cause significant neurological and functional impairment, affecting patients’ overall quality of life (QoL). While clinical assessments have traditionally focused on hearing preservation and tumor control, patients often emphasize other critical symptoms such as dizziness, pain, cognitive difficulties and satisfaction with care. Therefore, patient-centered care that addresses the full range of patient experiences is essential. Despite its importance, patient-centered care in VS remains underexplored. This study will address this gap by psychometrically validating the German version of the Vestibular Schwannoma Quality of Life (VSQOL) Index, a newly developed QoL tool that includes key patient-centered domains. The primary objective is to validate the reliability and validity of the German VSQOL Index. The secondary aim is to assess VS patients’ experience of patient-centered care and its impact on their well-being. This multicenter, cross-sectional study will involve German-speaking VS patients from several clinical centers in Germany and Switzerland as well as an online cohort. Psychometric testing of the German VSQOL will include reliability assessments (e.g., Cronbach’s alpha, test–retest reliability), confirmatory factor analysis and convergent validity. In parallel, the study will assess patient-centered experiences of care using the EPAT questionnaire. Ethical approval has been obtained and all participants will be asked to provide written informed consent. The results will be shared through scientific publications and conferences, as well as with patient groups, in order to support improvements in clinical care.

Audiology Research doi: 10.3390/audiolres16030067

Authors: Yuxuan Li Luofei Zhang Jia Chen Beibei Yang

Introduction: This study aimed to systematically assess the impact of hearing interventions on cognitive function in older adults with presbycusis. Methods: A comprehensive search was conducted across PubMed, EMBASE, and Web of Science databases from their inception to 22 June 2025 to identify eligible randomized clinical trials or cohort studies that used designated cognitive scales or cognitive test measures. Two separate meta-analyses were conducted: one using uncontrolled pre–post comparisons and another restricted to studies that included concurrent untreated control groups. Results: A total of 22 studies were identified, comprising 9 focused on hearing aid use and 13 on cochlear implantation. Ultimately, 19 studies were included in the quantitative analysis: 7 on hearing aid use and 12 on cochlear implantation. The pooled analysis of hearing intervention across 17 studies involving 1562 patients indicated a 4% improvement in cognitive test scores post-intervention compared with pre-intervention (ratio of means: 1.04; 95% CI: 1.03–1.05; p < 0.001). However, in the 4 controlled studies that included an untreated comparator group (815 intervention, 7450 control participants), hearing intervention did not confer a statistically significant cognitive benefit over no intervention (SMD = 0.03; 95% CI: −0.04 to 0.09; p = 0.369). Conclusions: Current controlled evidence does not support the claim that hearing interventions preserve or enhance cognitive function in older adults with presbycusis.

Audiology Research doi: 10.3390/audiolres16030066

Authors: Elisabeth Zangerl Franz Muigg Josef Seebacher Simone Graf Philipp Zelger

Background: This study investigates the impact of initial head position prior to stimulus presentation on sound localization accuracy in children. The quadratic angular root mean square error (RMSE) and the linear mean-absolute-error (MAE) have been considered for this study. Material and Methods: A total of 28 normal-hearing children (ages 6–10) participated in sound localization. The participants localized sounds presented from five speakers at the frontal semicircle. Head positions at stimulus onset were tracked using glasses with a built-in webcam. The localization results were analyzed with and without correcting for the offset from the frontal direction of the initial head position prior to stimulus presentation. Results: The initial head position prior to stimulus presentation significantly affected the RMSE but had no influence on the MAE. This effect was stronger in younger children. The MAE showed fewer changes in head position due to its linear nature, which reduces the effect of large errors. An analysis of the children’s initial head positions revealed a tendency to deviate from the frontal direction. Therefore, the initial head position prior to stimulus presentation should be considered when calculating localization measures. Conclusions: The initial head position prior to a stimulus can distort the RMSE in directional hearing tests for children, while the MAE remains robust against such deviations.

Audiology Research doi: 10.3390/audiolres16030065

Authors: Eva Kiktová Július Zimmermann

Background: This paper describes the development of speech materials in the Romani language intended for audiological and comprehension assessment of Romani-speaking children and adults living in Slovakia. The work responds to the documented lack of linguistic resources and test stimuli in Romani, which limits the accuracy of speech perception and comprehension testing. Method: The existing state of communication-assessment tests used in Slovakia was reviewed, and new Romani-language materials for audiology and comprehension testing were created. The work focused on developing word lists, matrix-based sentence tests, and comprehension sentences that were linguistically verified by native Romani speakers. Results: A set of Romani speech stimuli was developed, including a ten-word screening list, a 50-word illustrated set for pediatric audiometry, an adaptive matrix sentence test for advanced assessment, and a collection of comprehension sentences targeting various linguistic structures. Conclusions: The newly created Romani-language test materials address the absence of suitable diagnostic tools in Slovakia and provide culturally and linguistically appropriate resources for more accurate audiological and comprehension assessment.

Audiology Research doi: 10.3390/audiolres16030064

Authors: Anna Carolina Marques Perrella de Barros Joel Isaac Berger Richard S. Tyler

Background/Objectives: Tinnitus and reactions to the tinnitus are different dimensions that can be explored in research and in clinical settings. Notably, these dimensions can elucidate priorities and the most problematic areas for patient-centered approaches. The aim of this study is to determine how tinnitus is perceived and impacts people who have experienced tinnitus for different durations. Methods: People with tinnitus were invited to participate in a survey at the University of Iowa Tinnitus Website. 709 people responded and documented their perceived sound, problems experienced, and duration of tinnitus. We assessed correlations between the duration of tinnitus and the pitch rating, the loudness rating, and the Tinnitus Primary Function Questionnaire scores. Additionally, we performed a multiple linear regression analysis, considering the dependent variable ‘duration of tinnitus’, to explore associations between duration of tinnitus and the aforementioned factors. This was a cross-sectional study based on comparisons of responses from patients with different tinnitus durations, rather than examining the same patients longitudinally. Results: The analysis demonstrated that respondents with a longer duration of tinnitus reported higher loudness ratings (p = 0.010). However, their reactions to tinnitus (Tinnitus Primary Function Questionnaire) were associated with a decrease compared with a shorter duration of tinnitus (p = 0.048). There was no association between pitch rating and duration of tinnitus. Conclusions: Our findings indicated louder tinnitus was associated with a longer duration of tinnitus. However, in general, the functional impact of the tinnitus was associated with a decrease. Notably, there was considerable variability among individuals, suggesting that additional factors contribute to these relationships. These findings can be considered in treatment decisions and counseling strategies.

Audiology Research doi: 10.3390/audiolres16030063

Authors: Lena L. N. Wong Sin P. Lai Elaine Ng Alessandro Pasta Asterios Nastas

Objectives: This data-driven study aimed to explore the characteristics and initial hearing aid (HA) fitting parameters among older adults in Mainland China. Methods: Data were extracted from Oticon’s internal database, focusing on 82,834 older adults aged 55 or above who sought HAs for the first time. Results: Demographic details (e.g., age and gender), hearing-related data (e.g., the severity of hearing loss), and HA parameters (i.e., laterality of fitting, HA style, earpieces, gain settings, directionality settings, and noise reduction settings) were analyzed. The mean age was 71. There were more males (54.7%) than females, and the majority (78.1%) had at least moderately severe hearing loss. Bilateral fittings were common (76.6%), with receiver-in-canal (RIC) HAs being the dominant style (80%) and open fittings prevalent (44.1%). HA gain was set to below prescribed targets, along with adaptive directionality (93.4%) and low noise reduction levels (>68%). Conclusions: These findings offer insights into the Chinese hearing healthcare market. Future research should incorporate data from follow-up sessions to provide a more comprehensive understanding of the landscape, such as adjustments needed after initial fitting after first-time users have spent some time adapting to the use of HAs.

Audiology Research doi: 10.3390/audiolres16030062

Authors: Daniel Polterauer-Neuling Maike Polterauer-Neuling Peter Zoth Carmen Molenda

Background/Objectives: In addition to the clinical gold standard, tympanometry, several alternatives for middle ear diagnostics have evolved over the past decades. With the so-called pressureless acoustic impedance test, the Neuranix Medwave, another device, came into play. Methods: Using a retrospective, anonymous study design, descriptive data were reported, and the correlation between Medwave’s results and tympanometry types was evaluated. Also, the correlation between the patients’ age and the Medwave resulting parameters was evaluated. We were able to show changes in the measurement results over time in the case of paracentesis and tube insertion. Results: The analyzed data show that it is possible to differentiate between tympanometry result type A and type B using the Medwave resulting parameter resonance frequency (“fR”), but not when using peak admittance (“P”). Between all other types, it was not possible to differentiate using the Medwave resulting parameters, nor fR nor P. Due to the low statistical power, this may be due to a type II error. Regarding age, a correlation was found only for the tympanometry result type A. The case over time showed a clear difference in the affected ear between the time before and after the ear surgeries, as well as the contralateral healthy ear. Conclusions: While this study indicates the potential use of the PLAI technology, especially as a tool in situations where traditional tympanometry is not feasible, the results need to be interpreted with caution. Further validation with larger and more balanced groups of participants is necessary to confirm these initial findings and to more clearly define the clinical utility of this technology.

Audiology Research doi: 10.3390/audiolres16020061

Authors: Giovanni Motta Giuseppe Tortoriello Domenico Testa

Background: Age-related hearing loss (ARHL) is the most common sensory disorder in older adults and has been identified as a potentially modifiable risk factor for cognitive decline and dementia. Increasing evidence suggests that auditory dysfunction may contribute to adverse cognitive trajectories through multiple interacting pathways. This narrative review examines the mechanisms underlying the association between ARHL and cognitive decline, evaluates the impact of hearing rehabilitation, and discusses future research priorities. Methods: A narrative synthesis of epidemiological, neurobiological, and interventional studies was conducted, with emphasis on longitudinal cohort studies, neuroimaging research, and clinical investigations of hearing aids (HAs) and cochlear implants (CIs). Results: ARHL is consistently associated with accelerated cognitive decline and increased dementia risk. Proposed mechanisms include sensory deprivation-related cortical reorganization, increased cognitive load during effortful listening, shared neuropathological processes, and social disengagement. Neuroimaging studies demonstrate structural and functional alterations in auditory and associative brain regions in individuals with hearing loss. Emerging evidence suggests that HA and CI may improve cognitive performance and potentially attenuate decline, although long-term randomized data remain limited. Conclusions: Current evidence supports ARHL as a clinically relevant and potentially modifiable contributor to cognitive decline. Clarifying causal pathways and optimizing early hearing rehabilitation strategies represent key priorities for future dementia prevention research.

