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Purpose: To verify the relationship between consistency in the use of hearing aids, auditory speech perception and vocabulary in children using hearing aids., Methods: The population of Pereira's (2023) study was resumed and the database was analyzed containing information about the Speech Intelligibility Index (SII) for input sounds of 65 dBSPL (with or without hearing aids) of 29 children with neurosensorial hearing loss and hearing aid users bilaterally, with oral language, the number of hours per day of use of the device, four-tone average, results of the repetition of words with or without meaning in 65 dBSPL, Peabody Picture Vocabulary Test - PPVT. The consistency of the use was analyzed through measuring the auditory dosage which takes into account the average of use hours and the audibility with or without the device., Results: The PPVT has a positive correlation with the SII with the device at 65 dBSPL. The four-tone average has a significant negative correlation with the SII in both conditions; and the same happens with the hours on daily usage. The dosage has a significant positive correlation with the SII and negative with the PTA., Conclusion: The receptive vocabulary tends to grow alongside with the audibility dosage increment. Results suggest that listening experience, involving the audibility with or without the device and the consistency of the device daily use must be considered throughout the whole process of the rehabilitation.

Importance: Cochlear implants are an effective technique for enhancing speech perception abilities in quiet environments for people with severe to profound deafness. Nevertheless, complex sound signals perception, such as music perception, remains challenging for cochlear implant users., Objective: To assess the benefit of a tonotopic map on music perception in new cochlear implant users., Design, Setting, and Participants: A prospective, randomized, double-blind, 2-period crossover study including 26 new cochlear implant users was performed over a 6-month period (June 2021 to November 2021). An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on Greenwood function. New cochlear implant users older than 18 years with bilateral severe to profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. The trial was conducted from June to November 2021 (inclusion) and to February 2022 (end of the assessment procedure at 12 weeks postactivation), and the analysis itself was completed in December 2022., Intervention: Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa., Main Outcomes and Measures: Participants performed pitch-scaling tasks (multidimensional qualitative assessment, melodic contour identification, melodic recognition test) after 6 weeks of each setting., Results: Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (1 in each sequence) had to be excluded due to the COVID-19 pandemic. The multidimensional qualitative assessment (Gabrielsson test), melodic contour identification, and melodic recognition scores were significantly higher with the tonotopic setting than the conventional one (mean effect [ME], 7.8; 95% CI, 5.0-10.5; ME, 12.1%; 95% CI, 5.7%-18.4%; ME, 14.4%, 95% CI, 8.5%-20.2%; and ME, 2.1, 95% CI, 1.7-2.5, respectively). Among the different dimensions evaluated by the Gabrielsson test, the mean scores for clarity, spaciousness, fullness, nearness, and total impression were significantly higher with tonotopic fitting. Ninety-two percent of the participants kept the tonotopy-based map after the study period., Conclusions: In this randomized clinical trial of patients with new cochlear implants, a tonotopic-based fitting was associated with better results in perception of complex sound signals such as music listening experience., Trial Registration: ClinicalTrials.gov Identifier: NCT04922619.

Objectives: To determine our audiology clinics status in meeting the Joint Committee on Infant Hearing recommended 1-3-6 benchmarks for identification and intervention for congenital sensorineural hearing loss and identify those factors contributing to delay in identification and intervention., Design: This is a retrospective case series. Children with sensorineural hearing loss who underwent auditory brainstem response (ABR) testing, hearing aid evaluation, or cochlear implant mapping at our tertiary pediatric medical center between January 2018 and December 2021 were included. Simple and multiple linear regression analyses were used to identify social, demographic, and health factors associated with primary outcomes, defined as age at hearing loss identification, age at intervention (here defined as amplification start), and interval between identification and intervention., Results: Of 132 patients included, mean age was 2.4 years, 48% were male, and 51% were Hispanic. There was significant association between each Hispanic ethnicity ( p = 0.005, p = 0.04, respectively), insurance type ( p = 0.02, p = 0.001, respectively), and later age at identification and intervention. In multivariable analyses, Hispanic ethnicity was significantly associated with both delays in identification and intervention ( p = 0.03 and p = 0.03, respectively), and public insurance was associated with delays in intervention ( p = 0.01). In addition, the total number of ABRs was significantly associated with both older age of identification and intervention ( p < 0.001, p < 0.001, respectively). Mediator analysis demonstrated that the effect of ethnicity on age at identification is mediated by the total number of ABRs performed., Conclusions: A significant association between total number of ABRs and age at identification and intervention for children with hearing loss exists. Hispanic ethnicity was associated with delays in meeting milestones, further mediated by the number of ABRs, providing a potential avenue for intervention in addressing this disparity., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Usher syndrome (USH), characterized by bilateral sensorineural hearing loss (SNHL) and retinitis pigmentosa (RP), prompts increased reliance on hearing due to progressive visual deterioration. It can be categorized into three subtypes: USH type 1 (USH1), characterized by severe to profound congenital SNHL, childhood-onset RP, and vestibular areflexia; USH type 2 (USH2), presenting with moderate to severe progressive SNHL and RP onset in the second decade, with or without vestibular dysfunction; and USH type 3 (USH3), featuring variable progressive SNHL beginning in childhood, variable RP onset, and diverse vestibular function. Previous studies evaluating cochlear implant (CI) outcomes in individuals with USH used varying or short follow-up durations, while others did not evaluate outcomes for each subtype separately. This study evaluates long-term CI performance in subjects with USH, at both short-term and long-term, considering each subtype separately., Design: This retrospective, observational cohort study identified 36 CI recipients (53 ears) who were categorized into four different groups: early-implanted USH1 (first CI at ≤7 years of age), late-implanted USH1 (first CI at ≥8 years of age), USH2 and USH3. Phoneme scores at 65 dB SPL with CI were evaluated at 1 year, ≥2 years (mid-term), and ≥5 years postimplantation (long-term). Each subtype was analyzed separately due to the significant variability in phenotype observed among the three subtypes., Results: Early-implanted USH1-subjects (N = 23 ears) achieved excellent long-term phoneme scores (100% [interquartile ranges {IQR} = 95 to 100]), with younger age at implantation significantly correlating with better CI outcomes. Simultaneously implanted subjects had significantly better outcomes than sequentially implanted subjects ( p = 0.028). Late-implanted USH1 subjects (N = 3 ears) used CI solely for sound detection and showed a mean phoneme discrimination score of 12% (IQR = 0 to 12), while still expressing satisfaction with ambient sound detection. In the USH2 group (N = 23 ears), a long-term mean phoneme score of 85% (IQR = 81 to 95) was found. Better outcomes were associated with younger age at implantation and higher preimplantation speech perception scores. USH3-subjects (N = 7 ears) achieved a mean postimplantation phoneme score of 71% (IQR = 45 to 91)., Conclusions: This study is currently one of the largest and most comprehensive studies evaluating CI outcomes in individuals with USH, demonstrating that overall, individuals with USH benefit from CI at both short- and long-term follow-up. Due to the considerable variability in phenotype observed among the three subtypes, each subtype was analyzed separately, resulting in smaller sample sizes. For USH1 subjects, optimal CI outcomes are expected with early simultaneous bilateral implantation. Late implantation in USH1 provides signaling function, but achieved speech recognition is insufficient for oral communication. In USH2 and USH3, favorable CI outcomes are expected, especially if individuals exhibit sufficient speech recognition with hearing aids and receive ample auditory stimulation preimplantation. Early implantation is recommended for USH2, given the progressive nature of hearing loss and concomitant severe visual impairment. In comparison with USH2, predicting outcomes in USH3 remains challenging due to the variability found. Counseling for USH2 and USH3 should highlight early implantation benefits and encourage hearing aid use., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objectives: This study aimed to determine the speech-to-background ratios (SBRs) at which normal-hearing (NH) and hearing-impaired (HI) listeners can recognize both speech and environmental sounds when the two types of signals are mixed. Also examined were the effect of individual sounds on speech recognition and environmental sound recognition (ESR), and the impact of divided versus selective attention on these tasks., Design: In Experiment 1 (divided attention), 11 NH and 10 HI listeners heard sentences mixed with environmental sounds at various SBRs and performed speech recognition and ESR tasks concurrently in each trial. In Experiment 2 (selective attention), 20 NH listeners performed these tasks in separate trials. Psychometric functions were generated for each task, listener group, and environmental sound. The range over which speech recognition and ESR were both high was determined, as was the optimal SBR for balancing recognition with ESR, defined as the point of intersection between each pair of normalized psychometric functions., Results: The NH listeners achieved greater than 95% accuracy on concurrent speech recognition and ESR over an SBR range of approximately 20 dB or greater. The optimal SBR for maximizing both speech recognition and ESR for NH listeners was approximately +12 dB. For the HI listeners, the range over which 95% performance was observed on both tasks was far smaller (span of 1 dB), with an optimal value of +5 dB. Acoustic analyses indicated that the speech and environmental sound stimuli were similarly audible, regardless of the hearing status of the listener, but that the speech fluctuated more than the environmental sounds. Divided versus selective attention conditions produced differences in performance that were statistically significant yet only modest in magnitude. In all conditions and for both listener groups, recognition was higher for environmental sounds than for speech when presented at equal intensities (i.e., 0 dB SBR), indicating that the environmental sounds were more effective maskers of speech than the converse. Each of the 25 environmental sounds used in this study (with one exception) had a span of SBRs over which speech recognition and ESR were both higher than 95%. These ranges tended to overlap substantially., Conclusions: A range of SBRs exists over which speech and environmental sounds can be simultaneously recognized with high accuracy by NH and HI listeners, but this range is larger for NH listeners. The single optimal SBR for jointly maximizing speech recognition and ESR also differs between NH and HI listeners. The greater masking effectiveness of the environmental sounds relative to the speech may be related to the lower degree of fluctuation present in the environmental sounds as well as possibly task differences between speech recognition and ESR (open versus closed set). The observed differences between the NH and HI results may possibly be related to the HI listeners' smaller fluctuating masker benefit. As noise-reduction systems become increasingly effective, the current results could potentially guide the design of future systems that provide listeners with highly intelligible speech without depriving them of access to important environmental sounds., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To investigate the effects of previous occupational noise exposure in older adults with hearing loss on (1) audiometric configuration and acoustic reflex (AR) thresholds and (2) self-reported hearing abilities and hearing aid (HA) effectiveness., Design: A prospective observational study., Study Sample: The study included 1176 adults (≥60 years) with bilateral sensorineural hearing loss. Pure-tone audiometry, AR thresholds, and responses to the abbreviated version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire were obtained, along with information about previous occupational noise exposure., Results: Greater occupational noise exposure was associated with a higher prevalence of steeply sloping audiograms in men and women and a 0.32 (95% CI: -0.57; -0.06) scale points lower mean SSQ12 total score among noise-exposed men. AR thresholds did not show a significant relation to noise-exposure status, but hearing thresholds at a given frequency were related to elevated AR thresholds at the same frequency., Conclusions: A noise exposure history is linked to steeper audiograms in older adults with hearing loss as well as to poorer self-reported hearing abilities in noise-exposed men. More attention to older adults with previous noise exposure is warranted in hearing rehabilitation.

