Objectives: For cochlear implant (CI) patients, reliable predictors of speech outcome are desirable. In this longitudinal study, we examined the contributions of spectro-temporal sensitivity to successful speech recognition following cochlear implantation. Design: We assessed N = 46 recently implanted adult patients shortly after CI activation (T1) and 6 months later (T2) with an adaptive ripple discrimination paradigm where dynamic ripples varied around the temporal rate of 4 Hz and spectral scale of 0.5 cyc/oct. At time points T1 and T2, we evaluated speech-in-quiet recognition using the Freiburg number and monosyllabic word test. The Oldenburg speech-in-noise test was administered 1 year after implantation (T3) to a subset of N = 36 CI recipients. Results: Shortly after implantation (T1), temporal ripple discrimination thresholds predicted speech-in-noise recognition 1 year later (T3; Pearson’s r = 0.51). In a linear model predicting 1-year speech-in-noise outcome, the predictors temporal or spectral thresholds at T1 and age performed better than speech measures such as Freiburg wordrecognition. Conclusions: A simple spectro-temporal ripple discrimination test is a reliable predictor of speech-in-noise outcome 1 year after cochlear implantation, over and above established clinical speech tests. It offers an efficient method in clinical settings to improve the early prediction of speech outcome.
Objectives: The main objective of this study was to investigate the evolution in stimulation levels (C-/M- and T-levels) in adult cochlear implant users from both Advanced Bionics and Cochlear, and to assess whether this trajectory differs between the two brands. The secondary objective was to assess individual patterns of stimulation levels during the first year post-implantation. Design: This retrospective study was conducted at the Erasmus University Medical Center in Rotterdam, the Netherlands. A total of 183 postlingually deaf adults with a unilateral cochlear implant from either Advanced Bionics or Cochlear were included. Stimulation levels (C-, M-, and T-levels) were collected from these adults for six fitting sessions during the first year postimplantation. Linear mixed-effects models were used to analyze longitudinal changes. Results: Our findings were comparable for both Advanced Bionics and Cochlear implant users. Mean M/C and T levels changed over time, showing a similar characteristic pattern for each patient with a rapid increase during the initial period, followed by gradual stabilization. Post hoc comparisons revealed significant differences between appointments up to the fourth fitting session for M/C levels and up to the third fitting session for T-levels. There were no significant differences after these fitting sessions. These findings were consistent across the different electrode segments (apical, medial, upper basal, lower basal), although earlier stabilization occurred in the lower basal segment for M/C-levels and in both basal segments for T-levels. Conclusions: The present study gave valuable insights into the temporal evolution of M/C- and T-levels during the first year postimplantation for both Advanced Bionics and Cochlear implant users. The mean M/C- and T-levels stabilized after approximately 3 months and 5 weeks, respectively, showing equivalent trajectories between the two brands. A consistent pattern was observed across patients, with stimulation levels rising significantly in the first few months and gradually stabilizing over time.
OBJECTIVES:This study assessed the reliability and measurement error of cervical vestibular evoked myogenic potential (cVEMP) latency and amplitude parameters in cochlear implant candidates and synthesized previous reliability evidence through an embedded meta-analysis. Together with a preceding paper on cVEMP activation and threshold reliability, this investigation extends the evaluation of clinically used cVEMP measurement properties to latency and amplitude outcomes. DESIGN:A test-retest study was conducted in adults with profound bilateral hearing loss. Each participant underwent two independent cVEMP examinations using identical tone-burst stimulation (500 Hz, 2 msec duration) and recording parameters. Reliability was assessed for the p13 and n23 latencies, the inter-peak interval (IPI), and the corrected peak-to-peak amplitude (cAMP). Variance components were estimated using random-effects models accounting for subject, side, and test session. Single-measure, absolute-agreement intraclass correlation coefficients (ICCs), SEs of measurement (SEM), and minimal detectable change (MDC95%) were derived from the variance components. A random-effects meta-analysis of previous cVEMP reliability studies was conducted after transformation of reported ICCs to single-measure form and calculation of confidence intervals. RESULTS:Twenty-seven patients contributed to the full analysis. For threshold-level trials, ICCs (95% confidence interval) were: p13 = 0.61 (0.41 to 0.81), n23 = 0.32 (0.10 to 0.54), IPI = 0.29 (0.07 to 0.51), and cAMP = 0.16 (0.00 to 0.36). Corresponding SEMs were 1.27, 1.87, 1.47, and 0.16 msec, with MDC95% values of 3.5, 5.2, 4.1, and 0.45 msec, respectively. The wide confidence intervals and SEMs revealed considerable within-subject variability across sessions. For the meta-analysis, seven studies were identified, and up to five contributed to each outcome-specific analysis because sufficient methodological clarity permitted conversion to single-measure ICCs. Pooled random-effects estimates (95% confidence interval) were: p13 = 0.52 (0.38 to 0.64), n23 = 0.57 (0.39 to 0.71), IPI = 0.47 (0.08 to 0.73), and cAMP = 0.63 (0.44 to 0.76). Between-study heterogeneity varied across outcomes, ranging from negligible to high, reflecting methodological and analytical differences. Despite these differences, the clinical and pooled data were concordant, each showing only a moderate degree of reliability. CONCLUSIONS:Across the clinical test-retest data and the pooled evidence, cVEMP latency and amplitude measures showed moderate reliability with wide confidence intervals and notable measurement error. The MDC95% values for cVEMP latencies indicate that differences of several milliseconds are required to exceed random variability expectable from test repetition, limiting their interpretability for individual monitoring. Considered together with the meta-analytic findings and the preceding results on cVEMP activation and threshold detection, these findings suggest that current cVEMP measurement procedures do not achieve the reliability required for widespread clinical use in individual patients. Although cVEMP outcomes may be informative for group-level or research comparisons when measurement precision is explicitly considered, their role as diagnostic or monitoring tools should remain limited until methodological refinements demonstrably improve reproducibility.
