Search Results (46)

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

Background/Objectives: Cochlear implant (CI) candidacy has expanded beyond traditional bilateral hearing loss (HL) to include single-sided deafness (SSD) and asymmetric hearing loss (AHL), yet baseline differences in speech recognition and patient-reported outcome measures (PROMs) between these groups—bilateral HL, SSD, and AHL—remain poorly characterized. The objective of this study was to characterize and compare preoperative speech recognition performance and PROMs between traditional bilateral HL and SSD/AHL CI candidates, and to examine associations between preoperative word recognition scores and PROMs across the full cohort. Methods: Sixty-eight adults (mean age 71.6 years, SD 7.4) undergoing preoperative CI evaluation were enrolled (31 bilateral HL, 12 SSD, and 25 AHL). Consonant–Nucleus–Consonant (CNC) word recognition and AzBio sentence recognition were assessed for both the ear-to-be-implanted (CI ear) and the contralateral ear. The following PROMs were evaluated: the Speech, Spatial and Qualities of Hearing Scale (SSQ-12); Cochlear Implant Quality of Life–35 (CIQOL-35); Patient Health Questionnaire-2 (PHQ-2); Tinnitus Handicap Inventory (THI); and the Instrumental Activities of Daily Living (IADL). Group comparisons used Mann–Whitney U tests and t-tests. CNC, SSQ-Mean, and CIQOL-Global associations were assessed using multivariable linear regression analysis. Results: Preoperative CI-ear speech recognition did not differ between the bilateral HL and SSD/AHL groups. SSD/AHL candidates had significantly higher contralateral-ear speech recognition performance, better SSQ-12 scores across all domains, and higher CIQOL-35 Global, Communication, Entertainment, and Environment scores compared to bilateral HL candidates. However, the CIQOL-35 Emotional, Listening Effort, and Social domains, PHQ-2, THI, and IADL did not differ significantly between the bilateral HL and SSD/AHL groups. Across our entire sample of candidates, CI-ear CNC scores were not significantly associated with preoperative SSQ-Mean or CIQOL-Global scores, while contralateral-ear CNC scores showed moderate, significant associations with both measures. Conclusions: Traditional bilateral and SSD/AHL CI candidates exhibit distinct preoperative PROM profiles (namely, the SSQ-12 and CIQOL-35) despite having no significant differences in CI-ear speech recognition. Contralateral-ear CNC scores—but not CI-ear scores—were significantly associated with the SSQ-Mean and CIQOL-Global, suggesting that contralateral-ear CNC scores may offer relevant insight into CI candidates’ functional hearing. These findings support population-specific counseling and highlight the complementary value of PROMs and audiometric data in CI candidacy evaluations. Full article

Background/Objectives: Although vascular mechanisms are increasingly implicated in the etiology of sudden sensorineural hearing loss (SSNHL), the inability to directly visualize the labyrinthine artery remains a diagnostic obstacle. Sharing embryological and physiological parallels with the inner ear, the eye represents an accessible surrogate organ capable of reflecting systemic microvascular status. This study aimed to evaluate the diagnostic value of ocular hemodynamic and structural parameters in patients with acute unilateral idiopathic SSNHL. Methods: This prospective, comparative, cross-sectional study enrolled 30 patients with acute unilateral idiopathic SSNHL and 25 age and sex matched healthy controls. Three groups were defined: the affected eye, the contralateral eye, and the control eye. Retrobulbar hemodynamics (PSV, EDV, RI, PI) were assessed by color Doppler imaging; peripapillary choroidal thickness, RNFL, GCC+, and macular thickness by swept-source OCT; and macular microvascular perfusion by OCT angiography. Results: End diastolic velocity in the posterior ciliary arteries was significantly reduced in both patient eye groups relative to controls (p < 0.001), while RI and PI were significantly elevated (p = 0.001 and p = 0.004, respectively). Comparable hemodynamic impairment was observed in the ophthalmic artery. Peripapillary choroidal thickness was bilaterally reduced in the inferior and temporal quadrants in both patient groups (p = 0.003 and p = 0.010). No significant difference was detected between affected and contralateral eyes in any parameter. RNFL, GC+, and macular thickness remained comparable across all groups. Conclusions: The bilateral symmetry of hemodynamic impairment and choroidal thinning suggests that SSNHL arises against a background of systemic microvascular disease. The combined use of OCT and color Doppler ultrasonography holds clinical potential as a non-invasive biomarker panel for defining the vascular phenotype of the condition. Full article

