Search Results (164)

Background/Objectives: Cleft palate is developmentally and clinically distinct from cleft lip with or without cleft palate. Prenatal ultrasound reliably identifies clefts involving the lip but performs poorly for the secondary palate, whereas early feeding difficulty is concentrated in palatal clefts. These two observations have not previously been quantified within a single cohort. We aimed to determine whether prenatal detectability and neonatal feeding support requirements follow opposite gradients across cleft phenotypes. Methods: We conducted an ambispective study of a nationally ascertained referral-centre cohort of 328 consecutive children with an orofacial cleft and no clinically recognised syndrome, managed at the national referral centre for cleft surgery in Croatia. The cohort comprises children reaching surgical care and is not a population-based birth registry. Documented prenatal ultrasound diagnosis and feeding method during the first weeks of life were abstracted from medical records; cleft phenotype was confirmed by clinical examination. Proportions were compared with chi-square tests and exact binomial confidence intervals, and factors independently associated with each outcome were identified by multivariable logistic regression. Results: Overall prenatal detection was 76/316 (24.1%; 95% CI 19.4–29.2). Detection differed markedly by phenotype: 38.2% for cleft lip only, 34.0% for cleft lip and palate and 2.0% for cleft palate only (p < 0.001). Nasogastric tube feeding was required by 46/325 children (14.2%; 95% CI 10.6–18.4) and followed the opposite gradient: 0.0%, 14.2% and 24.8%, respectively (p < 0.001). Isolated cleft palate showed the strongest independent negative association with prenatal detection (adjusted OR 0.037; 95% CI 0.009–0.154) and was independently associated with tube feeding (adjusted OR 3.07; 95% CI 1.37–6.89). Of children requiring tube feeding, 43/46 (93.5%; 95% CI 82.1–98.6) had not been detected prenatally. Observed detection rose with year of birth in unadjusted analysis (OR 1.095 per year; 95% CI 1.012–1.185; p = 0.023) but was attenuated and no longer significant after adjustment (OR 1.071; 95% CI 0.991–1.157; p = 0.082); the temporal trend is therefore reported descriptively. An initial refer result at newborn hearing screening was markedly more frequent in children with palatal involvement than in those with cleft lip only (2.8%, 31.6% and 25.5% for cleft lip only, cleft lip and palate and cleft palate only; p < 0.001), contrasting cleft lip only with clefts involving the palate rather than following a monotonic gradient. Conclusions: Prenatal detectability and neonatal nasogastric tube use follow opposite gradients across cleft phenotypes. Children with cleft palate only are simultaneously the least likely to be identified before birth and the most likely to require assisted feeding, and almost all tube-fed infants arrive without a prenatal diagnosis. These findings support, as a practice consideration, routine structured neonatal feeding assessment for every newborn with a palatal cleft irrespective of prenatal findings. Full article

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. Full article

Deaf parents experience higher rates of healthcare barriers and adverse parenting outcomes compared with their hearing peers. This qualitative study explored the parenting experiences of Deaf parents to better understand barriers and facilitators to optimal parenting situations. Semi-structured, individual remote interviews were conducted with twenty Deaf parents in the United States who primarily communicate using American Sign Language (ASL) and have children aged 13 years old and under. Interviews examined experiences related to access to information and resources, relationships with healthcare providers, communication accessibility, and involvement with the educational system. Data were analyzed using thematic analysis. Four major themes emerged: communication accessibility across parenting contexts, lack of accessible parenting-related information and services, family dynamics, and the role of assistive technologies in parenting. Participants reported that systemic barriers across healthcare, educational, and service systems create persistent communication challenges and delays, disempowering experiences, and contribute to a critical lack of resources designed for Deaf parents. These findings underscore the need for increased awareness and improved communication access for Deaf parents across healthcare, educational, and legal settings to support positive parenting experiences. Full article

