Background: Recording parameters, including electrode placement and stimulus type, are critical for optimizing ocular vestibular evoked myogenic potential (oVEMP) responses. Purpose: This study aimed to determine whether differences exist between recordings based on electrode placement and stimulus type when using two different electrode placements and two stimuli to identify the optimal combination. Research Design: A prospective, cross-sectional, comparative study. Study Sample: The study included 29 adults (14 female and 15 male adults) 18 to 30 years of age (mean = 22.44 years; standard deviation = 1.54 years) without a history of otological or neurological disorders. All participants demonstrated hearing sensitivity within acceptable limits, acceptable middle ear function, and no symptoms of vertigo or dizziness. Intervention: The oVEMPs in both ears were recorded using two different stimuli (500-Hz tone burst [TB] and 500-Hz narrowband [NB] CE-Chirp) at two different electrode placements (belly tendon [BT] placement and infraorbital [IO] placement). Data Collection and Analysis: A total of eight recordings were obtained for each electrode placement and stimulus combination. Individual peak latencies (n1 and p1) and peak-to-peak amplitudes (n1-p1) were analyzed to determine statistical significance between conditions. Results: The individual peak latencies were significantly shorter for the combination comprising IO electrode placement and NB CE-Chirp stimulus compared with those for the other electrode placement and stimulus combinations (p < 0.001). The peak-to-peak amplitude was significantly larger for the NB CE-Chirp and BT electrode placement combination compared with that for the other combinations. Conclusions: During the oVEMP assessment, using the 500-Hz NB CE-Chirp instead of the 500-Hz TB stimulus yielded earlier and higher amplitude responses. A comparison of electrode placements indicated that latencies were shorter with IO placement and amplitudes were higher with BT placement. Clinical Relevance Statement: The NB CE-Chirp stimulus can enhance response detectability because of higher amplitudes; however, because of potential physiological limitations, its clinical application should be interpreted with caution. Clinicians should be aware of the significant effects of electrode placement on latency and amplitude values when interpreting results or selecting a recording protocol.
Background: Older adults with hearing loss and cognitive impairment face distinct barriers that hinder navigation of hearing care from detection through management. Primary care clinicians are not currently well-trained or supported in hearing care, which can be especially challenging in the context of cognitive concerns. Purpose: We examined how primary care processes support or inhibit hearing-related needs and practices among older adults with hearing loss and cognitive impairment. Research Design: This was an exploratory qualitative descriptive study. Study Sample: The sample included primary care physicians (n = 6), older adults with hearing loss and self-reported dementia/cognitive impairment (n = 6), and care partners (n = 5) from Mid-Atlantic academic health centers (March 2024–March 2025). Data Collection and Analysis: We conducted semistructured interviews analyzed using qualitative content analysis with hybrid deductive and inductive coding by two qualitative coders. Interviews focused on (1) perspectives on hearing loss, (2) caring for persons with hearing loss and cognitive impairment, (3) hearing care, and (4) clinic- and system-level implementation of hearing care processes. Results: All participants recognized hearing care as important for health, function, and maintaining connection and that cognitive or other medical concerns often take precedence during primary care visits. Older adults and care partners preferred that primary care physicians routinely inquire about hearing health to identify communication needs to reduce need for self-advocacy, particularly in the context of cognitive impairment. Participants emphasized the importance of interprofessional communication to support continuity of hearing care across settings. Physicians described hearing-health care as a “black hole,” noting limited understanding of audiology, inconsistent access to audiological results, and insufficient time to address hearing amid competing demands. Physicians expressed a desire for accessible professional and patient-facing resources to support hearing-related conversations when feasible. Conclusions: Hearing loss exacerbates vulnerabilities among persons with cognitive impairment by eroding communication, engagement, and care continuity. Addressing these challenges will require proactive, system-level approaches that integrate hearing care into routine medical practice and strengthen interprofessional practice. Clinical Relevance Statement: Findings highlight opportunities to advance interprofessional practice and care delivery systems to minimize cumulative vulnerabilities experienced by older adults with hearing loss and cognitive impairment and their care partners from insufficient communication accommodations and fragmented care processes.