Purpose: This study aimed to evaluate conversation hearing with an adaptive beamforming hearing aid that supports adaptive tracking of multiple talkers in an ecologically valid, real-world food court environment in a busy mall., Method: Twenty older adult experienced hearing aid wearers with sensorineural hearing loss were fitted in the lab with binaural receiver-in-the-canal style hearing aids set with two programs, each having a different beamforming strategy. The participant and two researchers then met in a moderately noisy and reverberant food court at a local mall where the participant was asked to listen to a conversation between the two researchers. Participants rated the extent of their agreement with 10 positively worded statements specific to the conversation twice, once for each program. Participants then provided program-preference ratings for seven different aspects of a conversation during which the programs were switched back and forth by the researcher, so that participants were unaware of the condition to which they were listening., Results: Real-world subjective ratings for all domains resulted in positive values on average for both programs. Pairwise comparisons indicated that the intervention algorithm had higher absolute ratings on five of the 10 criteria including understanding, clarity, focus, listening effort, and background noise. Ratings for preference between programs indicated a significant preference for the intervention algorithm for all seven criteria., Conclusions: In a real-world setting, the use of hearing aids with separate processing of sounds from the front and back hemisphere provided positive subjective ratings. However, following a group conversation with multiple conversation partners, improvements in the algorithm to account for the locations of interlocutors and the natural head turning of the hearing aid wearer that occurs during a conversation by adding and controlling multiple adaptive beams in the front hemisphere significantly influenced preference for all aspects rated.

Purpose: Hearing aid (HA) processing delay results in asynchronous overlap of the input sound and the delayed amplified sound at the eardrum in open-ear fittings. This may distort the temporal cues used for stop-consonant voicing distinctions. The current study evaluated the impact of HA processing delay on voiced-voiceless categorization of syllable initial consonants /d/ and /t/ for a range of voice onset times (VOTs)., Method: Nineteen older listeners ( M age = 73 years) with mild-moderate sensorineural hearing loss participated. All listeners performed the voiced-voiceless categorization task in double-blind within-subjects design. Thirteen stimulus tokens along the /di:/ - /ti:/ continuum were created by varying VOTs. Stimuli were then processed using an HA simulator, which simulated the overall sound pressure levels measured at the eardrum in open-ear fittings with four processing delay times (0, 0.5, 5, and 8 ms). Individualized stimuli were generated for each listener based on their audiogram and presented via calibrated ear inserts at the most comfortable listening level. Performance across all VOT intervals was fitted with psychometric functions, which were then used to estimate the voiced-voiceless crossover point and the slope parameter for each simulated delay condition., Results: The crossover point along the voiced-voiceless continuum shifted systematically with increased processing delay toward voiced /di:/ over unvoiced /ti:/ percepts. The shift in the crossover point between the 0-ms reference condition and the 8-ms processing delay condition corresponded to 5.8 ms of change in VOT. The 8-ms processing delay condition resulted in significantly shallower categorization slopes compared to the 0- and 0.5-ms delay conditions., Conclusions: Temporal distortions created by HA processing delay in open-ear fittings impacted voicing perception of syllable initial stop-consonant stimuli near the voiced-voiceless crossover point. Short HA processing delay should be considered for open-ear fittings to preserve the natural VOT cues used for voicing detection.

Purpose: Magnetic resonance imaging (MRI), electric compound action potential (eCAP), and electric auditory brainstem response (eABR) are among the routine assessments performed before and/or after cochlear implantation. The objective of this review was to systematically summarize and critically appraise existing evidence of the prognostic value of eCAP, eABR, and MRI for predicting post-cochlear implant (CI) speech perception outcomes in children, with a particular focus on the lesion site., Method: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Three electronic databases (ProQuest, PubMed, and Scopus) were searched with no restrictions on language, publication status, or year of publication. Studies on children identified with sensorineural hearing loss, auditory neuropathy spectrum disorder, cochlear nerve deficiency, or cochleovestibular nerve abnormalities reporting the relevance of eCAP, eABR, and/or MRI results to CI speech perception outcomes were included. The literature search yielded 1,887 publications. Methodological quality and strength of evidence were assessed by the Crowe Critical Appraisal Tool and the Grading of Recommendations Assessment, Development, and Evaluation tool, respectively., Results: Of the 25 included studies, the relevance of eCAP, eABR, and/or MRI findings to post-CI speech perception outcomes was reported in 10, 11, and 11 studies, respectively. The studies were strongly in support of the prognostic value of eABR and MRI for CI outcomes. However, the relevance of eCAP findings to speech perception outcomes was uncertain., Conclusion: Despite the promising findings, caution is warranted in interpreting them due to the observational and retrospective design of the included studies, as well as the heterogeneity of the population and the limited control of confounding factors within these studies., Supplemental Material: https://doi.org/10.23641/asha.26169859.

