Search Results (93)

Background/Objectives: Single-sided deafness (SSD) impairs speech perception, reduces spatial hearing, decreases quality of life, and is frequently accompanied by tinnitus. Cochlear implantation (CI) has become an established treatment option, but long-term prospective evidence across multiple functional and psychological domains remains limited. This study investigated auditory performance, subjective hearing outcomes, tinnitus burden, and psychological well-being over a two-year follow-up in a large SSD cohort. Methods: Seventy adults with SSD underwent unilateral CI. Assessments were conducted preoperatively and at 6 months, 1 year, and 2 years postoperatively. Outcome measures included the Freiburg Monosyllable Test (FS), Oldenburg Inventory (OI), Nijmegen Cochlear Implant Questionnaire (NCIQ), Tinnitus Questionnaire (TQ), Perceived Stress Questionnaire (PSQ), Generalized Anxiety Disorder scale (GAD-7), and General Depression Scale (ADS-L). Longitudinal changes were analyzed using Wilcoxon signed-rank tests with effect sizes; Holm-adjusted p-values were applied for baseline-to-follow-up comparisons. Results: Speech perception improved markedly within the first 6 months and remained stable through 2 years, with large effect sizes. All OI subdomains demonstrated early and sustained improvements in subjective hearing ability. Several hearing-related quality-of-life domains assessed by the NCIQ, particularly social interaction, self-esteem, and activity participation, showed medium-to-large long-term improvements. Tinnitus severity decreased substantially, with marked reductions observed by 6 months and maintained thereafter; the proportion of tinnitus-free patients increased at follow-up, although tinnitus symptoms persisted in a substantial subset of participants. Perceived stress was reduced initially at the early follow-up and remained below baseline thereafter. Anxiety and depressive symptoms mostly stayed within nonclinical ranges, showing no lasting changes after adjusting for multiple comparisons. Conclusions: In this prospective cohort, cochlear implantation was associated with durable improvements in auditory outcomes, tinnitus burden, and selected patient-reported quality-of-life domains over two years. Although significant functional and patient-centered improvements were noted, persistent tinnitus and diverse psychosocial outcomes underscore the need for personalized counseling and comprehensive follow-up that incorporate patient-reported outcomes and psychological assessments. Full article

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. Full article

People with visual impairments (VIPs) can participate in orientation and mobility (O&M) training to learn how to navigate to their desired goal locations. During O&M training, personal wayfinding preferences with regard to cue use and wayfinding strategy choice are taken into account. However, there is still a lack of clarity about which factors shape VIPs’ wayfinding experiences and how. Background/Objectives: In this study, we mapped individual differences in preferred sensory modality (both orientation- and mobility-related), and classified which personal and environmental factors are relevant for these preferences. Methods: To this end, interviews were conducted with eleven Dutch VIPs whose impairment varied in onset, ontology, and severity. Results: We concluded from our thematic analysis that hearing is the most important sensory modality to VIPs for orientation purposes, although it varies per person how and how often other resources are relied upon (i.e., other sensory modalities, existing knowledge of an environment, help from others, or navigational aids). Additionally, environmental factors such as weather conditions, crowdedness, and familiarity of the environment influence if, how, and which sensory modalities are employed. These preferences and strategies might be mediated by individual differences in priorities and needs pertaining to energy management. Conclusions: We discuss how the current findings could be of interest to orientation and mobility instructors when choosing a training strategy for individual clients. Full article

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. Full article

Background: Cochlear implants (CIs) are transformative neuroprosthetics that restore speech perception for individuals with severe-to-profound hearing loss. However, temporal envelope cues are well-represented within the signal processing, while spectral envelope cues are poorly accessed by CI users, resulting in substantial deficits compared to normal-hearing individuals. This profoundly impairs the perception of complex auditory stimuli like music and vocal prosody, significantly impacting users’ quality of life, social engagement, and artistic expression. Methods: This narrative review synthesizes research on CI signal-processing limitations, perceptual and production challenges in music and singing, the role of the auditory–motor feedback loop, and strategies for improvement, including rehabilitation, technology, and the influence of neuroplasticity and sensitive developmental periods. Results: The degraded signal causes marked deficits in pitch, timbre, and vocal emotion perception. Critically, this impoverished input functionally breaks the high-fidelity auditory–motor feedback loop essential for vocal control, transforming it from a precise fine-tuner into a gross error detector sensitive only to massive pitch shifts (~6 semitones). This neurophysiological breakdown directly causes pervasive pitch inaccuracies and melodic distortion in singing. Despite these challenges, improvements are possible through advanced sound-processing strategies, targeted auditory–motor training that leverages neuroplasticity, and capitalizing on sensitive periods for auditory development. Conclusions: The standard CI signal creates a fundamental neurophysiological barrier to singing. Overcoming this requires a paradigm shift toward holistic, patient-centered care that moves beyond speech-centric goals. Integrating personalized, music-based rehabilitation with advanced CI programming is essential for improving vocal production, fostering musical engagement, and ultimately enhancing the overall quality of life for CI users. Full article