Background: Robotic assistance in cochlear implants (CI) provides a slow, consistent, and atraumatic electrode array insertion. Patients’ awareness of robotic assistance and patients’ choice of providers have increased. Despite an increase in patients’ awareness and evidence supporting CI outcomes, many patients experience barriers to cochlear implantation. This study aimed to understand barriers, document patients’ awareness of robotic assistance, and explore how robotic assistance affects barriers to implantation. Purpose: We aimed to further understand barriers to implantation and explore the impact of robotic assistance, including awareness/interest in robotic-assisted CI, openness to switching providers, and traveling to access robotic-assisted CI. Research Design: This was an exploratory, descriptive survey. Study Sample: Respondents were invited through social media posts in two CI Facebook groups. A total of 113 responses to the survey were received across two cohorts, CI candidates and recipients. Data Collection and Analysis: Responses were collected via Microsoft Forms and Qualtrics, and analysis focused on descriptive statistics to summarize trends across respondents. Results: Of the respondents 78 percent were aged 45–84 years and 96 percent of respondents self-identified as savvy or average with new technology. Over 76 percent of respondents were aware of robotic-assisted surgical technologies, with 80 percent responding “definitely interested” or “interested and want to learn more.” A total of 48 percent of candidates and 41 percent of recipients expressed willingness to travel 50 or more miles to access robotic-assisted CI, aligning with their high awareness of and interest in the technology. Conclusions: Respondents of all ages have experience with technology, are knowledgeable about medical technology, and are interested in learning about robotic-assisted cochlear implantation. CI candidates and recipient respondents are open to traveling and/or changing providers to access robotic-assisted CI. Barriers to CI persist and could be addressed through patient education by audiologists throughout the CI patient’s journey including referral, evaluation, and activation. Clinical Relevance Statement: Significant interest by patients in robotic-assisted technology indicates clinicians could integrate robotic-assisted CI into preoperative counseling to help overcome some persistent barriers to CI. Willingness of candidates to change providers for robotic assistance suggests that the availability of this technology is a key consideration in patients’ decision-making and their selection of providers. Audiologists are ideally situated to use patients’ technological proficiency through education to improve the transition from candidacy evaluation to implantation.
Background: Bone conduction devices (BCDs) are used to rehabilitate conductive hearing loss, mixed hearing loss, and single-sided deafness. Preoperative softband simulation is commonly used to estimate expected postoperative benefit; however, its predictive accuracy is uncertain. Purpose: To determine how accurately preoperative softband simulation predicts postoperative audiological outcomes after BCD implantation. Research Design: This retrospective paired-control study compared preoperative softband performance with postoperative implanted BCD outcomes. Study Sample: This study included 19 patients with conductive hearing loss, mixed hearing loss, or single-sided deafness who underwent both preoperative softband simulation and postoperative audiological testing at a tertiary academic medical center. Intervention: Patients completed preoperative testing using softband-mounted sound processors and postoperative testing using their implanted BCD device. Data Collection and Analysis: Pure-tone average (PTA), consonant-nucleus-consonant (CNC) word recognition, and Quick Speech-in-Noise (QuickSIN) scores were collected preoperatively and postoperatively. Paired t tests or Wilcoxon signed-rank tests evaluated group differences. Predictive accuracy was assessed with Spearman correlation coefficients and intraclass correlation coefficients (ICCs). Results: Softband PTA significantly overestimated postoperative thresholds (mean difference = 5.8 dB HL; p = 0.023), and softband PTA was not significantly correlated with postoperative PTA (ρ = 0.43; p = 0.069). Agreement was poor (ICC = 0.28). Postoperative CNC word recognition scores were significantly higher than preoperative softband scores (mean difference = 7.5 percent; p = 0.034), and a strong correlation was observed between preoperative and postoperative performance (ρ = 0.67; p = 0.003). QuickSIN scores did not differ significantly and did not demonstrate a correlation. Conclusions: Softband simulation underestimates average postoperative improvement in hearing thresholds and speech discrimination after BCD implantation. Among individual predictors, preoperative simulated CNC scores approximate postoperative performance more closely than pure-tone thresholds, whereas PTA predictions show poor agreement. Clinical Relevance Statement: Softband simulation is widely used in counseling, but its predictive accuracy varies. These findings suggest that clinicians should place greater emphasis on speech-based testing rather than pure-tone thresholds when using softband results to guide patient expectations and preoperative decision-making. An improved understanding of softband limitations may enhance counseling and support to enable more accurate preparation for BCD outcomes.
Background: Patients with headache often report symptoms of imbalance, vertigo, and visually provoked dizziness. Vestibular migraine (VM) is a common cause of recurrent dizziness symptoms for many of these patients. Variable results are provided in the available literature describing objective and functional measures of vestibular system function, likely because of the inconsistency of diagnostic criteria over time and the range of clinical presentations of patients with headache and dizziness. Purpose: To describe the clinical presentation of patients with headache and dizziness who receive a final diagnosis of definite VM. Research Design: Retrospective case series. Method: We reviewed 304 consecutive patients between 18 and 62 years of age. All patients were evaluated between 2012 and 2024 and received a final diagnosis of definite VM. Data Collection and Analysis: The clinical assessment included objective measures of oculomotor and vestibular reflex performance as well as functional assessments of balance, gaze stability, and spatial orientation. All data were collected as part of the clinical diagnostic battery for patients presenting with headache and dizziness. Results: Imbalance (68.75 percent, n = 209) and rotational vertigo (62.5 percent, n = 190) were commonly reported. Vestibular assessment results were atypical for at least one metric in 92.1 percent ( n = 280) of patients. Most irregularities comprised otolith reflex (ocular vestibular evoked myogenic potentials: 68.39 percent, n = 155) or functional testing (subjective visual vertical: 67.68 percent, n = 198; dynamic visual acuity testing: 71.01 percent, n = 98). Semicircular canal function that was not typical was noted for at least one measure in 29.28 percent ( n = 89) of patients. Conclusion: The clinical presentation of VM varies; however, a more complete profile can be described using an expanded protocol beyond standard vestibular reflex pathway testing. Because of the assumed involvement of central vestibular system pathways, evaluations of dynamic and integrative reflex function are likely to improve our ability to identify and appropriately manage patients with suspected VM. Clinical Relevance Statement: Atypical objective and functional vestibular reflex pathway performance are associated with VM, which is a common disorder. The heterogeneous presentation of VM poses challenges for both its diagnosis and treatment.