Objectives: The study compared the utility of two approaches for collecting real-world listening experiences to predict hearing-aid preference: a retrospective questionnaire (Speech, Spatial, and Qualities of Hearing Scale [SSQ]) and in-situ Ecological Momentary Assessment (EMA). The rationale being that each approach likely provides different and yet complementary information. In addition, it was examined how self-reported listening activity and hearing-aid data-logging can augment EMAs for individualized and contextualized hearing outcome assessments., Design: Experienced hearing-aid users (N = 40) with mild-to-moderate symmetrical sensorineural hearing loss completed the SSQ questionnaire and gave repeated EMAs for two wear periods of 2-weeks each with two different hearing-aid models that differed mainly in their noise reduction technology. The EMAs were linked to a self-reported listening activity and sound environment parameters (from hearing-aid data-logging) recorded at the time of EMA completion. Wear order was randomized by hearing-aid model. Linear mixed-effects models and Random Forest models with five-fold cross-validation were used to assess the statistical associations between listening experiences and end-of-trial preferences, and to evaluate how accurately EMAs predicted preference within individuals., Results: Only 6 of the 49 SSQ items significantly discriminated between responses made for the end-of-trial preferred versus nonpreferred hearing-aid model. For the EMAs, questions related to perception of the sound from the hearing aids were all significantly associated with preference, and these associations were strongest in EMAs completed in sound environments with predominantly low SNR and listening activities related to television, people talking, nonspecific listening, and music listening. Mean differences in listening experiences from SSQ and EMA correctly predicted preference in 71.8% and 72.5% of included participants, respectively. However, a prognostic classification of single EMAs into end-of-trial preference with a Random Forest model achieved a 93.8% accuracy when contextual information was included., Conclusions: SSQ and EMA predicted preference equally well when considering mean differences, however, EMAs had a high prognostic classifications accuracy due to the repeated-measures nature, which make them ideal for individualized hearing outcome investigations, especially when responses are combined with contextual information about the sound environment., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Large vestibular aqueduct syndrome（LVAS） is a common recessive hereditary hearing loss disease, and some patients may also experience vestibular dysfunction. With the wide application of cochlear implant（CI） and the development of vestibular medicine, the pathophysiological mechanism of LVAS and the influence mechanism of CI on vestibular function are gradually elucidated. Consequently, the evaluation and rehabilitation of vestibular dysfunction function have also become research hotspots. This article reviews studies on vestibular function and related rehabilitation in patients with large vestibular aqueduct syndrome., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Purpose: The Microphone and Receiver in the ear (M&RIE) hearing aid is designed to consider the pinna cues by placing an additional microphone along with a standard receiver at the entrance of the ear canal. There is a need to clinically validate the technology using speech identification measures, as a literature shortage exists. The objective of the study was to evaluate speech identification and quality rating with hearing aids fitted with standard and M&RIE receivers., Method: Twenty individuals (mean ± SD age being 34.10 ± 11.9 years) with mild-to-moderately severe sensorineural hearing loss were divided into two groups: naïve and experienced. Their speech identification obtained using the receiver in the ear hearing aid compatible with standard and M&RIE receivers were compared. The study assessed speech identification in quiet using ten sentences, calculated SNR-50 using the Spearman-Karber equation, and used an 11-point scale for self-perceived quality rating., Results: The study analyzed data using SPSS and found no significant difference between naive and experienced hearing aid users in quiet and SNR-50 conditions (p > 0.05). However, naive users rated higher in clarity, naturalness, pleasantness, and overall impression of standard receiver settings. Across different receiver settings, both naïve and experienced groups revealed better speech identification with the M&RIE receiver for both SIS (p < 0.05) and SNR-50 (p < 0.05) measures., Conclusion: The study found that placing a third microphone in the ear canal improves speech identification and quality rating in both naïve and experienced users, with pinna and ear canal resonance playing a crucial role in prescribing hearing aid gain., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate if cartilage conduction (CC) rerouting devices are noninferior to air-conduction (AC) rerouting devices for single-sided deafness (SSD) patients by measuring objective and subjective performance using speech-in-noise tests that resemble a realistic hearing environment, sound localization tests, and standardized questionnaires., Study Design: Prospective, single-subject randomized, crossover study., Setting: Anechoic room inside a university., Patients: Nine adults between 21 and 58 years of age with severe or profound unilateral sensorineural hearing loss., Interventions: Patients' baseline hearing was assessed; they then used both the cartilage conduction contralateral routing of signals device (CC-CROS) and an air-conduction CROS hearing aid (AC-CROS). Patients wore each device for 2 weeks in a randomly assigned order., Main Outcome Measures: Three main outcome measures were 1) speech-in-noise tests, measuring speech reception thresholds; 2) proportion of correct sound localization responses; and 3) scores on the questionnaires, "Abbreviated Profile of Hearing Aid Benefit" (APHAB) and "Speech, Spatial, and Qualities of Hearing Scale" with 12 questions (SSQ-12)., Results: Speech reception threshold improved significantly when noise was ambient, and speech was presented from the front or the poor-ear side with both CC-CROS and AC-CROS. When speech was delivered from the better-ear side, AC-CROS significantly improved performance, whereas CC-CROS had no significant effect. Both devices mainly worsened sound localization, whereas the APHAB and SSQ-12 scores showed benefits., Conclusion: CC-CROS has noninferior hearing-in-noise performance except when the speech was presented to the better ear under ambient noise. Subjective measures showed that the patients realized the effectiveness of both devices., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Objective: To investigate retrospectively the frequency of usage of bimodal stimulation among cochlear implant (CI) users, as well its clinical benefit relative to unilateral use., Design: All subjects had been monitored with the clinical Minimal Outcome Measurements test battery., Study Samples: 103 adults with bilateral postlingual profound sensorineural hearing loss and unilateral CI use were extracted from the local database. These were divided into two groups: those who only used a CI and those who used bimodal stimulation., Results: The preoperative contralateral residual hearing in the bimodal group was significantly better than that of the CI-only group. In both groups, speech perception in quiet and in noise improved after CI, with no significant difference between postoperative unimodal conditions. For the bimodal group, an additional significant improvement was found for the bimodal condition compared to the unimodal., Conclusion: Given the observed auditory benefit of bimodal stimulation in comparison to unimodal stimulation and given the finding that degree of residual hearing is not correlated with bimodal benefits, it is recommended to encourage CI recipients to continue contralateral HA use after CI. As a result of expanding CI criteria worldwide, the population of bimodal users is expected to grow in the near future.

Objective: Children with hearing loss experience greater difficulty understanding speech in the presence of noise and reverberation relative to their normal hearing peers despite provision of appropriate amplification. The fidelity of fundamental frequency of voice (f0) encoding-a salient temporal cue for understanding speech in noise-could play a significant role in explaining the variance in abilities among children. However, the nature of deficits in f0 encoding and its relationship with speech understanding are poorly understood. To this end, we evaluated the influence of frequency-specific f0 encoding on speech perception abilities of children with and without hearing loss in the presence of noise and/or reverberation., Methods: In 14 school-aged children with sensorineural hearing loss fitted with hearing aids and 29 normal hearing peers, envelope following responses (EFRs) were elicited by the vowel /i/, modified to estimate f0 encoding in low (<1.1 kHz) and higher frequencies simultaneously. EFRs to /i/ were elicited in quiet, in the presence of speech-shaped noise at +5 dB signal to noise ratio, with simulated reverberation time of 0.62 sec, as well as both noise and reverberation. EFRs were recorded using single-channel electroencephalogram between the vertex and the nape while children watched a silent movie with captions. Speech discrimination accuracy was measured using the University of Western Ontario Distinctive Features Differences test in each of the four acoustic conditions. Stimuli for EFR recordings and speech discrimination were presented monaurally., Results: Both groups of children demonstrated a frequency-dependent dichotomy in the disruption of f0 encoding, as reflected in EFR amplitude and phase coherence. Greater disruption (i.e., lower EFR amplitudes and phase coherence) was evident in EFRs elicited by low frequencies due to noise and greater disruption was evident in EFRs elicited by higher frequencies due to reverberation. Relative to normal hearing peers, children with hearing loss demonstrated: (a) greater disruption of f0 encoding at low frequencies, particularly in the presence of reverberation, and (b) a positive relationship between f0 encoding at low frequencies and speech discrimination in the hardest listening condition (i.e., when both noise and reverberation were present)., Conclusions: Together, these results provide new evidence for the persistence of suprathreshold temporal processing deficits related to f0 encoding in children despite the provision of appropriate amplification to compensate for hearing loss. These objectively measurable deficits may underlie the greater difficulty experienced by children with hearing loss., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Cochlear implants (CIs) provide a solution for individuals with severe sensorineural hearing loss to regain their hearing abilities. When someone experiences this form of hearing impairment in both ears, they may be equipped with two separate CI devices, which will typically further improve the CI benefits. This spatial hearing is particularly crucial when tackling the challenge of understanding speech in noisy environments, a common issue CI users face. Currently, extensive research is dedicated to developing algorithms that can autonomously filter out undesired background noises from desired speech signals. At present, some research focuses on achieving end-to-end denoising, either as an integral component of the initial CI signal processing or by fully integrating the denoising process into the CI sound coding strategy. This work is presented in the context of bilateral CI (BiCI) systems, where we propose a deep-learning-based bilateral speech enhancement model that shares information between both hearing sides. Specifically, we connect two monaural end-to-end deep denoising sound coding techniques through intermediary latent fusion layers. These layers amalgamate the latent representations generated by these techniques by multiplying them together, resulting in an enhanced ability to reduce noise and improve learning generalization. The objective instrumental results demonstrate that the proposed fused BiCI sound coding strategy achieves higher interaural coherence, superior noise reduction, and enhanced predicted speech intelligibility scores compared to the baseline methods. Furthermore, our speech-in-noise intelligibility results in BiCI users reveal that the deep denoising sound coding strategy can attain scores similar to those achieved in quiet conditions.

Purpose: This study examined children's ability to perceive speech from multiple locations on the horizontal plane. Children with hearing loss were compared to normal-hearing peers while using amplification with and without advanced noise management., Method: Participants were 21 children with normal hearing (9-15 years) and 12 children with moderate symmetrical hearing loss (11-15 years). Word recognition, nonword detection, and word recall were assessed. Stimuli were presented randomly from multiple discrete locations in multitalker noise. Children with hearing loss were fit with devices having separate omnidirectional and noise management programs. The noise management feature is designed to preserve audibility in noise by rapidly analyzing input from all locations and reducing the noise management when speech is detected from locations around the hearing aid user., Results: Significant effects of left/right and front/back lateralization occurred as well as effects of hearing loss and hearing aid noise management. Children with normal hearing experienced a left-side advantage for word recognition and a right-side advantage for nonword detection. Children with hearing loss demonstrated poorer performance overall on all tasks with better word recognition from the back, and word recall from the right, in the omnidirectional condition. With noise management, performance improved from the front compared to the back for all three tasks and from the right for word recognition and word recall., Conclusions: The shape of children's local speech intelligibility on the horizontal plane is not omnidirectional. It is task dependent and shaped further by hearing loss and hearing aid signal processing. Front/back shifts in children with hearing loss are consistent with the behavior of hearing aid noise management, while the right-side biases observed in both groups are consistent with the effects of specialized speech processing in the left hemisphere of the brain.