This study presents the design, development, and evaluation of iSign, an Android-based educational mobile application developed to support sign language learning among deaf and hard-of-hearing individuals in rural communities. The project was conducted using a research and development (R&D) approach guided by the ADDIE instructional design framework. A preliminary needs assessment, based on municipal records and field validation, revealed limited access to structured sign language education and assistive learning resources in selected barangays of Odiongan, Romblon. The iSign application was designed as a user-centered and accessible mobile learning tool incorporating alphabet learning (A–Z), number recognition (0–9), a dictionary containing 160 commonly used vocabulary words with definitions and corresponding sign language video demonstrations, and multimedia content such as nursery rhyme songs interpreted in sign language. The system was developed using Android Studio and structured to support offline accessibility to accommodate low-connectivity environments. The application was evaluated in terms of functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. Twenty-one community participants and four information technology experts assessed the system using a five-point Likert scale. The overall weighted mean rating of 4.0 (“Agree”) indicates that the developed application met acceptable software quality standards and user satisfaction levels. The findings demonstrate that iSign is a functional and accessible mobile learning application that can serve as a supplementary tool for sign language education in underserved communities. Full article

Selective hearing in multi-talker environments remains a central challenge for assistive listening technologies: conventional devices improve audibility but cannot infer which talker the listener intends to follow. This Perspective examines the emerging transition from auditory attention decoding to neuro-steered selective hearing. We argue that a recent real-time intracranial proof-of-principle study marks an important inflection point in this transition, because it shows, under high-fidelity recordings from neurosurgical patients and in controlled two-talker conditions, that decoded neural attention can be coupled online to relative-gain control, thereby improving speech perception and reducing listening effort within that experimental setting. Building on this proof of principle, we argue that the field should move beyond offline decoding accuracy as its primary benchmark and instead treat neuro-steered hearing as a closed-loop translational problem linking neural inference, acoustic scene analysis, and control policy. From this perspective, future benchmarks should integrate device-level control metrics, including latency, effective switch time, false-switch rate and recovery after erroneous updates, with listener-centered outcomes such as speech intelligibility, listening effort, user preference and everyday benefit. Accordingly, we outline a staged roadmap for electroencephalography-based systems, from controlled two-speaker paradigms to scene-aware control and ultimately wearable real-world implementations. We also discuss the complementary roles of magnetoencephalography, functional near-infrared spectroscopy, and functional magnetic resonance imaging in defining the neural mechanisms and design constraints of future systems. Overall, this Perspective frames neuro-steered selective hearing as a systems-level research pathway for evaluating whether neural attention signals can be translated into practical assistive listening technologies. Full article

Treatment of cleft lip alveolus and/or palate includes surgical repair to treat communication-related outcomes such as velopharyngeal insufficiency and otological dysfunction. Robot-assisted surgery has recently evolved into a promising adjunct to conventional surgery, particularly for complex procedures such as transoral (reconstructive) surgery. This structured literature review aims to investigate whether robot-assisted transoral cleft palate repair enhances communication (i.e., speech and otological) outcomes compared to conventional manual cleft palate surgery. A literature search was performed using PubMed, Embase, the Cochrane Library and Google Scholar. Primary outcomes were the change in cleft speech characteristics and otological disease after robot-assisted cleft palate surgery versus manual cleft palate surgery. The available evidence on communication-related outcomes remains sparse. Six relevant articles were included. In only one study, transoral robotic cleft surgery (TORCS) significantly reduced otitis media with effusion (OME), need for ventilation tubes and hearing threshold within 2 years post-surgery. No postoperative speech or velopharyngeal outcomes were reported. In conclusion, transoral robotic cleft surgery (TORCS) appears safe and feasible for repair of a cleft palate. It provides superior intraoral view and improved surgeon ergonomics. Current drawbacks are the costs and the available tools, the extended surgical duration and the lack of haptic feedback, which limit the current clinical applicability of TORCS. Based on limited clinical evidence, TORCS may support faster recovery of Eustachian tube function and hearing, but no conclusions on speech outcomes can yet be drawn. Full article

Deaf people experience significant barriers to education, healthcare, employment, and information access, resulting in inequities across a myriad of contexts. To better understand these disparities, our all-deaf research team conducted semi-structured interviews with deaf and hearing (parents, caregivers, and educators) adults across Ecuador, exploring how structural, institutional, and social factors influence daily life and well-being. Participants (n = 36) described systemic exclusion from education and employment, limited access to interpreters and assistive technologies, and constrained autonomy due to insufficient family support and institutional resources. These barriers compound health risks by restricting access to care, information, and social participation. Participants’ narratives highlighted how political and economic instability, institutional neglect, and discrimination create structural vulnerabilities that extend beyond individual-level factors. Findings underscore the importance of public health interventions that address structural and communicative inequities, including inclusive education, accessible health services, and community-based support, to improve health equity and quality of life for deaf populations in Ecuador. Full article