Background: Accurate and timely postfitting outcome measures are essential for individualized care and to prevent hearing aid nonuse. Ecological momentary assessment (EMA) can aid in measuring outcomes and enhance ecological validity by reducing recall bias through the collection of near-real-time data on experiences, providing insights into user challenges, preferences, and activities. Purpose: This study aimed to qualitatively explore the everyday listening challenges that hearing aid users report in real time, using a large dataset of self-initiated EMA responses. Research Design: This is a retrospective manual qualitative content analysis of open-text responses, which were collected from hearing aid users through smartphone-based self-initiated EMAs. Study Sample: 3,696 open-text responses describing hearing aid challenges were considered for analysis. The data were a subset of a larger dataset, obtained from 2,301 predominantly English-speaking hearing aid users. Data Collection and Analysis: Deidentified data were collected through a smartphone app compatible with commercially available hearing aids. Clinicians enabled an EMA feature in the fitting software, allowing participants to self-initiate real-time feedback on notable listening experiences as part of their ongoing hearing-health care journey. Results: The categories identified were sound quality, connectivity, speech understanding, discomfort, battery life and charging, performance and practicality, and other user perceptions. Individuals in this study reported challenges with their hearing aids related to distorted or unnatural sound quality, intermittent Bluetooth connectivity, difficulty understanding speech in noisy environments, and challenging auditory acclimatization. The most frequently reported challenges (43.5 percent) related to sound quality. Conclusions: Using smartphones to collect EMA data offers an effective means for hearing aid users to provide real-life feedback to clinicians about their auditory experiences. EMA data from hearing aid users provide an ecologically valid view of their experiences, which could aid clinicians in performing needs assessments, personalized hearing aid adjustments, and clinical counseling. Clinical Relevance Statement: Insights from this study’s EMA data accentuate the importance of capturing real-world listening experiences, to guide needs assessments, personalized hearing aid adjustments, and clinical counseling as part of person-centered hearing-health care.
Background: Successful social interaction depends on communication and emotion recognition skills; however, these are areas in which adolescent cochlear implant users often perform more poorly compared with their peers with typical hearing. Purpose: This study used a multivariate approach to investigate independent and interdependent associations between auditory emotion recognition, pragmatic language, and social satisfaction among adolescents with typical hearing and cochlear implants. Study Sample: This study included 25 adolescents with typical hearing (mean age = 14.56 years) and 15 adolescents with at least one cochlear implant (mean age = 14.27 years). The age of the participants ranged from 12 to 18 years. Adolescents with cochlear implants had bilateral hearing loss and primarily communicated using spoken language. The cochlear implant group had a mean implantation age of 4.07 years and mean duration of cochlear implant experience of 10.20 years. Data Collection and Analysis: All participants completed measures of auditory emotion recognition using a subset of the Morgan Emotional Speech Set, self-reported emotional communication (Emotional Communication in Hearing Questionnaire), and social satisfaction (National Institutes of Health Toolbox) using an online questionnaire. A pragmatic language skill assessment (Comprehensive Assessment of Spoken Language-2) was completed with an examiner in person or virtually. Analyses of covariance and multivariate analyses of variance were conducted to evaluate the effect of auditory status on emotion recognition performance, self-reported emotion recognition, and self-ratings of social satisfaction. Descriptive statistics and trends were used to examine the effect of auditory status on pragmatic language abilities. Finally, correlations were used to assess the relationship between factors. Results: Compared with their peers with typical hearing, adolescent cochlear implant users exhibited significant deficits in auditory emotion recognition. However, the participant groups did not differ in terms of self-reported emotion recognition or social satisfaction ratings. Greater variability in pragmatic language abilities was observed in the cochlear implant group. Conclusions: Auditory status affects emotion recognition such that adolescents with typical hearing outperform those with cochlear implants. Future studies should investigate emotion recognition performance relative to specific areas of social relationships to determine more nuanced aspects of social communication in adolescent cochlear implant users. Clinical Relevance Statement: Clinical audiologists should monitor and identify adolescents at risk for poorer emotion recognition and social well-being who may need additional counseling and resources.
