Search Results (50)

Background: Pure-tone audiometry (PTA) does not fully capture functional hearing difficulties. This study examined relationships between audiometric thresholds, self-reported hearing quality (SSQ12), and cognitive screening in patients with auditory complaints, as well as the association of other factors such as age and noise exposure with these measures. Methods: Data from 178 patients complaining about subjective hearing loss (mean age 55 ± 17.4 years; 43.3% male), including PTA and SSQ12, were analyzed. A subgroup of 60 patients aged ≥ 60 years also completed the Subjective Cognitive Decline Questionnaire (MiCog/SuCog). Associations were assessed via bivariate correlation and multiple linear regression analyses. Results: Age was independently associated with higher PTA4 thresholds in both ears (right: B = 0.60 dB HL per year, 95% CI 0.47–0.73; left: B = 0.61 dB HL per year, 95% CI 0.48–0.74; p < 0.001). SSQ12 scores correlated with PTA (right ear ρ = −0.532) and age (ρ = −0.283; both p < 0.001) and were lower in noise-exposed participants after adjusting for PTA, age, sex and tinnitus (B = −1.005, 95% CI −1.565 to −0.446, p < 0.001). In the cognitive subgroup, right-ear PTA showed an unadjusted correlation with MiCog (ρ = 0.332, p = 0.010); in the adjusted model, neither PTA nor any other predictor was independently associated with MiCog (PTA: B = 0.095, 95% CI −0.075 to 0.264, p = 0.266). No significant association was found between MiCog and the SSQ12 total score (Pearson r = −0.166, p = 0.204; Spearman ρ = −0.241, p = 0.064). Conclusions: Audiometric thresholds, self-reported hearing quality, and cognitive screening capture partially distinct, interrelated dimensions of auditory function. Self-reported measures revealed noise-related difficulties undetected by audiometry. These findings support incorporating patient- and informant-reported outcomes alongside audiometry to support a more comprehensive, patient-centered approach to hearing and cognitive care. Full article

Introduction: Hearing loss and cognitive impairment are among the most common chronic conditions of aging, and a growing body of evidence links the two. The 2020 and 2024 Lancet Commissions identified midlife hearing loss as one of the largest potentially modifiable risk factors for dementia, raising the possibility that auditory rehabilitation could help preserve cognition. Methods: This narrative review provides a lifespan perspective by summarizing current evidence on the relationship between hearing loss and cognitive decline, the cognitive domains most affected, and the mechanisms proposed to explain the association, including the cognitive load, common cause, cascade, and overdiagnosis hypotheses, together with their neurobiological correlates. Results: We then examine the effect of auditory interventions on cognition in adults, considering hearing aids and cochlear implants separately, and discuss landmark trials such as ACHIEVE, which suggest that cognitive benefits may be greatest in older adults at increased risk of decline. Finally, we address the distinct situation of children, in whom early auditory deprivation may shape the development of working memory and executive function and in whom the timely fitting of hearing devices is critical. Conclusions: Overall, the evidence supports hearing loss as a modifiable contributor to cognitive decline and highlights early detection and rehabilitation as promising, though not universally effective, strategies for protecting cognitive health. Full article

Objective: To critically summarize current evidence regarding the burden of Eustachian tube dysfunction (ETD) in older adults, focusing on age-related pathophysiology, diagnostic challenges, therapeutic strategies and its interaction with major geriatric clinical implications. Methods: This narrative review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed-indexed original studies, systematic reviews, meta-analyses, consensus statements and clinical guidelines addressing ETD and ageing were systematically identified and critically appraised. Evidence was synthesized narratively with particular emphasis on studies applicable to geriatric populations. Results: Current evidence demonstrates that ageing induces progressive structural and functional alterations throughout the Eustachian tube–middle ear unit, including cartilage calcification, muscular degeneration, mucosal atrophy and impaired neuromuscular coordination. These changes may increase susceptibility to ETD, which in turn can exacerbate presbycusis, vestibular dysfunction, communication disability and potentially contribute to frailty and cognitive vulnerability by increasing the cumulative burden of sensory impairment. However, evidence specifically derived from geriatric cohorts remains limited, particularly regarding long-term outcomes and therapeutic interventions and is insufficient to establish ETD as an independent determinant of these conditions. Conclusions: ETD should be recognized as an underdiagnosed and potentially modifiable contributor to hearing-related disability in older adults. Greater clinical awareness, standardized diagnostic pathways and prospective geriatric-focused studies are needed to clarify whether timely diagnosis and treatment of ETD can reduce the overall burden of hearing impairment, improve functional independence and enhance quality of life in ageing populations. Full article

