OBJECTIVES: The objective of this study is to evaluate the 12-mo efficacy and response patterns of personalized sound therapy for chronic tinnitus and to identify the time window most informative for assessing treatment response. DESIGN: In this double-blind, randomized controlled trial, 66 adults with chronic tinnitus were assigned to receive either digital frequency-customized relieving sound (DFCRS), individualized to each participant's tinnitus pitch, or unmodified music (UM) for 12 mo. The primary outcome was change in Tinnitus Handicap Inventory score. Secondary outcomes included anxiety, depression, insomnia, and tinnitus loudness/annoyance. Overlap weighting was used to adjust for baseline imbalances. RESULTS: Both groups improved, but with fundamentally different temporal patterns. UM produced rapid early improvement that plateaued after 6 mo, whereas DFCRS exhibited delayed but progressive and sustained reduction in symptoms throughout the 12 mo. After adjustment, DFCRS was associated with a significantly greater long-term reduction in Tinnitus Handicap Inventory scores compared with UM (adjusted difference: -6.80 points; 95% confidence interval: -13.01 to -0.60; p = 0.036), alongside broader benefits in anxiety and tinnitus-related distress. Notably, attrition analysis revealed that DFCRS responders with higher baseline severity often achieved substantial improvement within 3 to 6 mo, suggesting this period may represent a critical window for evaluating therapeutic response and guiding clinical management. CONCLUSIONS: Personalized sound therapy produces greater relief of chronic tinnitus symptoms and associated conditions and induces a sustained response pattern. The 3- to 6-mo period emerges as a pivotal clinical decision point. These findings support the integration of hypothesis-driven, personalized acoustic neuromodulation into tinnitus management.
OBJECTIVES: More than half of the children identified in population-based newborn hearing screening programs (with permanent hearing loss) initially present with a mild bilateral or unilateral hearing loss (MBUHL). The longer-term effects of MBUHL (during the school years) on the development of early-identified children are still largely unknown. DESIGN: In a multicenter study, we evaluated outcomes in auditory functioning and spoken language development at school age for children who were identified with MBUHL and compared their development to children with normal hearing. Assessments were analyzed at two timepoints: early school years and later elementary school years. We used multiple regression analyses to examine the effect of laterality (unilateral versus bilateral mild hearing loss), hearing loss severity, age at amplification, and amplification use on outcomes in the group of children with MBUHL. RESULTS: A total of 80 children, 47 with hearing loss (27 unilateral and 20 mild bilateral) and 33 with normal hearing, who had been enrolled in a preschool study, were assessed during the elementary school years. Children were identified early at a median age of 4.8 mo (interquartile range [IQR], 2.5 to 6.9) for children with unilateral hearing loss (UHL) and 4.1 mo (IQR, 3.0 to 8.0) for those with mild bilateral hearing loss. Most children with MBUHL (85.1%) received amplification which was fitted at an overall median age of 15.3 mo (IQR, 5.9 to 30.3). School-age assessments were collected in the early school years at an average age of 7.6 yr (SD = 1.1) and in the later years at 10.3 yr (SD = 1.1). At both early and later school ages, children with MBUHL showed on average poorer outcomes than their peers with normal hearing on functional auditory outcomes (p < 0.001). Children with UHL tended to show poorer scores than those with mild bilateral loss on functional auditory abilities. The results for receptive vocabulary were not significantly different between the three groups (p = 0.30). However, after controlling for hearing-related variables, children with mild bilateral loss had significantly poorer receptive vocabulary scores than those with UHL (p = 0.007). More hearing aid use was associated with better scores in receptive vocabulary in both children with UHL and those with mild bilateral hearing loss. No significant change in scores was found between the early and later school years for any group in auditory function (p = 0.7) or in receptive vocabulary (p > 0.9). CONCLUSIONS: Despite early detection and intervention, as a group, children with MBUHL lag behind their peers with normal hearing in auditory functional outcomes and language development. These findings suggest that a substantial number of children with MBUHL will require early intervention support and may continue to require specific attention including monitoring and/or intervention in some areas during the school years.
OBJECTIVES: Hearing loss is a chronic condition in the U.S. with diverse causes, including viral infections, and significantly affects quality of life. Despite the rising incidence of Hepatitis C virus (HCV) infection, research on its relationship with hearing loss remains limited. Early and consistent interactions with the healthcare system have been shown to improve outcomes in extrahepatic manifestations of HCV and enhance quality of life. DESIGN: We conducted a cross-sectional analysis of HCV history, identified via HCV antibody and RNA testing obtained by the mobile examination center, and hearing loss, measured by pure-tone audiometry, using National Health and Nutrition Examination Survey data (1999-2004, 2011-2012) for adults aged 20 to 69. We utilized multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals, adjusting for important covariates. Results were stratified by degree of healthcare utilization. RESULTS: Among 6705 participants, hearing loss prevalence was 27.7% in those with HCV versus 12.7% in those without. The adjusted OR for hearing loss in individuals with HCV was 1.81 (95% confidence interval: 1.06, 3.10). Notably, the magnitude of association between HCV history and hearing loss was higher in the low healthcare utilization group than in the high healthcare utilization group (aOR: 2.82 versus 0.72). CONCLUSIONS: Our findings suggest an association between HCV and hearing loss, with healthcare utilization modifying this relationship. This study fills a gap in the literature and highlights the need for increased clinical monitoring of hearing health in individuals who have had an HCV infection.