Background/Objectives: Sequential bilateral cochlear implantation is being increasingly considered in paediatric patients with bilateral profound hearing loss, particularly when the contralateral ear shows limited residual hearing or poor speech discrimination. Although auditory benefits of a second cochlear implant (CI2) have been reported, concerns remain regarding possible vestibular impairment after surgery. This study aimed to provide a preliminary prospective evaluation of early audiological and vestibular outcomes in children undergoing sequential bilateral cochlear implantation and to explore whether the age at implantation or the inter-implant interval influenced longitudinal trajectories. Methods: Ten children with prelingual bilateral profound sensorineural hearing loss who underwent sequential bilateral cochlear implantation were prospectively enrolled. Assessments were performed at baseline and during follow-up up to 12 months after CI2 activation. The audiological evaluation included pure-tone audiometry, speech recognition in quiet with CI2 alone and bilaterally, and speech-in-noise testing in frontal and lateralised configurations. The vestibular evaluation included static stabilometry and video head impulse testing. Patient-reported outcomes were assessed using the speech, spatial and qualities of hearing scale for children. Longitudinal changes were analysed using mixed-effects models with false discovery rate correction. Results: Unilateral speech recognition with CI2 improved significantly over time, with median word recognition increasing from 0% at 3 months to 60% at 12 months (p < 0.0001; q = 0.0001). The speech-in-noise performance also improved significantly in the frontal and F1C configurations. Bilateral speech recognition in quiet remained stable at high levels, consistent with a ceiling effect. The vestibular measures were broadly stable at the group level, and the SSQ scores showed modest, non-significant changes. Exploratory analyses did not identify consistent effects of the implantation age or inter-implant interval on longitudinal trajectories. Conclusions: Sequential bilateral cochlear implantation was associated with early auditory benefit, particularly for CI2 unilateral performance and speech perception in noise, without evidence of major short-term vestibular deterioration. Full article

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. Full article

Background: Auricular keloids and ear helix deformities are undesirable and aesthetically unpleasing deformities that can cause significant patient psychologic and self-esteem problems. Pressure therapy for keloids is well documented to be an effective non-invasive treatment modality. However, current devices lack comfort and aesthetic appeal to deliver the pressure forces required effectively and uniformly. This work aims to highlight some different pressure therapy approaches for the management of keloids and irregularities in the ear helix morphology. Methods: A case series of four patients presenting with auricle keloids of various sizes and at different locations secondary to ear piercing and one case of congenital helix deformity were treated successfully with pressure therapy devices. The device designs varied based on the keloids’ characteristics and patients’ preferences and involved wire-based spring-activated appliances resembling ear rings for moderate keloid lesions, modified double-spring systems for large or elongated lesions, and magnet-based devices. A pair of inert magnetic discs of different diameters was positioned on the anterior and posterior aspects of the keloid lesion. The magnets were then encapsulated in acrylic resin to improve retention and adaptation, and the external surface was masked with gold glitter to enhance aesthetics and patient acceptance. The helix-deformity case was treated following a complete digital workflow integration where the sound contralateral ear was digitally scanned, mirror-imaged and then 3D-printed in resin to produce an ear model based on which an anatomically symmetrical pressure device was constructed. Results: All devices were successfully fitted and well tolerated, with no reported discomfort or adverse reactions. The wire spring devices were effective in reducing a large keloids volume; however, frequent reactivation every two weeks was required to ensure continuous pressure application. Incorporating magnets in the customised design allowed controlled and uniform pressure application to small keloid-lesion morphology, with enhanced aesthetics and improved patient acceptance and compliance. The digitally assisted case achieved near-perfect anatomical symmetry with the contralateral ear, reducing operator dependency and fabrication guesswork. Conclusions: Customised pressure therapy devices, of magnetic and spring-based systems, alongside utilising digital technologies, offer effective, non-invasive management for auricular keloids and irregular ear helices as long as the patient is committed to wearing the device. Full article