Audiology Research doi: 10.3390/audiolres16020060

Authors: Nirmal Srinivasan Sadie O’Neill Chhayakanta Patro

Background/Objectives: Phonemic restoration refers to improved speech understanding when periodic silent interruptions are replaced by a plausible masking sound, reflecting an interaction between perceptual continuity and top-down linguistic inference. This study tested whether the magnitude and rate dependence of phonemic restoration vary systematically with stimulus complexity, operationalized using speech materials that differ in response constraints and linguistic variability. Methods: Young adults with normal audiometric thresholds completed an interrupted-speech identification task using five corpora spanning closed-set and open-set speech corpora. Stimuli were periodically interrupted at 2 Hz and 3 Hz with a 50% duty cycle. For each corpus and rate, interruption intervals were either left silent or filled with speech-shaped noise. Results: Closed-set materials yielded higher intelligibility than open-set materials across conditions. Replacing silent gaps with speech-shaped noise improved intelligibility for all corpora. Importantly, the joint influence of interruption rate and gap-filler depended on the stimulus type: rate-by-filler interactions were most evident for the open-set corpora as compared to the closed-set corpora. Keyword identification varied systematically with word position for the open-set materials, indicating nonuniform vulnerability across sentence structures. Conclusions: These results indicate that phonemic restoration is robust but material-dependent. Stimulus complexity shapes how temporal sampling and masking plausibility combine to support perceptual repair, and open-set, high-variability materials are particularly sensitive to these interactions.

Audiology Research doi: 10.3390/audiolres16020059

Authors: Dekun Gao Jianyong Chen Feng Li Yao Chen

Objective: This study aims to analyze the characteristics of vestibular evoked myogenic potentials (VEMPs) and evaluate specific vestibular nerve pathway impairments in children with Attention Deficit Hyperactivity Disorder (ADHD) compared to typically developing (TD) children. Methods: Forty-five children with ADHD and 34 TD children were recruited. All participants underwent comprehensive acoustic (ACS) and galvanic (GVS) VEMP examinations. To account for within-subject correlation, statistical analyses were performed at the subject level. Results: Children with ADHD exhibited prolonged P13 and N23 latencies in both ACS-cVEMP and GVS-cVEMP compared to TD children. For oVEMP, the N1 latency of ACS-oVEMP was significantly shorter in the ADHD group, and the interval was prolonged. Additionally, the absolute amplitude of ACS-cVEMP was significantly and markedly higher in children with ADHD. Conclusions: Children with ADHD exhibit functional abnormalities in both the saccule inferior vestibular nerve pathway (reflected by cVEMP) and the utricle superior vestibular nerve pathway (reflected by oVEMP). These impairments are primarily characterized by altered neural conduction latencies and hyperactive amplitude responses, providing valuable electrophysiological insights into vestibular dysfunction in ADHD.

Audiology Research doi: 10.3390/audiolres16020058

Authors: Giacinto Asprella-Libonati Fernanda Asprella-Libonati Marco Familiari Vito Rizzi Camilla Gallipoli Margherita Laguardia Giuseppe Gagliardi Anna Guida Giuseppe Lapacciana Luca Colella Giada Cavallaro

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo and is diagnosed clinically, yet many patients initially present in primary care. Early identification may optimize referral and management. Objective: To perform a pilot Phase 1 validation of the Benign Paroxysmal Positional Vertigo Screening Questionnaire (BPPV-SQ), a brief screening questionnaire designed for future use in general practice (primary care settings where patients are initially evaluated by general practitioners), assessing its ability to identify BPPV, suggest canal involvement, and support progression to Phase 2 validation. Methods: In this prospective observational study, 108 patients with positional vertigo and no neurological signs were evaluated in a specialist setting. The 7-item dichotomous questionnaire (score 0–3 for diagnostic core) was administered prior to bedside examination, which served as the reference standard. Results: Higher questionnaire scores were associated with an increased probability of confirmed BPPV. Among patients with the maximum score of 3, BPPV was confirmed in 73.5% of cases, with a lateralization concordance of 69.4% between questionnaire responses and specialist diagnosis. In contrast, lower scores (0–1) were associated with a markedly lower rate of confirmed BPPV (14.3%). Conclusions: In this pilot Phase 1 validation, the BPPV-SQ demonstrated score-dependent diagnostic reliability and acceptable lateralization agreement in high-score patients, supporting progression to Phase 2 validation in primary care.

Audiology Research doi: 10.3390/audiolres16020057

Authors: Andrea Migliorelli Marianna Manuelli Chiara Visentin Chiara Bianchini Francesco Stomeo Stefano Pelucchi Nicola Prodi Andrea Ciorba

Background/Objectives: The objective of this scoping review was to map and critically describe emerging speech-in-noise assessment tools developed over the last decade for the evaluation of hearing loss beyond conventional audiological measures. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive literature search was performed in the PubMed/MEDLINE, Scopus, and Embase databases. A comprehensive review of studies describing novel or emerging SIN-based assessment tools was conducted, with a particular emphasis on those including adult participants with normal hearing and hearing loss. Results: Nine studies met the inclusion criteria and were included in the review. The identified tools cover a range of methodological innovations, including advanced digits-in-noise paradigms, antiphasic and binaural presentation modes, optimized adaptive procedures, and digital or automated testing platforms. Several studies also incorporated artificial intelligence-based approaches, such as machine learning, text-to-speech, and automatic speech recognition, to enhance test development, administration, and hearing loss classification. Across all studies, SIN measures demonstrated the ability to reliably differentiate between normal hearing listeners and individuals with hearing loss and to provide complementary information beyond pure-tone audiometry. Conclusions: Emerging speech-in-noise tools show considerable potential to improve the functional assessment of hearing loss and to support more sensitive, accessible, and scalable approaches for hearing evaluation. Further research is required to assess their clinical integration and long-term impact on hearing screening and diagnostic pathways.

Audiology Research doi: 10.3390/audiolres16020056

Authors: Toshihito Sahara Yujiro Hoshi Anjin Mori Hajime Koyama Yasuhiro Osaki Waki Nakajima Takeshi Fujita Akinori Kashio Katsumi Doi

Background/Objectives: Frequency-to-place mismatch between cochlear implant (CI) electrodes and cochlear tonotopy has been suggested to affect postoperative speech perception. This study aimed to examine the associations between frequency-to-place mismatch and speech perception outcomes across multiple linguistic levels in patients with CI and to assess how these associations change over time using postoperative computed tomography. Methods: This retrospective cohort study included 44 postlingually deafened adults who underwent unilateral cochlear implantation with a Flex28 electrode by a single surgeon at a tertiary care hospital. Speech perception was assessed using CI-2004, a Japanese speech perception test consisting of monosyllables, consonants, words, and sentences, in quiet settings at 3, 6, and 12 months after CI activation. Partial correlation analyses between frequency-to-place mismatch and postoperative speech perception scores were performed in 35 of the 44 patients, controlling for age and mean preoperative pure-tone thresholds. Results: Negative associations were observed between frequency-to-place mismatch and CI-2004 scores, particularly for monosyllable and consonant perception in uncorrected analyses. After correction for multiple comparisons, only consonant perception at 3 months after CI activation remained significant (r = −0.52, p = 0.002). Similar patterns were observed for other speech measures and at later time points, although these did not remain significant after correction. Conclusions: Frequency-to-place mismatch was associated with postoperative speech perception outcomes, particularly those involving phoneme-level recognition. After correction for multiple comparisons, only consonant perception at 3 months after CI activation remained significant.

Audiology Research doi: 10.3390/audiolres16020055

Authors: Seeon Kim Linda Thibodeau

Background: The recent U.S. Food and Drug Administration authorization of AirPods Pro as over-the-counter hearing aids (HAs) has increased interest in consumer devices as potential alternatives to traditional amplification; however, their electroacoustic performance relative to clinically fitted HAs remains unclear. The purpose of this study was to compare the electroacoustic characteristics and real-ear measures of AirPods Pro 2nd generation (APP2), AirPods Pro 3rd generation (APP3), and a traditional receiver-in-the-canal HA across mild flat, mild-to-moderate sloping, and moderate flat hearing loss configurations. Methods: Outcome measures included 2cc coupler output curves, saturation sound pressure level for a 90 dB input (SSPL90), real-ear speech mapping, maximum power output (MPO), and real-ear-to-coupler differences. Results: Coupler-based electroacoustic measures showed that APP2 and APP3 produced output comparable to the traditional HA (within 7 dB). SSPL90 outputs were similar for APP2 and APP3, whereas the HA demonstrated profile-dependent increases. In contrast, real-ear measurements demonstrated that both APP2 and APP3 consistently produced less output relative to the HA that was fitted to NAL-NL2 targets, with the largest deviations observed for moderate hearing loss and at higher frequencies (up to 14 dB). Across all configurations, MPO was consistently highest for the HA, with both AirPods devices exhibiting reduced maximum output, especially in speech-critical frequency regions. Real-ear-to-coupler difference findings indicated reduced acoustic coupling for APP3 relative to APP2 and the HA, contributing to reduced in-ear amplification despite comparable coupler outputs. Conclusions: While AirPods Pro may offer benefit for mild hearing loss or moderate high-frequency hearing loss, they do not provide output comparable to prescriptively fitted HAs. These findings underscore the continued importance of clinical verification and prescription-based fitting of hearing assistive technology for achieving appropriate audibility across hearing loss configurations.

