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.

Audiology Research doi: 10.3390/audiolres16010018

Authors: Meilin He Inho Chung

This study explored the relationship between different home language activities and language ability in Chinese preschoolers with cochlear implants (CIs) (mean age = 4.50, range = 3–5), comparing them with normally hearing (NH) peers (mean age = 4.66, range = 3–5). Correlation and regression analyses revealed distinct predictive patterns between the two groups. In the CI group, although family literacy activities such as shared reading were associated with language skills, daily communication activities (e.g., conversational interactions) had a more significant predictive effect on language outcomes, even after controlling for key demographic variables. Conversely, for NH preschool children, family literacy activities showed a clearer independent association with language development. This study offers clearer insights for home-based rehabilitation practices among CI preschool children, suggesting that interventions should prioritize high-quality daily communication (e.g., open-ended questioning, extended dialog, contextualized interactions) rather than over-reliance on structured literacy activities. It also indicates that intervention models designed for NH preschool children cannot be simply applied.

Audiology Research doi: 10.3390/audiolres16010017

Authors: Anoop Basavanahalli Jagadeesh Ajith Kumar Uppunda

Background/Objectives: Speech processing engages both hemispheres of the brain but exhibits a degree of hemispheric asymmetry. This asymmetry, however, is not fixed and can be shaped by stimulus-related and listener-related factors. The present study examined how background noise and attention influence hemispheric differences in speech processing using high-density cortical auditory evoked potentials (CAEPs). Methods: Twenty-five young adults with clinically normal hearing listened to meaningful bisyllabic Kannada words under two background conditions (quiet, speech-shaped noise) and two attentional conditions (active, passive). N1 peak amplitudes were compared between the left and right hemispheres across conditions using linear mixed-effects modeling. Results: Results revealed significantly larger N1 amplitudes in the left hemisphere and during active compared to passive listening, confirming left-hemisphere dominance for speech processing and robust attentional modulation. In contrast, background noise did not significantly modulate N1 amplitude or hemispheric asymmetry. Importantly, a significant Hemisphere × Attention interaction indicated that hemispheric asymmetry depended on attentional state, with clear left-hemisphere dominance being observed during active listening in both quiet and noise conditions, whereas hemispheric differences were reduced or absent during passive listening, irrespective of background. Conclusions: Together, these findings demonstrate that attentional engagement, rather than background noise, plays a critical role in modulating hemispheric specialization during early cortical speech processing, highlighting the adaptive nature of auditory cortical mechanisms in challenging listening environments.

Audiology Research doi: 10.3390/audiolres16010016

Authors: Christoph Schmid Stefanie Blatter Eberhard Seifert Philipp Aebischer Martin Kompis

Objective: This paper describes the development of a speech intelligibility test in Swiss German dialects, designed for children aged four to nine who are not yet familiar with standard German. Method: Suitable monosyllabic words and trochees in different Swiss German dialects were compiled, illustrated, and evaluated. Picture-pointing test procedures appropriate for children were developed. The selected test words and the pictures representing them were evaluated in a preliminary trial with forty-six normal-hearing children between two and nine years of age. Results: A set of 60 monosyllabic words and 40 trochees was recorded in four different Swiss German dialects as well as in standard German, resulting in a total of 500 recordings. Drawings were created to illustrate each word and found to be appropriate for children aged four years old or older. A non-adaptive and an adaptive test procedure using a weighted up–down method to measure speech reception thresholds in quiet and in noise were developed. Conclusions: A novel test to determine speech intelligibility in children in four different Swiss dialects was developed and evaluated in a pilot study. A validation study with more participants was designed to evaluate the test material and procedures.

Audiology Research doi: 10.3390/audiolres16010015

Authors: Eleonore Lebelle Maria-Pia Tuset Ralph Haddad Dario Ebode Daniel Levy Laetitia Ros Quentin Mat Mary Daval Justin Michel Laure De Charnace Stéphane Gargula

Background/Objectives: Endolymphatic sac surgery (ELSS) is a non-destructive surgical option for medically refractory Ménière’s disease (MD), yet factors influencing surgical outcomes remain poorly understood. This exploratory study aimed to describe clinical outcomes following ELSS and identify potential associations between preoperative characteristics and surgical success. Methods: This retrospective, bicentric cohort study included 45 patients with definite MD who underwent ELSS (predominantly endolymphatic duct blockage) between 2019 and 2024. Vertigo control was assessed using AAO-HNS criteria. Hearing outcomes were evaluated through pure-tone and speech audiometry. Univariate analyses explored associations between demographic, clinical, imaging, and surgical variables and treatment outcomes. Results: Surgical success (Class A/B vertigo control) was achieved in 66.7% of patients (95% CI: 51.0–80.0%). In a post hoc exploratory analysis, longer disease duration (>5 years) showed an association with better outcomes (87.5% vs. 55.2%, p = 0.029), though this threshold was not prespecified and requires validation. Hearing was preserved in 77.5% of patients at 45-day follow-up but declined progressively to 50% at 2 years. Seven patients developed postoperative Tumarkin attacks, with five requiring non-conservative interventions. ELSS demonstrated low morbidity, with one labyrinthitis as the only significant complication. Conclusions: ELSS was associated with vertigo control in two-thirds of patients with refractory MD, with a favorable safety profile. Longer disease duration before surgery may be associated with improved outcomes, though this exploratory finding requires confirmation in prospective studies. The progressive hearing decline may reflect both natural disease progression and potential surgical effects. Further research with larger cohorts is needed to establish robust predictive criteria for patient selection.