Background/Objectives: Hearing loss and dementia are highly prevalent conditions in older adults and represent a growing public health challenge. Over the past decade, a substantial body of epidemiological evidence has demonstrated a consistent association between age-related hearing loss and cognitive dysfunction, including incident dementia. However, the nature of this relationship remains incompletely understood. Methods: This narrative review provides a structured overview of current evidence, focusing on epidemiological findings, mechanistic pathways, and clinical implications. Hearing loss has been associated with both accelerated cognitive decline and increased dementia risk, with a clear severity–impact relationship. Results: Several interacting mechanisms have been proposed, including increased cognitive load, structural and functional brain changes, social isolation, and shared vascular and metabolic risk factors. Emerging concepts such as the “auditory brain” and central auditory dysfunction further suggest that hearing impairment may also represent an early manifestation of neurodegenerative processes. Intervention studies have yielded mixed results. While hearing rehabilitation improves communication and quality of life, randomized evidence has not consistently demonstrated a reduction in cognitive decline in the general population, but potential benefits may exist in higher-risk subgroups. Increasing attention has been directed toward the role of neuroplasticity, with evidence suggesting that delayed intervention may limit the effectiveness of rehabilitation due to long-standing auditory deprivation. Conclusions: Taken together, current evidence suggests that hearing loss may represent both a potentially modifiable risk factor and an early marker of cognitive decline. Early identification and timely management of hearing impairment may therefore play an important role in maintaining cognitive and brain health and improving quality of life in older adults. Full article

Presbycusis, or age-related hearing loss (ARHL), is a multifactorial disorder characterized by a gradual, bilateral sensorineural decline in hearing sensitivity, predominantly affecting high-frequency sounds. It is one of the most common chronic conditions in the aging population and represents a major public health concern due to its high prevalence and progressive nature. Presbycusis significantly impairs speech perception, especially in noisy environments, leading to communication difficulties, reduced social participation, increased risk of social isolation, and a decline in quality of life. Moreover, growing evidence highlights a strong association between ARHL and cognitive impairment, dementia, depression, and increased frailty in older adults. The etiology of presbycusis is complex and involves the interplay between genetic predisposition and cumulative environmental and lifestyle-related factors. Genetic susceptibility influences cochlear aging, neural degeneration, and vulnerability to external insults. Non-genetic contributors include chronic noise exposure, cardiovascular and metabolic disorders such as diabetes and dyslipidemia, ototoxic medications, smoking, and other lifestyle factors that may accelerate cochlear damage through oxidative stress and microvascular dysfunction. This narrative review aims to provide an updated overview of the genetic and environmental determinants involved in the development and progression of presbycusis. Furthermore, it discusses the clinical implications of these factors for early identification, audiological evaluation, prevention strategies, and personalized management approaches. A better understanding of the multifactorial nature of presbycusis may support the development of targeted interventions to preserve hearing function and improve overall health outcomes in the aging population. Full article