Audiology Research doi: 10.3390/audiolres16020054

Authors: Felicity Bleckly Emilie Francis-Auton Frances Rapport Robyn Clay-Williams Chi Yhun Lo

Background/Objectives: Hearing loss, coupled with the configurations of hearing devices, adds to the complexity of understanding the subjective and personal implications of losing musical fidelity. Hearing music through assistive listening devices significantly impacts music perception and enjoyment, yet research examining music-related quality of life for late-deafened adults is limited. This study aimed to capture late-deafened adults’ experiences related to music and quality of life. Methods: The study administered a cross-sectional survey designed around three established questionnaires: Cochlear Implant Quality of Life, Goldsmiths Musical Sophistication Index, and Music Related Quality of Life. It was completed by 116 late-deafened adults (mean age 65.4 years, with an average of 23.1 years of hearing loss). It was hypothesised that the use of different hearing devices would impact music importance, engagement, enjoyment, and related quality of life in disparate ways. To determine if and how quality of life differed between hearing device users, statistical analyses were stratified across a subgroup of 75 participants with bilateral hearing aids (n = 33; musicians n = 18, and non-musicians n = 15), bilateral cochlear implants (n = 21; musicians n = 5, and non-musicians n = 16), and bimodal configurations (n = 21) musicians n = 8, and non-musicians n = 13). Results: Music remained important for most participants (n = 55, 73%) despite hearing loss. However, regardless of music being valued, only 36 (48%) participants enjoyed music “Always” or “Most of the Time”, while 17 (23%) “Rarely” or “Never” enjoyed it. Bilateral hearing aid users reported the highest, and bilateral cochlear implant users the lowest quality-of-life scores. These effects extended to participation in real-world musical activities: hearing aid users attended more live music events, while bilateral cochlear implant users experienced the greatest reduction in musical activities compared to other hearing device users. Conclusions: Musical quality of life is fundamentally about music enjoyment and engagement and how late-deafened adults integrate music into their everyday life. Hearing loss and hearing devices create a profound disconnect between the capacity to enjoy and engage with music. Musicianship did not guarantee better musical enjoyment or engagement. However, musicians demonstrated greater perseverance when enjoyment was limited, in the hope of improvement. Understanding this allows clinicians to develop effective rehabilitation strategies tailored to different hearing devices and musicianship abilities and set realistic expectations.

Audiology Research doi: 10.3390/audiolres16020053

Authors: Beauty Hariz Latifa Alkoheji Mariam Alsaeed Amany Tahon Shahad Alhammad Maram Alhedaithy Sara Ali AlKhamiss Hasna’a Shathan Toga Alharbi Salam Orabi Sabine El-Deek Per Cayé-Thomasen Lone Percy-Smith

Background/Objectives: Receptive vocabulary is essential for children’s language, academic, and cognitive development. While cochlear implants (CIs) help children with severe to profound hearing loss develop spoken language, their vocabulary skills often fall behind their typical hearing (TH) peers, although early implantation and auditory-verbal therapy (AVT) can help narrow this gap. Children with CIs and other developmental difficulties face additional challenges, but can still progress, with outcomes depending on the disabilities’ type and severity. Limited research exists on Arabic-speaking children with CIs, where cultural factors may delay intervention, and outcomes vary widely. It remains unclear how well these children develop receptive vocabulary compared to hearing peers and which factors influence their progress. Methodology: A multicenter, cross-sectional study in six GCC hospitals compared 103 children with CIs to a control group of 94 children with TH. Children with CIs were divided into those with and without additional difficulties. Receptive vocabulary was evaluated utilizing the Peabody Picture Vocabulary Test, Fifth Edition. Results: Children with CIs in the GCC scored lower (mean 89.5; SD = 20.5) than the TH control group (mean 104; SD = 16.8). Children with CIs without additional difficulties (mean 97.7; SD = 18.8) scored similarly to TH, while children with CIs and additional difficulties scored significantly lower (mean 76.7; SD = 15). Age at switch-on and presence of additional difficulties significantly affected receptive vocabulary outcomes. Conclusions: Children with CI who have no additional disabilities can reach receptive vocabulary levels similar to typical hearing peers, while those with extra difficulties show very diverse outcomes and continue to face challenges.

Audiology Research doi: 10.3390/audiolres16020052

Authors: Jiyu Zhang Shuqi Yao

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder that has been receiving more research attention lately. Nonetheless, there is a lack of systematic bibliometric overviews tracing the conceptual evolution, knowledge structure, and emerging research frontiers within this field. The utilization of bibliometric and visualization analyses can enhance the understanding of trends and central themes in PPPD research, offering valuable insights for future studies. Methods: Data were retrieved from the Web of Science Core Collection, yielding a final dataset of 370 bibliographic records (“DATA”). We employed CiteSpace, HistCite, the Alluvial Generator, and R software to conduct multi-dimensional statistical and visualization analyses on publication trends, collaborative networks (countries/institutions/authors), disciplinary distribution, citation bursts, and the evolution of keyword clusters. Results: Starting from 2005, there has been a notable increase in publication volume, reaching its peak in 2024. The United States and Germany are at the forefront of national collaboration, with the University of Munich and the Mayo Clinic being key research institutions. The research focus has transitioned from a primary emphasis on Psychiatry to a broader scope encompassing Neurosciences, Otorhinolaryngology, and General Medicine. Keyword analysis reveals a shift towards standardized terminology, transitioning from “phobic postural vertigo” to “diagnostic criteria” and “consensus documents”. Current research trends are centered around comorbidity mechanisms like “vestibular migraine”, therapeutic approaches such as “vestibular rehabilitation”, and quality of life assessments using the “dizziness handicap inventory”. The 2017 consensus document by the Bárány Society is highlighted as a pivotal publication with significant citation impact. Conclusions: The intellectual structure of the field, as revealed by this bibliometric analysis, has transitioned from a phenomenological description to a conceptual unification. The bibliometric analysis indicates that the field is currently in a conceptually stabilized stage characterized by a research focus on refining diagnostic precision and comorbidity exploration, while scholarly attention remains biologically exploratory regarding objective biomarkers and pathophysiological mechanisms.

Audiology Research doi: 10.3390/audiolres16020051

Authors: Alexandre Karkas Clément Arnold Yann Lelonge Norbert Laroche Fabien Tinquaut Florian Bergandi Hubert Marotte Kelly Daouda

Background/Objectives: Atraumatic electrode array insertion should be targeted in cochlear implantation. Robotic insertion is used in many centers worldwide. Our objective was to evaluate manual electrode placement and robot-assisted placement using RobOtol® on human temporal bones (TBs), in terms of endocochlear trauma and completion of insertion. Methods: Sixteen TBs originating from eight bodies were implanted with Medel-FLEX24 electrodes through the round window. The right TB was implanted manually, while the left TB of the same body was implanted using RobOtol® for electrode insertion. Results were analyzed through micro-computed tomography imaging. No statistical analysis was used, given the small sample size; a descriptive interpretation of micro-CT scans was rather preferred. Results: In the “manual group”, there were two cases (25%) of insertion trauma: elevation of basilar membrane at basal turn (Eshraghi-stage-1). In the “robotic group”, there were two cases (25%) of insertion trauma: one case of elevation of basilar membrane at the middle turn (Eshraghi-stage-1) and one case of dislocation of all electrodes in scala vestibuli (Eshraghi-stage-3). There were six cases (75%) of incomplete insertion in the “manual group” and four cases (50%) of incomplete insertion in the “robotic group”. Conclusions: Both techniques of electrode placement yielded fairly similar results, in terms of endocochlear trauma and completion of insertion. New larger-scale cadaveric and clinical studies are needed to determine the possible benefit of robot-assisted electrode insertion in cochlear implantation.

Audiology Research doi: 10.3390/audiolres16020050

Authors: Francesco Lazzerini Francesca Forli Stefano Berrettini Federica Di Berardino Marco Pozzi Diego Zanetti

Cochlear implantation (CI) effectively restores hearing across the whole lifespan but may be followed by vestibular complaints, especially in adult recipients. The aim of this narrative review is to provide a comprehensive characterization of vestibular complaints after CI in adults, collecting clinical and instrumental data, as well as discussing the risk factors for their development. From data reported in the literature, we defined five recurring clinical presentations of postoperative vestibular disturbances (phenotypes): acute postoperative vestibular syndrome, benign paroxysmal positional vertigo (BPPV), delayed Ménière-like vertigo attributable to secondary endolymphatic hydrops, chronic postoperative disequilibrium, and stimulation-linked vertigo. According to the different pathogeneses underlying each presentation, the management of postoperative vestibular complaints should be phenotype-guided, including short-course vestibular suppressants and early mobilisation for acute presentations; canalith repositioning for BPPV; empiric therapy for hydropic-like episodes; and vestibular rehabilitation when imbalance is persistent, programming changes for stimulation-linked symptoms. Alongside this phenotype-driven approach, subjective symptoms are common across cohorts but are usually transient and persistent disability is uncommon. Furthermore, instrumental data across the studies indicate that objective abnormalities cluster in otolith and low-frequency canal measures: Cervical, ocular VEMP, and caloric responses are more often impaired than high-frequency canal function on vHIT, confirming histopathological studies showing preferential saccular involvement during the insertion of the electrode array. The risk of postoperative vestibular complaints not only appears to be modulated more by patient-related factors, especially pre-existing vestibular loss, but also by the aetiology of deafness, or age, rather than by device characteristics; atraumatic surgical approaches may further reduce this risk. This review emphasizes that future research on vestibular complaints after CI should adopt standardized phenotypes when evaluating symptoms, objective vestibular function, falls, and quality of life. Additionally, it should correlate these outcomes with hypothetical risk factors and detailed surgical reports.

Audiology Research doi: 10.3390/audiolres16020049

Authors: Valeria Caragli Alessandro Martini

Purpose: Hearing loss (HL) is a prevalent condition significantly impairing quality of life, with genetic mutations accounting for a substantial proportion of congenital cases, notably those involving the GJB2 gene encoding connexin 26. This study aims to analyze the current knowledge, feasibility, and challenges of gene therapy targeting GJB2-related HL, emphasizing both embryonic and postnatal interventions. Methods: A comprehensive scoping review was conducted across electronic databases up to October 2025, including studies focusing on GJB2-associated HL, gene therapy approaches, and the timing of interventions. Data extraction encompassed mutation types, animal models, delivery strategies, outcomes, and ethical considerations. Results: The results indicated over 467 GJB2 variants which could impair cochlear ion homeostasis and development. Animal models, mainly murine, demonstrated early-onset degeneration with limited recovery following delayed gene therapy, while early postnatal intervention showed greater efficacy. Viral vectors like AAV have been employed for targeted gene delivery via cochlear injections, achieving partial restoration of connexin expression and cochlear function, yet they have faced limitations including transduction efficiency, immune responses, and long-term stability. Challenges in translating these findings to humans have been compounded by anatomical, immunological, ethical, and safety issues, particularly regarding embryonic gene therapy and germline modifications. Ethical frameworks can vary internationally, highlighting the necessity for careful regulation. Conclusions: While promising advances in gene therapy for GJB2-related HL have been achieved in preclinical studies, significant scientific, technical, and ethical barriers must be addressed before clinical application, especially during embryogenesis. A multidisciplinary, cautious approach is essential to realize the potential of gene therapy in restoring natural hearing while safeguarding individual and societal interests.