Audiology Research doi: 10.3390/audiolres16010014

Authors: Mirela Mătăsaru Elena Niculet Emil Anton Ancuța Lupu Oana Ramona Roșca Doina Carina Voinescu Mădălina Nicoleta Matei Alina Pleșea-Condratovici Camer Salim Silvia Fotea

Universal newborn hearing screening is essential for early identification of sensorineural hearing loss. Infants born to adolescent mothers may be more vulnerable to abnormal screening outcomes due to biological, socio-economic, and obstetrical risk factors frequently associated with adolescent pregnancy. This study evaluates hearing screening outcomes in newborns of adolescent mothers and examines whether maternal and neonatal vulnerabilities contribute to abnormal (REFER) results. A retrospective observational study was conducted over four years (January 2021–January 2025) at the “Sf. Ap. Andrei” County Emergency Clinical Hospital, Galați, Romania. The study included 187 newborns of adolescent mothers (≤18 years) and 3203 newborns of mothers aged >19 years. All infants underwent transient evoked otoacoustic emission (TEOAE) testing within 48–72 h after birth, according to institutional protocol. PASS/REFER outcomes were recorded, and retesting was performed when indicated. Although otological conditions such as middle ear dysfunction may influence OAE responses, routine otoscopic examination and clinical assessment were performed prior to testing. Automated auditory brainstem response (AABR) testing was not routinely applied due to equipment availability and local screening practices. The final REFER rate was slightly higher in the adolescent group (5.3%) compared with the adult group (4.8%). Maternal age alone was not directly associated with abnormal outcomes; however, maternal anemia, limited prenatal care, rural residence, prematurity, and low birth weight were more frequently observed among cases with persistent REFER results. Infants born to adolescent mothers show a modestly increased likelihood of abnormal hearing screening outcomes, primarily related to cumulative maternal and neonatal vulnerabilities. Strengthening prenatal care and targeted audiological follow-up may improve early detection of sensorineural hearing loss in this population.

Audiology Research doi: 10.3390/audiolres16010013

Authors: Leora Moss Levy Kinneret Weisler

Background/Objectives: Accumulation of cerumen (earwax) in the auditory canal is a common condition, particularly in children and older adults, and often causes temporary hearing loss. While chronic hearing loss is known to affect mood and cognition, little is known about the psychological impact of short-term auditory deprivation. This pilot study aimed to examine the emotional and cognitive effects of simulated temporary hearing loss. Methods: Thirty healthy adults (16 females, aged 18–60) participated. Temporary hearing loss was simulated by placing earplugs in both ears for two hours. Participants completed four tests, assessing anxiety, mood, and attention at three time points: before wearing earplugs, during the blocked condition, and after earplug removal. Results: Participants showed a significant increase in state anxiety and a decrease in mood during the earplug condition. Interestingly, visual attention performance improved while hearing was obstructed and remained elevated even after earplug removal. Conclusions: Short-term simulated hearing loss produces measurable emotional and cognitive changes, including increased anxiety but enhanced visual attention. Clinicians should consider these effects when assessing patients with temporary hearing obstruction, such as those with cerumen impaction. The results carry implications for the broader population wearing earplugs on a temporary basis including musicians, construction employees, and, in general, people working in noisy environments.

Audiology Research doi: 10.3390/audiolres16010012

Authors: Craig Richard St. Jean Jacqueline Cummine Gurjit Singh William (Bill) Hodgetts

Background/Objectives: This study explored how attribute framing (lifestyle-focused vs. technology-focused product descriptions) and popularity cueing (presence or absence of a “best-seller” label) influenced purchase likelihood for a fictitious selection of hearing aids (HAs) among Canadian adults aged 40 years and above. The study further aimed to investigate whether the effects observed were unique to HAs or applicable to less-specialized consumer technology contexts. Method: A 2 × 2 × 2 mixed experimental design compared attribute framing and popularity cueing effects across HAs and notebook computers at three technology levels (entry-level, midrange, and premium). Participants (n = 122) provided ratings indicating their purchase likelihood for each product. Results: Attribute framing showed no significant influence on purchase decisions across technology levels. The presence of a popularity cue that the midrange HA was the best-seller negatively affected purchase likelihood for the entry-level HA, with higher purchase likelihood ratings observed when this cue was absent. Participants expressed stronger purchase likelihood for premium HAs compared to premium notebook computers. Notably, these two effects were not statistically significant following correction for multiple comparisons. Conclusions: Popularity cues for HAs may have inadvertent consequences for consumer perceptions of models with differing technology levels. Findings also suggest potentially greater willingness to invest in premium health-related technologies versus familiar consumer technology. Further research involving current HA users or candidates is needed to better understand these findings.