Introduction: This study aimed to systematically assess the impact of hearing interventions on cognitive function in older adults with presbycusis. Methods: A comprehensive search was conducted across PubMed, EMBASE, and Web of Science databases from their inception to 22 June 2025 to identify eligible randomized clinical trials or cohort studies that used designated cognitive scales or cognitive test measures. Two separate meta-analyses were conducted: one using uncontrolled pre–post comparisons and another restricted to studies that included concurrent untreated control groups. Results: A total of 22 studies were identified, comprising 9 focused on hearing aid use and 13 on cochlear implantation. Ultimately, 19 studies were included in the quantitative analysis: 7 on hearing aid use and 12 on cochlear implantation. The pooled analysis of hearing intervention across 17 studies involving 1562 patients indicated a 4% improvement in cognitive test scores post-intervention compared with pre-intervention (ratio of means: 1.04; 95% CI: 1.03–1.05; p < 0.001). However, in the 4 controlled studies that included an untreated comparator group (815 intervention, 7450 control participants), hearing intervention did not confer a statistically significant cognitive benefit over no intervention (SMD = 0.03; 95% CI: −0.04 to 0.09; p = 0.369). Conclusions: Current controlled evidence does not support the claim that hearing interventions preserve or enhance cognitive function in older adults with presbycusis. Full article

Background/Objectives: Coenzyme Q10 (CoQ10) is crucial for mitochondrial bioenergetics and redox balance and has been studied in hearing disorders. Its clinical use ranges from genetic mitochondrial deafness to acquired hearing loss associated with oxidative stress. This review aimed to map human clinical evidence on CoQ10 in hearing issues and differentiate its therapeutic roles based on underlying causes. Methods: This review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic search of PubMed, Europe PubMed Central, the Directory of Open Access Journals (DOAJ), and ClinicalTrials.gov was performed. Human clinical studies evaluating CoQ10 or water-soluble CoQ10 formulations with hearing-related outcomes were included and synthesized descriptively. Results: Fourteen studies met the inclusion criteria, including randomized controlled trials, non-randomized clinical studies, case series, and case reports. Two distinct therapeutic roles of CoQ10 emerged: in primary mitochondrial hearing disorders caused by defects in mitochondrial DNA or CoQ10 biosynthesis pathways, CoQ10 acted as a replacement therapy and was consistently linked to stabilization or prevention of progressive sensorineural hearing loss. Conversely, in acquired or age-related conditions—including presbycusis, noise-induced hearing loss, ototoxicity, tinnitus, and sudden sensorineural hearing loss—CoQ10 was used as an antioxidant or neuroprotective supplement, with outcomes showing functional preservation, symptom reduction, or decreased cochlear injury. Internal validity varied across studies: most evidence for replacement therapy was derived from observational designs, and antioxidant applications were mainly supported by small or preliminary clinical trials. Conclusions: The available evidence suggests two distinct clinical roles of CoQ10 in hearing disorders: (i) replacement therapy in genetically defined mitochondrial deafness and (ii) adjunctive antioxidant/neuroprotective use in acquired conditions. Given heterogeneity and limited study quality, further well-designed trials are needed before broad clinical recommendations can be made. Full article