Audiology Research doi: 10.3390/audiolres16020048

Authors: Massiel Cepeda Uceta Estela Lladó-Carbó Raidili Mateo Montero Catalina Villa Jurado Montserrat Virumbrales Iván Domènech Juan

Background/Objectives: The objective of the study was to assess the benefits on quality of life (QoL) of a natural-based dietary supplement in patients with tinnitus. Methods: An observational, prospective and exploratory study was conducted in 30 patients (mean age 50.7 years) diagnosed with tinnitus. The dietary supplement (Otocalm®) contained L-theanine, Gingko biloba, melatonin, GABA, zinc, selenium and vitamins B3, B6 and B12, and was administered for 90 consecutive days. Clinical assessment included tone verbal audiometry, the Tinnitus Handicap Inventory (THI), the Goldberg anxiety and depression scale (GADS), and a 0–10 mm visual analogue scale (VAS) to score the intensity of tinnitus. Results: The mean THI score decreased from 40.8 at baseline to 30.9 at the end of the study (p = 0.012), and the percentage of patients with THI grade 1 (no handicap) increased from 3.3% to 20%. The mean anxiety score decreased from 4.7 to 3.0 (p = 0.006), and the percentage of patients scoring ≥ 4 in the GADS decreased from 63.3% to 33.3%. Changes in VAS scores and verbal tone audiometry were not observed. A decrease in the mean frequency of tinnitus from 2417.4 Hz to 1603.3 Hz (p = 0.519) was found. The product was safe and well-tolerated. Conclusions: The administration of a natural-based dietary supplement composed of L-theanine, Ginkgo biloba, melatonin, GABA, zinc, selenium, and group B vitamins during 90 days in patients with tinnitus was associated with a significant increase in QoL by reducing tinnitus-associated handicap and anxiety.

Audiology Research doi: 10.3390/audiolres16020047

Authors: Florin-Vlad Hodea Eliza-Maria Bordeanu-Diaconescu Andrei Cretu Vladut-Alin Ratoiu Cristian-Sorin Hariga Cristian-Radu Jecan Ioan Lascar Andreea Grosu-Bularda

Reconstruction of the ear and temporal region presents unique challenges due to the complex anatomy of the lateral skull base and the need to restore both structural integrity and auditory function. Historically managed as separate entities, auricular reconstruction and hearing rehabilitation are increasingly approached in an integrated manner, supported by advances in microsurgical techniques and implantable hearing technologies. This narrative review synthesizes contemporary evidence on microsurgical reconstruction of the ear and temporal region in conjunction with hearing rehabilitation, analyzing a wide range of existing surgical techniques in an integrative manner. Reconstructive techniques discussed include local and regional flaps, free tissue transfer, auricular framework reconstruction using autologous cartilage or alloplastic materials, external auditory canal reconstruction, and subtotal petrosectomy. Hearing rehabilitation options reviewed encompass bone-anchored hearing systems, active and passive transcutaneous devices, middle ear implants, and cochlear implantation. Simultaneous reconstruction and implantation may reduce surgical burden and enable earlier hearing restoration in carefully selected patients, while staged approaches remain advantageous in complex or high-risk scenarios, particularly in the presence of chronic infection or extensive temporal bone surgery. Multidisciplinary collaboration, meticulous preoperative planning, and long-term follow-up are essential to optimize outcomes.

Audiology Research doi: 10.3390/audiolres16020046

Authors: Joan Lorente-Piera Raquel Manrique-Huarte Sebastián Picciafuoco Janaina P. Lima Valeria Serra Manuel Manrique

Introduction: In patients with conductive and mixed hearing loss, implantable hearing devices such as active middle ear implants (AMEIs) and bone conduction implants (BCIs) are established alternatives when conventional hearing aids fail. Although bone conduction (BC) thresholds are routinely used as eligibility criteria, their role as frequency-specific predictors of postoperative functional outcomes remains poorly defined. This study aimed to evaluate the influence of preoperative BC thresholds across the audiometric spectrum on postoperative speech recognition outcomes after implantation with AMEIs and BCIs. Methods: A retrospective observational study was conducted at a tertiary referral center including patients implanted with BCIs or AMEIs. Pre- and postoperative audiological data were analyzed, including air and bone conduction thresholds, frequency-segmented BC measures (low, mid, and high frequencies), cochlear frequency gradient (ΔBC Slope), and speech recognition scores (SRSs) at 65 dB HL one year after implantation. Results: 102 patients were included (50 BCI, 52 AMEI). Both implant types achieved significant postoperative improvements in tonal thresholds and SRS compared with pre-implantation values (all p < 0.001). High-frequency BC thresholds (BC-High, 4–6 kHz) showed a significant inverse correlation with postoperative SRS in both BCI (r = −0.382, p = 0.001) and AMEI users (r = −0.398, p < 0.001), and emerged as the only independent predictor in multivariable models (BCI: β = −0.533, p = 0.022; AMEI: β = −0.491, p = 0.020). Low- and mid-frequency BC measures were not associated with postoperative speech outcomes (all p > 0.05). ROC analyses demonstrated excellent discriminative performance of BC-High for identifying suboptimal outcomes, with area under the curve values of 0.92 for BCI (p = 0.001) and 0.94 for AMEI (p = 0.002), and implant-specific cutoff values of >47 dB HL and >61 dB HL, respectively. Conclusions: High-frequency BC thresholds showed the strongest association with postoperative speech recognition after implantable hearing rehabilitation. BC-High could function as a prognostic marker of functional outcome rather than an eligibility criterion, providing clinically meaningful information to refine preoperative counseling and individualized decision-making within current indication frameworks.

Audiology Research doi: 10.3390/audiolres16020045

Authors: Valerio Maria Di Pasquale Fiasca Alfredo Gabriele Nanni Marco Pozzi Lorenzo Collino Barbara Martino Paolo Ranieri Eliana Filipponi Giulio Dehesh Andrea Beghi Federica Di Berardino

Background: Objective assessment of postural control is central to the clinical evaluation of vestibular disorders. Although force-platform-based posturography is considered the gold standard, its use may be limited by cost and infrastructural requirements. Wearable inertial measurement units (IMUs) represent a promising alternative; however, their clinical validation should account for intrinsic differences in measurement paradigms rather than strict metric equivalence. Objective: To preliminarily evaluate the within-session reliability of a wearable IMU-based medical device for balance assessment (Gravity), and its agreement with established static (SBP) and computerised dynamic posturographic systems (CDP) in healthy subjects. Methods: Sixty-three healthy adults were enrolled in two independent method comparison studies: a wearable IMU-based balance system versus a static stabilometric platform (GRAVITY vs. SVEP; n = 42) and a wearable IMU-based balance system versus computerised dynamic posturography (Gravity vs. EquiTest; n = 21). Gravity measurements were obtained simultaneously with reference systems across standardised sensory conditions. Within-session reliability and method agreement were assessed. Results: Within-session reliability of Gravity was outcome-dependent. Length-based components demonstrated higher repeatability (ICC (single) = 0.25–0.35; ICC (average) = 0.41–0.52), with narrower limits of agreement (LoA = ±9–12%) and lower measurement error (SEM = 3.3–4.3%). In comparison with SBP, length-based measures exhibited narrower limits (LoA = ±12–17) and more consistent relationships. Comparison with CDP revealed moderate agreement for composite and preferential scores (LoA: −2.20–7.07; −5.54–8.12). Conclusions: Gravity sensor may represent a clinically meaningful, outcome-dependent performance, with superior reliability and comparability for length-based postural measures compared with area-based measures. The device could provide balance assessments compatible with both static and dynamic posturographic systems, accounting for physiological variability. These findings support the potential clinical use of wearable IMU-based posturography, particularly in settings where conventional force-platform systems are not readily available, and warrant further validation in larger, more clinically diverse populations.

Audiology Research doi: 10.3390/audiolres16020044

Authors: David H. Elisha David H. Cohen Andrea Monterrubio Ryan Hossain Nicholas DiStefano Rahul Mittal Adrien A. Eshraghi

Objective: The aim was to evaluate cochlear implantation (CI) outcomes in children with Down syndrome (DS) with severe-to-profound sensorineural hearing loss (SNHL), addressing a literature gap and discussing challenges including anatomical abnormalities, cognitive deficits, and Eustachian tube dysfunction. Data Sources: Systematic searches were conducted in PubMed, Web of Science, Scopus, and Embase from inception through to June 2025. Review Methods: A systematic review adhering to PRISMA guidelines was performed. Included studies reported CI outcomes in DS patients receiving otolaryngologic care for SNHL. Extracted data included findings on ear anatomy, auditory performance, speech/language development, intelligibility, and duration of CI use. Results: A total of 149 abstracts were screened, yielding six studies with 26 patients that met the inclusion criteria. The review included pediatric DS patients with documented ages at implantation spanning from 11 months to 17.9 years. CI provided significant benefits for DS patients, including improved audiometric results, enhanced environmental awareness, and psychosocial gains. Optimal outcomes were associated with early implantation, thorough preoperative imaging (CT/MRI), and management of middle ear disease. Variability in outcomes often reflected cognitive limitations and anatomical challenges such as cochlear nerve hypoplasia and Eustachian tube dysfunction. Conclusions: CI can significantly improve quality of life and communication in children with DS when tailored to their unique needs. Preoperative imaging is essential to assess candidacy, and middle ear disease should be addressed prior to surgery. Clinicians should counsel families with individualized goals that emphasize functional hearing gains over normative speech benchmarks. Broader adoption of CI in this population may be supported by standardized, population-sensitive outcome measures and future prospective studies.