Background: Vestibular neuritis, typically caused by viral infections, is an inflammation of the vestibular nerve characterized by sudden onset of vertigo, nausea, and vomiting, without associated hearing loss or central nervous system involvement. Although vestibular function in vestibular neuritis has been extensively evaluated using conventional vestibular assessment tools, the role of masseter vestibular evoked myogenic potentials (mVEMP), a relatively novel measure reflecting the vestibulo-masseteric reflex, remains underexplored. Purpose: The purpose of the study was to investigate the vestibulo-masseteric reflex pathway in individuals with vestibular neuritis and to determine whether a significant correlation exists between cervical vestibular evoked myogenic potential (cVEMP), ocular vestibular evoked myogenic potential (oVEMP), and mVEMP responses. Research Design: The study followed a cross-sectional design. Study Sample: The study included 30 ears from individuals diagnosed with vestibular neuritis and 30 ears from age-matched healthy controls (20–60 years of age). Participants underwent thorough audio-vestibular evaluations that included recordings of 500-Hz evoked cVEMP, oVEMP, and mVEMP. Data Collection and Analysis: The cVEMP, oVEMP, and mVEMP responses were analyzed for absolute peaks, absolute peak latencies, peak-to-peak amplitudes, and interaural amplitude asymmetry ratios. Results: The mVEMP response rate in individuals with vestibular neuritis was 73 percent, whereas cVEMP and oVEMP response rates were 40 percent and 62.5 percent, respectively; in contrast, the controls demonstrated a 100 percent response rate for cVEMP, oVEMP, and mVEMP. There was no significant correlation observed between mVEMP and cVEMP responses (p > 0.05) or between mVEMP and oVEMP responses (p > 0.05). Furthermore, patients with vestibular neuritis displayed lower peak-to-peak mVEMP amplitudes, likely indicating compromised neural transmission due to inflammation. Conclusions: The observed dissociation between mVEMP and both cVEMP and oVEMP responses in vestibular neuritis supports the hypothesis that mVEMP is generated through a distinct neural mechanism, despite a potentially common otolithic origin. Clinical Relevance Statement: This study highlights the complexity of vestibular innervation and suggests that mVEMP may serve as a complementary diagnostic tool in evaluating vestibular pathologies. Further research is warranted to delineate the specific neural mechanisms underlying VEMP responses.
Background: The auditory brainstem response (ABR) is the gold standard for pediatric screening, but it captures threshold information only. Speech-evoked frequency-following responses (FFRs) index sustained, periodic speech encoding yet are rarely added in busy clinics. A single stimulus that elicits both would improve efficiency and broaden functional assessment. Purpose: We tested whether a combined stimulus yields ABR peaks and FFR magnitudes equivalent to those obtained with conventional, separate protocols. Research Design: This was a within-subject, three-condition comparison: click ABR (80, 60 dB), conventional speech-evoked FFR (cABR), and ABR+ (60-dB click followed by a short steady vowel). Study Sample: Twenty-three children without hearing difficulties (3–12 years of age; mean 6.65 years) were recruited during routine electrophysiology at Nanjing Maternity and Child Health Care Hospital. Data Collection and Analysis: Recordings used a standard vertical montage with epoch windows of −10 to 12.5 ms for click ABR and −20 to 55 ms for cABR and ABR+. For ABR outcomes, three blinded raters marked waves I, III, and V on individual averages. For FFR outcomes, root mean square and narrow-band fast Fourier transform magnitudes (100, 200, 300, and 400 Hz; ±30 Hz) were computed on a fixed vowel window with prestimulus noise subtraction. Repeated-measures models tested condition effects (and frequency for FFR); paired t tests used Holm correction and effect sizes were reported as Cohen’s d. Results: ABR latency analyses showed the expected level effects (80 dB < 60 dB) for waves I, III, and V. Critically, wave V latency did not differ between the 60-dB click ABR and the ABR+ click segment. In the frequency domain, spectra declined from 100 to 400 Hz with no main effect of condition and no condition × frequency interaction. Conclusions: ABR+ reproduces click-ABR timing and speech-FFR magnitudes obtained with separate protocols, consolidating threshold-relevant synchrony and suprathreshold speech encoding in a single, clinic-feasible run. Clinical Relevance Statement: ABR+ can streamline pediatric assessments by providing a measure of audibility and functionally relevant encoding of periodic speech in one recording. This supports broader, time-efficient adoption of speech-evoked brainstem measures in clinical workflows.
Background and Purpose: Misophonia is characterized by a negative reaction to triggering stimuli. Although it can be hypothesized that attentional shifts toward triggering stimuli can influence cognitive performance in individuals with misophonia, the present study focused on evaluating the baseline working memory ability and listening effort of individuals with typical hearing with and without misophonia in the absence of such triggers. Research Design: Data were collected using a standard group comparison design and nonprobability purposive sampling method. Study Sample: The current study comprised 30 participants 18–30 years of age who were divided into two groups of 15 each. Data Collection: Working memory was assessed using the forward digit span, backward digit span, ascending digit span, and descending digit span. Listening effort was measured using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX) after completion of each task. These tests were conducted in the absence of triggers. Results: It was found that the working memory ability measured using digit span tests was comparable (p > 0.05) between groups with and without misophonia. No statistically significant difference (p > 0.05) in NASA TLX scores was observed between these groups. Conclusions: Individuals with and without misophonia have comparable working memory ability and listening effort while performing simple working memory tasks, which could be attributed to the noncontinuous nature of misophonia. To generalize these findings, further research of a wider population is required.
