Search Results (334)

Filled pauses are thought to be reflections of linguistic processes (e.g., lexical retrieval, speech planning and execution). Uh may be a self-directed cue for when a speaker needs more time to retrieve lexical–semantic representations, whereas um serves as a listener-directed, pragmatic cue. The use of filled pauses has not been examined in children who are hard of hearing (CHH). Participants included 68 CHH and 33 children with typical hearing (CTH). Participants engaged in conversations, expository discourse, and fable retells. We analyzed filled pauses as a function of hearing status and discourse contexts and evaluated the relationship between filled pauses and language ability. CHH produced uh across discourse contexts more often than their hearing peers. CHH did not differ in their use of um relative to CTH. Both um and uh were used more often in conversational samples compared to other types of discourse. Spearman’s correlations did not show any significant associations between the rate of filled pauses and standardized language scores. These results indicate that CHH produces uh more often than CTH, suggesting that they may have difficulty retrieving lexical–semantic items during ongoing speech. This information may be useful for interventionists who are collecting language samples during assessment. Full article

Background/Objectives: This study investigated the association between cochlear implant (CI) users’ assessed perception of musical sound quality and their subjective music perception and music-related quality of life (QoL). The aim was to provide a comprehensive evaluation by integrating a relatively objective Turkish Multiple Stimulus with Hidden Reference and Anchor (TR-MUSHRA) test and a subjective music questionnaire. Methods: Thirty CI users and thirty normal-hearing (NH) adults were assessed. Perception of sound quality was measured using the TR-MUSHRA test. Subjective assessments were conducted with the Music-Related Quality of Life Questionnaire (MuRQoL). Results: TR-MUSHRA results showed that while NH participants rated all filtered stimuli as perceptually different from the original, CI users provided similar ratings for stimuli with adjacent high-pass filter settings, indicating less differentiation in perceived sound quality. On the MuRQoL, groups differed on the Frequency subscale but not the Importance subscale. Critically, no significant correlation was found between the TR-MUSHRA scores and the MuRQoL subscale scores in either group. Conclusions: The findings demonstrate that TR-MUSHRA is an effective tool for assessing perceived sound quality relatively objectively, but there is no relationship between perceiving sound quality differences and measures of self-reported musical engagement and its importance. Subjective music experience may represent different domains beyond the perception of sound quality. Therefore, successful auditory rehabilitation requires personalized strategies that consider the multifaceted nature of music perception beyond simple perceptual judgments. Full article

Background/Objectives: Traditional hearing aid noise reduction algorithms offer no additional benefit in noisy situations for bimodal cochlear implant (CI) users with a CI in one ear and a hearing aid (HA) in the other. Recent breakthroughs in deep neural network (DNN)-based noise reduction have improved speech understanding for hearing aid users in noisy environments. These advancements could also boost speech perception in noise for bimodal CI users. This study investigated the effectiveness of DNN-based noise reduction in the HAs used by bimodal CI patients. Methods: Eleven bimodal CI patients, aged 71–89 years old, were fit with a Phonak Audéo Sphere Infinio 90 HA in their non-implanted ear and were provided with a Calm Situation program and Spheric Speech in Loud Noise program that uses DNN-based noise reduction. Sentence recognition scores were measured using AzBio sentences in quiet and in noise with the CI alone, hearing aid alone, and bimodally with both the Calm Situation and DNN HA programs. Results: The DNN program in the hearing aid significantly improved bimodal performance in noise, with sentence recognition scores reaching 79% compared to 60% with Calm Situation (a 19% average benefit, p < 0.001). When compared to the CI-alone condition in multi-talker babble, the DNN HA program offered a 40% bimodal benefit, significantly higher than the 21% score seen with the Calm Situation program. Conclusions: DNN-based noise reduction in HA significantly improves speech understanding in noise for bimodal CI users. Utilization of this technology is a promising option to address patients’ common complaint of speech understanding in noise. Full article