Audiology Research doi: 10.3390/audiolres16010011

Authors: Mayur Bhat Krithi Rao Sinchana Hegde Kaushlendra Kumar Aditya Khandagale KM Prajwal Shezeen Abdul Gafoor

Background/Objectives: Vestibular migraine (VM) is one of the most prevalent causes of episodic vertigo, yet it remains underdiagnosed due to overlapping features with other vestibular disorders and the absence of definitive diagnostic tests. Vestibular evoked myogenic potentials (VEMPs) assess otolith and vestibular nerve function and may help identify pathophysiological mechanisms in VM. This systematic review aimed to evaluate the usefulness of VEMP in understanding VM, synthesize existing findings, and explore its clinical implications. Method: A systematic search was performed in PubMed, ProQuest, Scopus, Web of Science, and EMBASE up to 2025 following PRISMA guidelines. Studies were included if they assessed cVEMP and/or oVEMP in patients diagnosed with VM using established clinical criteria. Data extraction and quality assessment were conducted independently by three reviewers using Cochrane and Joanna Briggs Institute tools. A total of 2578 titles and abstracts were screened, and 28 studies met the inclusion criteria. Results: Across 28 studies, 23 reported VEMP abnormalities in VM. The most frequent findings were reduced amplitudes and increased asymmetry ratios compared to healthy controls, indicating potential otolithic dysfunction. Latency prolongations were less consistently reported. Differences between cVEMP and oVEMP findings in individuals with VM suggested variable involvement of saccular and utricular pathways, with oVEMP abnormalities appearing more prominent. Conclusions: VEMP testing reveals subtle vestibular dysfunction in VM, primarily reflected in reduced amplitude and altered asymmetry ratios. However, the association between VEMP abnormality and VM is inconclusive, specifically due to heterogeneity among the included studies. Although findings support its potential as a diagnostic adjunct, methodological variability (including variability in patient recruitment) underscores the need for standardized VEMP protocols to enhance diagnostic accuracy and comparability across studies.

Audiology Research doi: 10.3390/audiolres16010010

Authors: M. Ramiz Malik Kaushlendra Kumar Mohan Kumar Kalaiah Niraj Kumar Singh Mayur Bhat

Background/Objectives: This study compared vestibular evoked myogenic potentials (VEMP) and video head impulse test (vHIT) findings between long-term hearing aid users and non-users with moderately severe to profound sensorineural hearing loss (SNHL) to investigate whether prolonged use of high-power hearing aids has any effect on the functioning of peripheral vestibular organs. Methods: A cross-sectional study was conducted in the audiology clinic of a tertiary care hospital. Using convenience sampling, 67 adults aged 20–64 years who visited for hearing evaluation or hearing aid services were recruited and allocated into hearing aid user and non-user groups. VEMP latency and amplitude and vHIT vestibulo-ocular reflex (VOR) gain values were compared between groups. Multiple linear regression was performed to examine the association between the duration of hearing aid use and vestibular function. Results: No significant group differences were observed for any VEMP or vHIT parameter, except for the latency of P1 of the cVEMP in the left ear. Regression analyses indicated that the duration of hearing aid use was not significantly associated with any vestibular test measure. Conclusions: Long-term use of high-power hearing aids does not appear to be associated with measurable alterations in vestibular function. Nonetheless, longitudinal studies with improved control of confounding variables are recommended to validate these preliminary findings.

Audiology Research doi: 10.3390/audiolres16010009

Authors: Maria Luisa Fiorella Luca Ballini Valentina Lavermicocca Maria Sterpeta Ragno Domenico A. Restivo Rosario Marchese-Ragona

Dysphagia and dysarthria are common, co-occurring manifestations in neurodegenerative diseases, resulting from damage to distributed neural networks involving cortical, subcortical, cerebellar, and brainstem regions. These disorders profoundly affect patient health and quality of life through complex sensorimotor impairments. Objective: The aims was to provide a comprehensive, evidence-based review of the neuroanatomical substrates, pathophysiology, diagnostic approaches, and management strategies for dysphagia and dysarthria in neurodegenerative diseases with emphasis on their multisystem nature and integrated treatment approaches. Methods: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases (2000–2024), focusing on Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA). Search terms included “dysphagia”, “dysarthria”, “neurodegenerative diseases”, “neural networks”, “swallowing control” and “speech production.” Studies on neuroanatomy, pathophysiology, diagnostic tools, and therapeutic interventions were included. Results: Contemporary neuroscience demonstrates that swallowing and speech control involve extensive neural networks beyond the brainstem, including bilateral sensorimotor cortex, insula, cingulate gyrus, basal ganglia, and cerebellum. Disease-specific patterns reflect multisystem involvement: PD affects basal ganglia and multiple brainstem nuclei; ALS involves cortical and brainstem motor neurons; MSA causes widespread autonomic and motor degeneration; PSP produces tau-related damage across multiple brain regions. Diagnostic approaches combining fiberoptic endoscopic evaluation, videofluoroscopy, acoustic analysis, and neuroimaging enable precise characterization. Management requires multidisciplinary Integrated teams implementing coordinated speech-swallowing therapy, pharmacological interventions, and assistive technologies. Conclusions: Dysphagia and dysarthria in neurodegenerative diseases result from multifocal brain damage affecting distributed neural networks. Understanding this multisystem pathophysiology enables more effective integrated assessment and treatment approaches, enhancing patient outcomes and quality of life.