Background: Hearing loss (HL) is associated with decreased appreciation of music, which may be partially restored with hearing aids (HAs). Individuals with perfect pitch (PP) may be expected to experience greater deterioration in music enjoyment with HL and HA use. Purpose: In this study, we investigate the impact of HL and HA use on music enjoyment and music listening time in individuals with PP, compared to those without PP (NPP). Research Design: Bilateral HA users were recruited from a tertiary academic center and community HL organizations. Participants completed an online survey rating current music enjoyment and the impact of HAs on music enjoyment and music listening time on 10-point Likert scales. Participants then completed a melody discrimination task to assess music perception. Study Sample: A total of 118 participants completed the survey, including 15 with PP. Intervention: None. Data Collection and Analysis: Statistical analyses were performed on Microsoft Excel and R version 4.4.1. Multiple linear regression analysis was used to compare music enjoyment and engagement between PP and NPP groups. Results: Mean ± standard deviation impact of HAs on music enjoyment was positive for both PP users (6.33 ± 2.98) and NPP users (5.76 ± 2.43) (linear regression p = 0.65). Current self-rated music enjoyment was also similar between groups (6.99 vs. 6.74, linear regression p = 0.36). Both groups reported comparable amounts of time spent listening to music (5.40 vs. 4.77, linear regression p = 0.76). Conclusions: Hearing aid users with PP reported music enjoyment and listening habits similar to those of NPP participants. Moreover, both groups perceived a positive impact of HAs on music enjoyment and reported stable listening time after HA fitting. Clinical Relevance Statement: These findings suggest that HAs benefit music enjoyment and engagement regardless of innate musical abilities. This research suggests that in the context of precision audiological care, patients, particularly musicians for whom music is a priority, can be counseled on what to expect when re-engaging with music through HAs.
Background: The auditory brainstem response (ABR) is an essential tool for assessing the hearing sensitivity of newborns and other patients who are unable to provide behavioral responses. During a typical ABR session, clinicians rely on extensive training and expertise to rapidly identify the hearing threshold of the patient by adaptively optimizing the acoustic stimuli presented to the patient. Nevertheless, ABR sessions are notoriously long, which may lead to an incomplete diagnosis or necessitate additional appointments, which may impose a significant burden on the caregiver. Furthermore, clinical best practice requires clinicians to identify ABRs based on visual inspection of the recordings, which may introduce errors that lead to inaccurate diagnoses. Purpose: The long-term goal of this study was to develop a clinical decision support system (CDSS) to enable faster and objective ABR threshold estimation. This study sought to validate an algorithm that suggests optimal stimuli based on accruing data during an ABR session. Research Design: Two estimates of ABR thresholds at 500, 1000, 2000, and 4000 Hz were measured. The first estimate followed the algorithm and the second estimate followed clinical best practice. Behavioral audiograms were also measured. Study Sample: Fifty adult ears with typical hearing and hearing loss up to 80 dB HL. Data Collection and Analysis: ABRs were recorded using the Interacoustics Eclipse platform in a sound-attenuating booth. The two ABR thresholds were compared via the mean absolute difference and mean bias. The intraclass correlation coefficient (ICC) between the two ABR thresholds and behavioral thresholds were computed. Results: We found that 72 percent of the ears had a mean absolute difference of approximately 10 dB or less and 96 percent had a mean absolute difference of approximately 20 dB or less. The ICC for the algorithm and clinician threshold estimates was 0.78, indicating good agreement. Conclusions: This algorithm can estimate ABR thresholds with clinically acceptable accuracy for a majority of ears. Additional development and validation are necessary before the algorithm is clinically viable. Clinical Relevance Statement: A CDSS that suggests optimal stimuli for rapid and objective ABR threshold estimation would permit shorter clinical sessions, allow clinicians to spend more time on other aspects of clinical care, and expand access to rural areas that do not have dedicated audiology clinics.
Background: There is a need for a tinnitus review linking models, assessment, and clinical treatments. Purpose: The purpose of this review is to show how integration of mechanisms, assessment, and treatment of tinnitus may be beneficial for clinical practice. Methods: A literature review and interpretation will illustrate mechanisms of tinnitus, identify how these mechanisms currently (and partially) may be assessed, demonstrate how the mechanisms may be influenced by tinnitus treatment strategies, and compare current tinnitus treatment outcomes. Results: Tinnitus etiology is heterogeneous; no one assessment measurement or treatment strategy is likely to benefit all patients, or all patients to the same extent. The many models of tinnitus mechanisms do, however, have one or all of the following schemas: auditory system dysfunction, cognitive/emotional nonauditory central neural circuits, and somatosensory input. Efficacious treatments reviewed here include sound therapy, counseling approaches, and bimodal stimulation. Conclusions: The three tinnitus treatments have different treatment goals and target different mechanisms of both auditory and nonauditory networks to reduce tinnitus distress. Despite these differences, these treatments show some effectiveness in managing bothersome tinnitus and should be recommended in our clinical practice guidelines for patients. Clinical Relevance Statement: Incorporating tinnitus assessment measures that address all three schemas allows clinicians to better identify the underlying mechanisms or contributing factors in each patient, thereby guiding the selection of a more targeted and effective treatment approach. Because tinnitus etiology is heterogeneous and possibly multifaceted, combinations of treatments may be advisable. Rather than suggesting a shotgun approach or even a synergistic approach, combinations of treatments may reflect an integrated approach, targeting all aspects of tinnitus measured in the assessment protocol.