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. Full article

Background/Objectives: Single-sided deafness (SSD) treatment options include Contralateral Routing of Signal (CROS) or Bilateral Routing of Signal (BiCROS) systems, bone conduction devices, cochlear implants (CIs) and no intervention. Aligning treatment recommendations with patient motivations is fundamental for satisfaction and successful outcomes. At our institution, a structured telehealth consultation precedes formal testing and includes treatment motivation exploration and comprehensive review of all interventions. This study examined SSD treatment motivations and their association with pursuing cochlear implantation. Methods: Adults who completed a pre-treatment SSD telehealth consultation over a four-year period were identified. Charts were retrospectively reviewed for demographics, SSD characteristics, treatment motivations, treatment choice, and CI outcomes. Results: A total of 122 adults were evaluated. Mean age was 56.3 (±13.0) years, and 59.8% were male. Mean SSD duration was 10.8 (±15.8) years. The most common etiology was sudden sensorineural hearing loss. The top primary motivations were improving overall hearing (23.0%), restoring hearing to the deaf ear (22.1%), and improving hearing in noise (21.3%). Most patients (45.1%) opted for a hearing aid, CROS or BiCROS system; 38.5% chose CI; and 14.8% declined treatment. Only 57.4% of those who selected CI had the implant, primarily due to surgery avoidance (31.5%) and insurance limitations (10.5%). Motivation did not predict treatment choice or CI receipt. Among CI recipients (n = 27), those motivated by hearing restoration demonstrated poorer speech outcomes and datalogging. Conclusions: Improving overall hearing and restoring hearing to the deaf ear were the most common motivations for seeking SSD treatment. Adult CI recipients had similar motivations to those who chose non-surgical options. Full article

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. Full article

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. Full article

Background: Cochlear implants (CIs) serve diverse populations with hearing loss, but patients with single-sided deafness (SSD) often show lower post-implantation usage and satisfaction than bilateral CI users. This disparity may stem from their normal contralateral ear providing sufficient auditory input for many daily situations, reducing the perceived need for consistent CI use. Consequently, uniform screening and evaluations, typically designed for bilateral hearing loss, often fail to address SSD’s unique needs. Methods: This narrative review synthesizes the current literature to explore patient and device factors shaping CI integration, outcomes, and experience in SSD. It highlights implications for developing personalized care strategies distinct from those used in bilateral hearing loss. Results: SSD patients face unique challenges: reliance on compensatory behaviors and significant auditory processing difficulties like acoustic–electric mismatch and place–pitch discrepancy. Anatomical factors and deafness of duration also impact outcomes. Traditional measures are often insufficient due to ceiling effects. Music perception offers a sensitive metric and rehabilitation tool, while big data and machine learning show promise for predicting outcomes and tailoring interventions. Conclusions: Optimizing CI care for SSD necessitates a personalized approach across candidacy, counseling, and rehabilitation. Tailored strategies, including individualized frequency mapping, adaptive auditory training, advanced outcome metrics like music perception, and leveraging big data for precise, data-driven predictions, are crucial for improving consistent CI usage and overall patient satisfaction. Full article

Introduction: Most audiometers have an in-built “Stenger test” setting. The test is sometimes applied in cases of single-sided deafness as an indicator of malingering. Although textbooks have been written about it, the underlying conditions remain enigmatic. The literature usually points to psychological problems, pointing to the patient as having “nonorganic hearing loss”, “malingering”, “false and exaggerated hearing loss”, “hysterical hearing loss”, or “pseudohypoacusis”. These are all non-objective features without a sound scientific base, and the test tends to blame the patient for providing non-repeatable hearing thresholds. Methods: This opinion piece looks at the literature surrounding the Stenger test and the factors that might cause hearing threshold variability and concludes that the test has a subjective basis that makes it unscientific. In our opinion, we also think it is ethically questionable to blame the patient for malingering when there are non-repeatable findings. In order to make the test scientifically valid, we frame a testable hypothesis: that the Stenger effect could be due to unrecognised contraction of the middle ear muscles in response to stimulation of the contralateral (worse-hearing) ear. That is, we suppose that bilateral contraction impairs thresholds in both the good and poor ear, so the subject can no longer hear a tone in their good ear which they previously could when their audiogram was established monaurally. Thus, we make the case that the subject is not malingering—they genuinely cannot hear the test tones in either ear. Discussion and Conclusions: We believe it is incorrect to blame the patient when the problem may lie with incomplete understanding of how the auditory system functions bilaterally. The test needs to be objectively investigated and perhaps reinterpreted in terms of hearing sensitivity in one ear being reduced by sound levels in the contralateral ear. If this is not possible, we suggest it would be better if the Stenger test were abolished. Full article