Background: Age-related vestibular decline frequently accompanies presbycusis, and older adults undergoing cochlear implantation (CI) may be particularly vulnerable to postoperative dizziness due to a reduced compensatory capacity and a higher burden of comorbidities. Although CI is an effective treatment for severe-to-profound sensorineural hearing loss in the elderly, its impact on vestibular function remains a critical concern. This study aimed to compare pre and postoperative vestibular performance in older patients (≥65 years) versus younger adults undergoing CI in order to identify the risk factors for postoperative vestibular deterioration and critical issues that characterize this category and carry out personalized preoperative counseling. Methods: In this monocentric observational study, adults undergoing CI were divided into two groups: older patients (OPS, ≥65 years) and younger patients (YPS, <65 years). Vestibular function was assessed preoperatively and one month postoperatively through a Dizziness Handicap Inventory (DHI), history of recurrent falls, clinical examination, video head impulse test (VHIT), bithermal caloric testing, and computerized dynamic posturography (Sensory Organization Test, SOT). Risk factors for postoperative vestibular worsening were analyzed using ANOVA test and chi-square statistics, with significance set at p < 0.05. Results: A total of 63 patients were included, with 18 surgeries involving OPS and 45 involving YPS. Preoperatively, OPS showed significantly higher rates of vestibular abnormalities on caloric testing (55.5% vs. 17.7% bilateral hyporeflexia, p < 0.05) and a higher prevalence of recurrent falls (33.3% vs. 4.4%, p < 0.05). Early postoperative dizziness (DHI¹) increased significantly in both groups, but age ≥ 65 was a risk factor for ≥10% worsening (OR 2.2, p < 0.05). At one month, YPS returned to baseline DHI values, whereas OPS showed persistent dizziness with significantly higher DHI² scores (29.2 vs. 12.9, p < 0.05). Vestibular worsening was identified in 33.3% of VHIT assessments and 44.4% of caloric tests in OPS, with caloric testing proving more sensitive than VHIT. Implantation on the better-functioning vestibular side and the presence of ≥3 comorbidities increased the likelihood of persistent postoperative dizziness. Conclusions: Older age is a significant risk factor for persistent dizziness and vestibular impairment one month after CI. Given the reduced compensatory capacity typical of older adults, vestibular assessment should play a central role in preoperative decision-making, particularly for side selection. Bithermal caloric stimulation is recommended as the most sensitive tool for detecting clinically relevant vestibular changes. Preoperative counseling for older CI candidates should include a detailed discussion of vestibular risks and the possible need for postoperative rehabilitation. Full article

This scoping review aims to synthesize peer-reviewed literature exploring quality of life (QoL) for individuals with age-related hearing loss (ARHL), age-related central auditory processing (ARCAP) deficits, and age-related cognitive decline. A growing body of research has identified ARHL as a risk factor for the development of dementia, highlighting the connection between the sensory and cognitive systems. As the aging population continues to grow, examining comorbid age-related hearing and cognitive decline is especially relevant. These conditions may have potential negative consequences on the daily functioning, social participation, mental health, and overall wellbeing of older adults. A systematic search of peer-reviewed literature was conducted across multiple databases, adhering to the PRISMA guidelines for scoping reviews. Studies that focused on the impact of ARHL, ARCAP deficits, and/or related cognitive deficits on QoL were included in the present review. Key data extracted included QoL measures categorized into the ICF framework, the effects of hearing loss intervention on QoL, and the impact of ARHL on QoL for aging individuals. This review summarizes the reported effects that ARHL, ARCAP, and/or cognitive decline have on older adults, and discusses the clinical and practical implications for managing clients with these conditions. In addition to preventative measures and deficit management, maintenance of life participation, social engagement, and overall wellbeing should be considered when caring for aging adults with hearing and/or cognitive impairment. Full article

Connexins, as key players in intercellular communication in the inner ear, are vital for maintaining normal hearing function. While numerous studies have explored their role in congenital hereditary hearing loss, the underlying mechanisms and therapeutic potential of connexins in acquired hearing loss remain to be fully elucidated. This review summarizes recent advances in connexin research in the context of acquired hearing loss, with a focus on presbycusis, noise-induced, and drug-induced hearing loss, and delves into their pathophysiological roles. Through the analysis and organization of these research findings, the article aims to provide a theoretical basis and research direction for future connexin-targeted therapies for acquired hearing loss. Full article