Background: The effect of auditory cues on postural stability has mostly been examined in a unidirectional manner, with evidence indicating that auditory impairment negatively affects postural stability and increases postural sway. However, to our knowledge, sound localization ability has not previously been investigated according to the level of postural stability in young adults. Purpose: This study shifts this perspective by examining the association between postural stability and spatial hearing. Accordingly, this study aims to investigate the relationship between postural stability and spatial auditory abilities, including sound localization performance. Research Design: This is a prospective cross-sectional study. Study Sample: A total of 120 young adults (mean age: 23.31 ± 2.89 [range 21–39] years) with pure-tone average (PTA) ≤ 20 dB HL were included in this study. Data Collection and Analysis: Postural stability was assessed using the tandem stance test conducted on a force platform. Navigation ability was assessed using the Wayfinding Questionnaire, while spatial auditory abilities were evaluated using the sound lateralization test and the Turkish Auditory Localization Scale (TALS). Results: There were no significant associations between center of pressure displacement and the Wayfinding Questionnaire, sound lateralization test, or TALS scores (p > 0.05). A moderate negative correlation was found between the Wayfinding Questionnaire score and the TALS score (r = −0.31, p = 0.007). However, no significant relationship was observed between the Wayfinding Questionnaire score and the sound lateralization test score (p = 0.205). Conclusions: The findings indicate that, in young adults with PTA ≤ 20 dB HL, static balance performance is not associated with wayfinding or spatial auditory performance. The relationship between postural control and spatial perception appears to be limited and task dependent. Clinical Relevance Statement: The findings suggest that, in young adults with PTA ≤ 20 dB HL, variations in static postural stability do not meaningfully affect spatial hearing or sound localization performance. This indicates that routine balance differences alone may not need to be considered a confounding factor during clinical spatial hearing assessments in young adults. However, the observed task-dependent relationship between wayfinding and auditory localization highlights the potential value of integrated vestibular–auditory evaluations in selected clinical populations.
Background: New treatments are needed for individuals affected by hearing loss. Enhancing hearing loss phenotyping in clinical trials and increasing the diversity of patient populations will benefit programs focusing on screening, awareness, and education. Purpose: This study aimed to create a digital composite covariate (DCC) for pure-tone average (PTA) to enhance the screening process and prognostic capabilities for hearing loss clinical trials. Research Design and Study Sample: This study used cross-sectional data from the National Health and Nutrition Examination Survey. We downloaded, cleaned, and harmonized data across nine cohorts from 1999 to 2018 and identified 21,946 participants with audiometry data. Data Collection and Analysis: The DCC was created by predicting the PTA using simple-to-measure variables. A least absolute shrinkage and selection operator (LASSO) regression and an extreme gradient boosted (XGBoost) tree-based model were used. A stacking ensemble model was created by combining the predictions from LASSO and XGBoost. Results: The three machine learning models performed similarly. Stacking provided minute improvements over LASSO and XGBoost. The stacking ensemble model yielded a root mean square error of 7.63 dBHL (95 percent confidence interval [CI] 7.34, 7.92), a bias of 0.55 dB (95 percent CI 0.32, 0.76), and a correlation of 0.78 (95 percent CI 0.77, 0.80). A classification model was developed to predict the participants’ hearing status (i.e., no hearing loss vs. some hearing loss). Our model yielded an accuracy and balanced accuracy of 0.82 (95 percent CI 0.8, 0.83) and 0.84 (95 percent CI 0.83, 0.86), respectively, and an area under the receiving characteristic curve of 0.92 (95 percent CI 0.91, 0.93). Conclusions: The use of DCC prognostic factors for PTA can be used for phenotyping of hearing loss using simple-to-measure variables. Ultimately, this will aid in the optimization of clinical trials. Clinical Relevance Statement: This study has demonstrated that a person’s hearing ability can be predicted using easy-to-collect variables. In turn, we showed the potential to enhance the screening process for the recruitment of patients into audiology trials by identifying patient subpopulations that would benefit the most from the proposed treatment. In addition, the use of prognostic risk scores may contribute to sample size optimization, as well as the enhancement of auditory phenotyping and diversity of patient populations in clinical trials.