Audiology Research doi: 10.3390/audiolres16020043

Authors: María del Carmen Moleón González Farzon Danesh Ali A. Danesh

Background: Tinnitus, the perception of sound in the absence of an external source, is a prevalent condition that can substantially affect physical and mental health. Although tinnitus is not typically curable, it is often manageable with structured, multidisciplinary care. This pilot research describes the Sensation–Emotion–Cognition (SEC) model, a practical audiological framework developed by Danesh et al. that targets three core dimensions of the tinnitus experience. Methods: We integrate findings from an exploratory retrospective cohort and a prospective expansion study. The SEC protocol included sound therapy, counseling and relaxation training, and cognitive behavioral therapy (CBT) delivered through either unguided, module-based internet CBT, clinician-guided module-based internet CBT, or six therapist-led CBT sessions. The objective was to evaluate whether this multifactorial approach is associated with reductions in tinnitus-related distress. Results: In this prospective study, preliminary results from 16 participants who completed the study were associated with significant pre–post changes in tinnitus-related outcomes: 4C management confidence increased from M = 30.38 to 60.19 (p < 0.001; Cohen’s dz = 1.04), and SAD-T emotional distress decreased from M = 4.75 to 2.38 (p = 0.001; Cohen’s dz = 0.99). Conclusions: These findings suggest the potential value of an integrated management strategy; however, given the single-group pre–post design and attrition, the results should be interpreted as exploratory and warrant confirmation in larger controlled trials.

Audiology Research doi: 10.3390/audiolres16020042

Authors: Francesca Campoli Andrea Fabris Donatella Di Corrado Dorota Kostrzewa-Nowak Robert Nowak Lucio Caprioli Vincenzo Cristian Francavilla Elvira Padua Giuseppe Messina

Background: Balance impairment and falls are a major health concern in older adults. Beyond vestibular and visual factors, growing evidence indicates that age-related hearing loss contributes to postural instability through altered multisensory integration. However, interventions addressing the interaction between auditory input and postural control remain limited. This study examined whether integrating Taopatch® nanotechnology, based on localized photobiomodulation, into conventional hearing aids could influence postural control in individuals with hearing loss. Methods: Forty experienced hearing aid users (mean age 77.3 ± 15.6 years) completed five postural assessments using a SensorMedica® baropodometric platform. Four sessions employed a placebo patch identical in appearance to the active device, and the fifth used Taopatch®. Static and stabilometric parameters were analyzed under open- and closed-eye conditions. Results: Significant improvements were observed with the Taopatch®-integrated device. Sway path length (−8%, p = 0.002), mean velocity (−8%, p = 0.002), and low-frequency sway (−30%, p = 0.04) decreased, indicating smoother and more efficient postural control. A lateral redistribution of plantar load and an increase in contact surface area (up to +15%) were also found. These effects were less evident without visual input. Conclusions: Preliminary findings suggest that localized photobiomodulation integrated into hearing aids may positively influence postural stability in older adults with hearing impairment, possibly by supporting sensory integration processes. Further controlled studies are needed to confirm these effects and clarify the underlying mechanisms.

Audiology Research doi: 10.3390/audiolres16020041

Authors: Shai Chordekar Haim Sohmer Miriam Geal-Dor

Background: Bone vibrator (BV) stimulation applied to skin sites on the body elicits hearing by soft tissue conduction (STC). However, BV stimulation to sites far from the ear requires the delivery of higher-intensity stimulus vibrations to achieve threshold, which can then induce hearing by air conduction (AC) contamination. This problem limits the study of STC thresholds at sites more distant from the ear. Objective: To overcome this problem, we evaluated the possibility of delivering STC vibratory stimuli to body sites in a water bath, based on the different acoustic impedances between air and water, which produces a 30 dB reduction in transmission from water to air. Methods: A standard clinical BV delivered vibration stimuli (tonal and speech stimuli) applied directly to two body sites: finger and foot. BV and body sites were immersed in a water bath. One control involved both stimulation site and BV both in water, but not in contact. In an additional control, the BV was in the bath, while the stimulation site was out of the bath. Results: STC hearing of both pure tones and speech could be elicited at stimulus intensities below those induced by control stimulation (body site and BV both in water, but not in contact; BV in bath, stimulation site out of bath). STC thresholds at the finger site were lower than those at the foot. Conclusions: The current results suggest that water-immersion method enables study of STC hearing in response to higher-intensity vibrational stimuli, and at body sites more distant from the ear, without contamination by AC hearing.

Audiology Research doi: 10.3390/audiolres16020040

Authors: Ahmet Mutlu Ayse Yasemin Gunduz Burcu Bakici Murat Erinc Erdogan Bulut Onur Ersoy Serdal Celik Dogan Cakan Mahmut Tayyar Kalcioglu

To evaluate the potential ototoxic effects of lactoferrin on the inner ear using electrophysiological and histological methods. Methods: Thirty-two Sprague-Dawley rats (64 ears) were divided into four groups: control, saline, antiseptic solution (70% isopropyl alcohol + 2% chlorhexidine), and lactoferrin. Groups II–IV received three intratympanic injections. Auditory brainstem response (ABR) tests were performed at baseline, day 7, and day 21. Cochlear histology and VEGF immunoreactivity were assessed. Results: Baseline hearing was similar across groups. Post-treatment, Groups II and IV showed partial recovery at 8, 16, and 24 kHz, while Groups III and IV had worsening thresholds at higher frequencies. Histologically, Group IV’s cochlear structures remained largely intact. VEGF immunoreactivity was severe to moderate in Groups I, II, and IV, and weaker in Group III. Conclusions: Lactoferrin showed relative safety at lower frequencies but possible ototoxicity at higher frequencies. However, no significant structural damage was observed in cochlear tissues.

Audiology Research doi: 10.3390/audiolres16020039

Authors: Luigi Califano Cataldo Latorre Maria Grazia Melillo Iacopo Cangiano Giuseppe Manna Maria Gabriella Coppola Roberto Teggi

Background: Acute vertigo is among the most frequent causes of access to the Emergency Department. In acute vestibular syndrome, differentiating peripheral from central causes remains challenging. The HINTS protocol provides high diagnostic accuracy but requires expertise and adequately informed physicians. The caloric ice-water test has recently been proposed as a bedside tool to aid this differential diagnosis. This study evaluates a novel approach: simultaneous bilateral ice-water irrigation in association with the HINTS protocol. Methods: One hundred consecutive patients presenting with acute vertigo and spontaneous unidirectional nystagmus were enrolled across three Italian centers. All patients underwent clinical assessment including among other the HINTS protocol and the simultaneous bilateral ice-water irrigation. Changes in spontaneous nystagmus during the ice test were recorded. Results: Eighty-six patients fulfilled HINTS criteria for acute unilateral peripheral vestibulopathy, all of whom demonstrated marked suppression/abolition of nystagmus during the simultaneous ice test. In contrast, nystagmus persisted in all 12 patients classified as having central vestibular pathology. Conclusions: Simultaneous bilateral ice-water irrigation is a simple and well-tolerated bedside test that demonstrates strong concordance with the HINTS protocol. While it cannot replace comprehensive clinical assessment, it represents a valuable complementary tool to distinguish peripheral from central causes of acute vertigo.

Audiology Research doi: 10.3390/audiolres16020038

Authors: Henri Albert Didier Federica Di Berardino Giorgio Lilli Diego Zanetti Alexander Henri Didier Giorgio Raponi Saverio Joshua Leone Silvia Romano Marco Farronato Elisa Boccalari Marco Serafin Alberto Caprioglio Dino Re Aldo Bruno Giannì

Objectives: This study aimed to determine whether adults with tinnitus exhibit altered phase-specific mandibular kinematics during saliva swallowing and increased prevalence of tongue thrust and Eustachian-tube insufficiency versus tinnitus-free controls. Methods: This was a cross-sectional case–control study including adults with tinnitus and controls. Standardized computerized kinesiography recorded three spontaneous saliva swallows per participant. Primary outcomes were opening/closing time (OCT) and post-closure stabilization time (STT); total swallowing time (SWT) was secondary. Tongue thrust (TT) and tubal insufficiency (TI) were assessed clinically. Distributional assumptions were checked with Shapiro–Wilk; between-group comparisons used two-sided Mann–Whitney U tests and Fisher’s exact tests (TT, TI). Effect sizes included rank-biserial correlation (r), Hodges–Lehmann median difference (Δ), and odds ratios (ORs) with 95% confidence intervals. Co-occurrence of TT and TI and their relationships with OCT, STT, and SWT were evaluated within strata (cases vs. controls) using Fisher’s exact test, φ, Mann–Whitney U tests, and Spearman’s ρ. Given the marked imbalance in age and sex between groups, unadjusted non-parametric comparisons were complemented by multivariable models with adjustment for age and sex. An omnibus non-parametric combination test summarized case–control differences across OCT, STT, and SWT. Results: Statistical analysis was performed on 77 cases with tinnitus and 78 controls. Tinnitus cases showed longer OCT (1.75 ± 0.92 vs. 1.12 ± 0.62 s; p < 0.001; r ≈ 0.40; Δ ≈ +0.60 s) and STT (1.44 ± 0.88 vs. 0.84 ± 0.62 s; p < 0.001; r ≈ 0.42; Δ ≈ +0.60 s), while SWT differed modestly and was not significant (2.75 ± 0.69 vs. 2.57 ± 0.65 s; p = 0.115; r ≈ 0.15; Δ ≈ +0.18 s). TT was more frequent in cases (18.2%) than controls (6.4%; OR = 3.05, 95% CI 1.08–8.61; p = 0.029), whereas TI occurred in 16.9% of cases and 0% of controls (corrected OR = 32.85, 95% CI 1.92–563.49; p < 0.001). Within tinnitus cases, TT and TI did not show meaningful co-occurrence (φ ≈ −0.03; p = 1.00). TT+ tinnitus patients exhibited markedly prolonged OCT compared with TT− (median 2.22 vs. 1.45 s; Δ ≈ +0.88 s; r ≈ 0.60; p < 0.001), whereas STT and SWT were minimally affected; TI was not materially associated with any swallowing-time parameter. Spearman analyses confirmed a moderate monotonic association between TT and OCT in tinnitus cases (ρ ≈ 0.40; p < 0.001), with all other correlations small and clinically negligible. Age- and sex-adjusted analyses confirmed longer OCT and STT in tinnitus cases, whereas SWT remained non-significant; TT and TI also remained more frequent in cases after adjustment. The omnibus test indicated a clear global separation between groups across OCT, STT, and SWT (permutation p < 0.001). Conclusions: Adults with tinnitus exhibit a distinct swallowing signature characterized by prolonged OCT and STT, together with higher prevalence of TT and TI. TT in tinnitus patients is specifically linked to a pronounced prolongation of OCT, while STT and SWT remain largely unchanged, and TI shows no relevant impact on kinematic indices.