Diffusion tensor imaging (DTI) metrics provide insights into neural pathways, which can be pivotal in differentiating congenital and acquired hearing loss to support diagnosis, especially for those diagnosed late. In this study, we analyzed DTI parameters and developed machine learning to classify these two patient groups. The study included 29 patients with congenital hearing loss and 6 with acquired hearing loss. DTI scans were performed to obtain metrics, such as fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Statistical analyses based on p-values highlighted the cortical auditory system’s prominence in differentiating between groups, with FA and RD emerging as pivotal metrics. Three machine learning models were trained to classify hearing loss types for each of five dataset scenarios. Random forest (RF) trained on a dataset consisting of significant features demonstrated superior performance, achieving a specificity of 87.12% and F1 score of 96.88%. This finding highlights the critical role of DTI metrics in the classification of hearing loss. The experimental results also emphasized the critical role of FA in distinguishing between the two types of hearing loss, underscoring its potential clinical utility. DTI parameters, combined with machine learning, can effectively distinguish between congenital and acquired hearing loss, offering a robust tool for clinical diagnosis and treatment planning. Further research with larger and balanced cohorts is warranted to validate these findings. Full article

Background/Objectives: Cochlear “injury” is thought to be a significant cause of tinnitus in patients with hearing loss. Interestingly, individuals with normal hearing may also experience tinnitus. This study evaluates otoacoustic distortion product emissions (DPOAEs) in individuals with normal hearing who experience tinnitus perception. Methods: In this prospective study, the tinnitus group (TG) consisted of 34 subjects with tinnitus (four unilaterally) and normal hearing (threshold ≤ 25 dBHL at 0.25–8 kHz). The control group (CG) comprised 10 healthy volunteers (20 ears) without tinnitus and normal hearing. Medical history was recorded, and all participants underwent a complete otolaryngological examination, pure tone audiometry, and DPOAE recording (DP-gram, L1 = 55 dB, L2 = 65 dB, for F2: 619–10,000 Hz). Moreover, participants in the TG completed a detailed tinnitus history (with self-rated loudness scoring) and the Tinnitus Handicap Inventory (Greek-version THI-G) and underwent tinnitus analysis. Results: The recorded mean DPOAE values during the DP-gram of the CG were significantly larger in amplitude at low (t-test, Bonferroni-corrected p < 0.09) and high frequencies (t-test, Bonferroni-corrected p < 0.02) compared with the TG. Tinnitus assessment showed tinnitus pitch matching at the frequency area in the DP-gram, where the acceptance recording criteria were not met. There were no statistically significant differences in tinnitus onset, self-rated loudness scores of >70, and severe disability (THI-G > 58) for TG subjects in whom DPOAEs were not recorded at frequencies of ≤1000 Hz. Participants with abnormal DPOAEs at around 4000 Hz had tinnitus of sudden onset and severe disability (THI-G > 58). Finally, those with pathological recordings of DPOAEs at ≥6000 Hz had gradual onset tinnitus (Pearson Chi-square test, p < 0.05). Conclusions: DPOAEs in normal hearing individuals with tinnitus show lower amplitudes in low and high frequencies compared with normal hearing individuals without tinnitus. The tinnitus matched-frequency coincided with the frequency area where DPOAEs were abnormal. Full article

Background/Objectives: Cochlear implants (CIs) and hearing aids (HAs) have enhanced auditory rehabilitation in elderly individuals, yet limitations in musical perception and psychosocial integration persist. This systematic review aimed to evaluate the effects of music therapy (MT) on the quality of life (QoL), self-esteem, auditory perception, and cognition in older CI and HA users. Methods: A comprehensive search of PubMed was conducted up to March 2022 following PRISMA guidelines. Studies involving participants aged ≥ 60 years with CIs and/or HAs were included. Ten studies (n = 21,632) met eligibility criteria. Data were extracted and assessed using the Newcastle–Ottawa Scale. Results: MT led to improved sound quality, with HISQUI19 scores rising from 60.0 ± 21.8 to 74.2 ± 27.5. Early MT exposure was associated with significantly better MUMU outcomes (p = 0.02). Bilateral CI users showed enhanced stereo detection (52% to 86%), and CI + HA users achieved CNC scores exceeding 95%. Postlingual CI users outperformed prelingual peers in musical discrimination (9.81 vs. 3.48; p < 0.001). Long-term HA use was linked to better a QoL and reduced loneliness. Conclusions: While music therapy appears to support auditory and psychosocial functioning in hearing-impaired older adults, the absence of randomized controlled trials limits causal inference regarding its effects. These results support its integration into hearing rehabilitation strategies for older adults. Full article