Hearing loss (HL) affects more than 1.5 billion people worldwide and remains a leading cause of disability across the lifespan. While genetic predispositions, otitis media (OM), and cholesteatoma are well-recognized contributors, Eustachian tube dysfunction (ETD) is an underappreciated but pivotal determinant of auditory morbidity. By impairing middle ear pressure (MEP) regulation, ETD drives conductive hearing loss (CHL) through stiffness and mass-loading effects, contributes to sensorineural hearing loss (SNHL) via altered window mechanics and vascular stress, and produces mixed hearing loss (MHL) when these pathways converge. A characteristic clinical trajectory emerges in which conductive deficits often resolve quickly with restored ventilation, whereas sensorineural impairment requires prolonged, physiology-restoring intervention, resulting in transient or persistent MHL. This review integrates mechanistic insights with clinical manifestations, diagnostic approaches, and therapeutic options. Diagnostic frameworks that combine patient-reported outcomes with objective biomarkers such as wideband absorbance, tympanometry, and advanced imaging enable reproducible identification of ETD-related morbidity. Conventional treatments, including tympanostomy tubes and balloon dilation, offer short-term benefit but rarely normalize tubal physiology. In contrast, Eustachian tube catheterization (ETC) has emerged as a promising, mechanism-based intervention capable of reestablishing dynamic tubal opening and MEP regulation. Looking forward, integration of physiology-based frameworks with personalized diagnostics and advanced tools such as artificial intelligence (AI) may help prevent progression from reversible conductive deficits to irreversible SNHL or MHL. Full article

Background: hearing loss represents, today, one of the most significant health problems affecting the world’s population. This clinical condition, particularly manifest in adulthood, can arise or be aggravated by both the presence of specific pathologies and by taking multiple classes of drugs at the same time. Methods: to understand this relationship, the present non-interventional observational study aimed to investigate the relationship between worsening hearing abilities in 1651 patients aged between 18 and 99 years. In particular, the thorough history of patients allowed us to evaluate the pathological profiles, pharmacological profiles, and therapeutic regimens adopted. This allowed us to evaluate its association with self-reported hearing loss, assessed through the administration of the HHIE-S-It questionnaire. Furthermore, given the presence of multimorbidity, the possible correlation between self-reported hearing loss and the specific classes of drugs, categorized using the Anatomical Therapeutic Classification (ATC) system, was evaluated. Results: the results highlighted how patients taking drugs, both in mono- and polytherapy regimens, had higher hearing deficits than patients not taking drugs. Furthermore, an apparent dose–response effect, in which the risk of moderate to severe impairment progressively increased with the number of drugs taken, was also observed. Different classes of drugs, particularly those used for the treatment of diseases of the cardiovascular system, as well as drugs for acid-related disorders, were significantly linked to an increased risk of perceived hearing impairment. On the contrary, agents belonging to the antidiabetic category have proven to be drugs capable of offering a potential protective effect. Conclusion: this study highlighted how both the number of drugs taken and some specific categories of drugs can contribute to perceived hearing impairment. While this evidence highlights the importance of integrating audiological evaluation into the management of patients in polypharmacy, the cross-sectional nature of the design precludes the inference of causality. This evidence still favors safer and more personalized therapeutic strategies. Full article

Background/Objectives: Temperament is an innate personality trait, influenced by genetic, biological, and environmental factors. Hearing loss, particularly during the critical period of auditory development, can influence cognitive and temperamental development. This study aims to assess the impact of hearing loss on temperamental development in infants aged between 1 and 12 months. Methods: A cross-sectional study of a sample of 132 pediatric patients from the infant hearing screening program was conducted from June 2023 to June 2024. The infants were divided into two groups based on hearing status and the presence of risk factors; cognitive and temperamental parameters were assessed using the QUIT questionnaire. Results: No significant differences were found between infants with and without hearing loss when also considering the infants without risk factors. Normal temperament was found in infants with and without hearing loss, considering both risk and non-risk factors. Finally, no relationship between hearing loss degree and temperament type, considering both the absence and presence of risk factors, was observed. Conclusions: In the early months of an infant’s life, hearing loss does not appear to significantly affect temperamental development. Only through the monitoring of these hearing-impaired infants to detect more severe hearing loss and/or in the presence of other risk factors can deviant development be hypothesized. In this regard, multidisciplinary evaluations may be crucial for the early detection and correction of dysfunctional behaviors. Full article

