Search Results (85)

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

Background: Usher syndrome (USH), the most common cause of combined deaf-blindness, is a genetically and phenotypically heterogeneous disorder characterized by congenital hearing impairment and progressive vision loss due to rod-cone dystrophy. Although the original classification in three subtypes (USH I, USH II, and USH III) is still valid, recent findings have changed and widened perspectives in its classification, genotype–phenotype correlations, and management strategies: Objective: This study aims to provide new insights into the classification of Usher syndrome, explore the genotype-phenotype correlations, and review current and emerging management strategies. Methods: A comprehensive literature review has been conducted, incorporating data from clinical studies, genetic databases, and patient registries. Results: Recent studies have led to the identification of several novel pathogenic variants in the USH genes, leading to refined subclassifications of Usher syndrome. Interactions between different genes being part of the network of this ciliopathy have been investigated and new mechanisms unveiled. Significant correlations were found between certain genotypes and the presentation of both auditory and visual phenotypes. For instance, pathogenic variants in the MYO7A gene (USH1B) were generally associated with more severe hearing impairment and earlier onset of retinal dystrophy, if compared to other USH genes-related forms. Other genes, such as USH1G, traditionally considered as causing a specific subtype, can display phenotypic heterogeneity in some patients. Conclusions: This review provides insights into a better understanding of Usher syndrome that considers recent findings regarding its genetic causes and clinical features. Precise genotype–phenotype correlations can lead to better genetic counselling, more precise characterization of the natural history of the condition, and a personalized and effective management approach. Recent progress has been made in research into gene-specific therapies that appear promising for improving the quality of life for individuals affected by Usher syndrome. Full article

Objectives: This study investigates the prevalence, determinants, and educational implications of sensory disorders in Saudi Arabia. We hypothesize that sociodemographic factors (e.g., gender, marital status), genetic consanguinity, and regional disparities significantly influence sensory health outcomes, including vision, hearing, balance, and social participation, with consequences for learning environments and educational access. Participants: The primary data were analyzed data from 33,575 households across all administrative regions of Saudi Arabia. The sample includes Saudi nationals residing within the Kingdom and those temporarily abroad (e.g., for treatment, study, or tourism) who are considered household members. Households were selected via a stratified random sampling framework, drawing 25 households from each of 1300 statistical areas (out of 3600 total), ensuring nationwide representation aligned with the 2010 Population and Housing Census. Study Method: An observational analysis of secondary data from the nationally representative survey was conducted. Variables included vision, hearing, mobility, personal care, and communication disorders. Statistical methods encompassed chi-square tests for associations and Cramer’s V effect sizes, with regional, gender, and consanguinity-based sub-analyses. Findings: Males exhibited higher mild vision impairments (1.6% vs. 1.0% females; p < 0.001), while females had greater severe hearing disorders (2.3% vs. 1.8%; p < 0.001). Consanguineous groups showed autosomal recessive patterns (e.g., 91,512 mobility issues in first-degree relatives; Cramer’s V = 0.12). Regional disparities emerged, with rural Najran reporting elevated balance/motion deficits (3.1% vs. national 1.9%; p < 0.01). Never-married individuals faced extreme communication barriers (18.4% vs. 8.7% married; p < 0.001). Conclusions: Sensory disorders in Saudi Arabia are shaped by genetic, environmental, and sociocultural factors, with implications for educational access and inclusive learning environments. Gender-sensitive interventions, genetic counseling, and expanded sensory disability metrics are critical for equitable educational policies. Regional programs targeting trauma prevention, chronic disease management, and sensory-friendly accommodations in schools are recommended to address multisensory disorder burdens and enhance educational outcomes. Full article