Audiology Research doi: 10.3390/audiolres16020037

Authors: Darine Kebsi Chamseddine Barki Ismail Dergaa Riadh Gouider Halil İbrahim Ceylan Amina Maddouri Abderrazak Jemai Mourad Elloumi Nicola Luigi Bragazzi Hanene Boussi Rahmouni

Background: Hearing loss affects over 466 million individuals globally and is recognized as a major risk factor for Alzheimer’s disease, yet treatment personalization remains limited due to the complexity and diversity of underlying causes. Current diagnostic and therapeutic approaches lack standardized methods to accurately predict the most appropriate intervention for individual patients. The integration of medical ontologies with machine learning offers a promising solution for enhancing diagnostic accuracy and treatment personalization. Aim: Our study aimed to (i) develop a Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT)-aligned clinical ontology for hearing loss using Semantic Web Rule Language for automated reasoning; (ii) implement a Random Forest classifier trained on ontology-enriched patient data to classify hearing loss types (conductive, sensorineural, mixed, or normal); and (iii) predict optimal personalized treatments based on laterality, severity, audiometric thresholds, and medical history using real-world patient data. Methods: We developed a task ontology using Protégé 5.6.3 with Web Ontology Language (OWL), integrated SNOMED CT terminology alignment, and implemented Semantic Web Rule Language rules executed by the Pellet 2.2.0 reasoner. The framework was trained and evaluated on 3723 adult patients from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) dataset with complete audiometric and clinical data. Random Forest models were developed using an 80–20 train-test split with stratified sampling and five-fold cross-validation. Performance was compared between K-Means clustering-based labeling and ontology-based semantic inference using accuracy, precision, recall, F1-score, and log loss metrics. Results: The ontology successfully generated semantic labels for all 3723 patients, enabling precise classification of hearing loss types, severity levels, and laterality. The Random Forest model with K-Means clustering achieved a test accuracy of 90.2% with a log loss of 0.2766 and a cross-validation mean accuracy of 91.22% (standard deviation 1.2%). Integration of ontology-based semantic enrichment significantly improved performance, achieving a test accuracy of 92.48% with a cross-validation mean accuracy of 92.80% (standard deviation 0.9%). F1-scores improved across all classes, with mixed hearing loss showing a notable increase from 0.86 to 0.92. Feature importance analysis identified audiometric thresholds, ontology-derived severity labels, and medical history as top predictors, enhancing clinical interpretability. Conclusions: This study demonstrates that combining SNOMED CT-aligned ontology with Random Forest classification achieves superior diagnostic accuracy and enables personalized treatment recommendations for hearing loss. The hybrid framework provides clinically interpretable decision support while ensuring semantic interoperability with electronic health records. Multi-institutional validation studies are necessary to assess generalizability across diverse populations before clinical deployment.

Audiology Research doi: 10.3390/audiolres16020036

Authors: Sung Kyun Kim Han-Gyu Bae Jun Hee Kim

Background/Objectives: Blast-induced hearing loss (BIHL) is a major concern, particularly for military personnel, and is linked to impaired auditory neuron survival and synaptic plasticity. This study investigates the potential of the TrkB agonist 7,8-dihydroxyflavone (7,8-DHF) to reduce the severity of BIHL and promote recovery in a mouse model. Methods: Eight-week-old male C57BL/6J mice were used. A custom-built, compressed air-driven system utilizing a modified paintball apparatus was employed to deliver controlled unilateral double blasts (~22 psi exposure pressure) to the left ear. The blasts were administered 30 min apart. Immediately following the second blast, mice received either 7,8-DHF (10 mg/kg) or vehicle (10% DMSO) via intraperitoneal injection. Auditory brainstem responses (ABRs) were measured in both ears at baseline (pre-blast) and at several post-exposure time points. Results: The consecutive blast exposure induced a significant elevation in ABR thresholds, indicative of hearing loss, in both the ipsilateral (exposed) and contralateral (unexposed) ears of vehicle-treated mice. Notably, mice treated with 7,8-DHF demonstrated a marked improvement in hearing recovery compared to the vehicle group. Significant reductions in ABR thresholds were observed in the ipsilateral ear at 4 weeks post-blast (p < 0.0001) and in the contralateral ear as early as 1-week post-blast (p = 0.0236). However, the recovery was partial, with ABR thresholds plateauing after 4 weeks. Conclusions: A controlled blast model demonstrates that systemic administration of the TrkB agonist 7,8-DHF exerts a protective effect, partially restoring auditory function after blast injury. This supports the therapeutic potential of targeting the BDNF-TrkB signaling pathway for managing BIHL.

Audiology Research doi: 10.3390/audiolres16020035

Authors: Mitra Britton Ishan Sunilkumar Bhatt

Background/Objectives: Tinnitus has been increasingly associated with cardiovascular disease, and recent phenome-wide analyses have identified angina pectoris as a condition linked to tinnitus. This study aimed to replicate and quantify the association between tinnitus and angina pectoris in a nationally representative U.S. adult sample using NHANES, while adjusting for key demographic, cardiovascular, and tinnitus-related risk factors. Methods: Using data from four NHANES cycles 2009–2018, a cross-sectional analysis was conducted, which included 9185 participants, and used multivariate logistic regression analyses to investigate the association between tinnitus and angina pectoris. Results: Among 9185 adults, angina was associated with higher odds of tinnitus in all models. In the crude model, OR = 3.30 (95% CI: 2.18–4.91, p < 0.001); partially adjusted, OR = 1.92 (95% CI: 1.27–2.89, p = 0.002); fully adjusted, OR = 1.65 (95% CI: 1.07–2.55, p = 0.026). In the fully adjusted model, hearing loss (OR = 4.11), noise exposure (OR = 1.63), current smoking (OR = 1.29), older age (OR = 1.01 per year), and total cholesterol (OR = 1.003 per mg/dL) were additional significant predictors for tinnitus. Conclusions: In this nationally representative sample of U.S. adults, tinnitus was more frequently reported among individuals with a history of angina pectoris, and this association persisted after adjustment for demographic factors, socioeconomic status, hearing loss, noise exposure, smoking, and cardiometabolic comorbidities. These findings support emerging evidence that cardiovascular conditions may be associated with tinnitus, potentially reflecting shared vascular or systemic mechanisms. Given the cross-sectional design, causal inferences cannot be drawn, and the temporal relationship between angina and tinnitus remains unclear. Future longitudinal studies are needed to clarify underlying mechanisms, assess directionality, and determine whether cardiovascular risk modification may have implications for tinnitus prevention or management.

Audiology Research doi: 10.3390/audiolres16020034

Authors: John A. Kara Tashonda B. Vaughn Tanya Gandhi Charles C. Lee

The central auditory system integrates signals received from both ears to derive information about the spatial and spectral features of the emitting sound source. This binaural processing of acoustic information is critical for both communication and environmental awareness. However, these binaural computations may become disrupted in individuals diagnosed with autism spectrum disorder (ASD), potentially leading to difficulties with speech perception, sound attention, and sensory hypersensitivity. Here, we present a narrative review of the emerging evidence regarding binaural processing deficits in ASD. These deficits include elevated thresholds for interaural time and level differences and reduced sound localization accuracy. In addition, physiological data suggests that these behavioral traits correspond with abnormal activity in central auditory structures. Molecular and cellular alterations to central auditory circuits may underlie these behavioral and physiological features, which could arise from both genetic and environmental factors. Overall, binaural processing alterations in ASD remain under-studied, with a need for future studies to identify neural circuit-level mechanisms and potential interventions.

Audiology Research doi: 10.3390/audiolres16020033

Authors: Regina Fefelova Ilia Poputnikov Mikhail Mozgovoi Mikhail Konstantinov

Background/Objectives: The study examines the characteristics of reading written texts depending on the type of hearing aid (monaural or binaural) and the individual hearing compensatory device used (cochlear implant or hearing aid) by students studying engineering fields of study in inclusive higher education. Methods: The identification of the students’ characteristics while reading was carried out using an eye-tracker. Results: The data obtained by eye-tracking technology indicate that there are no significant differences in the gaze point indicators when reading everyday text between students with binaural hearing aids and students without hearing impairments. At the same time, students with monaural cochlear implants showed different gaze point indicators when reading everyday text compared to the results of groups of students without hearing impairments and students with binaural hearing aids. Significant differences were found in indicators related to pupil diameter, in particular between the groups of students with monaural cochlear implants and students with binaural hearing aids. Conclusions: The results demonstrate the need to adapt written teaching materials not only to take into account the characteristics caused by the hearing impairment itself, but also to take into account individual characteristics caused by the type of hearing aid. However, given the small sample size (13–14 people in each group) and multiple variables included (types of devices and number), the results should be interpreted with caution and considered preliminary—additional studies involving a larger number of participants are needed to confirm the identified patterns.

Audiology Research doi: 10.3390/audiolres16020032

Authors: Giuseppe Alberti Sabrina Loteta Daniele Portelli Cosimo Galletti Francesco Galletti Bruno Galletti Mario Lentini Salvatore Ronsivalle Salvatore Maira Jérôme René Lechien Stephane Gargula Antonino Maniaci

Background: Hearing loss is one of the most common yet often overlooked sensory deficits worldwide, with consequences extending well beyond auditory function. Mounting evidence highlights the complex interrelationships among hearing loss, cognitive decline, and psychosocial well-being. Neural mechanisms underlying this association include increased cognitive load, cortical reorganisation, and social isolation, which mediate the impact of auditory deprivation on the brain and mental health. Furthermore, hearing impairment is consistently associated with a higher risk of depression and anxiety, particularly when the duration of untreated deafness is prolonged. Methods: This narrative review summarises recent longitudinal and neuroimaging studies investigating the effects of hearing loss and the timing of intervention with hearing aids. The review focuses on evidence addressing cognitive, psychological, and neural outcomes in relation to early versus delayed amplification. Results: Across multiple studies, early adoption of hearing aids within a limited timeframe after diagnosis is linked to better cognitive performance, lower depressive symptom scores, and more preserved neural network integrity. Experimental evidence supports the existence of sensitive periods for auditory intervention, during which brain plasticity allows for optimal reorganisation and recovery of function. Conversely, delayed amplification may lead to irreversible cortical changes and persistent psychosocial distress. Despite this, several barriers—healthcare accessibility, patient attitudes, and economic constraints—continue to delay timely intervention. Conclusions: Early identification and management of hearing loss are critical to preserve cognitive and emotional health. An integrated approach addressing both hearing and cognitive well-being, supported by patient education and personalised care strategies, may maximise the benefits of amplification and improve overall quality of life.