Background: Presbycusis, also known as age-related hearing loss (ARHL), is the most frequent sensory disability affecting elderly adults worldwide. ARHL is characterized by bilateral, progressive, sensorineural hearing loss that is more pronounced at a high frequency. Conventional factors associated with ARHL include diabetes, hypertension, and a family history of hearing loss. The severity of hearing impairment varies between individuals. The defined causative molecular pathogenesis for ARHL is unknown, thus the identification of underlying pathogenic mechanisms involved in ARHL is imperative for the development of effective therapeutic approaches. Epigenetics is the study of phenotypic changes caused by the modification of gene expression rather than the alteration of a DNA sequence. While it is hypothesized that ARHL could result from undiscovered epigenetic susceptibility, there is a shortage of information on the role that epigenetic modification plays in ARHL. Here we present an investigation on the involvement of DNA methylation in ARHL. Results: Clinical, audiometric and DNA testing, and high-throughput methylation pattern screening were undertaken for ARHL patients and matched control subjects. Our results demonstrate a strong correlation between patients’ hearing measurements and methylation at CpG sites cg1140494 (ESPN) and cg27224823 (TNFRSF25). We identified 136 differentially methylated CpGs that were shared between a high and low audiometric frequency in the patient’s cohort. CpG cites in hearing loss candidate genes, KCNQ1, TMEM43, GSTM1, TCF25, and GSR, were found to be highly methylated in presbycusis patients as compared to the controls. A methylation polymerase chain reaction (PCR) assay was used to confirm methylation levels at a specific gene locus in ARHL patients and controls. Conclusions: Altered DNA methylation and its impact on gene expression has been implicated in many biological processes. By interrogating the methylation status across the genome of both hearing loss patients and those with normal hearing, our study can help to establish an association between the audiometric patterns and methylation status in ARHL, yielding new avenues for the identification of potential candidate genes for hearing loss. Full article

Background/Objectives: In the early stage of presbycusis, patients experience reduced speech perception in noisy environments despite normal audiometry, normally known as hidden hearing loss. Diagnostic indicators like the reduced amplitude of ABR wave I, elevated extended high-frequency threshold (EHT), and decreased middle ear muscle reflex (MEMR) amplitude aim to identify biomarkers of peripheral auditory pathology but remain inconsistent. Mismatch negativity (MMN) is a cortical auditory evoked potential generated when the brain detects sound changes. This study aimed to assess MMN as a diagnostic tool for hidden hearing loss in adults. Methods: Seventy-three subjects with normal hearing underwent an extended pure-tone audiogram examination ranging from 0.125 to 16 kHz and a subsequent MMN assessment with two different paradigms: a speech (ba/da) and a tone (1/2 kHz) paradigm. The MMN’s amplitude and latency were measured and analyzed. Results: The outcome shows a significant age-related effect on MMN amplitude in the speech condition (χ² = 13.0, p = 0.002). Specifically, the MMN amplitude in the 25–30-year-old group was significantly smaller than in the 20–25-year-old group (p = 0.0015, Cohen’s d = 0.63). Additionally, no further effects of age were observed on the cortical potentials examined. Also, neither tone nor speech paradigms showed a significant influence of EHT on the amplitude or latency of either MMN or P300. Conclusions: The application of MMN as an electrophysiological tool to diagnose hidden hearing loss in normal hearing adults has limitations. However, in contrast to MMN responses to tonal stimuli, the present study reveals that MMN amplitude obtained with speech stimuli may indicate early signs of central auditory deficits. Full article

Diabetes mellitus (DM) is a common chronic health condition, affecting millions of people worldwide, and its incidence is projected to increase by almost 50% in the next two decades. The effects of DM on the auditory system have been reported. However, there is limited evidence on the association between DM and middle ear pathologies. This scoping review aimed to map the available evidence and identify research gaps regarding DM and middle ear pathologies in the adult population. Five electronic databases, namely Scopus, CINAHL, MEDLINE, PubMed, and Web of Science, were searched using a combination of specific key terms. This review followed the guidelines stipulated by the Joanna Briggs Institute (JBI) methodology for scoping reviews and reporting using PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. A thematic narrative analysis was used to synthesize key findings. Of the 1809 articles, only 2 articles met the inclusion criteria. Neither of these studies focused exclusively on middle ear pathologies in DM, but they did report incidental findings related to middle ear function. Available evidence suggests that middle ear pathologies may occur in individuals with DM, with a reported prevalence ranging from 3.1% to 19.6%. Otitis media with effusion and conductive hearing loss were common middle ear pathologies identified. Additionally, recent studies have provided new evidence suggesting ossicular joint changes in individuals with DM and a causal link between DM and acute suppurative otitis media. However, age-related hearing loss (presbycusis) and sensorineural hearing loss (SNHL) were more commonly associated with DM, with studies reporting a high prevalence of SNHL in younger to middle-aged adults with diabetes. This review highlights a significant research gap in the literature, as no studies directly investigated the relationship between DM and middle ear function as a primary focus. Further research is required to investigate this potential association using methodologies explicitly designed for middle ear assessment. While some evidence suggests a possible association, the lack of age-stratified analyses, imaging data, and comprehensive diagnostic testing limits the ability to draw strong conclusions. Further research incorporating age-based analyses, radiological assessments, and microbiome studies is needed to fully understand the potential impact of DM on middle ear health. Full article