Background: Hearing aid help-seeking and uptake remain low despite technological advancements and increased accessibility. Understanding the enablers and barriers influencing these behaviors is essential for improving strategies to promote hearing-health care use. Purpose: This study explores user perspectives on hearing aid help-seeking and uptake in the United States, using the Capability, Opportunity, Motivation–Behavior (COM-B) model to analyze behavioral enablers and barriers among prescription and over-the-counter (OTC) device users. Research Design: This was a qualitative study using an inductive thematic analysis framework. Study Sample: Participants (n = 41) included adult hearing aid users from the Hearing Tracker (n = 37) website community and the Lexie Hearing database (n = 4). Participants had a mean age of 69 years (11 standard deviations; range 36–88 years), and 68 percent were male. Data Collection and Analysis: Semistructured interviews were conducted virtually, transcribed verbatim, and analyzed using thematic analysis. Themes and subthemes were mapped onto the COM-B model to explore the behavioral drivers of hearing aid help-seeking and uptake. Results: The analysis, framed within the COM-B model, identified 20 themes and 55 subthemes across two overarching categories of enablers and barriers to help-seeking and hearing aid uptake. For hearing aid help-seeking, opportunity factors (e.g., support from hearing care professionals [HCPs] and social networks and trial periods) and motivation factors (e.g., job performance and self-perceived need) were primary enablers, and preconceived beliefs (capability), fear of dependence (motivation), stigma, and cost (opportunity) acted as key barriers. For hearing aid uptake, capability factors (e.g., ability to make adjustments on an app and technology advancements levels), opportunity factors (e.g., support and guidance from HCP, device trials, and affordability), and motivation factors (e.g., social interaction) promoted adoption, whereas lack of informational counseling (capability), device functionality, limited insurance coverage, negative HCP experiences (opportunity), and stigma (motivation) discouraged uptake. Conclusions: Hearing aid help-seeking and uptake are influenced by a complex interplay of capability, opportunity, and motivation factors. Targeted interventions addressing stigma, affordability, and user expectations, especially for the growing OTC population, may improve adoption. Clinical Relevance Statement: Understanding enablers and barriers to hearing aid help-seeking and uptake may guide audiologists in developing more personalized, motivation-based counseling strategies. The findings highlight practical approaches for addressing stigma and affordability concerns, enhancing user autonomy, and personalizing support for both prescription and OTC hearing aid users, ultimately improving patient engagement and hearing-health care outcomes.
Background: Hearing aids are the primary intervention for hearing loss, yet disparities in use persist, impacting user experiences. Limited research has examined how expectations and perceived value for money influence these experiences, particularly through theoretical models such as the Health Belief Model (HBM). Purpose: This study explored how outcome expectations and perceived value for money shape adult hearing aid users’ experiences, framed within the HBM. Research Design: A qualitative descriptive design was used with semistructured interviews and content analysis. Study Sample: Thirty-five adult hearing aid users (new and experienced; mean age = 67.2 years) were recruited from the Hearing Tracker website. Results: The expectations domain included three categories with 12 subcategories reflecting fulfilled and unfulfilled experiences, while the perceived value for money domain comprised five categories with 10 subcategories capturing both contributors and limiters. Participants described perceived benefits including improved hearing, greater environmental awareness, and device customization as important contributors to fulfilled expectations and greater perceived value for money. Self-efficacy was evident among users with realistic expectations, who described confidence in their ability to manage hearing aids and reported that expectations were met. In contrast, perceived barriers such as device limitations, background noise, and physical fit challenges were described in accounts of unfulfilled expectations and reduced hearing aid use. Affordability also reflected perceived barriers, with some participants describing hearing aids as a worthwhile investment, whereas others described financial burden because of high costs and limited insurance coverage. Conclusions: Framed by the HBM, perceived benefits and self-efficacy align with fulfilled expectations and higher perceived value for money, whereas performance, fit, and financial barriers undermine them. Focused expectation management, skills training, and affordability strategies can improve outcomes and sustained use. Clinical Relevance Statement: Integrate counseling-based intervention aligned with HBM constructs during prefitting care to set accurate expectations, build self-efficacy for device management, and address performance and affordability barriers. Tailored counseling and financing support could enhance positive experiences and long-term use.
Background: Hearing loss in older adults is associated with cognitive decline. Emerging evidence suggests a possible link between hearing aid use and cognitive protection. However, the underlying factors associated with the hearing–cognition connection are currently unknown. Purpose: This study examined changes in emotion and motivation in older adults before and after short-term hearing aid use. Analyses further explored the relationship of emotion and motivation to previously documented cognitive changes associated with hearing aid use. Establishing relationships among these factors will clarify their individual and combined associations with cognitive performance and emotional well-being in hearing aid users. Research Design: A single-group repeated-measures design was used in this study. Study Sample: Participants included 29 new hearing aid users with bilateral sensorineural hearing loss and an average age of 70 years. Intervention: Participants were fitted with bilateral digital hearing aids. Data Collection and Analysis: Emotions and motivation were assessed in a group of older adults before and after a hearing aid acclimatization period of 4 months. Cognition operationalized as working memory performance and datalogged hours of hearing aid use documented in a previous study were used in the analyses. Data were analyzed with repeated-measures analysis of variance and principal-component analyses. Results: Significant improvements were found in autonomous motivation after using hearing aids for 4 months. In contrast, no effect of hearing aid use was found for controlled motivation or emotions. After using hearing aids, stronger and more cohesive associations were found among positive emotions, increased autonomous motivation, and reduced fear, and these factors were related to actual hearing aid use over the 4-month study period. In addition, after using hearing aids, autonomous motivation was associated with higher working memory scores, emotional support, and general life satisfaction. Conclusions: Autonomous motivation improved after 4 months of hearing aid use. Associations among emotions, motivation, working memory, and hearing aid usage suggest an intricate mechanism underlying hearing aid adoption. Clinical Relevance Statement: Because emotional and motivational factors, as well as cognitive performance, were associated with hearing aid usage, rehabilitative and counseling efforts with individuals who have hearing loss should support the value of intrinsically driven hearing aid use, self-efficacy, and social connectedness as part of a holistic approach to maximize hearing aid outcomes. The connection among these variables also supports the notion that hearing-health care and hearing aids are an essential aspect of aging and emotional well-being in individuals with hearing loss.