Reverberation and background noise remain persistent obstacles to achieving clear and intelligible speech in enclosed environments. Conventional data-driven or purely empirical dereverberation systems often perform well only under training conditions but lack robustness and physical interpretability when exposed to new acoustic spaces. To address these limitations, this paper proposes a physics-informed speech enhancement algorithm that integrates analytical room acoustics modeling with a descriptor-guided optimization framework. The method employs virtual field simulations based on the Helmholtz equation to estimate key acoustic descriptors, reverberation time (RT60), direct-to-reverberant ratio (DRR), and clarity index (C50), which are then used to adaptively control a model-informed dereverberation filter. This hybrid formulation bridges physical modeling and signal processing, allowing the algorithm to minimize late reverberation energy while maintaining spectral fidelity. Experimental results across multiple simulated and real-room conditions demonstrate measurable improvements over baseline methods, achieving average gains of +6.4 dB in SNR, +1.2 in PESQ, and +0.13 in STOI, along with reduced RT60 and enhanced clarity. The proposed approach offers both computational efficiency and interpretability, making it suitable for real-time deployment in teleconferencing, hearing-assistive, and smart audio applications. Full article

Background: Sensorineural hearing loss represents a significant global health burden affecting over 1.5 billion individuals worldwide. Modern hearing aids, equipped with digital signal processing and smart connectivity features, constitute a cornerstone of neuro-sensory rehabilitation. However, the psychosocial impact of these assistive smart technologies on patient self-esteem remains incompletely characterized. Methods: A cross-sectional multivariate study was conducted with 245 participants, divided into three groups: normal-hearing controls (NH, n = 73), hearing-impaired patients using smart hearing aid technology (HA users, n = 86), and hearing-impaired patients not using hearing aid technology (HA non-users, n = 86). Self-esteem was measured using the Rosenberg Self-Esteem Scale (SES). Hearing disability and tinnitus severity were assessed with the Hearing Handicap Inventory for Adults (HHIA) and Tinnitus Handicap Inventory (THI), respectively. Data analysis included one-way ANOVA, Tukey’s HSD post hoc tests, Pearson correlations, and multivariate regression. Results: Hearing aid users showed significantly higher SES scores (35.41 ± 5.32) compared to non-users (22.99 ± 4.53; p < 0.001, Cohen’s d = 2.515). One-way ANOVA indicated highly significant differences among groups (F = 299.00, p < 0.001, η² = 0.712). SES was negatively correlated with HHIA (r = −0.573, p < 0.001) and THI (r = −0.443, p < 0.001), while HHIA and THI were strongly positively correlated (r = 0.729, p < 0.001). In multivariate analysis, HA use remained a strong independent predictor of self-esteem (β ≈ 11.9, p < 0.001), even after adjustment for age, sex, HHIA, and THI. Perceived hearing handicap was independently associated with lower self-esteem, whereas tinnitus severity was not a significant predictor in the fully adjusted model. The model explained approximately 65% of the variance in self-esteem scores. Conclusions: Smart hearing-aid use is strongly and independently associated with higher self-esteem in patients with sensorineural hearing loss. These results support the inclusion of modern audiological rehabilitation devices in comprehensive management strategies for long-term conditions and highlight psychosocial benefits that extend beyond hearing restoration. Full article