Audiology Research doi: 10.3390/audiolres16010008

Authors: Mauro Gufoni Nicola Ducci Davide Bernacca Luigi Califano Augusto Pietro Casani

Introduction: The aim of this study was to determine the position of otoconial debris in lateral ampullar or non-ampullar canalolithiasis, based on two parameters: (1) the direction of the nystagmus appearing when the patient lies down, if present, and (2) the positional nystagmus evoked by the supine roll test. Methods: Theoretical results were compared with a population of 170 patients observed over the past ten years for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The series included 141 geotropic and 29 apogeotropic cases. Results: Among the geotropic forms, 80 showed no supine nystagmus (Geotropic Nystagmus with no supine nystagmus, GT0) (56.7%), 51 had supine nystagmus directed toward the healthy side (Geotropic Nystagmus with supine nystagmus congruent, direct toward the healthy side, GT+) (36.2%), and 10 toward the affected side (Geotropic Nystagmus with supine nystagmus incongruent direct to the affected side, GT−) (7.1%). In the apogeotropic group, 10 showed no supine nystagmus (Apogeotropic nystagmus with no supine nystagmus, AGT0) (34.6%), 16 had nystagmus toward the affected side (Apogeotropic Nystagmus with supine nystagmus congruent, direct toward the affected side, AGT+) (55.2%), and 1 toward the healthy side (Apogeotropic Nystagmus with supine nystagmus Incongruent, direct toward the healthy side, AGT−) (3.4%). Two cases presented monopositional apogeotropic nystagmus (mAGT), consistent with a “sieve-type canal jam” (6.8%). Overall, 90 out of 170 patients (52.9%) showed no nystagmus in the supine position, with a statistically significant difference between variants (p = 0.0474, Yates correction). Conclusions: The comparison between lying-down nystagmus and positional nystagmus, assessed through the Supine Roll Test as the leading diagnostic maneuver for horizontal canal involvement, may help identify the initial location of debris within the lateral semicircular canal and guide the appropriate liberatory maneuver, while the effectiveness and side of the maneuver allow the distinction between canal-side and utricular-side jams.

Audiology Research doi: 10.3390/audiolres16010007

Authors: Gaelle Ngankam Fotsing Epse Vofo Matityahou Ormianer Marrigje Aagje de Jong Julia Meyler Yaakov Noble Ron Eliashar Menachem Gross

Background/Objectives: Patients with Idiopathic sudden sensorineural hearing loss (ISSNHL) are often devastated by the unknown etiology coupled with the unknown pathway to recovery. The aim of this study was to evaluate whether abnormalities on the video Head Impulse Test (vHIT) performed early in the course of ISSNHL are associated with poorer hearing recovery. Methods: Forty-four patients with ISSNHL were prospectively enrolled between 2019 and 2022 following exclusion of differential diagnoses on clinical and MRI evaluation. vHIT was performed within 1–14 days of symptom onset and within 48 h of hospitalization. Recovery at six months was assessed both as a dichotomous outcome and by change in pure tone average (PTA). Group differences were analyzed using Fisher’s exact and Mann–Whitney U tests. A two-predictor logistic regression model examined the association between vHIT results, dizziness, and recovery. Results: Twelve patients exhibited abnormal vHIT findings. Abnormal vHIT was strongly associated with the presence of dizziness and with markedly poorer hearing recovery at six months. Patients with normal vHIT demonstrated substantially greater improvement in PTA thresholds compared with those showing abnormal results. Logistic regression further confirmed that abnormal vHIT was an independent predictor of reduced likelihood of hearing recovery, whereas dizziness alone did not independently influence outcomes. Conclusions: Our findings suggest that abnormal vHIT results in ISSNHL patients are linked to poor hearing recovery, which can enhance patient counseling regarding expectations. Although promising as a prognostic tool, we acknowledge our limited sample size and recommend validation in larger prospective cohorts.

Audiology Research doi: 10.3390/audiolres16010006

Authors: Andreanne Sharp Daniel Beaudoin Julie Dufour Benoit-Antoine Bacon François Champoux

Research exploring the impact of stimulation rate modifications on perception in cochlear implant users continues to expand. The existing body of research remains contradictory, making it difficult to establish a clear consensus that could inform clinical recommendations. In this context, this article aims to question the usefulness of such adjustments as a clinical intervention beyond the initial fitting, particularly for optimizing non-speech processing. To do so, we combined an overview of the existing literature on the effects of stimulation-rate changes on speech and non-speech processing with a discussion of observational data. The current evidence base is sparse, often contradictory, and affected by interoperability challenges that limit cross-study comparability. Consequently, it is not possible to formulate robust, evidence-based clinical recommendations at this time. Clinicians should be cautious about implementing stimulation-rate adjustments beyond the initial fitting and should wait for more robust evidence to emerge before considering such changes.