Background:  Incomplete partition type II (IP-II) malformation is often accompanied by a large vestibular aqueduct (LVA). In IP anomalies, the patient's auditory rehabilitation requirements are decided according to the presence of inner ear structures and the degree of hearing loss (HL). There has been limited research on auditory rehabilitation (AR) requirement selection in patients diagnosed with IP-II and LVA. This study investigated the typical characteristics of HL and AR choices in patients diagnosed with IP-II and LVA., Methods:  Patients with IP-II and LVA (n=55; 25 women and 30 men) were identified, and audiological evaluations were performed. The patient's demographic characteristics, the type and degree of HL, the AR method, age at diagnosis, and educational status were retrospectively compared., Results:  The distribution of our 55 patients according to cochlear implants, hearing aids (HA), and bimodal applications was 29.1% (n=16), 43.6% (n=24), and 27.3% (n=15), respectively. Statistical analyses using chi-square tests found no significant differences in the incidence of dizziness/imbalance, tinnitus, HL progression, or the degree and onset of HL among the patients., Conclusion:  The data revealed different audiological characteristics among patients with IP-II and LVA, as well as different AR solutions. The most widely used AR modality was found to be HA. Prediction of sudden versus progressive HL development among patients is challenging, and the characteristics of IP-II vary. Therefore, they should be interpreted with caution.

Objectives: Hearing aid processing in realistic listening environments is difficult to study effectively. Often the environment is unpredictable or unknown, such as in wearable aid trials with subjective report by the wearer. Some laboratory experiments create listening environments to exert tight experimental control, but those environments are often limited by physical space, a small number of sound sources, or room absorptive properties. Simulation techniques bridge this gap by providing greater experimental control over listening environments, effectively bringing aspects of the real-world into the laboratory. This project used simulation to study the effects of wide-dynamic range compression (WDRC) and digital noise reduction (DNR) on speech intelligibility in a reverberant environment with six spatialized competing talkers. The primary objective of this study was to determine the efficacy of WDRC and DNR in a complex listening environment using virtual auditory space techniques., Design: Participants of greatest interest were listeners with hearing impairment. A group of listeners with clinically normal hearing was included to assess the effects of the simulation absent the complex effects of hearing loss. Virtual auditory space techniques were used to simulate a small restaurant listening environment with two different reverberation times (0.8 and 1.8 sec) in a range of signal to noise ratios (SNRs) (-8.5 to 11.5 dB SNR). Six spatialized competing talkers were included to further enhance realism. A hearing aid simulation was used to examine the degree to which speech intelligibility was affected by slow and fast WDRC in conjunction with the presence or absence of DNR. The WDRC and DNR settings were chosen to be reasonable estimates of hearing aids currently available to consumers., Results: A WDRC × DNR × Hearing Status interaction was observed, such that DNR was beneficial for speech intelligibility when combined with fast WDRC speeds, but DNR was detrimental to speech intelligibility when WDRC speeds were slow. The pattern of the WDRC × DNR interaction was observed for both listener groups. Significant main effects of reverberation time and SNR were observed, indicating better performance with lower reverberation times and more positive SNR., Conclusions: DNR reduced low-amplitude noise before WDRC-amplified the low-intensity portions of the signal, negating one potential downside of fast WDRC and leading to an improvement in speech intelligibility in this simulation. These data suggest that, in some real-world environments that include both reverberation and noise, older listeners with hearing impairment may find speech to be more intelligible if DNR is activated when the hearing aid has fast compression time constants. Additional research is needed to determine the appropriate DNR strength and to confirm results in wearable hearing aids and a wider range of listening environments., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

A vestibular schwannoma is a benign tumor; however, the schwannoma itself and interventions can cause sensorineural hearing loss. Most vestibular schwannomas are unilateral tumors that affect hearing only on one side. Attention has focused on improving the quality of life for patients with unilateral hearing loss and therapeutic interventions to address this issue have been emphasized. Herein, we encountered a patient who was a candidate for hearing preservation surgery based on preoperative findings and had nonserviceable hearing after the surgery, according to the Gardner-Robertson classification. Postoperatively, the patient had decreased listening comprehension and ability to localize sound sources. He was fitted with bilateral hearing aids, and his ability to localize sound sources improved. Although the patient had postoperative nonserviceable hearing on the affected side and age-related hearing loss on the unaffected side, hearing aids in both ears were useful for his daily life. Therefore, the patient was able to maintain a binaural hearing effect and the ability to localize the sound source improved. This report emphasizes the importance of hearing preservation with vestibular schwannomas, and the demand for hearing loss rehabilitation as a postoperative complication can increase, even if hearing loss is nonserviceable., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: Digital noise reduction (DNR) minimizes the effect of noise on speech signals by continuously monitoring frequency bands in the presence of noise. In the present study, we explored the effect of DNR technology on speech intelligibility in individuals using hearing aids (HAs) and investigated implications for daily use., Methods and Material: Eighteen participants with bilateral moderate sensorineural hearing loss (aged 16-45 years) were included. Bilateral receiver-in-the-ear HAs were fitted in the participants. The adaptive and nonadaptive (with a signal-to-noise ratio (SNR) of +5 and -5 dB, respectively) Turkish matrix sentence test (TURMatrix) in noise and free-field hearing assessments, including hearing thresholds with hearing aids, speech recognition thresholds (SRT), and speech discrimination scores, were conducted in two different conditions: HA in the DNR-on and DNR-off conditions., Results: No significant difference was observed between free-field hearing assessments with the HA in the DNR-off and DNR-on conditions (P > 0.05). Furthermore, the adaptive and nonadaptive TURMatrix revealed significant differences between the scores under the DNR-on and DNR-off conditions (P < 0.05). Nevertheless, under the DNR-on condition, there was no correlation between free-field hearing assessments with HA and TURMatrix results (P > 0.05). However, a significant correlation was observed between SRT scores with HA and TURMatrix scores (adaptive and nonadaptive, +5 and -5 dB SNR, respectively) under the DNR-off condition (P < 0.05)., Conclusion: Our study findings suggest that DNR can improve speech intelligibility in noisy environments. Therefore, DNR can enhance an individual's auditory comfort by improving their capacity to grasp speech in background noise., (Copyright © 2024 Noise & Health.)

Objectives: The aim of this study is to develop a mobile auditory training application based on gaming for children aged 3-5 years using cochlear implants and to evaluate its usability., Methods: 4 games were developed in the scope of the application World of Sounds; the crucible sound for auditory awareness, mole hunting for auditory discrimination, find the sound for auditory recognition, and choo-choo for auditory comprehension. The prototype was applied to 20 children with normal hearing and 20 children with cochlear implants, all of whom were aged 3-5. The participants were asked to fill out the Game Evaluation Form for Children. Moreover, 40 parents were included in the study, and the Evaluation Form for the Application was applied., Results: According to the form, at least 80% of children using cochlear implants, and all children in the healthy group, responded well to the usability factors. All factors were obtained as highly useable by parents of the children using cochlear implants. The results indicated that in the healthy group, the usefulness and motivation factors were above moderate, and the other factors were highly useable. In the mole-hunting game, there was no significant difference between the groups in the easy level of the first sub-section (p > 0.05). There was a significant difference between the groups in terms of the other sub-sections of the mole-hunting game and all sub-sections of the crucible sound, find the sound, and the choo-choo games (p < 0.05). While there was no correlation between duration of cochlear implant use and ADSI scores and the third sub-section of the crucible sound game (p > 0.05); a correlation was found in the other sub-sections of crucible sound and all sub-sections of the mole hunting, find the sound, and Choo-Choo games (p < 0.05)., Conclusion: It is thought that the application World of Sounds can serve as an accessible option to support traditional auditory rehabilitation for children with cochlear implants., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Asses the efficacy of a Vestibular-balance rehabilitation program to minimize or reverse balance disability in children with sensorineural hearing loss., Method: Forty-five hearing-impaired children with balance deficits (i.e., variable degrees of sensorineural hearing loss or auditory neuropathy). Thirty-five were rehabilitated with cochlear implants, and ten with hearing aids. Their age ranged from 4 to 10 years old. A Pre-rehab evaluation was done using questionnaires, neuromuscular evaluation, vestibular and balance office testing, and vestibular lab testing (using cVEMP and caloric test). Customized balances, as well as vestibular rehabilitation exercises, have been applied for three months. That was followed by post-rehab assessment, including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test., Results: There was a statistically significant difference in all measured parameters (including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test) after rehabilitation., Conclusions: Vestibular-balance rehabilitation intervention positively impacts vestibular and balance functions in hearing-impaired children., Competing Interests: Declaration of competing interest All authors declare that they have no competing interests regarding this research., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: In patients with unilateral sensorineural hearing loss (USNHL), we explored both objective functional audiological gains and subjective satisfaction, indicating when a unilateral hearing aid is valuable., Methods: Thirty-seven patients with mild-to-moderate USNHL (mean pure-tone thresholds between 25 and 70 dB) were prescribed unilateral hearing aids. Functional gain, the aided speech discrimination score (SDS), the Hearing in Noise Test (HINT) score, and the sound localization test score were collected, and a questionnaire (the Hearing Handicap Inventory for the Elderly, HHIE) completed after 1, 2, and 3 months of hearing aid use. We classified the participants as having 'no handicap' (HHIE < 17), 'mild-to-moderate handicap' (17-42), and 'significant handicap' (> 42)., Results: The decrease in handicap afforded by unilateral hearing aids was largest in the 'significant handicap' group (the HHIE total score fell from 59.1 to 37.2; P = 0.007). There were no between-group differences in either functional gain or the aided SDS. Only the 'significant handicap' group evidenced an improved HINT score; the composite signal-to-noise ratio (SNR) fell from - 1.5 to - 2.2 dB [S/N] (P = 0.023). The HHIE usefully indicated when a hearing aid alleviated the discomfort of USNHL; patients with unaided HHIE scores ≥ 20 evidenced significant decreases in the composite SNR (- 1.7 to - 2.0 dB [S/N]; P = 0.045)., Conclusions: When considering whether to prescribe a unilateral hearing aid for patients with mild-to-moderate USNHL, it is helpful to use the HHIE to evaluate discomfort. If the total score is ≥ 20, a hearing aid is appropriate., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This paper provides a review of various machine learning approaches that have appeared in the literature aimed at individualizing or personalizing the amplification settings of hearing aids. After stating the limitations associated with the current one-size-fits-all settings of hearing aid prescriptions, a spectrum of studies in engineering and hearing science are discussed. These studies involve making adjustments to prescriptive values in order to enable preferred and individualized settings for a hearing aid user in an audio environment of interest to that user. This review gathers, in one place, a comprehensive collection of works that have been conducted thus far with respect to achieving the personalization or individualization of the amplification function of hearing aids. Furthermore, it underscores the impact that machine learning can have on enabling an improved and personalized hearing experience for hearing aid users. This paper concludes by stating the challenges and future research directions in this area.