Background/Objectives: Since high frequencies are susceptible to disruption in various types of hearing loss, a symptom which is common in people with tinnitus, the aim of the study was to investigate EEG cortical auditory evoked and P300 responses to both a high- and low frequency-centered oddball paradigm to begin to establish the most suitable cognitive physiologic testing conditions for those with both unimpaired hearing and those with hearing impairments. Methods: Cortical auditory evoked potential (CAEP) P1, N1, P2 and P300 (subtraction wave) peaks were identified in response to high- (standard: 6000 Hz, deviant: 8000 Hz) and low frequency (Standard: 375 Hz, Deviant: 500 Hz) oddball paradigms. Each paradigm was presented at various intensity levels. Latencies and amplitudes were then computed for each condition to assess the effects of frequency and intensity. Results: Stimulus intensity had no effect on either the high- or low frequency paradigms of P300 characteristics. In contrast, for the low frequency paradigm, intensity influenced the N1 latency and P2 amplitude, while for the high frequency paradigm intensity influenced P1 and P2 latency and P2 amplitude. Conclusions: Obligatory CAEP components responded more readily to stimulus frequency and intensity changes, and one possible consideration is that higher frequencies could play a role in the response characteristics exhibited by N1 (except for N1 amplitude) and P2, given their involvement in attentional processes linked to the detection of warning cues. P300 latency and amplitude were not influenced by such factors. These findings support the hypothesis that disentangling the cognitive from the more sensory-based response is possible, even in those with hearing loss, provided that the patient’s hearing loss is considered when determining the presentation level. While the present study was performed in participants with unimpaired hearing, these data set up future studies investigating the effectiveness of using similar methods in hearing-impaired persons. Full article

Background/Objectives: 22q11.2 microdeletion syndrome (22q11DS) is a genetic disease caused by aberration of chromosome 22 that results in some phenotypic features and developmental disorders. This paper presents a cross-sectional study on speech and communication of Polish children with 22q11DS. Methods: Individuals affected with 22q11DS may show difficulties in functioning, including speech and hearing. Therefore, we prepared a speech development questionnaire and employed it to obtain data from parents (or legal guardians) of 54 children with 22q11DS. The questionnaire covered the following speech and communication development stages: babbling, using first words, first sentences, verbal and non-verbal communication, speech disfluencies, hearing loss, speech intelligibility, difficulties in interpersonal contact, and participation in speech therapy. The obtained answers underwent statistical analysis to verify relationships between the stages of personal development and selected dysfunctions and disorders. Results: In the study group we observed delays in achieving subsequent speech developmental stages and that hearing loss was associated with delays in producing first words. Hearing loss was reported in about a quarter of cases, but a significant proportion of children (55.56%) reported speech disfluencies, which had not been emphasized in previous works, where hearing loss is considered a common co-occurring disorder. Conclusions: Our findings suggest that this may represent a phenomenon associated with 22q11DS that warrants further investigation using standardized tests for assessing disfluencies. Additionally, we observed that speech therapists and caregivers were perceived as not fully aware of the speech development impairments caused by 22q11DS. These preliminary observations point to the need for future studies and increased awareness efforts in this area. Full article

The misuse of personalized listening devices (PLDs) resulting in noise-induced hearing loss (NIHL) has become a public health concern, especially among youths, including medical students. The occupational use of PLDs that produce high-intensity sounds amplifies the danger of cochlear deterioration and high-frequency NIHL especially when used in noisy environments. This study aims to evaluate the incidence and trends of NIHL among medical students using PLDs. Background/Objectives: The purpose of this study is to assess the prevalence of high-frequency NIHL among PLD-using medical students. Methods: A semi-structured questionnaire covering details on PLD usage, exposure to noisy environments, and hearing difficulties was used to gather the data required. Conventional pure-tone audiometry with extended high-frequency audiometry was preceded by routine clinical evaluation using tuning fork tests and otoscopic examination for hearing loss assessment and to rule out middle-ear pathology. Hearing impairment was determined and categorized according to the Goodman and Clark classification system (250 Hz to 8000 kHz). SPSS version 21 was used in the analysis of the frequency data collected. Results: Out of 100 participants, using conventional PTA, 33% were found to have hearing loss, with 42.9% of males and 23.5% of females affected. Bilateral hearing loss was seen in 36.4% of the cases. Left-sided hearing loss was found to be more common (28%). The duration of usage of PLD had a significant correlation with hearing loss with a p-value < 0.0001. Hearing thresholds were significantly elevated at 16 kHz and 18 kHz in both the right and left ear. Conclusions: The high prevalence of PLD misuse among medical students is a major risk factor for NIHL. To help combat chronic hearing loss, students need to be educated about safe listening levels that can prevent further damage to the cochlea and auditory system. Full article