Audiology Research doi: 10.3390/audiolres16010005

Authors: Domenico Cuda Patrizia Mancini Giuseppe Chiarella Rosamaria Santarelli

Background/Objectives: Retrocochlear auditory dysfunctions (RADs), including auditory neuropathy (AN) and auditory processing disorders (APD), encompass disorders characterized by impaired auditory processing beyond the cochlea. This narrative review critically examines their distinguishing features, synthesizing recent advances in classification, pathophysiology, clinical presentation, and treatment. Methods: This narrative review involved a comprehensive literature search across major electronic databases (e.g., PubMed, Scopus) to identify and synthesize relevant studies on the classification, diagnosis, and management of AN and APD. The goal was to update the view on etiologies (genetic/non-genetic) and individualized rehabilitative strategies. Diagnosis relies on a comprehensive assessment, including behavioral, electrophysiological, and imaging tests. Rehabilitation is categorized into bottom-up and top-down approaches. Results: ANSD is defined by neural desynchronization with preserved outer hair cell function, resulting in abnormal auditory brainstem responses and poor speech discrimination. The etiologies (distal/proximal) influence the prognosis for interventions, particularly cochlear implants (CI). APD involves central processing deficits, often with normal peripheral hearing and heterogeneous symptoms affecting speech perception and localization. Rehabilitation is multidisciplinary, utilizing bottom-up strategies (e.g., auditory training, CI) and compensatory top-down approaches. Remote microphone systems are highly effective in improving the signal-to-noise ratio. Conclusions: Accurate diagnosis and personalized, multidisciplinary management are crucial for optimizing communication and quality of life. Evidence suggests that combined bottom-up and top-down interventions may yield superior outcomes. However, methodological heterogeneity limits the generalizability of protocols, highlighting the need for further targeted research.

Audiology Research doi: 10.3390/audiolres16010004

Authors: Melissa Blanco-Pareja Alberto Vieco García Teresa Perucho Javier Santos José Manuel Moreno-Villares Nicolas Pérez-Fernández

Background and Clinical Significance: Vestibular disorders in children are often overlooked, delaying treatment. Early diagnosis of benign paroxysmal positional vertigo (BPPV) allows for targeted maneuvers during acute episodes. Though rare, BPPV can occur in children due to stereocilin gene (STRC) deletions or variants, causing hearing loss and vestibular dysfunction. Case Presentation: This study highlights a case of recurrent vertigo linked to a homozygous deletion on chromosome 15 affecting the STRC gene.

Audiology Research doi: 10.3390/audiolres16010003

Authors: Tomáš Mimra Martin Augustynek Marek Penhaker Lukáš Klein

Background: The objective assessment of hearing in non-cooperative populations, such as neonates, remains a challenge. While Brainstem Evoked Response Audiometry (BERA) is the gold standard, its sensitivity to motion artifacts necessitates alternatives. Objective: This scoping review maps the current literature on functional near-infrared spectroscopy (fNIRS) as a supplementary method in objective audiometry. Data Synthesis: fNIRS shows potential to detect cortical hemodynamic responses, particularly to complex stimuli like speech, which BERA cannot fully assess. Key advantages include motion tolerance and suitability for pediatric and cochlear implant populations. However, the literature reveals significant heterogeneity in stimulation protocols and data processing. Evidence suggests fNIRS is better suited for assessing higher-level auditory processing rather than replacing BERA for threshold estimation. Conclusions: fNIRS is a promising complementary tool. However, due to the lack of standardized protocols and large-scale validation studies, it is not yet a direct clinical replacement for BERA. Future work must focus on protocol standardization and establishing robust normative data.

Audiology Research doi: 10.3390/audiolres16010002

Authors: Haúla F. Haider Ana Solange Fernandes Ana Filipa Aguiar Beatriz Oliveira Iris Peixoto Marília Antunes Derek James Hoare Helena Caria

Objective: Several questionnaires for the diagnosis and characterization of tinnitus are available in English but there is a need for Portuguese standardized questionnaires for use in research and in clinic. The goals of this study were to translate and culturally adapt the ESIT-SQ (European School for Interdisciplinary Tinnitus Research Screening Questionnaire) to Portuguese, and to validate the questionnaire for clinical use. Methods: Translation and cross-cultural adaptation of the instrument were performed. The translation stage included the translation and retroversion of the instrument in the languages of interest (English–Portuguese) by three bilingual translators. Subsequently, cross-cultural adaptation was performed involving an Experts Panel (n = 5) and a Patient Panel (n = 4) to evaluate the questionnaire versions obtained after translation and retroversion. Participants completed their evaluation in Microsoft Forms. All ambiguities and uncertainties were addressed by the research team. Validation of the questionnaire involved an ENT specialist (n = 1), health researchers (n = 3), and patients (n = 300). Results: The Portuguese version of the ESIT-SQ (ESIT-SQ-PT) was found to be culturally appropriate, clear, and valid for clinical use. Expert review confirmed strong face validity, with only minor textual adjustments needed. The validation study, involving both online and paper responses, demonstrated good reproducibility and internal consistency across diverse participant profiles. The questionnaire effectively captured a wide range of tinnitus characteristics and associated factors, and reliability analyses confirmed its temporal stability. Overall, the ESIT-SQ-PT proved to be a robust and reliable instrument for assessing tinnitus in Portuguese-speaking populations. Conclusion: The ESIT-SQ in Portuguese (ESIT-SQ-PT), had good face validity, was comprehensible, and was culturally appropriate; thus, it is a valid tool for the screening and assessment of tinnitus and associated symptoms in Portuguese populations.