Background: The cochlear implant (CI) is effective for rehabilitating patients with severe to profound sensorineural hearing loss. However, its placement and use have been associated with various complications, such as those affecting the vestibular system. The objective of this study was to compare vestibular function using the video head impulse test (vHIT) in pediatric patients before and after CI placement., Methods: A descriptive and retrospective study was conducted. The outcomes of 11 pediatric patients of both sexes with a history of profound hearing loss were evaluated. The results of vestibular-ocular reflex (VOR) gain, saccades, asymmetry, Pérez Rey (PR) index, and VOR/saccade ratio for both ears obtained by the vHIT test before and after CI placement were compared., Results: Of the 11 patients evaluated, the VOR gain showed that 81.8% had normal function, 18.2% had hypofunction, and no patients had hyperfunction before implantation. No statistically significant differences were found when compared with post-implant off and post-implant on conditions (p > 0.05). The extracted variables, asymmetry, PR index, and the VOR/saccades ratio also showed no statistically significant differences between the pre- and post-implant conditions, whether off or on., Conclusions: The vestibular function of pediatric patients did not show significant changes before and after CI placement. The vHIT test is a valuable tool for assessing vestibular function and could be considered a criterion for surgical and rehabilitation decisions in patients undergoing CI placement., (Copyright: © 2024 Permanyer.)

Background: Sensorineural hearing loss is the most common type of permanent hearing impairment and results in postural control and motor deficits in children that may affect or delay all developmental indicators., Objective: The purpose of the study was to investigate the efficacy of balance exercises intervention on postural control-related impairment in children with sensorineural hearing loss., Methods: Forty students of both genders, ages ranging from 10 to 16 years, diagnosed with severe to profound sensorineural hearing loss, were selected from the Public School for the Deaf and Hard of Hearing in El-Minia district, Minia governorate, Egypt. They divided randomly into two groups, 20 (study group), received balance exercises in addition to their ordinary daily living activities. Meanwhile, the control group of 20 children practiced only the ordinary daily living activities. The outcome was assessed pre-treatment and post-treatment by Humac Balance System and Bruininks-Oseretsky Test (BOT-2) subtest (5) for balance., Results: Regarding the Humac balance system and subtest (5) of BOT-2, there was a statistically significant difference between pre-treatment data and post-treatment data of the study group with a p value equal to 0.036 or less. However, no statistically significant difference was observed in the control group with a p value equal to 0.096 or more. Finally, there was a statistically significant difference between the groups with respect to the post-treatment data, where the p value was 0.014 or less., Conclusion: Postural control of children with sensorineural hearing loss has been improved by balance exercises.

Introduction: Bone conduction implants have been indicated for patients with conductive hearing loss, mixed hearing loss, and even profound unilateral sensorineural hearing loss. With the introduction of Bonebridge®, new transcutaneous implant options emerged. The latest is Osia®, a direct-drive variant or active systems, where the implant directly generates and applies vibration to the bone., Materials and Methods: Retrospective study of two cohorts of patients treated with active bone conduction implants at a single center, one with the Bonebridge® device and the other with Osia®., Outcomes: Fourteen patients were included, seven in each group (n = 14). The Bonebridge® group showed an average hearing gain in tonal intelligibility thresholds of 32.43 ± 21.39 dB and a gain in the average intelligibility threshold (with 50% discrimination) of 26.29 ± 19.10 dB. In the Osia® group, there was a gain in average tonal thresholds of 41.49 ± 14.16 dB and 23.72 ± 6.98 dB in average intelligibility thresholds. Both devices contributed to improvements in patients' quality of life, as assessed with APHAB in all the variables studied in the test. Both devices offer rehabilitation for hearing loss as an alternative to hearing aids. The Osia® system shows statistically significant (p &lt; 0.05) improvements in mid and high frequencies, but Bonebridge® slightly outperforms in speech understanding at 50%. Differences in average tonal thresholds and quality of life are not statistically significant., Conclusions: While auditory improvement is observed postimplantation, other aspects, such as intelligibility thresholds and quality of life, lack statistical significance. Given the limited experience with Osia® and the small sample size, the choice of the device should be personalized. Although the literature is inconsistent due to small sample sizes and variable approaches, some studies suggest potential advantages of the Osia® system, especially in speech comprehension in different environments and greater hearing gain compared to Bonebridge®., (© 2024 S. Karger AG, Basel.)

This study measured electroencephalographic activity in the alpha band, often associated with task difficulty, to physiologically validate self-reported effort ratings from older hearing-impaired listeners performing the Repeat-Recall Test (RRT)-an integrative multipart assessment of speech-in-noise performance, context use, and auditory working memory. Following a single-blind within-subjects design, 16 older listeners (mean age = 71 years, SD = 13, 9 female) with a moderate-to-severe degree of bilateral sensorineural hearing loss performed the RRT while wearing hearing aids at four fixed signal-to-noise ratios (SNRs) of -5, 0, 5, and 10 dB. Performance and subjective ratings of listening effort were assessed for complementary versions of the RRT materials with high/low availability of semantic context. Listeners were also tested with a version of the RRT that omitted the memory (i.e., recall) component. As expected, results showed alpha power to decrease significantly with increasing SNR from 0 through 10 dB. When tested with high context sentences, alpha was significantly higher in conditions where listeners had to recall the sentence materials compared to conditions where the recall requirement was omitted. When tested with low context sentences, alpha power was relatively high irrespective of the memory component. Within-subjects, alpha power was related to listening effort ratings collected across the different RRT conditions. Overall, these results suggest that the multipart demands of the RRT modulate both neural and behavioral measures of listening effort in directions consistent with the expected/designed difficulty of the RRT conditions., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors are employees of WS Audiology.