OBJECTIVES:To evaluate the predictive value of two novel video head impulse test-derived biomarkers-supersaccades (single covert saccades) and the VOR Inconsistency Score (VIS)-in forecasting early vestibulo-ocular reflex (VOR) gain recovery in patients with unilateral peripheral vestibular dysfunction (UPVD). DESIGN:Retrospective cohort study including 90 patients with UPVD assessed within 48 hours of symptom onset and followed up at 1 month. Examinations were performed at two neurotology units between July 2014 and December 2023. RESULTS:Early VOR gain recovery was achieved by 32 patients (36%): binary logistic regression identified age, supersaccades, and VIS as independent predictors of recovery. A significant interaction was found between age and VIS, indicating that the detrimental effect of reflex inconsistency on VOR recovery is significantly amplified by older age. Receiver operating characteristic analysis of the logistic regression model yielded an area under the curve of 0.881. Using the Youden Index to determine the optimal cut-off probability provided a sensitivity of 81.3% and a specificity of 87.9%. Restricted cubic splines and segmented regression identified a critical structural breakpoint at a VOR gain of 0.448. This threshold defined two physiological states: when gain <0.448, supersaccades were rarely observed, and VIS served as the dominant predictor. When gain ≥0.448, VIS was more stable and less discriminant, whereas supersaccades were more frequent and served as the main recovery marker. CONCLUSIONS:Supersaccades and VIS independently predict early VOR gain recovery, offering a more nuanced prognostic assessment than gain values alone. Incorporating dynamic VOR response features may improve early patient stratification and guide rehabilitation strategies in UPVD.
OBJECTIVES:Auditory frequency selectivity is a critical determinant of speech intelligibility in noise. Although fast psychophysical tuning curves (fPTCs) and otoacoustic emission (OAE)-based metrics are often interpreted as indirect estimates of cochlear tuning, they differ in measurement pathway and physiological source. It remains unclear whether these methods provide interchangeable estimates at the individual-listener level. This study evaluated the correlation, absolute agreement, and Bland-Altman limits of agreement among behavioral and OAE-based tuning estimates to determine whether one method can serve as a reliable proxy for another in clinical or translational assessments. DESIGN:A secondary analysis was performed on a dataset of 67 adults with hearing profiles ranging from normal to moderate high-frequency loss. Frequency selectivity was quantified at 2, 4, and 8 kHz using three methods: fPTCs, distortion product OAE-level ratio function estimates, and stimulus-frequency otoacoustic emission (SFOAE) phase-gradient delays. Tuning sharpness, quantified as the equivalent-rectangular-bandwidth quality factor (QERB), was compared across methods using Pearson correlations, intraclass correlation coefficients, and Bland-Altman limits of agreement. The impact of high-frequency thresholds and signal to noise ratio on method discrepancy was also modeled. RESULTS:Intermethod associations were weak and inconsistent across frequencies. Absolute agreement was poor, with intraclass correlation coefficient [(2,1)] values near or below zero across method pairs. Bland-Altman analyses showed wide limits of agreement, indicating substantial individual-level disagreement. At 4 kHz, the fPTC-SFOAE comparison showed limits of agreement from approximately -2.11 to 1.53 log units, corresponding to multiplicative limits of approximately 0.12× to 4.63× on the original QERB scale. Higher high-frequency thresholds and lower SFOAE signal to noise ratio were associated with greater intermethod disagreement. CONCLUSIONS:Behavioral and OAE-based tuning metrics were not interchangeable at the individual-listener level. The weak correlations, poor absolute agreement, and wide limits of agreement suggest that fPTC, distortion product OAE-level ratio function, and SFOAE phase estimates should be treated as complementary rather than redundant measures. Future work should determine whether intermethod mismatch provides diagnostic information beyond any single tuning metric.