Audiology Research doi: 10.3390/audiolres16010001

Authors: Christos Tsilivigkos Riccardo Di Micco Evangelos N. Vitkos Athanasia Warnecke

Background/Objectives: The diagnosis of vestibular migraine (VM) and Meniere’s disease (MD) is based mainly on clinical criteria. The aim of this study is to systematically review and investigate the potential role of the video Head Impulse Test (vHIT) in the differential diagnosis between VM and MD. Methods: A systematic review of the English-language literature was conducted, including studies from database inception to November 2023, in accordance with PRISMA guidelines. Medline (via PubMed), Cochrane Database and Scopus were reviewed. The review included studies involving adult patients diagnosed with VM, MD, or healthy control individuals who underwent vHIT and reported data on vHIT abnormalities, gain, and refixation saccades. The AXIS tool was applied for risk of bias assessment in all cross-sectional studies. A random-effects meta-analysis was performed to compare vHIT gains between individuals with VM and those with MD. Results: Eleven cross-sectional observational studies with a case–control comparison design were included, comprising a total of 362 patients with VM, 307 patients with MD, and 135 healthy control subjects. All studies applied the same diagnostic criteria for VM; however, varying criteria were used for the diagnosis of MD. Four studies evaluated the duration of vestibular symptoms, two assessed migraine duration, and six provided a rationale for excluding individuals with overlapping VM and MD diagnoses. Criteria for defining an abnormal vHIT result were specified in six studies. Seven studies reported vHIT gain values for the lateral semicircular canal, while eight presented data on saccade incidence and characteristics. Additionally, four studies were included in the meta-analysis, which yielded a mean difference in the vHIT gain of −0.0203 (95% CI: −0.0789 to 0.0383; p = 0.4968), indicating no statistically significant difference between patients with VM and those with MD. Conclusions: In this review, vHIT gain did not differ significantly between VM and MD groups, suggesting that vHIT gain alone has limited utility in their differential diagnosis. Combined saccade patterns may still prove clinically useful as more robust and consistent data become available.

Audiology Research doi: 10.3390/audiolres15060176

Authors: Morgan Potier Arnaud Noreña Fabien Seldran Mathieu Marx Stéphane Gallego

Background and Aim: Asymmetric sensorineural hearing loss is difficult to rehabilitate acoustically. Bilateral amplification may induce binaural interference, while CROS/BiCROS systems provide benefit only when the speech signal reaches the poorer ear. A hybrid approach combining CROS strategy with bilateral acoustic amplification, called Stereophonic Bilateral Contralateral Routing of Signal—StereoBiCROS—has recently emerged. Methods: A one-month home trial was conducted with hearing aids programmed in three listening modes: Stereophonic, BiCROS, and StereoBiCROS. Speech-in-noise perception was assessed in dichotic and reverse-dichotic conditions. Speech recognition thresholds were derived using logistic regression. Daily mode usage was extracted from datalogging. Pre/post subjective benefit was evaluated using the SSQ-15 and SF-12. Results: Eighteen participants (mean age 70.7 ± 8.2 years) used the devices 12.4 ± 1.6 h per day, predominantly in StereoBiCROS mode (76.9 ± 24.2%). In the dichotic condition, this mode yielded the best speech-to-noise ratio (0.96 ± 2.74 dB; p < 0.0001), outperforming unilateral rerouting (3.00 ± 2.05 dB; p = 0.001) and bilateral amplification (5.16 ± 1.31 dB; p = 0.001). In the reverse-dichotic condition, only bilateral amplification provided a non-significant improvement (3.08 ± 1.38 dB), whereas the other modes deteriorated intelligibility. SSQ-15 total and subscale scores significantly improved after one month, while SF-12 scores did not change. Conclusions: StereoBiCROS stimulation appears to be a promising acoustic alternative for improving speech intelligibility in noise and patient-reported outcomes in asymmetric sensorineural hearing loss. Further research is required to identify the most responsive audiological profiles.