Background/Objectives: Menière’s disease (MD) is a debilitating disorder with episodic and variable ear symptoms. Diagnosis can be challenging, and evidence for therapeutic approaches is low. Furthermore, patients show a unique and fluctuating configuration of audiovestibular impairment. As a psychometric instrument to assess hearing-specific disability is currently lacking, we evaluated a short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) in a cohort of patients with MD. Methods: Data was collected in the context of a multicenter prospective patient registry intended for the long-term follow up of MD patients. Hearing was assessed by pure tone and speech audiometry. The SSQ was applied in the German language version with 17 items. Results: In total, 97 consecutive patients with unilateral MD with a mean age of 56.2 ± 5.0 years were included. A total of 55 individuals (57.3%) were female, and 72 (75.0%) were categorized as having definite MD. The average total score of the SSQ was 6.0 ± 2.1. Cronbach’s alpha for internal consistency was 0.960 for the total score. We did not observe undue floor or ceiling effects. SSQ values showed a statistically negative correlation with hearing thresholds and a statistically positive correlation with speech recognition scores of affected ears. Conclusions: The short form of the SSQ provides insight into hearing-specific disability in patients with MD. Therefore, it may be informative regarding disease stage and rehabilitation needs. Full article

Background/Objectives: Congenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. In cases of severe-to-profound SNHL, cochlear implantation (CI) is a widely used intervention, but outcomes remain variable due to possible neurodevelopmental comorbidities. This study aimed to evaluate the long-term auditory and language outcomes in children with cCMV after CI and to explore clinical and radiological predictors of post-CI performance. Methods: Fifty-three children with cCMV and bilateral severe-to-profound SNHL who underwent CI at five tertiary referral centers in Italy were included in the study. Auditory and language outcomes were assessed pre- and post-implantation using the Categories of Auditory Performance II (CAP-II) scale, the Nottingham 3-Level Classification, and the Bates Language Development Scale. Brain MRI abnormalities were classified according to the Alarcón classification. Correlations were explored between outcome scores and symptomatic status at birth, MRI findings, and neurodevelopmental comorbidities. Results: At birth, 40 children (75.5%) were symptomatic and 13 (24.5%) asymptomatic. Neurodevelopmental comorbidities were present in 19 children (35.8%). MRI was normal in 15 (28.3%), mildly abnormal in 26 (49%), and moderately to severely abnormal in 12 (22.6%). Auditory and language outcomes improved significantly post-CI (p < 0.001), though the outcomes varied widely. Twenty-five children (47%) reached CAP level ≥ 6, and thirteen (23%) reached Bates Level 6. Symptomatic status at birth correlated weakly with worse CAP (ρ = −0.291, p = 0.038) and Bates (ρ = −0.310, p = 0.028) scores. Higher Alarcón scores were significantly associated with neurodevelopmental comorbidities, though not directly with post-CI auditory and language outcomes. Finally, the presence of neurodevelopmental disabilities was generally associated with lower results, even if without statistical significance. Conclusions: CI provides substantial auditory and language benefit in children with cCMV, even in cases of severe neurodevelopmental comorbidities. MRI and developmental assessments, as well as perinatal history for clinical signs and symptoms, are helpful in guiding expectations and personalizing post-implantation support. Full article

Background/Objectives: This study aimed to (i) cross-culturally adapt the Inventory of Hyperacusis (IHS) into Danish and (ii) assess its usability, validity, and reliability in Danish adults with hyperacusis. Methods: The translation followed established guidelines for adapting hearing-related questionnaires. A two-phase design ensured linguistic and cultural adaptation and evaluated test–retest reliability and construct validity. The IHS, consisting of 25 items, was translated and tested in seven participants through cognitive debriefing. In phase two, temporal consistency was assessed in 32 patients. Results: Thirty-two participants (twenty-eight female; mean age 49.8 years) completed the study over 2–4 weeks (mean 22 days). Eight used hearing aids, and twenty-four reported tinnitus. The Danish IHS showed good reliability (Cronbach’s alpha = 0.95) and acceptable test–retest reliability, except for the General Loudness factor. While no systematic score changes occurred, significant variability in score changes were noted. Conclusions: The Danish IHS appears to be a reliable and valid tool for assessing hyperacusis. Further research is needed, but the IHS-DK shows potential as an effective clinical and research tool for evaluating hyperacusis impact and treatment outcomes. Full article