An objective method for assessing speech audibility is essential to evaluate hearing aid benefit in children who are unable to participate in hearing tests. With consonant-vowel syllables, brainstem-dominant responses elicited at the voice fundamental frequency have proven successful for assessing audibility. This study aimed to harness the neural activity elicited by the slow envelope of the same repetitive consonant-vowel syllables to assess audibility. In adults and children with normal hearing and children with hearing loss wearing hearing aids, neural activity elicited by the stimulus /su∫i/ or /sa∫i/ presented at 55-75 dB SPL was analyzed using the temporal response function approach. No-stimulus runs or very low stimulus level (15 dB SPL) were used to simulate inaudible conditions in adults and children with normal hearing. Both groups of children demonstrated higher response amplitudes relative to adults. Detectability (sensitivity; true positive rate) ranged between 80.1 and 100%, and did not vary by group or stimulus level but varied by stimulus, with /sa∫i/ achieving 100% detectability at 65 dB SPL. The average minimum time needed to detect a response ranged between 3.7 and 6.4 min across stimuli and listener groups, with the shortest times recorded for stimulus /sa∫i/ and in children with hearing loss. Specificity was >94.9%. Responses to the slow envelope of non-meaningful consonant-vowel syllables can be used to ascertain audible vs. inaudible speech with sufficient accuracy within clinically feasible test times. Such responses can increase the clinical usefulness of existing objective approaches to evaluate hearing aid benefit., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: This study was designed to examine the effects of hearing aid delay on the neural representation of the temporal envelope. It was hypothesized that the comb-filter effect would disrupt neural phase locking, and that shorter hearing aid delays would minimize this effect., Design: Twenty-one participants, ages 50 years and older, with bilateral mild-to-moderate sensorineural hearing loss were recruited through print advertisements in local senior newspapers. They were fitted with three different sets of hearing aids with average processing delays that ranged from 0.5 to 7 msec. Envelope-following responses (EFRs) were recorded to a 50-msec /da/ syllable presented through a speaker placed 1 meter in front of the participants while they wore the three sets of hearing aids with open tips. Phase-locking factor (PLF) and stimulus-to-response (STR) correlations were calculated from these recordings., Results: Recordings obtained while wearing hearing aids with a 0.5-msec processing delay showed higher PLF and STR correlations compared with those with either 5-msec or 7-msec delays. No differences were noted between recordings of hearing aids with 5-msec and 7-msec delays. The degree of difference between hearing aids was greater for individuals who had milder degrees of hearing loss., Conclusions: Hearing aid processing delays disrupt phase locking due to mixing of processed and unprocessed sounds in the ear canal when using open domes. Given previous work showing that better phase locking correlates with better speech-in-noise performance, consideration should be given to reducing hearing aid processing delay in the design of hearing aid algorithms., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objectives: This study assessed hearing aid benefits for people with a normal audiogram but hearing-in-noise problems in everyday listening situations., Design: Exploratory double-blinded case-control study whereby participants completed retrospective questionnaires, ecological momentary assessments, speech-in-noise testing, and mental effort testing with and without hearing aids. Twenty-seven adults reporting speech-in-noise problems but normal air conduction pure-tone audiometry took part in the study. They were randomly separated into an experimental group that trialed mild-gain hearing aids with advanced directional processing and a control group fitted with hearing aids with no gain or directionality., Results: Self-reports showed mild-gain hearing aids reduce hearing-in-noise difficulties and provide a better hearing experience (i.e., improved understanding, participation, and mood). Despite the self-reported benefits, the laboratory tests did not reveal a benefit from the mild-gain hearing aids, with no group differences on speech-in-noise tests or mental effort measures. Further, participants found the elevated cost of hearing aids to be a barrier for their adoption., Conclusions: Hearing aids benefit the listening experience in some listening situations for people with normal audiogram who report hearing difficulties in noise. Decreasing the price of hearing aids may lead to greater accessibility to those seeking remediation for their communication needs., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Auditory neuropathy (AN) is a nosological entity of unknown etiology, which is associated with fluctuations in rates of speech discrimination. Its diagnosis is based on presence of otoacoustic emissions and lack of, or abnormal, brainstem auditory evoked potential. With respect to treatment, we have variable results in the literature about development of speech perception and skills, in children with AN and cochlear implant (CI) rehabilitation., Objectives: Comparatively assessing results recorded for the development of auditory and speech skills in children with auditory neuropathy spectrum disorder (ANSD), who were subjected to cochlear implantation, in comparison to results recorded for children with sensorineural hearing loss associated with other causes was the objective of this study., Method: A systematic literature review with meta-analysis was performed, with studies published from 1975 to 2023., Results: Nineteen studies were included in the systematic review, and eight were selected for the meta-analysis, which showed there was no evidence allowing the conclusion that the two groups were different from each other about results in speech performance after 1 year of CI placement., Conclusion: Therefore, this study shows that CI provides the comparable benefit to children with ANSD in comparison to children with neurosensory hearing loss associated with other causes in their speech development., (© 2023 S. Karger AG, Basel.)

Objective: Waardenburg syndrome (WS) is a genetic condition associated with moderate to profound sensorineural hearing loss. The aim of this review is to characterize cochlear implant (CI) outcomes in patients with a confirmed clinical diagnosis of WS., Data Sources: MEDLINE, Ovid EMBASE, and Cochrane Library., Review Methods: All reports describing defined sets of patients with WS who underwent CI and subsequent evaluation of clinical outcomes were included. To harmonize outcome data between studies that used different measures, a binary variable Favored CI was developed to capture success of procedures (1 = favored, 0 = unfavored) based on original authors' description, commentary, discussion, and conclusions. Expert reviewers independently reviewed and selected articles, extracted data and scored Favored CI values. Synthetic and analytic meta-analyses were implemented using standard analytic techniques., Results: Twenty articles meeting inclusion criteria provided data on 192 WS patients and 210 CIs. The mean age at CI was 3.8 years (95% confidence interval [95%CI]; 3.1-4.5 years), and the mean duration of follow up was 5.2 years (95% CI; 3.4-7.0 years). Surgical complications were rare (11/210 implants, 5.2%) where gusher was the most common complication. CIs yielded favorable hearing outcomes in 90% (95% CI; 84-94%) of cases, and appear successful for those with temporal bone anomalies (p = 0.04)., Conclusions: Quantitative synthesis of the study data demonstrates that in the majority of patients with WS, CI yield favorable hearing outcomes and low rates of surgical complications. CI has shown to provide clinical benefits in patients with WS., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: A long-standing observation is that the Mismatch Response (MMR) has the potential to offer a clinically feasible index of sound discrimination. However, findings that positively identify MMRs at the individual level have been mixed, even for those who are normally hearing and who can discriminate sounds behaviourally. This complicates interpretation when an MMR is not observed. The objective of this study was to determine the reliability of the MMR using an optimised paradigm and a range of stimuli relevant to audiological applications in relation to objective verification of hearing aid fittings., Design: MMRs were measured using an optimised 3-deviant paradigm in response to a range of sounds designed for aided and unaided sound field assessments, including complex tones (CTs) and speech-like signals., Study Sample: Seventeen normally hearing adults (18-56 years)., Results: The most robust MMRs were recorded in response to CTs; responses were positively identified in 50 out of 51 instances (98%), assessed via objective Hotelling's T 2 bias-free statistical analyses., Conclusions: The results indicate that CTs in conjunction with optimised recording and analysis parameters offer the potential to elicit robust MMRs, supporting future utilisation of MMRs for clinical audiological applications.

Early assessment of hearing aid benefit is crucial, as the extent to which hearing aids provide audible speech information predicts speech and language outcomes. A growing body of research has proposed neural envelope tracking as an objective measure of speech intelligibility, particularly for individuals unable to provide reliable behavioral feedback. However, its potential for evaluating speech intelligibility and hearing aid benefit in children with hearing loss remains unexplored. In this study, we investigated neural envelope tracking in children with permanent hearing loss through two separate experiments. EEG data were recorded while children listened to age-appropriate stories (Experiment 1) or an animated movie (Experiment 2) under aided and unaided conditions (using personal hearing aids) at multiple stimulus intensities. Neural envelope tracking was evaluated using a linear decoder reconstructing the speech envelope from the EEG in the delta band (0.5-4 Hz). Additionally, we calculated temporal response functions (TRFs) to investigate the spatio-temporal dynamics of the response. In both experiments, neural tracking increased with increasing stimulus intensity, but only in the unaided condition. In the aided condition, neural tracking remained stable across a wide range of intensities, as long as speech intelligibility was maintained. Similarly, TRF amplitudes increased with increasing stimulus intensity in the unaided condition, while in the aided condition significant differences were found in TRF latency rather than TRF amplitude. This suggests that decreasing stimulus intensity does not necessarily impact neural tracking. Furthermore, the use of personal hearing aids significantly enhanced neural envelope tracking, particularly in challenging speech conditions that would be inaudible when unaided. Finally, we found a strong correlation between neural envelope tracking and behaviorally measured speech intelligibility for both narrated stories (Experiment 1) and movie stimuli (Experiment 2). Altogether, these findings indicate that neural envelope tracking could be a valuable tool for predicting speech intelligibility benefits derived from personal hearing aids in hearing-impaired children. Incorporating narrated stories or engaging movies expands the accessibility of these methods even in clinical settings, offering new avenues for using objective speech measures to guide pediatric audiology decision-making., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning., Design: This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables., Results: Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results., Conclusions: The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objective: This study aimed to analyse outcomes with hearing aid (HA) use and to determine whether common audiological tests, including pure-tone audiometry or word recognition test, correlate with HA wearers' subjective benefit., Design: A retrospective chart review., Study Sample: A total of 129 patients who adopted new HAs between January 2011 and December 2018 were enrolled. Outcome measures including pure tone thresholds, word recognition score (WRS), and self-reported questionnaires were obtained 1, 4, and 12 months post fit., Results: The mean aided threshold and WRS at each post-fit visit significantly improved from the unaided condition. Self-reported outcomes confirmed by the Hearing Handicap Inventory for the Elderly (HHIE) scores significantly improved compared to the unaided condition at 1- and 4-month follow-up. Results of the regression analysis indicated that the aided WRS score is a significant factor at all post-fit visits that explains less than 10% of the variance in HHIE scores., Conclusions: Aided WRS is the factor most associated with subjectively reported HA outcomes, both in the short- and long term. Therefore, aided WRS should be considered as a useful tool for evaluating HA benefits, even after the prolonged use of HAs.