Millions of persons worldwide experience varying degrees of hearing loss, traditionally addressed through prosthetic solutions such as hearing aids and cochlear implants. However, a significant proportion of individuals cannot benefit from these technologies, cannot access them, or choose not to use them. In this context, non-prosthetic assistive technologies have emerged as a complementary paradigm, leveraging advances in sensing, artificial intelligence, and wearable computing to transform acoustic information into alternative perceptual representations rather than restoring auditory function. This survey provides a review of such systems, focusing on technologies that enhance environmental awareness, communication, and social interaction. Existing approaches are categorized along two main dimensions: the tasks they perform and the platforms on which they operate. Task-oriented analysis includes sound recognition (speech and non-speech), sound source localization, emotion recognition, sign language recognition, and related emerging functionalities. Platform-based analysis emphasizes wearable devices and mobile solutions enabling real-time and context-aware assistance. The survey further highlights key research trends, including real-time auditory scene analysis, portable processing, and artificial intelligence. It shows that recent studies increasingly demonstrate that combining auditory, visual, and haptic modalities improves robustness and usability in real-world conditions, particularly in noisy and dynamic environments. Finally, open challenges such as energy efficiency, latency, evaluation methodologies, and user acceptance are discussed. By synthesizing existing work and identifying open research directions, this survey aims to provide a structured foundation for future developments in intelligent, non-prosthetic assistive systems that redefine how auditory information is accessed and interpreted. Full article

Filipino Sign Language (FSL) serves as a vital means of communication for the Deaf and hard-of-hearing in the Philippines. However, its societal use remains limited due to the scarcity of qualified interpreters and the general lack of FSL literacy among the population. Therefore, this study aims to address the gap between FSL development and automated FSL translation by employing machine learning and computer vision techniques. A model was trained using the FSL-105 dataset, which comprises video clips of gestures related to greetings and colors, and utilized MediaPipe for real-time detection of hand, face, and body landmarks. Through iterative training with transfer learning, the model’s performance improved from an initial accuracy of 80% to a final accuracy of 98.75%. The results demonstrate that the MediaPipe-based model can reliably interpret FSL gestures, positioning it as a potentially accessible assistive tool for the Deaf and hard of hearing community. This technology holds promise for applications in education, healthcare, and public service, offering new opportunities to promote the social inclusion of Filipino Deaf communities through more inclusive communication. Full article

We present a Tagalog lip-reading system designed to enhance communication accessibility for individuals with hearing impairments. Existing lip-reading models focus on English and other major languages and cannot recognize Tagalog visual speech patterns. To address this gap, we implemented 3D Convolutional Neural Network combined with Bidirectional Long Short-Term Memory network, supported by a custom Tagalog dataset of common words. This architecture achieved an average character error rate of 10.09%, word error rate of 24.08%, and overall word accuracy of 76.27%, demonstrating promising recognition accuracy for Tagalog lip movements. By introducing the Tagalog-specific lip-reading framework, the potential of deep learning-based visual speech recognition was validated to support inclusive technologies, with applications in daily communication, education, and assistive tools for the Filipino deaf community. Full article

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. Full article

Background/Objectives: Wolfram syndrome type 1 (WS1) is a rare, progressive, multisystem neurodegenerative disorder characterized by diabetes mellitus, optic atrophy, diabetes insipidus, and sensorineural hearing loss. As survival has improved, an increasing number of affected women are reaching reproductive age. However, evidence on pregnancy and peripartum management in WS1 remains scarce, and practical guidance is limited. This case report describes the multidisciplinary management of pregnancy and delivery in a woman with genetically confirmed WS1 and highlights key considerations for peripartum care. Case Presentation: A woman with genetically confirmed WS1 and long-standing multisystem involvement, including diabetes mellitus, diabetes insipidus, neurogenic bladder requiring frequent self-catheterization, progressive neurologic manifestations, and severe sensory impairment, achieved pregnancy through assisted reproduction with oocyte donation and was closely monitored by a multidisciplinary team. Due to persistent breech presentation, a planned external cephalic version was performed at 37 + 5 weeks’ gestation with immediate availability for cesarean delivery. After unsuccessful attempts, cesarean delivery was performed under combined spinal–epidural anesthesia. Peripartum management focused on strict glycemic control, careful monitoring of fluid balance and urine output, neuraxial anesthesia with proactive hemodynamic management, precautions related to the cochlear implant, and tailored communication strategies. Postpartum recovery was favorable, although anemia on postoperative day 1 required transfusion of one unit of packed red blood cells and intravenous iron therapy. Discussion and Conclusions: Pregnancy in WS1 represents a high-risk clinical scenario because of the coexistence of endocrine, urologic, and neurologic comorbidities, while published evidence on peripartum management remains limited. This case supports an individualized, multidisciplinary approach to obstetric and anesthetic planning and the use of a practical framework to optimize peripartum management and enhance maternal–fetal safety in this rare condition. Full article

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. Full article