Background: Thyroid eye disease (TED) is a rare autoimmune orbital disorder predominantly associated with Graves’ disease. It is characterized by orbital inflammation, tissue remodeling, and potential visual morbidity. Conventional therapies, particularly systemic glucocorticoids, offer only partial symptomatic relief, failing to reverse chronic structural changes such as proptosis and diplopia, and are associated with substantial adverse effects. This review aims to synthesize recent developments in understandings of TED pathogenesis and to critically evaluate emerging therapeutic strategies. Methods: A systematic literature review was conducted using MEDLINE, Embase, and international clinical trial registries focusing on pivotal clinical trials and investigational therapies targeting core molecular pathways involved in TED. Results: Current evidence suggests that TED pathogenesis is primarily driven by the autoimmune activation of orbital fibroblasts (OFs) through thyrotropin receptor (TSH-R) and insulin-like growth factor-1 receptor (IGF-1R) signaling. Teprotumumab, a monoclonal IGF-1R inhibitor and the first therapy approved by the U.S. Food and Drug Administration for TED, has demonstrated substantial clinical benefit, including improvements in proptosis, diplopia, and quality of life. However, concerns remain regarding relapse rates and treatment-associated adverse events, particularly hearing impairment. Investigational therapies, including next-generation IGF-1R inhibitors, small-molecule antagonists, TSH-R inhibitors, neonatal Fc receptor (FcRn) blockers, cytokine-targeting agents, and gene-based interventions, are under development. These novel approaches aim to address both inflammatory and fibrotic components of TED. Conclusions: Teprotumumab has changed TED management but sustained control and toxicity reduction remain challenges. Future therapies should focus on targeted, mechanism-based, personalized approaches to improve long-term outcomes and patient quality of life. Full article

This study examines, within the broader context of historical and cultural influences from Byzantine and Western canonical traditions, the canonical and theological treatment of physical disabilities as impediments to the priesthood within modern Orthodox Canon Law. It shows how traditional Orthodox Canon Law, particularly influenced by medieval Roman Catholic canonical understanding, has historically emphasised physical integrity as a requirement for ordination. The study critically examines historical and contemporary canonical attitudes towards candidates with hearing, speech, or visual impairments or with locomotor disability through the analysis of Apostolic canons, Canons of Ecumenical Councils, and later canonical sources. The methods include a critical canonical and historical analysis of primary sources such as the Canons, patristic writings, and synodal legislation, with particular reference to the initiatives of the Romanian Orthodox Church in the modern cultural and pastoral context. The study observes that, although such impairments continue to be recognised as canonical impediments according to traditional Orthodox law, contemporary ecclesial practice increasingly reflects a pastoral sensitivity that allows, in certain contexts, for the inclusion of persons with disabilities in ordained ministry. This is typically achieved through adaptations that preserve the integrity of liturgical function, such as assistance from co-ministers or specialised training. These developments, while not amounting to a formal canonical revision, signal a broader pastoral and ecclesiological openness toward the integration of persons with disabilities within the life of the Church. Full article

Hearing loss (HL) is a major global health concern, with drug-induced ototoxicity contributing significantly, particularly in patients undergoing treatment for drug-resistant tuberculosis (DR-TB). In South Africa, where both TB and HIV are prevalent, the risk of treatment-related auditory damage is especially high. This study aimed to assess the prevalence and predictors of hearing impairment among DR-TB patients in rural Eastern Cape, South Africa. A retrospective analysis was conducted on 438 DR-TB patients treated between 2018 and 2020, using pure tone audiometry (PTA) to assess hearing status post-treatment. Demographic, clinical, and lifestyle data were extracted from patient records and analyzed using logistic regression. The overall prevalence of hearing loss was 37.2%. Risk was significantly associated with an older age, a male gender, DR-TB classification (MDR, pre-XDR, and XDR), unsuccessful treatment outcomes, and substance use. Prevalence of HL increased notably in patients aged 70 and older. Lifestyle factors, particularly combined use of tobacco, alcohol, and drugs, were linked to higher odds of HL. These findings underscore the need for routine audiometric screening and personalized treatment monitoring in DR-TB care, especially for high-risk populations. Early identification of ototoxicity risk factors can inform safer treatment regimens and improve patient outcomes in resource-limited settings. Full article