Objectives: Genetic testing to identify an underlying etiology of sensorineural hearing loss is increasingly important in an evolving landscape of precision medicine. However, little is known about hearing health providers’ genetic literacy, perceived importance of genetic testing, or comfort with implementation of genetic testing in clinical practice. In this study, we sought to assess these domains among providers caring for patients with hearing loss and examine differences across clinical training and patient populations served. Design: A cross-sectional online survey was distributed to hearing health providers across clinical settings. The survey included demographic and practice characteristics, the Genetic Literacy and Comprehension assessment, perceived importance of genetic testing, current and desired use of testing, scope of practice, and comfort with ordering and interpreting genetic tests. Respondents were categorized by clinical degree (audiology, medical degree, other) and by patient population (primarily pediatric versus primarily adult). Group differences were evaluated using Fisher’s exact tests. Results: Ninety-six respondents were included. Genetic literacy was high across providers, with accuracy scores on the Genetic Literacy and Comprehension assessment exceeding 96% and no significant differences by clinical degree. Pediatric providers rated genetic testing as significantly more important than adult providers (87 versus 41% reported genetic testing as extremely or very important/useful, respectively) and reported higher rates of routine testing (55 versus 29%, respectively). Across all respondents, desired use of genetic testing exceeded current use, with 71% reporting that they desired to use genetic testing in their clinical practice and only 43% reporting they currently utilized genetic testing in their practice. Comfort with genetic testing was low, with more than half of the respondents reporting being uncomfortable ordering or interpreting genetic testing. However, there were provider-level differences in comfort, with medical doctors being significantly more comfortable than audiologists or other providers. Patterns of comfort were consistent with current ordering practice, in which medical doctors—particularly otolaryngologists—were most identified as ordering genetic testing. However, these patterns did not align with respondents’ preferences, as many indicated that both audiologists and medical doctors should be involved in ordering testing for patients with hearing loss. Conclusions: Despite high genetic literacy amongst respondents, gaps exist between the perceived importance of and provider comfort with genetic testing. Gaps also exist between current and desired use of genetic testing in clinical practice. Findings highlight the need for expanded practical training in clinical genetics and institutional support to facilitate broader integration of genetic testing into hearing healthcare.
Objectives: Adults with hearing loss (HL) may experience stigma, which can reduce help-seeking and may contribute to social isolation and psychological distress. Perceptions of HL and hearing devices vary across cultural contexts, underscoring the importance of examining cultural influences on stigma. The primary aim of this cross-sectional, online survey study was to examine differences in public stigma (negative societal beliefs regarding HL and hearing devices), self-stigma (internalization of these beliefs), and affiliate stigma (stigma experienced by individuals associated with someone with HL, such as family members, referred to as “affiliates”) across ethnic groups living in the United Kingdom. The secondary aim was to explore whether acculturation indicators (e.g., duration of stay in the United Kingdom, generational status determined using participants’ and their parents’ country of birth, and languages spoken at home) were associated with stigma perceptions. It was hypothesized that stigma perceptions would vary across (1) ethnic groups and (2) acculturation indicators. Design: Participants completed an online survey assessing stigma related to HL and hearing devices using validated questionnaires. The survey was designed to include individuals with and without HL, as well as affiliates. All items were rated on 5-point Likert scales ranging from “strongly disagree” to “strongly agree.” The final sample comprised 385 individuals: 256 with self-reported HL, 107 without HL, and 22 who were unsure. Participants were grouped into three ethnic categories, with 164 identifying as Black, 100 as South Asian, and 121 as White. Hierarchical regression analyses were used to examine whether ethnicity and acculturation indicators predicted public, self-, and affiliate stigma while controlling for covariates (age, gender, education level, hearing status). Results: Ethnicity was a significant predictor of public stigma, with South Asian ( β = 9.97, p < 0.001) and Black ( β = 4.03, p = 0.001) participants having higher stigma scores than White participants. A similar pattern was observed for self-stigma, with higher scores among Black ( β = 8.71, p < 0.001) and South Asian ( β = 6.28, p = 0.017) participants. Generational status also predicted stigma. Compared with second-generation participants, immigrants and first-generation participants reported lower public stigma ( β = −6.98, p = 0.004; β = −4.05, p = 0.039) and self-stigma ( β = −6.97, p < 0.001; β = −5.63, p = 0.011). Affiliate stigma was not associated with ethnicity or acculturation indicators (all p > 0.05). Conclusions: Ethnicity and generational status were key predictors of public and self-stigma, highlighting the role of sociocultural context in shaping perceptions of HL and hearing aid use. This suggests that a uniform approach to addressing stigma may be inadequate, as experiences of stigma may differ across cultural and generational contexts. Future qualitative work is needed to better understand lived experiences of stigma within and between ethnic groups to ground the development of culturally responsive stigma-reduction interventions and patient education materials, with implications for both translational research and clinical practice.