Objective: Some studies have directly compared the National Acoustic Laboratories' prescription for non-linear hearing aids (HAs) version 2 (NAL-NL2) and Desired Sensation Level for non-linear HAs version 5 (DSLv5), although none were performed in Japan. As the Japanese language is a tonal language that has different linguistic characteristics than those of the studied languages, we compared the outcomes of the NAL-NL2 and DSLv5 in hearing-impaired Japanese participants., Methods: A crossover-controlled trial was conducted on 18 first-time HA users with bilateral moderate sensorineural hearing loss. Participants wore HAs adjusted with each prescriptive method for four weeks. The prescriptions were assessed using speech discrimination testing and the abbreviated profile of hearing aid benefit (APHAB). Consequently, participants were asked to select their preferred prescription and determine which was better for "listening to a conversation" and when "noisy.", Results: The mean DSLv5 real ear insertion gain for an input level of 65 dB sound pressure level (SPL) was higher than that of the NAL-NL2 at 250 and 500 Hz. The average speech discrimination score was 78 ± 14% at a 65-dB SPL and 75 ± 17% at an 80-dB SPL for the NAL-NL2, and 79 ± 11% at a 65-dB SPL and 77 ± 17% at an 80-dB SPL for the DSLv5. These differences were not significant. No significant differences were observed in APHAB subscale scores between the two prescription methods. Ultimately, 11 (61%) and 7 (39%) participants preferred the NAL-NL2 and DSLv5, respectively, with no significant differences., Conclusion: Although the gain of the NAL-NL2 is smaller than that of the DSLv5, both had the same hearing effect. Therefore, the NAL-NL2 may be more useful than the DSLv5 in Japanese., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: The main objective of this study is to evaluate the short-term and long-term audiological outcomes in patients who underwent cochlear implantation with a robot-assisted system to enable access to the cochlea, and to compare outcomes with a matched control group of patients who underwent cochlear implantation with conventional access to the cochlea., Methods: In total, 23 patients were implanted by robot-assisted cochlear implant surgery (RACIS). To evaluate the effectiveness of robotic surgery in terms of audiological outcomes, a statistically balanced control group of conventionally implanted patients was created. Minimal outcome measures (MOM), consisting of pure-tone audiometry, speech understanding in quiet and speech understanding in noise were performed pre-operatively and at 3 months, 6 months, 12 months and 2 years post-activation of the audioprocessor., Results: There was no statistically significant difference in pure-tone audiometry, speech perception in quiet and speech perception in noise between robotically implanted and conventionally implanted patients pre-operatively, 3 months, 6 months, 12 months and 2 years post-activation. A significant improvement in pure-tone hearing thresholds, speech understanding in quiet and speech understanding in noise with the cochlear implant has been quantified as of the first measurements at 3 months and this significant improvement remained stable over a time period of 2 years for HEARO implanted patients., Conclusion: Clinical outcomes in robot-assisted cochlear implant surgery are comparable to conventional cochlear implantation. CLINICALTRAILS., Gov Trail Registration Numbers: NCT03746613 (date of registration: 19/11/2018), NCT04102215 (date of registration: 25/09/2019)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To determine tinnitus prevalence and severity in a cohort of unselected first-time cochlear implant (CI) recipients whose primary motive for CI was sensorineural hearing loss (SNHL), and to evaluate the effect of CI on tinnitus after cochlear implantation., Methods: Prospective longitudinal study of 45 adult CI recipients with moderate to profound SNHL. Patients completed the Danish version of the Tinnitus Handicap Inventory (THI) and a visual analogue scale (VAS) for tinnitus burden before implantation, 4 months after implantation and 14 months after implantation., Results: The study included 45 patients, of which 29 (64%) had pre-implant tinnitus. Median THI score (IQR) significantly decreased from 20 (34) to 12 (24) at first follow-up (p < 0.05) and to 6 points (17) at second follow-up (p < 0.001). Median VAS (IQR) for tinnitus burden decreased from 33 (62) to 17 (40; p = 0.228) and 12 (27, p < 0.05) at the first and second follow-ups, respectively. Tinnitus was totally suppressed in 19% of patients, improved in 48%, remained unchanged in 19% and worsened in 6%. 2 patients reported new tinnitus. At the second follow-up, 74% of patients had slight or no tinnitus handicap, 16% had mild handicaps, 6% had moderate handicaps, and 3% had severe handicaps. High pre-implant THI and VAS scores correlated with greater decrease in THI scores over time., Conclusion: 64% of the patients with SNHL had pre-implant tinnitus, which was decreased 4 and 14 months after implantation. Overall, 68% of patients with tinnitus improved their tinnitus handicap after CI. Patients with higher THI and VAS scores had a larger decline and the highest benefits in terms of tinnitus handicap improvement. The study findings demonstrate that the majority of patients with moderate to profound SNHL eligible for cochlear implantation benefit from complete or partial tinnitus suppression and improved quality of life after implantation., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The cortical auditory evoked potential (CAEP) test is a candidate for supplementing clinical practice for infant hearing aid users and others who are not developmentally ready for behavioral testing. Sensitivity of the test for given sensation levels (SLs) has been reported to some degree, but further data are needed from large numbers of infants within the target age range, including repeat data where CAEPs were not detected initially. This study aims to assess sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants., Design: One hundred and three infant hearing aid users were recruited from 53 pediatric audiology centers across the UK. Infants underwent aided CAEP testing at age 3 to 7 months to a mid-frequency (MF) and (mid-)high-frequency (HF) synthetic speech stimulus. CAEP testing was repeated within 7 days. When developmentally ready (aged 7-21 months), the infants underwent aided behavioral hearing testing using the same stimuli, to estimate the decibel (dB) SL (i.e., level above threshold) of those stimuli when presented at the CAEP test sessions. Percentage of CAEP detections for different dB SLs are reported using an objective detection method (Hotellings T 2 ). Acceptability was assessed using caregiver interviews and a questionnaire, and feasibility by recording test duration and completion rate., Results: The overall sensitivity for a single CAEP test when the stimuli were ≥0 dB SL (i.e., audible) was 70% for the MF stimulus and 54% for the HF stimulus. After repeat testing, this increased to 84% and 72%, respectively. For SL >10 dB, the respective MF and HF test sensitivities were 80% and 60% for a single test, increasing to 94% and 79% for the two tests combined. Clinical feasibility was demonstrated by an excellent >99% completion rate, and acceptable median test duration of 24 minutes, including preparation time. Caregivers reported overall positive experiences of the test., Conclusions: By addressing the clinical need to provide data in the target age group at different SLs, we have demonstrated that aided CAEP testing can supplement existing clinical practice when infants with hearing loss are not developmentally ready for traditional behavioral assessment. Repeat testing is valuable to increase test sensitivity. For clinical application, it is important to be aware of CAEP response variability in this age group., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objectives: The current study characterizes age and incidence of cochlear implantation among qualifying children with congenital bilateral profound hearing loss in the U.S., Study Design: Deidentified cochlear implantation data were acquired from prospectively collected patient registries from two cochlear implant (CI) manufacturers (Cochlear Americas and Advanced Bionics). Children <36 months old were assumed to have congenital bilateral profound sensorineural hearing loss., Setting: U.S. CI centers., Patients: Children <36 months old who received CIs., Interventions: Cochlear implantation., Main Outcome Measures: Age at implantation and incidence., Results: A total of 4,236 children <36 months old underwent cochlear implantation from 2015 to 2019. The median age at implantation was 16 months (interquartile range, 12-24 mo) and did not change significantly during the 5-year study period ( p = 0.09). Patients residing closer to CI centers ( p = 0.03) and treated at higher-volume centers ( p = 0.008) underwent implantation at a younger age. Bilateral simultaneous implantation increased from 38% to 53% of CI surgeries in 2015 and 2019, respectively. Children who received bilateral simultaneous CIs were younger compared with those receiving unilateral or bilateral sequential CIs (median, 14 versus 18 mo; p < 0.001). The incidence of cochlear implantation increased from 7,648 per 100,000 person-years in 2015 to 9,344 in 2019 ( p < 0.001)., Conclusion: Although the incidence of pediatric CI recipients and the frequency of bilateral simultaneous implantation increased over the study period, age at implantation did not change significantly and far exceeded current Food and Drug Administration (9 mo) and American Academy of Otolaryngology and Head and Neck Surgery position statement (6-12 mo) guidelines., (Copyright © 2023, Otology & Neurotology, Inc.)