Recent studies applying machine learning (ML) to saccade and vergence eye movements have demonstrated the ability to distinguish individuals with dyslexia, learning disorders, or attention disorders from healthy individuals or those with other pathologies. Stroke patients are known to exhibit visual deficits and eye movement disorders. This study focused on saccade and vergence measurements using REMOBI technology V3 and the Pupil Core eye tracker. Eye movement data were automatically analyzed with the AIDEAL V3 (Artificial Intelligence Eye Movement Analysis) cloud software developed by Orasis-Ear. This software computes multiple parameters for each type of eye movement, including the latency, accuracy, velocity, duration, and disconjugacy. Three ML models (logistic regression, support vector machine, random forest) were applied to the saccade and vergence eye movement features provided by AIDEAL to identify stroke patients from other groups: a population of children with learning disorders and a population with a broader spectrum of dysfunctions or pathologies (including children and adults). The different classifiers achieved macro F1 scores of up to 75.9% in identifying stroke patients based on the saccade and vergence parameters. An additional ML analysis using age-matched groups of stroke patients and adults or seniors reduced the influence of large age differences. This analysis resulted in even higher F1 scores across all three ML models, as the comparison group predominantly included healthy individuals, including some with presbycusis. In conclusion, ML applied to saccade and vergence eye movement parameters, as measured by the REMOBI and AIDEAL technology, is a sensitive method for the detection of stroke-related sequelae. This approach could be further developed as a clinical tool to evaluate recovery, compensation, and the evolution of neurological deficits in stroke patients. Full article

Background: Although hearing loss influences voice characteristics, such changes may be under-recognized during clinical consultations. This systematic review examines voice alterations in adults with post-lingual hearing loss, considering diagnostic and rehabilitative implications. Methods: A comprehensive search of PubMed, Scopus, and Google Scholar was conducted following PRISMA guidelines, targeting studies reporting quantitative data on vocal parameters in adults with sensorineural hearing loss. Exclusion criteria included pre-lingual hearing loss and non-English studies. Data extraction focused on pitch, loudness, and prosody, with study quality assessed using NIH tools. Results: Eleven case–control studies, involving 594 patients with sensorineural hearing loss and 326 control patients, were analyzed. Patients with untreated hearing loss exhibited elevated fundamental frequency, F₀ (males: 158–169 Hz; females: 206–251 Hz) and loudness levels (males: 79–96 dB; females: 89–116 dB) compared to controls (F₀—males: 75–150 Hz; females: 150–300 Hz; loudness—males: 30–70 dB; females: 40–68 dB). Alterations in jitter, shimmer, and maximum phonation time (MPT) contributed to the distinct “hearing loss voice”. Cochlear implants (CIs) and hearing aids improved vocal parameters, with CIs reducing F₀ by approximately 12–15 Hz. Continuous hearing aid use normalized pitch and loudness within four months. Prosody alterations, such as monotone speech, were reported in long-term cases. In noisy environments, individuals with hearing loss exhibited exaggerated increases in pitch and loudness, indicative of compensatory mechanisms. Conclusions: Post-lingual hearing loss disrupts the central regulation of voice, altering pitch, loudness, and other vocal parameters. Recognizing these changes, particularly in noisy environments, could facilitate the early diagnosis and timely rehabilitation of hearing deficits, potentially mitigating associated risks of cognitive decline. Full article