Background/Objectives: Tonal thresholds, typically assessed through pure-tone audiometry (PTA), are central to the audiological evaluation of Ménière’s disease (MD). However, they fail to capture the complexity of real-life speech perception. This study aimed to characterize the relationship between PTA and speech recognition performance in unilateral MD and to determine whether a measurable dissociation exists between hearing sensitivity and verbal processing. We also evaluated frequency-specific audiometric patterns and potential threshold cut-off values associated with speech recognition decline. Methods: A total of 254 ears from 127 patients were included in the study across three groups: the Ménière group (affected and unaffected ears, n = 64 each) and the control group (n = 63). The pure-tone thresholds, speech recognition threshold (SRT), and the maximum word recognition scores (Rmax) were assessed in all participants. Results: Although the Ménière affected and control groups showed comparable pure-tone average (PTA) values (46.33 vs. 38.13 dB, p = 0.439), the affected group demonstrated significantly poorer speech performance (Rmax: 76.25% vs. 87.49%, p < 0.001; SRT: 50.64 vs. 38.45 dB, p = 0.009). The Ménière unaffected group exhibited near-ceiling performance (Rmax: 99.38%, SRT: 18.33 dB) and a mean PTA of 19.59 dB. A strong correlation between PTA and SRT was observed only in the Ménière affected group (r = 0.942, p < 0.001), whereas correlations were moderate in the unaffected (r = 0.671, p < 0.001) and control (r = 0.728, p < 0.001) groups. The ROC analysis revealed that PTA predicted impaired speech recognition with high accuracy in unaffected (AUC = 0.956, p < 0.001) and control (AUC = 0.829, p < 0.001) ears but far less so in affected ears (AUC = 0.784; all p < 0.001), confirming a functional tonal–verbal dissociation in MD. Conclusions: This study demonstrates a functional audiometric dissociation in unilateral Ménière’s disease. Affected ears show poorer speech recognition and require higher intensities despite similar PTA values. The predictive link between thresholds and verbal performance is disrupted. These findings support the need for combined tonal and speech-based assessment in clinical practice. Full article

Thyroid eye disease (TED) is a complex autoimmune disorder characterized by orbital inflammation and tissue remodeling. Teprotumumab, a fully human monoclonal antibody targeting insulin-like growth factor-1 receptor (IGF-1R), represents a significant breakthrough in TED treatment. This review comprehensively analyzes the therapeutic role of teprotumumab in TED management. Mechanistically, teprotumumab inhibits the IGF-1R/TSHR signaling complex, thereby reducing orbital fibroblast differentiation and inflammatory responses. Phase II and III clinical trials have demonstrated its remarkable efficacy in reducing proptosis and improving clinical activity scores, with the benefits extending to both active and chronic TED cases. Real-world studies have validated these findings further and expanded its potential applications to various clinical scenarios, including dysthyroid optic neuropathy and steroid-resistant cases. However, several challenges remain. These include treatment-related adverse effects such as hyperglycemia and hearing impairment, with emerging evidence suggesting ethnic variations in susceptibility. The high cost of treatment poses significant accessibility barriers, while limited long-term follow-up data and potential disease recurrence necessitate further investigation. This review synthesizes the current evidence to inform clinical decision-making and highlights areas requiring additional research to optimize teprotumumab’s therapeutic application in TED management. Full article

Introduction: This study aimed to compare different scoring methods, such as phoneme, syllable, and word-based scoring, during word recognition in noise testing and their interaction with hearing loss severity. These scoring methods provided a structured framework for refining clinical audiological diagnosis by revealing underlying auditory processing at multiple linguistic levels. We highlight how scoring differences inform differential diagnosis and guide targeted audiological interventions. Methods: Pure tone audiometry and word-in-noise testing were conducted on 100 subjects with a wide range of hearing loss severity. Speech recognition was scored using phoneme, syllable, and word-based methods. All procedures were designed to reflect standard diagnostic protocols in clinical audiology. Discriminant function analysis examined how these scoring methods differentiate the degree of hearing loss. Results: Results showed that each method provides unique information about auditory processing. Phoneme-based scoring has pointed out basic auditory discrimination; syllable-based scoring can capture temporal and phonological processing, while word-based scoring reflects real-world listening conditions by incorporating contextual knowledge. These findings emphasize the diagnostic value of each scoring approach in clinical settings, aiding differential diagnosis and treatment planning. Conclusions: This study showed the effect of different scoring methods on hearing loss differentiation concerning severity. We recommend the integration of phoneme-based scoring into standard diagnostic batteries to enhance early detection and personalize rehabilitation strategies. Future research must involve studies about integration with other speech perception tests and applicability across different clinical settings. Full article