Background:  Spatial orientation is an executive function which includes vital activities and auditory organization according to daily bodily movements, directionality, and environmental information. It is directly linked to the vision and hearing and used throughout life, building complex relationships with these systems, based on learning., Purpose:  Our purpose in our study is to try to see the effects of noise and reverberation on the users by comparing the localization and auditory performances of the cochlear implant (CI) user individuals in a silent, noisy environment and reverberation., Research Design:  All subjects were subjected to immitancemetric/audiological tests, language development test (TIFALDI, Receptive/Expressive Language Test score 7 years and above), localization determination in noise, and localization determination test in reverberation. Study sample : In our study, 18 female and 16 male bilateral CI users with profound sensorineural hearing loss were included. The age range of subjects was 8 years 4 months and 10 years 11 months., Data Collection and Analysis:  Data from subjects were collected prospectively. Data analysis was analyzed with SPSS 21 program., Results:  It was observed that the subjects did not have difficulty in determining the direction in silent condition, but they had a significant difficulty in localizing the 135-, 225-, and 315-degree angles especially when the noise was signal-to-noise ratio (SNR) -10 dB and the reverberation was 06 and 09 second ( p ≤ 0.005). Subjects' performances were significantly altered in sequential implanted users both when the SNR was changed and in the presence of reverberation ( p  < 0.05)., Conclusion:  As a result of our study, it is thought that individuals with hearing loss will experience intense difficulties, especially in noisy and reverberant environments such as schools, and using assistive listening devices in these environmental conditions will contribute positively to their academic development., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Objectives: The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child's unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child's hearing technology or intervention plan., Design: The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay., Results: Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals., Conclusions: Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child's hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study aimed to compare intracochlear electrocochleography (ECochG) findings in a group of cochlear implant (CI) recipients with auditory neuropathy spectrum disorder (ANSD) with a group of CI recipients with sensorineural hearing loss (SNHL). Auditory outcome and spectral resolution findings were also compared among CI recipients with and without cochlear microphonic (CM) responses., Methods: This single-center, prospective cohort study was undertaken at a tertiary referral center. CM responses by the intracochlear ECochG test were recorded in CI recipients at 0.25-2 kHz. Speech, spatial, and hearing quality (SSQ) outcomes and spectral resolution measured with the spectral-temporally modulated ripple test were obtained for each recipient. The study included 62 implanted ears in 46 recipients, of which 59% (n = 27) were male and 41% (n = 19) were female. Twenty-nine ears with ANSD and 33 ears with SNHL were included. The mean age of the participants was 11 years. The results compared the intracochlear ECochG findings of the ANSD group with those of the SNHL group., Results: Participants were divided into two groups with and without obtainable CM responses. CM responses were obtained in 13 of 29 ears in the ANSD group and 14 of 33 ears in the SNHL group. CM thresholds obtained were better according to behavioral audiometric responses in some frequencies in the ANSD group. No significant difference was found in the auditory outcome and spectral resolution among CI recipients with and without CM responses., Conclusions: Intracochlear ECochG has a limited potential clinical value for monitoring ANSD. CM thresholds obtained using ECochG may not reflect behavioral hearing thresholds., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Consistent hearing device use in young children with hearing loss is challenging for families. A hearing aid accessory, called a pilot cap, is often recommended to families to help mitigate the issues around device retention. Although pilot caps are commonly suggested to families, there is sparse data available about how acoustically transparent they are when used with a hearing aid. The purpose of this study was to measure the acoustic transparency when a hearing aid functions under a pilot cap accessory., Method: The Verifit 2 Hearing Aid Analyzer and the Speech Intelligibility Index (SII) were used to measure acoustic transparency related to access of aided speech. Measurements involved four hearing aids that are commonly fit on pediatric patients and four different commercially available pilot caps. SII data were collected at two intensity levels for four simulated sensorineural hearing losses (SNHLs). Response differences between acoustic measurements with a hearing aid plus a pilot cap compared with the hearing aid alone (control) were collected., Results: A total of 80 SII measurements were made. There were 16 SII measurements of the hearing aid alone (control conditions) and 64 SII measurements with combinations of the hearing aids and pilot caps selected for this study. For each hearing aid, there was no significant difference between the SII measurements collected for the hearing aid alone and the hearing aid plus a pilot cap. Additionally, there was no significant difference between the different pilot caps used with each hearing aid tested., Conclusions: Pilot cap use with the four types of hearing aids in this study results in no significant differences in acoustic transparency compared with the control condition. The data in this study support the use of the pilot caps for hearing device retention in children with hearing loss., Supplemental Material: https://doi.org/10.23641/asha.22647217.

Objective: We aimed to evaluate the relationship between hearing ability and cognitive domains and determine how the relationship changes after 6 months of introducing a hearing aid., Methods: We conducted a 6-month hearing aid lending study between September 2014 and March 2019, including 59 older participants who visited the Memory Clinic at the National Center for Geriatrics and Gerontology. The hearing level was assessed using pure tone audiometry. Speech intelligibility was measured using the monosyllabic word discrimination score. We assessed the relationship between hearing ability and cognitive domains using the Mini-Mental State Examination (MMSE) total score and four subscale scores (orientation, memory, attention, and language). Differences in the cognitive function between baseline (pre-) and 6 months later (post-) after introducing a hearing aid were also assessed., Results: The pre-orientation score was significantly associated with the pure-tone average (p = 0.013), and the pre-language score was significantly associated with speech intelligibility (p = 0.006) after adjusting for confounders. None of the MMSE subscale scores were significantly different between pre- and post-scores, however, an expectation of improvement with continuous hearing aid use was implied in the attention domain., Conclusion: We found a significant association between hearing ability and cognitive domains in individuals whose cognitive functions were not considered healthy. The presence of a potential relationship between cognitive domains, hearing ability, and auditory compensation is suggested., (Copyright © 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.)

Purpose: This study investigated to what extent residual hearing and rehabilitation options (e.g., hearing aids [HAs]) affect the auditory cortex in children with hearing loss., Method: Twenty-one children with bilateral congenital sensorineural hearing loss who were candidates for cochlear implantation were recruited. Voxel-based morphometry analysis was conducted to assess the gray matter (GM) volume in the auditory cortex. Children's residual hearing was measured by pure-tone audiometry at different frequencies. Multiple linear regression models were conducted to examine the effects of residual hearing and the use of HAs on GM volume in the auditory cortex with the control of age and gender., Results: Children with more residual hearing at high frequencies had larger GM volume ratio (corrected by total intracranial volume) in the left Heschl's gyrus ( r = -.545, p = .013). An interaction effect between residual hearing and the use of HAs suggested that the effect of residual hearing on GM ratio was moderated by the use of HAs (β = -.791, p = .020). Compared with children with less residual hearing, children who had more residual hearing benefited more from longer use of HAs in terms of a larger GM ratio., Conclusions: Our preliminary findings highlight the impact of residual hearing on the neuroanatomy of the auditory cortex in children with hearing loss. Moreover, our results call for more auditory input via HAs for children with more residual hearing to preserve the auditory cortex before cochlear implantation. For children with less residual hearing who might receive limited benefit from HAs, an early cochlear implant would be necessary.

Importance: Hearing loss is a highly prevalent condition, with numerous debilitating consequences when left untreated. However, less than 20% of US adults with hearing loss use hearing aids. Over-the-counter (OTC) hearing aids became available in October 2022 to improve access and affordability. However, clinical effectiveness studies of available OTC hearing aids using the existing devices in the market are limited., Objective: To compare the clinical effectiveness of a self-fitting OTC hearing aid with remote support and a hearing aid fitted using audiologist-fitted best practices., Design, Setting, and Participants: This randomized clinical effectiveness trial was conducted between April 14 and August 29, 2022. Sixty-eight adults with self-perceived mild to moderate hearing loss were recruited and randomly assigned to either the self-fitting or the audiologist-fitted group. Following bilateral hearing aid fitting, participants first completed a 2-week, take-home field trial without any support. Access to fine-tuning for both groups was only available after the 2-week trial. Support and adjustment were provided remotely for the self-fitting group per request and by the audiologist for the audiologist-fitted group. Participants were then reassessed after an additional 4-week take-home trial., Interventions: A commercially available self-fitting OTC hearing aid was provided to participants in the self-fitting group who were expected to set up the hearing aids using the commercially supplied instructional material and accompanying smartphone application. In the audiologist-fitted group, audiologists fitted the same hearing aid according to the National Acoustics Laboratories nonlinear version 2 algorithm for prescriptive gain target using real-ear verification with hearing aid use instruction., Main Outcomes and Measures: The primary outcome measure was self-reported hearing aid benefit, measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB). Secondary measures included the International Outcome Inventory for Hearing Aids (IOI-HA) and speech recognition in noise measured using an abbreviated speech-in-noise test and a digits-in-noise test. All measures were completed at baseline and at 2 intervals following hearing aid fitting (2 and 6 weeks)., Results: Sixty-four participants were included in the analytic sample (33 men [51.6%]; mean [SD] age, 63.6 [14.1] years), with equal numbers of participants (n = 32) randomized into each group. The groups did not differ significantly in age (effect size r = -0.2 [95% CI, -0.3 to 0.2]) or 4-frequency pure-tone average (effect size r = 0.2 [95% CI, -0.1 to 0.4]). After the 2-week field trial, the self-fitting group had an initial advantage compared with the audiologist-fitted group on the self-reported APHAB (Cohen d = -0.5 [95% CI, -1.0 to 0]) and IOI-HA (effect size r = 0.3 [95% CI, 0.0-0.5]) but not speech recognition in noise. At the end of the 6-week trial, no meaningful differences were evident between the groups on any outcome measures., Conclusion and Relevance: In this randomized clinical effectiveness trial, self-fitting OTC hearing aids with remote support yielded outcomes at 6 weeks post fitting comparable to those of hearing aids fitted using audiologist best practices. These findings suggest that self-fitting OTC hearing aids may provide an effective intervention for mild to moderate hearing loss., Trial Registration: ClinicalTrials.gov Identifier: NCT05337748.