Audiology Research doi: 10.3390/audiolres16020031

Authors: Pietro Salvago Davide Vaccaro Fulvio Plescia Francesca Di Marco Sabrina Loteta Daniele Portelli Giuseppe Alberti Francesco Dispenza Francesco Freni Pasquale Riccardi Francesco Martines

Objectives: To analyze speech perception outcomes of a cohort of experienced adult cochlear implant (CI) users to explore whether there is a correlation with electrical dynamic range (EDR) parameters, and to describe speech intelligibility curve morphology according to the degree of CI performance. Methods: A bicentric retrospective observational study. Data were extracted from a cochlear implantation database from a total of 36 CI users implanted with Advanced Bionics devices. Results: Mean age at implantation was 56.61 years. In the majority of cases, hearing loss onset was more than 15 years before implantation (80.55%), and only 11.11% of cases preserved residual hearing. This resulted in a significant relationship between speech therapy and better speech recognition (p = 0.044). At the same time, no correlation was found between age, duration of deafness before implantation, and maximum speech perception achieved (p > 0.05). Mean speech audiometry curves displayed a roll-over phenomenon in poor performers and a plateau effect in average performers. In contrast, the mean curve of high performers exhibited a steeper morphology (p < 0.0001). Speech recognition threshold (SRT) and word recognition score (WRS) were predictors of speech audiogram curves (p = 0.006). No direct correlation was found between the mean T-level, M-level, dynamic range, and maximum recognition score, even after clustering electrodes by position along the cochlea (p > 0.05). Conclusions: EDR parameters did not emerge as independent predictors of speech recognition outcomes within this specific cohort. Speech therapy and rehabilitative efforts showed a significant relationship with improved performance, and speech audiogram curve morphology may offer a more specific clinical tool for assessing global CI performance. Further prospective studies with larger, more homogenous populations are required to validate these findings.

Audiology Research doi: 10.3390/audiolres16020030

Authors: Alina Catalina Ivanov Luminita Radulescu Cristian Neagos Sebastian Cozma Corina Butnaru Raluca Olariu Petronela Moraru Violeta Necula Cristian Martu

In the published paper [...]

Audiology Research doi: 10.3390/audiolres16020029

Authors: Ceren Aksoy Koçak

Background and Objectives: Artificial intelligence (AI) and machine learning (ML) are increasingly integrated into audiology, supporting diagnosis, screening, rehabilitation, and digital health. Despite rapid growth, the literature remains methodologically and clinically heterogeneous, limiting a consolidated view of research trajectories and translational readiness. This scoping review examined the evolution of AI and ML applications in audiology and hearing disorders, focusing on thematic development, research productivity, collaboration patterns, and clinical orientation. Methods: A scoping review was conducted using the Web of Science Core Collection (Science Citation Index Expanded). Original and review articles published between 1995 and 2025 were included. Bibliometric and thematic mapping were applied to analyze publication trends, citation patterns, keyword evolution, and collaboration networks. A structured translational categorization assessed clinical domains and validation maturity. Findings reflect the Web of Science-indexed segment of the literature. Results: A total of 127 publications were analyzed. Research output increased markedly after 2020, with an estimated doubling time of approximately 2.1 years. China, the United States, and South Korea contributed the highest publication volumes, although citation impact did not consistently parallel productivity. Thematic analyses revealed a shift toward AI-driven methodological frameworks, particularly in machine learning, deep learning, and cochlear implant-related applications. Most studies remain at proof-of-concept or internally validated stages, with limited external validation. Emerging areas include tele-audiology and personalized hearing aid optimization. Conclusions: AI and ML research in audiology is increasingly application-oriented; however, broader external validation and prospective implementation are required to support routine clinical integration.

Audiology Research doi: 10.3390/audiolres16010028

Authors: Chul Ho Jang Do Yeon Kim

Background/Objectives: Cochlear implant (CI) electrode array design plays a critical role in determining intracochlear position, hearing outcomes, and insertion-related risks. Straight (lateral wall) and perimodiolar electrode arrays are the two principal designs used in modern cochlear implantation, yet their comparative benefits and risks remain debated. We aim to systematically review and compare hearing outcomes and surgical risks associated with straight versus perimodiolar electrode arrays in cochlear implantation. Methods: A systematic literature search of PubMed, Embase, Scopus, and the Cochrane Library was conducted for studies published between 2015 and 2025. Comparative clinical studies reporting speech perception outcomes, residual hearing preservation, or electrode-related complications were included. Study selection followed PRISMA 2020 guidelines. Results: A total of 32 studies were included. Speech perception outcomes were generally comparable between straight and perimodiolar arrays. However, straight electrode arrays demonstrated significantly lower rates of scalar translocation and tip fold-over and superior residual hearing preservation in most comparative cohorts. Perimodiolar arrays showed potential advantages in electrophysiological efficiency but were associated with a higher risk of intracochlear trauma when malposition occurred. Conclusions: Contemporary evidence suggests that straight (lateral wall) electrode arrays offer a more favorable safety profile with equivalent functional hearing outcomes compared to perimodiolar arrays. Electrode positioning within the scala tympani appears to be a stronger determinant of outcome than electrode design alone.

Audiology Research doi: 10.3390/audiolres16010027

Authors: Virginia Dallari Enrico Apa Silvia Palma Chiara Gherpelli Alberto Pisetta Luca Sacchetto Daniele Monzani

Background: Hearing aid (HA) outcome is a multidimensional construct that requires not only the analysis of auditory function improvement, but also a subjective evaluation of benefits from HAs. Indeed, subjective satisfaction of patients with HAs is not entirely predictable from audiometric outcomes such as real ear gain or functional gain. In light of this possible discrepancy the 1990 Consensus Statement for “Recommended Components of a Hearing Aid Selection Procedure for Adults” suggested that verification of hearing aids benefit also incorporate the subjective satisfaction with amplification. Objectives: The aim of this study was to test the validity and reliability of the Italian version of International Outcome Inventory for Hearing Aids (IOI-HA-It). Methods: Ninety-eight outpatients were randomly recruited to participate in this study. They all made regular use of HAs and were supplied with three different self-administered questionnaires. The International Outcome Inventory for Hearing Aids (IOI-HA), the Hearing Handicap Inventory for Adults (HHIA) or for elderly (HHIE) and the Italian translation of the MOS 36-Item Short Form Health Survey (SF-36). The epidemiological features and results were analyzed as descriptive statistics. Continuous variables were expressed as means with standard deviations (SDs). Reliability of the Italian version was assessed by the following two parameters: internal and test–retest consistencies. Internal consistency reliability was measured by Cronbach’s alpha coefficient. Results and Conclusions: This study evidenced that the IOI-HA-It is proved to offer adequate subjective outcome measures to better appreciate the integral evaluation of a patient’s rehabilitative experience. Furthermore, since it is a very brief questionnaire with low demand on time and cost involved in its compilation, it should be recommended in clinical practice.

Audiology Research doi: 10.3390/audiolres16010026

Authors: Vibha Kanagokar Yashu Yashu Jayashree S. Bhat Arivudai Nambi Pitchaimuthu

Background/Objectives: Speech understanding in noise relies on both temporal fine structure (TFS) and temporal envelope (ENV) cues. While TFS primarily conveys interaural time differences (ITDs) at low frequencies, ENV cues can also support ITD processing, especially when TFS is unavailable or degraded. Expanding the ENV by increasing modulation depth has been proposed to improve speech perception, but its effects on spatial release from masking (SRM) and binaural temporal processing in normal-hearing listeners remain unclear. The goal of this study was to evaluate the effect of ENV enhancement on SRM in young adults with normal hearing and its influence on ITD sensitivity and interaural coherence (IC). Method: Thirty normal-hearing native Kannada speakers (19–34 years) participated. Speech stimuli consisted of Kannada sentences embedded in four-talker babble at −5, 0, and +5 dB signal to noise ratio (SNR). Target and masker were spatialized using head-related transfer functions at 0°, 15°, and 37.5° azimuths. Stimuli were presented with and without ENV enhancement (compression–expansion algorithm). Speech recognition scores were analyzed using generalized linear mixed models, and SRM was calculated as performance differences between co-located and spatially separated conditions. Cross-correlation analyses were performed to estimate ITDs and IC across SNRs. Result: ENV enhancement yielded significantly higher SRM values across all SNRs and spatial separations. Benefits were greatest at lower SNRs and wider target–masker separations. Cross-correlation analysis showed enhanced IC and more reliable ITD estimates under the expanded condition, particularly at moderate SNRs. Conclusions: Temporal ENV enhancement strengthens spatial unmasking and binaural timing cues in normal-hearing adults, especially under adverse listening conditions. These findings highlight its potential application in auditory rehabilitation and hearing technologies where ENV cues are critical.

Audiology Research doi: 10.3390/audiolres16010025

Authors: Ritik Roushan Mohan Kumar Kalaiah Usha Shastri Kaushlendra Kumar Gagan Bajaj Megha M. Nayak

Background/Objectives: The present study examined the effect of age on sentence recognition in noise in different noise conditions among adults with normal hearing sensitivity throughout the adult lifespan. Methods: A total of 113 adults aged between 21 and 65 years participated in the study; based on age, they were categorized into five groups. The sentence recognition was assessed in five noise conditions: speech-shaped noise (SSN), amplitude-modulated speech-shaped noise (AM-SSN), two-male-talker babble (2MB), four-male-talker babble (4MB), and four-female-talker babble (4FB). The sentences were presented at a signal-to-noise ratio of −5 dB in all noise conditions. Results: The sentence recognition scores declined with increasing age in all noise conditions. In addition, age had a differential effect on the sentence recognition scores in the AM-SSN and 2MB conditions compared with the SSN, 4MB, and 4FB conditions. In the AM-SSN and 2MB conditions, the scores were significantly different in the fourth decade compared with young adults. In other noises, the scores were significantly different after 30 years compared with younger adults. Further, across noise conditions, greater scores were obtained in the AM-SSN and 2MB conditions, and the lowest scores were obtained in the 4FB condition. Partial Spearman correlations revealed a moderate-to-strong negative correlation between age and sentence recognition scores across noise conditions. Conclusions: The findings of the present study showed that sentence recognition is negatively affected by age. In addition, age has a differential effect on sentence recognition in different noises.