To determine candidate key proteins involved in synaptic transmission in the thalamus in tinnitus, we used bioinformatic methods by analyzing protein–protein interaction networks under different conditions of acoustic activity. The motor system was used to analyze the specificity of the response reaction in the auditory system. The databases GeneCard, STRING-, DAVID-, and Cytoscape version 3.9.1 were applied to identify the top three high-degree proteins, their high-score interaction proteins and the gene ontology—biological processes (GO-BPs) associated in the thalamus with synaptic transmission in tinnitus. Under normal hearing conditions, a balanced state of functional connectivity was observed for both systems, the auditory system and the motor system of the thalamus. Under conditions of acoustic stimulation, the GO-BP-enrichment analyses suggest that in the auditory system, tinnitus-related proteins may be involved in responses typically associated with “xenobiotic stimuli”; in the motor system, the activation of the dopaminergic system was observed. Under conditions of tinnitus in the auditory system, key proteins and the GO-BPs indicate the regulation of different developmental processes and regulation by microRNA transcription; in the motor system, tinnitus is also identified as “xenobiotic” but responded with GO-BPs, corresponding to various signaling systems, e.g., tachykinin. Key proteins and their interactions with neurotransmitter receptors may be useful indicators for tinnitus-associated changes in synaptic transmission in the thalamic auditory system. Full article

Background/Objectives: Rehabilitation success with a cochlear implant (CI) varies considerably and identifying predictive factors for the reliable prediction of speech understanding with CI remains a challenge. Hoppe and colleagues have recently described a predictive model, which was specifically based on Cochlear™ recipients with a four-frequency pure tone average (4FPTA) ≤ 80 dB HL. The aim of this retrospective study is to test the applicability to an independent patient cohort with extended inclusion criteria. Methods: The Hoppe et al. model was applied to CI recipients with varying degrees of hearing loss. Model performance was analyzed for Cochlear™ recipients with 4FPTA ≤ 80 dB HL and for all recipients regardless of 4FPTA. Subgroup analyses were conducted by WRS_max and CI manufacturer. Results: The model yielded comparable results in our patient cohort when the original inclusion criteria were met (n = 24). Extending the model to patients with profound hearing loss (4FPTA > 80 dB HL; n = 238) resulted in a weaker but significant correlation (r = 0.273; p < 0.0001) between predicted and measured word recognition score at 65 dB with CI (WRS₆₅(CI)). Also, a higher percentage of data points deviated by more than 20 pp, either better or worse. When patients provided with CIs from different manufacturers were enrolled, the prediction error was also higher than in the original cohort. In Cochlear™ recipients with a maximum word recognition score (WRS_max) > 0% (n = 83), we found a moderate correlation between measured and predicted scores (r = 0.3274; p = 0.0025). Conclusions: In conclusion, as long as the same inclusion criteria are used, the Hoppe et al. (2021) prediction model results in similar prediction success in our cohort, and thus seems applicable independently of the cohort used. Nevertheless, it has limitations when applied to a broader and more diverse patient cohort. Our data suggest that the model would benefit from adaptations for broader clinical use, as the model lacks sufficient sensitivity in identifying poor performers. Full article

This paper explores how sound design in the Harry Potter film series shapes the symbolic significance of written words within the magical world. Sound mediates between language and meaning; while characters gain knowledge by reading and seeing, viewers are guided emotionally and thematically by how these written texts are framed through sound. For example, Harry’s magical identity is signalled to viewers through the score long before he fully understands himself—first through music when he speaks to a snake, then more explicitly when he receives his letter from Hogwarts. Throughout the series, characters engage with a wide array of written media—textbooks, letters, newspapers, diaries, maps, and inscriptions—that gradually shift in narrative function, from static props to dynamic, multi-sensory agents of transformation. Using a close analysis of selected scenes to examine layers of utterances, diegetic sounds, underscore, and sound design, this study draws on metaphor theory and adaptation theory to examine how sound design gives writing a metaphorical voice, sometimes framing it as character, landscape, or moral authority. As the series progresses, becoming more autonomous from the literary source, written words take on greater symbolic significance, and sound increasingly determines which texts are granted narrative power, whose voices are trusted, and how viewers interpret truth and agency across media. Ultimately, written words in the films are animated through sound into agents of growth, memory, resistance, and transformation. Thus, the audio-visual treatment of written magic reveals not just what is written, but what matters. Full article