This study aims to design and develop a virtual reality platform (VR-ISLS) tailored to support hearing and physically impaired students at the university library for navigating and utilizing library services. By employing an immersive virtual environment, the platform replicates the physical setting of the university’s library to create a realistic experience that reduces anxiety and enhances familiarity. The platform integrates assistive technology functions, including sign language interpretation, customizable audio cues, vibration feedback, and various locomotion controls to meet the diverse needs of impaired students. The research methodology employs an iterative development process, incorporating feedback from library staff, disability support services, and students to ensure usability and accessibility. Evaluation of the platform using the System Usability Scale (SUS) and user feedback revealed a positive reception, with recommendations for further customization and enhanced assistive features to optimize the user experience. This study underscores the importance of inclusive design and continuous iteration in creating immersive virtual reality tools that provide significant benefits for persons with disabilities, enhancing both accessibility and learning experiences. Full article

Background and Objectives: In Saudi Arabia, persons with disabilities (PWDs) face considerable oral health challenges, including a higher prevalence of dental caries and gingival inflammation, which adversely affects their oral health-related quality of life (OHRQoL). This population experiences distinct and substantial barriers in accessing adequate dental care. This systematic review and meta-analysis aims to quantify disparities in OHRQoL between PWDs and individuals without disabilities in Saudi Arabia, focusing on caries and gingivitis prevalence, and to identify specific areas for intervention. Materials and Methods: A structured search of PubMed, Scopus, Web of Science, and Google Scholar yielded 803 articles, of which seven met the inclusion criteria. These studies reported on OHRQoL and oral health outcomes in populations with autism, Down syndrome, cerebral palsy, and hearing impairments. Data on caries rates, gingival health, and self- or caregiver-reported quality of life were extracted and analysed. Results: PWDs in Saudi Arabia exhibit significantly higher caries prevalence (ranging from 60% to over 80%) and moderate-to-severe gingival inflammation (up to 60%) compared to individuals without disabilities. The caregivers of children with disabilities reported heightened stress levels, and PWDs experienced reduced functional and social well-being. These disparities were compounded by limited preventive care access and high unmet treatment needs, particularly among those with severe disabilities and limited caregiver support. Conclusions: PWDs in Saudi Arabia face marked oral health disparities, with notably higher rates of dental caries and gingivitis, severely impacting their quality of life. The findings underscore the need for targeted oral health policies and community-based interventions to enhance care accessibility, promote preventive measures, and address the unique needs of this vulnerable population. Full article

Streptococcus species represent a significant global cause of meningitis, leading to brain damage through bacterial virulence factors and the host inflammatory response. Upon entering the central nervous system (CNS), excessive inflammation leads to various neurological and psychological complications. This review explores the pathophysiological mechanisms and associated outcomes of streptococcal meningitis, particularly its short- and long-term neurological sequelae. Neurological symptoms, such as cognitive impairment, motor deficits, and sensory loss, are shown to vary in severity, with children being particularly susceptible to lasting complications. Among survivors, hearing loss, cognitive decline, and cranial nerve palsies emerge as the most frequently reported complications. The findings highlight the need for timely intervention, including neurorehabilitation strategies that focus on optimizing recovery and mitigating long-term disabilities. Future recommendations emphasize improving early diagnosis, expanding vaccine access, and personalizing rehabilitation protocols to enhance patient outcomes. As a novel contribution, this review proposes the term “post-meningitic syndrome” to showcase the broad spectrum of CNS complications that persist following streptococcal meningitis, providing a framework for a future clinical and research focus. Full article