Audiology Research doi: 10.3390/audiolres16010024

Authors: Luka Bonetti

Background/Objective: Self-perceived hearing handicap (SPHH) reflects functional consequences of hearing loss beyond audiometric measures. Clarifying its relationship with audiometric severity and demographic factors is important for understanding age-related hearing loss (ARHL). This study examined associations between SPHH, audiometric measures, age, and sex in individuals with ARHL. Methods: A total of 145 adults (50 men, 95 women) aged 60–89 years (mean 71.65 ± 7.19 years) participated. Hearing status was defined using better-ear pure-tone average thresholds at 0.5, 1, 2, and 4 kHz (BE PTA-4), with ≥20 dB HL as the cutoff and World Health Organization (WHO)-defined severity categories. SPHH was assessed using the Croatian Hearing Handicap Inventory for the Elderly–Screening version (HHIE-S-CRO). HHIE-S-CRO total and subscale scores were examined across BE PTA-4 values and hearing loss categories. Associations were analyzed using correlation and linear regression adjusted for age and sex; group differences were tested using the Kruskal–Wallis test, and ordinal logistic regression assessed monotonic trends across ordered severity categories. Results: HHIE-S-CRO total and subscale scores increased with worsening BE PTA-4 and across hearing loss categories, with substantial overlap. Strong correlations were observed between HHIE-S-CRO scores and audiometric measures. In linear regression, BE PTA-4 was independently associated with HHIE-S-CRO total, emotional, and social/situational scores, whereas age and sex were not. Kruskal–Wallis tests showed significant differences across hearing loss categories. Ordinal logistic regression anchored to WHO severity categories demonstrated graded associations for HHIE-S-CRO total and emotional scores, while the social/situational subscale showed greater dispersion and overlap despite a statistically significant association. Conclusions: SPHH in ARHL shows a strong association with audiometric severity, with particularly robust correspondence for overall and emotional domains, underscoring the complementary role of patient-reported outcome measures alongside audiometric assessment.

Audiology Research doi: 10.3390/audiolres16010023

Authors: Giacinto Asprella-Libonati Fernanda Asprella-Libonati Giuseppe Lapacciana Camilla Gallipoli Giuseppe Gagliardi Anna Guida Giada Cavallaro

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and most frequently involves the posterior semicircular canal (PSC). Atypical apogeotropic variants of PSC-BPPV may present with pure down-beating positional nystagmus, mimicking contralateral anterior semicircular canal involvement and resulting in diagnostic and therapeutic uncertainty. Objective: To assess the effectiveness of the Bascule/Pendular maneuver in managing patients with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. Methods: A total of 178 patients presenting with pure down-beating positional nystagmus without a torsional component were evaluated using a standardized diagnostic protocol under video-Frenzel goggle monitoring. All patients underwent the Bascule/Pendular maneuver, a modification of the classical Semont maneuver designed to mobilize otoconial debris along the vertical canal planes (Left Anterior–Right Posterior and Right Anterior–Left Posterior), regardless of precise lateralization. Conversion of nystagmus from the apogeotropic to the geotropic variant was considered the primary outcome. Results: The maneuver was well tolerated, with no procedural interruptions or complications. Immediate conversion to the geotropic variant was achieved in 86 patients (48.3%) after a single maneuver. In the remaining patients, successful conversion was obtained after additional maneuvers, most commonly following a second application on the contralateral plane. Once geotropization was achieved, all patients were successfully treated using a standard posterior canal repositioning maneuver. Conclusions: The Bascule/Pendular maneuver is a practical and effective approach for patients presenting with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. By facilitating conversion to the geotropic form, it allows prompt treatment with conventional repositioning maneuvers and may represent a useful first-line strategy in atypical BPPV presentations.

Audiology Research doi: 10.3390/audiolres16010022

Authors: Daniela Parrino Guglielmo Romano Graziano Pavan Paolo Castelnuovo Maurizio Bignami

Background and objectives: Stapedotomy is the surgical treatment for otosclerosis, with excellent results in terms of hearing recovery. Various laser systems have proven to be an interesting alternative to the conventional technique, allowing for a more precise footplate fenestration with apparently less trauma to the inner ear. The diode laser, more recently introduced, seems to offer more controlled tissue interaction, potentially reducing thermal damage to surrounding structures. However, the literature remains limited. The aim of the present study was to evaluate the functional outcomes and clinical safety of diode laser stapedotomy by comparing the observed results with those previously reported. Materials and methods: A retrospective analysis of 105 patients who underwent diode laser stapedotomy was conducted. The audiological data and the complications were analyzed and compared with a cohort of patients who underwent stapedotomy performed using the conventional technique. Results: In patients who underwent diode laser stapedotomy, the postoperative air–bone gap (ABG) improved significantly at all frequencies. Hearing outcomes were excellent (ABG ≤ 10 dB) in 60.9% of cases, good (ABG ≤ 20 dB) in 89.5%, and poor (ABG > 20 dB) in 10.5% of patients. Intraoperative complications occurred in seven patients (6.7%), including two cases (1.9%) of footplate damage. Postoperatively, 13 cases of vertigo (12.4%), three cases of tinnitus (2.8%), and one case of sensorineural hearing loss (0.9%) were reported. Conclusions: Diode laser stapedotomy is an effective and safe procedure, providing excellent audiological outcomes without increasing the risk of surgical complications. The possibility of thermal damage to the inner ear must be considered, and appropriate laser parameters should be used to minimize these risks.

Audiology Research doi: 10.3390/audiolres16010021

Authors: Leonardo Manzari

Background: The vestibular system encodes head motion through specialized Type I and Type II hair cells, which differentially respond to acceleration and its temporal derivative, jerk. Molecular gradients of retinoic acid establish zonal distributions of these hair cells, prefiguring their functional specialization. Objectives & Methods: Here I integrate developmental, synaptic, biomechanical, and neural evidence to propose that Type I hair cells, via multimodal synaptic transmission, are particularly well suited for ultrafast detection of transient inertial deformation (jerk), whereas Type II cells play a greater role in encoding sustained acceleration through viscous-flow mechanisms. Molecular gradients of retinoic acid help establish central–peripheral zonal patterning in the otolith and canal epithelia, which in turn underlies differential mechanical and synaptic specialization rather than a simple redistribution of hair-cell types. Computational and experimental studies reveal that the vestibular organs operate in dual mechanical regimes, enabling the dynamic encoding of motion onset and continuity. In systems terms, these viscous and inertial activation modes correspond to distinct temporal filters, whose different time constants naturally give rise to distinct frequency responses. What has traditionally been described as ‘low- vs. high-frequency’ tuning therefore emerges as the frequency-domain signature of acceleration- versus jerk-sensitive pathways. Conclusions: This hierarchical organization elucidates the selective activation observed in clinical vestibular tests and informs novel diagnostic and rehabilitative strategies targeting specific receptor pathways. Together, these findings redefine vestibular transduction as a multimodal dynamic sensor, enhancing our understanding of balance and spatial orientation under complex motion conditions.

Audiology Research doi: 10.3390/audiolres16010020

Authors: Francesco Pavani Valerio Leonetti

Background/Objectives: In mainstream educational settings, deaf and hard-of-hearing (DHH) students may have limited or no access to the spoken lectures and discussions that are central to the hearing majority classroom. Yet, engagement in these educational and social exchanges is fundamental to their learning and inclusion. Two primary visual accessibility solutions can support this need: real-time speech-to-text transcriptions (i.e., captioning) and high-quality sign language interpreting. Their combined use (or coexistence), however, raises concerns of competition between concurrent streams of visual information. This article examines the empirical evidence concerning the effectiveness of using both captioning and sign language simultaneously in educational settings. Specifically, it investigates whether this combined approach leads to better or worse content learning for DHH students, when compared to using either visual accessibility solution in isolation. Methods: A review of all English language studies in peer-reviewed journals until August 2025 was performed. Eligible studies used an experimental design to compare content learning when using sign language and captions together, versus using sign language or captions on their own. Databases Reviewed: EMBASE, PubMed/MEDLINE, and PsycInfo. Results: A total of four studies met the criteria for inclusion. This limited evidence is insufficient to decide on the coexistence of captioning and sign language. Yet, it underscores the potential of captions for content access in education for DHH, even when sign language is available. Conclusions: The present article reveals the lack of evidence in favor or against its coexistence with sign language. With the aim to be constructive for future research, the discussion offers considerations on the attentional demands of simultaneous visual accessibility resources, the diversity of DHH learners, and the impact of current and forthcoming technological advancements.

Audiology Research doi: 10.3390/audiolres16010019

Authors: Patrick D’Haese Paul Van de Heyning Javier Gavilan Mario Emilio Zernotti Paula Greenham

Background: Adults with severe to profound hearing loss have limited access to cochlear implants (CIs). The objective of this study was to assess the evidence to establish whether the uptake rate of CIs has changed over the past decade. Methods: A PubMed search, supplemented with manual searching, identified 15 relevant papers published from 2000 to 4 February 2025 reporting the uptake rate of CIs in adults. In addition, new calculations of uptake rates were made for 2019, based on total numbers of CIs implanted and the prevalence of hearing loss from the 2019 Global Burden of Disease Study. Results: There was a lack of published data on the uptake rates for cochlear implants, with very little consensus in the methods used across studies. The overall uptake rates for adults and children combined, calculated for 2019 using the Lancet Global Burden of Disease Study, showed that uptake is still ≤20% for those with profound to complete hearing loss in most high-income countries. When the global population is considered (including high- to low-income countries), it is merely 2.5%. Conclusions: Despite the cochlear implant awareness activities of recent years, the percentage of profoundly deaf individuals with cochlear implants, even in high-income countries, remains low. Uptake rates are much worse than those for hearing aid use for severe to profound deafness. Better and more accurate data must be gathered on the number of CI recipients to meet the reporting requirements of the World Health Organisation’s report on hearing.