Background: Pediatric vestibular dysfunction results in motor delays, imbalance, and reduced academic performance. Despite this, pediatric vestibular assessment remains limited, likely because of reduced provider training and awareness of pediatric dizziness, which then results in delayed or missed diagnoses. Establishing an interdisciplinary pediatric vestibular program can improve early identification with timely and targeted rehabilitation. Purpose: The purpose of this review is to describe steps taken to initiate a multidisciplinary pediatric vestibular program and retrospectively review pediatric cases after initiation of the program. Research Design: This is a retrospective review. Study Sample: The study sample included children referred for vestibular evaluation (n = 119) at the Medical University of South Carolina (June 2023 to June 2025). Intervention: A pediatric vestibular program was established. Education and hands-on training were provided to pediatric audiologists, otolaryngologists, and rehabilitation therapists to increase comfort in identifying and managing pediatric vestibular disorders and to form a multidisciplinary network. Vestibular assessment was completed in children at risk for vestibular dysfunction. Testing was expanded from vestibular evoked myogenic potential (VEMP) only to include other vestibular function tests. Data Collection and Analysis: Medical records were reviewed for demographic, case history, audiological, vestibular, imaging, diagnoses, and management data. Results: Over 2 years, 119 children (mean age: 6.3 years, range: 2 months to 18 years) underwent vestibular testing. Most children (85 percent) presented with dizziness and/or balance concerns. Hearing loss was present in 60 percent of patients, and imaging was abnormal in 53 percent of those imaged. Among vestibular function tests, the highest completion rates were noted for cervical VEMPs (96.6 percent) and the video head impulse test (80 percent). Peripheral vestibular dysfunction was identified in 62 percent of ears, with otolith dysfunction (54 percent) more common than semicircular canal dysfunction (26 percent). The most common diagnoses included vestibular migraine/recurrent vertigo of childhood (15 percent) and unilateral peripheral vestibular hypofunction (15 percent). Children were most frequently referred to neurology and/or physical therapy for ongoing management. Conclusions: Developing a pediatric vestibular program is feasible through targeted provider education, expansion of diagnostic tools, and interdisciplinary collaboration, and will provide assessment and rehabilitation to a significant number of children. Clinical Relevance Statement: This model demonstrates an approach for health systems seeking to improve pediatric dizziness care pathways.
Background: Audiologists are expected to use evidence-based practices to guide their decision-making practices and recommendations regarding specific hearing aid technology for each patient. However, guidance regarding how to make these decisions is limited and sometimes conflicting. Hearing aid manufacturers have promoted the idea that an individual’s auditory ecology, which refers to their listening demands and environments, may contribute to interpatient differences in outcomes and benefits of specific technology. How the limited and conflicting evidence surrounding technology levels and auditory ecology impacts audiologists’ decision-making is unknown. Purpose: We sought to understand audiologists’ decision-making practices, including how they assess patients’ auditory ecologies and apply the results of such assessments to their decisions. Research Design: An online survey was sent to audiologists across the United States. The 21 survey questions covered respondent demographics, the hearing aid selection process, use of auditory ecology, and patients’ success with hearing aids. Study Sample: Survey respondents were clinical audiologists. A total of 185 completed surveys were included in the analysis. Data Collection and Analysis: The results of each topic area were summarized descriptively and investigated inferentially. Results: Most participants reported that a patient’s listening demands and environments were the most important considerations when selecting the technology level. The most popular method of evaluating a patient’s auditory ecology was a clinical interview. Most audiologists reported recommending higher-level technology for patients with more active lifestyles and lower-level technology for patients with calmer lifestyles. Conclusions: Audiologists reported prioritizing auditory ecology when selecting a technology level and using many different methods, sometimes in combination, to evaluate the auditory ecology of their patients. Clinician factors did not impact the use of auditory ecology or how they recommended technology levels. The use of auditory ecology did not impact return/exchange rates. Clinical Relevance Statement: Most audiologists have adopted a recommendation pattern of encouraging higher technology levels for patients who report more demanding listening environments and needs. More research is needed to gain a better understanding of the nuances of clinical interviews and unique practice approaches to evaluate auditory ecology.