Noise-induced hearing loss (NIHL) is a common type of sensorineural hearing loss caused by exposure to high-intensity noise that leads to irreversible cochlear damage. Despite extensive research on cochlear pathophysiology, the precise mechanisms remain unclear, and no established treatment exists. This is due to the challenges in imaging and the inability to perform biopsies in human patients. Consequently, animal models, particularly mice, have been widely used to study NIHL. Clinically, NIHL presents as either a temporary threshold shift, in which hearing recovers, or a permanent threshold shift, which results in an irreversible loss. Histopathological studies have identified the key features of NIHL, including outer hair cell loss, auditory nerve degeneration, and synaptic impairment. Recent findings suggest that oxidative stress and inflammation are major contributors to NIHL, highlighting the potential for therapeutic interventions, such as antioxidants and anti-inflammatory agents. Given the increasing prevalence of NIHL owing to occupational noise exposure and personal audio device use, addressing this issue is a pressing public health challenge. This review summarizes the clinical features, underlying mechanisms, and emerging treatment strategies for NIHL while identifying current knowledge gaps and future research directions. Full article

Hearing loss is one of the most common and undertreated medical conditions worldwide, with an estimated 466 million people (5% of the world’s population) reporting disabling hearing impairment. The implications are significant; untreated hearing loss increases the risk of depression, social isolation, unemployment, cognitive decline, and falls. Cochlear implants (CIs) are surgically implanted electrical devices that allow people with severe hearing loss to process sound. Over the past 50 years, CI development has made remarkable ground, such that most CI users have adequate speech perception in a silent environment. These language achievements, while significant milestones, fall short of perfect sensory restoration. Many of these limitations with complex sound perception are due to our one-size-fits-all approach towards CIs and speech-based metrics for evaluating implant performance. In the past decade, there has been exponential interest in improving CI-mediated music perception, as it serves as a key conduit to restoring normal hearing. The present literature demonstrates the need for a personalized approach towards cochlear implantation and management. Our proposed narrative review illustrates the limitations of CI-mediated sound processing and discusses ways in which precision medicine can be introduced into the ever-expanding hearing loss population. Full article

Artificial intelligence (AI) is regarded as a pivotal instrument in the realm of inclusive education, offering a means to enhance accessibility and personalize learning experiences for students with disabilities. This study presents a comprehensive and systematic review of the impact of AI on inclusive education, elucidating both its advantages and the challenges associated with its implementation. In accordance with the PRISMA guidelines, studies published between 2021 and 2024 in databases including Scopus, Web of Science, ScienceDirect, and ERIC were subjected to analysis. A bibliometric analysis was conducted using Bibliometrix to identify key trends, and ATLAS.ti was employed to organize topics such as accessibility, personalization, and ethics. The findings demonstrate that AI enhances accessibility through the provision of adapted materials, including image descriptions for visually impaired students and audio transcripts for those with hearing impairments. Furthermore, it alleviates the administrative burden on educators, enabling them to prioritize pedagogical guidance. Nevertheless, several obstacles persist, including a dearth of AI training, inadequate infrastructure, and ethical concerns regarding privacy and equitable access to technology. Ultimately, AI holds immense promise for enhancing inclusive education and fostering greater accessibility. However, its success hinges on surmounting these challenges. This study underscores the necessity for policies and strategies that ensure the ethical and sustainable utilization of AI in inclusive environments. Full article

This perspective paper introduces a novel bidirectional framework for communication neuroprosthetics that integrates non-invasive brain stimulation (NIBS) with artificial intelligence (AI) to address both speech production and auditory processing impairments. Traditional approaches typically target only one aspect of communication, while this framework supports the complete communication cycle. The integration of transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) with advanced AI algorithms enables the personalized, adaptive enhancement of neural signals for both speaking and listening functions. This paper examines current evidence for NIBS efficacy in communication disorders, explores AI innovations in neural signal processing, and discusses implementation considerations for closed-loop systems. This bidirectional approach has the potential to provide more natural, effective communication support while promoting neuroplasticity for long-term recovery. The framework presented offers a roadmap for developing accessible communication interventions that could significantly improve the quality of life for individuals with speech and hearing impairments resulting from neurological conditions. Full article