Audiology Research doi: 10.3390/audiolres15060175

Authors: Enrico Ciminello Domenico Cuda Francesca Forli Anna Rita Fetoni Stefano Berrettini Eugenio Mattei Tiziana Falcone Adriano Cuccu Paola Ciccarelli Stefania Ceccarelli Marina Torre

Background/Objectives: Cochlear implants (CIs) and other implantable hearing devices are crucial to treat hearing loss. The aim of this study was to analyze the temporal trends of implantation for hearing devices in Italy between 2001 and 2023, with stratification by age. Methods: This population-based study explored Hospital Discharge Records and used codes from the International Classification of Diseases, 9th revision—Clinical Modification (ICD9-CM) to identify cochlear and non-cochlear implants. Patients were partitioned into six age classes: <1, 1–2, 3–17, 18–65, 66–80, and >80; and time series for counts and incidence rates (IRs) per 1,000,000 inhabitants with confidence intervals (CI95%) were explored overall and by age class. Trends were assessed by incidence rate ratio and Cox–Stuart test with a significance threshold for p-values at 0.05. Results: 22,850 (83.6%) records for cochlear and 4476 (16.4%) for non-cochlear implants were extracted. Cochlear implants volume shifted from 537 procedures in 2001 to 1595 in 2023 (p < 0.01), while IR increased (p < 0.01) from 9.4 (CI95%: 9.7, 10.3) in 2001 to 27 (CI95%: 25.7, 28.4) in 2023. The volumes of implanted CIs increased in children and adults. Volumes for non-cochlear implants increased between 2001 and 2010, from 62 to 254, and remained stable afterwards. IR shifted from 1.1 (CI95%: 0.8, 1.4) in 2001 to 4.1 (CI95%: 3.6, 4.7) in 2023. Conclusions: Those trends highlight the importance of monitoring efficacy and safety of hearing devices, and the establishment of the Italian Implantable Hearing Device Registry at the Italian National Institute of Health is a first step in such a direction.

Audiology Research doi: 10.3390/audiolres15060174

Authors: Lakshmi Satheesan Usha Shastri Gagan Bajaj Mohan Kumar Kalaiah

Background: Individuals with untreated hearing loss often experience cognitive decline as a result of increased cognitive load and reduced sensory stimulation. Despite the well-established link between untreated hearing loss and cognitive decline in older adults, its impact on cognition in young and middle-aged adults has not been systematically examined. Given the Lancet Commission’s identification of midlife hearing loss as the leading modifiable risk factor for dementia, early identification of cognitive decline is essential. This review explored the cognitive impact of untreated hearing loss in adults. Method: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and EMBASE to include studies comparing cognitive function between adults with normal hearing and those with untreated hearing loss aged 18–65 years. The methodological quality of the included studies was examined via the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Pooled mean differences and heterogeneity were analysed for each domain. Results: Seven studies included in the qualitative synthesis had “moderate” to “strong” methodological quality. The cognitive domains assessed in these studies were global cognitive function, memory, attention, and executive function. Of these, six were eligible for meta-analysis, which revealed a small but statistically significant decline in overall cognitive performance and memory and executive function among adults with untreated hearing loss. Conclusions: Cognitive vulnerabilities exist in young and middle-aged adults with untreated hearing loss. Hence, incorporating cognitive assessment into routine audiological evaluation may enable earlier intervention and delay the future burden of Alzheimer’s disease and related dementias in such a population.

Audiology Research doi: 10.3390/audiolres15060173

Authors: Petra Brueggemann Gernot G. Supp Paul Schmidt Birgit Mazurek

Background/Objectives: Subjective tinnitus, defined as the perception of sound without an external source, is a common and often debilitating condition. In the absence of pharmacotherapy, disease management guidelines recommend counseling interventions to alleviate tinnitus-related distress and improve patient outcome. This study evaluated the benefit of guideline-compliant counseling provided by “Meine Tinnitus App”, a smartphone-based application, for the treatment of subjective tinnitus. Methods: A randomized controlled study was conducted in 204 patients with confirmed chronic subjective tinnitus enrolled at 33 ear, nose and throat (ENT) practices in Germany. Tinnitus improvement was evaluated after 10 weeks of intervention (digital counseling in addition to standard care vs. standard care only). The primary endpoint was the change in tinnitus-related distress (measured by the Mini-TQ-12 validated questionnaire). The secondary endpoint was the change in tinnitus-associated daily burden and coping difficulties (measured by the validated BVB-2000 questionnaire). Treatment effects for the primary and secondary endpoints were represented by the estimated marginal means (EMMs). Results: Patients of the intervention group showed a significant reduction in tinnitus-related distress (EMM [95% CI]: 4.5 [3.3–5.8]; p < 0.001) and a significant improvement in tinnitus-associated daily burden and coping difficulties (EMM [95% CI]: 0.5 [0.2–0.7]; p < 0.001) compared to patients of the control group, with large to moderate effect sizes (Hedges’ g between 1.1. and 0.5). These positive treatment effects were confirmed by responder and sensitivity analyses. Additionally, patients with high vs. low app usage showed a greater improvement in treatment effect for both endpoints (p < 0.05), further supporting the health benefits of digital counseling. Conclusions: This study demonstrated the efficacy of tinnitus counseling provided by “Meine Tinnitus App” to alleviate tinnitus-related distress, daily burden, and coping difficulties in patients with subjective tinnitus (German Clinical Trials Register DRKS00025379).