Background/Objectives: Auricular epitheses play a vital role in restoring facial symmetry and patient confidence following congenital or acquired defects. Traditional wax-based fabrication is labor-intensive and lacks reproducibility. This study proposes and evaluates a simplified, digitally driven workflow for auricular prosthesis manufacturing, integrating virtual patient creation, mirrored ear design, and three-part mold fabrication using two design platforms—CATIA V5R21 (industrial CAD) and Blender (open-source graphics software). Key outcomes include mold reusability, patient-centered evaluation, and workflow feasibility. Methods: A 28-year-old female patient with right-sided microtia was selected. A light-based 3D facial scan was performed, and the intact contralateral ear was mirrored and adapted virtually to the defect site. Molds were designed in both CATIA and Blender using a standardized three-parallelepiped approach and printed using FDM technology (Elegoo Neptune 4 Plus). Five silicone epitheses were carefully fabricated with each mold. Surface trueness was evaluated with Geomagic Control X, while subjective assessments were conducted by an independent prosthetic team and the patient using Visual Analogue Scales (VAS). Results: Both design workflows resulted in clinically usable prostheses. No statistically significant difference in RMS deviation was observed (p = 0.53), although CATIA-derived epitheses achieved higher subjective scores (mean 9.22/10) compared to Blender (mean 7.67/10). The preferred prosthesis (CATIA #4) was selected for final pigmentation and delivery to the patient. All molds were reused five times without any structural damage or significant signs of wear. Conclusions: This study demonstrates that both CATIA and Blender can support an effective, patient-centered digital workflow for auricular prosthesis fabrication. The methodology enables reproducibility, mold reusability, and improved clinical accessibility of custom prosthetics. Full article

In the context of ear-based biometric identity authentication, symmetry between the left and right ears emerges as a pivotal factor, particularly when registration involves one ear and authentication utilizes its contralateral counterpart. The extent to which bilateral ear symmetry supports consistent identity verification warrants significant investigation. This study addresses this challenge by proposing a novel framework, the Symmetry Alignment–Feature Interaction Network, designed to enhance authentication robustness. The proposed network incorporates a Symmetry Alignment Module, leveraging differentiable geometric alignment and a dual-attention mechanism to achieve precise feature correspondence between the left and right ears, thereby mitigating the robustness deficiencies of conventional methods under pose variations. Additionally, a Feature Interaction Network is introduced to amplify nonlinear interdependencies between binaural features, employing a difference–product dual-path architecture to enhance feature discriminability through Dual-Path Feature Interaction and Similarity Fusion. Experimental validation on a dataset from the University of Science and Technology of Beijing demonstrates that the proposed method achieves a similarity detection accuracy of 99.03% (a 9.11% improvement over the baseline ResNet18) and an F1 score of 0.9252 in identity authentication tasks. Ablation experiments further confirm the efficacy of the Symmetry Alignment Module, reducing the false positive rate by 3.05%, in combination with the Feature Interaction Network, shrinking the standard deviation of similarity distributions between the positive and negative samples by 67%. A multi-task loss function, governed by a dynamic weighting mechanism, effectively balances feature learning objectives. This work establishes a new paradigm for the authentication of biometric features with symmetry, integrating symmetry modeling with Dual-Path Feature Interaction and Similarity Fusion to advance the precision of ear authentication. Full article

Background/Objectives: Aural toilet using microsuction is a common procedure in ENT clinics, and vertigo is a frequent complaint during this procedure. This study aimed to investigate the characteristics and incidence of microsuction-induced nystagmus and vertigo based on the appearance of the tympanic membrane (TM). Methods: In 85 patients with various TM appearances, microsuction-induced vertigo and nystagmus were assessed. Results: Microsuction elicited nystagmus in 95% (81 of 85) of patients and vertigo in 36% (31 of 85). The nystagmus direction was towards the ipsilateral ear in a bowing position and towards the contralateral ear in a leaning position. The proportion of patients who complained of rotatory vertigo was significantly higher in those with TM perforation, open cavity mastoidectomy, and adhesive otitis media (74%, 26 of 35) compared to those without TM perforation (10%, 5 of 50) (p < 0.001, X² test). Conclusions: Aural toilet using microsuction commonly induces vertigo due to convection in the lateral semicircular canal endolymph caused by the cooling effect. While microsuction-induced nystagmus was observed in most patients, the incidence of vertigo varied depending on the TM condition. Clinicians should closely monitor patients for vertigo during the procedure, and methods to prevent microsuction-induced vertigo should be explored. Full article