Audiology Research doi: 10.3390/audiolres15060172

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

Objective: The aim of the study was to evaluate the validity, clinical applicability, and developmental sensitivity of the Romanian LEESPQ in children with cochlear implants (CIs), by analyzing its association with age at implantation, duration of auditory experience, and implantation laterality, and by comparing the developmental trajectory with that of normal-hearing (NH) children. Methods: The study assesses the validity, reliability, and clinical sensitivity of the LEESPQ in pediatric cochlear implant users. Furthermore, it investigates the associations between total questionnaire scores and key clinical variables, including implantation laterality (unilateral versus bilateral), age at device activation, and duration of implant use. Forty-seven children with CIs (26 boys, 21 girls) were included, with implantation ages ranging from 9 months to 5 years. Of these, 21 received unilateral implants and 26 bilateral implants. Responses were analyzed both in relation to clinical variables and in comparison with available normative data from NH children, in order to delineate potential differences in linguistic developmental trajectories. Results: Findings suggest that the LEESPQ is a reliable and clinically valuable instrument for monitoring post-implant linguistic progress. It provides relevant insights into early auditory access, the linguistic environment within the family, and the development of early verbal production. Scores were significantly influenced by age at implantation and duration of auditory experience, confirming the role of early stimulation and neural plasticity in shaping speech development after cochlear implantation. Conclusions: The LEESPQ demonstrates strong clinical utility as a sensitive tool for monitoring early preverbal and verbal development in children with CIs. By capturing score variations associated with age at implantation, auditory experience, and implantation laterality, the questionnaire provides meaningful insights into early post-implant outcomes and supports individualized rehabilitation planning. These findings highlight the value of the LEESPQ for early outcome assessment in pediatric cochlear implant users.

Audiology Research doi: 10.3390/audiolres15060171

Authors: Nikolaos Trimmis Melina Kaparou Theodoros Tsoukalas Panagiotis Plotas Voula Chris Georgopoulos

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

Audiology Research doi: 10.3390/audiolres15060170

Authors: Peter Torre Haley Elliott Zhongli J. Zhang Tzy-Jyun Yao Barbara Laughton

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

Audiology Research doi: 10.3390/audiolres15060169

Authors: Tiziana Di Cesare Paola Michieletto Maria Teresa Bonati Federica De Caro Pietro Cossu Francesco Torelli Eva Orzan

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

Audiology Research doi: 10.3390/audiolres15060168

Authors: Concheri Stefano Vito Pontillo Alberto D’Amico Stefano Di Girolamo Francesco Signorelli Elisabetta Zanoletti Nicola Antonio Adolfo Quaranta

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

Audiology Research doi: 10.3390/audiolres15060167

Authors: Daniele Portelli Sabrina Loteta Cosimo Galletti Mariangela D’Angelo Leonard Freni Pietro Salvago Francesco Ciodaro Giuseppe Alberti

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

Audiology Research doi: 10.3390/audiolres15060166

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

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

Audiology Research doi: 10.3390/audiolres15060165

Authors: Gerard Joseph Gianoli

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

Audiology Research doi: 10.3390/audiolres15060164

Authors: Anusha Yellamsetty Gianmaris Fortuna Egbe-Etu Etu Shaowen Bao

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

Audiology Research doi: 10.3390/audiolres15060163

Authors: Abdulaziz Alasmi Mada Aljabr Dalal Alrushaydan Hassan Yalcouy Fida Almuhawas

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

Audiology Research doi: 10.3390/audiolres15060162

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

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

Audiology Research doi: 10.3390/audiolres15060161

Authors: Rieke Ollermann Nils Strodthoff Andreas Radeloff Robert Böscke

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

Audiology Research doi: 10.3390/audiolres15060160

Authors: Elisa Vivado Daniele Cossellu Paola Perin

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

Audiology Research doi: 10.3390/audiolres15060159

Authors: Mario Faralli Giuseppe Santopietro Francesco Frati Luigi Califano

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

Audiology Research doi: 10.3390/audiolres15060158

Authors: Shruthi Raghavendra Sungmin Lee Chin-Tuan Tan

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

Audiology Research doi: 10.3390/audiolres15060157

Authors: Kate Pfingstgraef Robin O’Hagan Jana N. Bataineh Danielle Glista

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

Audiology Research doi: 10.3390/audiolres15060156

Authors: Ivy Cheng Wan-Qi Li Shaheen Hamdy Emilia Michou Maggie-Lee Huckabee Noemí Tomsen Pere Clavé Rainer Dziewas

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

Audiology Research doi: 10.3390/audiolres15060155

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

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

Audiology Research doi: 10.3390/audiolres15060154

Authors: Marco Tramontano Laura Casagrande Conti Nicola Ferri Leonardo Manzari

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

Audiology Research doi: 10.3390/audiolres15060153

Authors: Lucia D’Alatri Maria Raffaella Marchese Angelo Tizio Jacopo Galli

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

Audiology Research doi: 10.3390/audiolres15060152

Authors: Silvia Capobianco Luca Bastiani Francesca Forli Bruno Fattori Francesco Stomeo Maria Russo Maria Rosaria Barillari Andrea Nacci

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

Audiology Research doi: 10.3390/audiolres15060151

Authors: Khaled H. A. Abdellatif Horst Hessel Moritz Wächtler Verena Müller Martin Walger Hartmut Meister

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

Audiology Research doi: 10.3390/audiolres15060150

Authors: Augusto Pietro Casani Mauro Gufoni Nicola Ducci Giacinto Asprella Libonati Giuseppe Chiarella

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