Objectives: Single-sided deafness (SSD) disrupts binaural auditory input and can lead to cortical reorganization affecting neural oscillatory activity. Whether the side of hearing loss (left versus right) yields distinct electroencephalography (EEG) spectral and lateralization patterns remains unclear. We compared spectral resting-state EEG power and hemispheric asymmetry among patients with left SSD (LSSD), right SSD (RSSD), and normal-hearing controls (NH). Design: Resting-state EEG was recorded from 100 participants, including 32 with LSSD, 31 with RSSD, and 37 NH. A power spectrum was computed for six canonical frequency bands ( δ , θ , α , β , γ 1 , γ 2 ). Group differences in spectral power were tested, and hemispheric asymmetry was quantified with a lateralization index per band. Associations between EEG measures and hearing thresholds, the Speech, Spatial and Qualities of Hearing Scale, and speech recognition were analyzed. Results: Compared with NH, both LSSD and RSSD showed a significant increase in γ 1 power over frontocentral to posterior regions. Notably, RSSD additionally exhibited widespread power increases in the θ and β bands, with pronounced effects in frontocentral and parieto-occipital regions. Lateralization analysis revealed stronger right-hemisphere dominance in the parietal δ and θ power in RSSD compared with NH, whereas LSSD showed a large symmetric power distribution and did not differ significantly from NH. No significant associations were observed between spectral power and clinical measures after multiple-comparison correction. Conclusions: Resting-state EEG indicates side-specific cortical reorganization in SSD. LSSD is marked by localized γ 1 band enhancements, whereas RSSD shows more widespread power increases and greater right-hemispheric dominance in low frequencies. These asymmetric patterns suggest distinct compensatory mechanisms involving attention and multimodal integration and may have implications for laterality-specific rehabilitation approaches.
Objectives: This study aims to elucidate the timing and mechanisms associated with postoperative residual hearing loss following cochlear implantation and to assess the feasibility of clinical tools designed for prospective cochlear health monitoring. Design: A prospective clinical cohort investigation was conducted utilizing patient-administered in-home cochlear health monitoring to track electrocochleography (ECochG) and four-point impedance (4PI) fluctuations during the first three postoperative months. Results: The study included 32 subjects who completed the in-home testing over the first 3 months following cochlear implantation. ECochG markers identified during real-time ECochG monitoring of electrode insertion correlated with poorer hearing preservation outcomes (Skarzynski hearing preservation scores [mean hearing preservation: 56.88 versus 38.91%, p = 0.0328]) and higher impedances recorded on in-home testing (peak median 4PI: 398.46 Ω versus 270.75 Ω, p = 0.0478). Drops in cochlear microphonic (CM) amplitude detected through in-home monitoring were associated with poorer hearing preservation (mean LFPTM loss: 31.45 versus 11.78 dB, p = 0.0003) and higher impedance values (431.3 Ω versus 262.9 Ω, p = 0.0047). The study identified significant markers of hearing preservation in CM amplitude and 4PI, detectable through postoperative in-home monitoring. Conclusions: Patient-initiated in-home monitoring of cochlear health biomarkers is feasible and provides valuable insights into the recovery of inner ear function following CI. The identified markers, CM amplitude, and 4PI have the potential to personalize postoperative care and improve hearing preservation outcomes.
OBJECTIVES:A recent study found that hearing aids fitted with highly occluding domes had an impact on the perception of externally presented speech, producing sound images that were perceived as too close or even inside the head. The present study examined whether this phenomenon is related to the well-known occlusion effect, which describes changes in ear canal levels and perceived own-voice quality during speaking. DESIGN:Participants were 10 young adults with normal hearing and 10 young adults with sensorineural hearing loss. All participants were fitted with both closed- and open-fit hearing aids, and hearing aid users were also tested with their own devices. Externalization was measured using a numerical scale from 0 (inside the head) to 10 (at the loudspeaker). Participants also rated the naturalness of their own voice while speaking using a subjective scale from 1 (most unnatural) to 10 (most natural). Occlusion was also measured objectively for open and closed fittings using real ear measurements. RESULTS:Externalization ratings were significantly higher for unaided than aided listening and for open versus closed domes. Similarly, own-voice ratings tended to be higher for unaided versus aided listening and for open versus closed domes. Although these broad patterns suggest that reduced ratings are associated with more occlusion, objective measures of occlusion did not account for a significant amount of the variance in either kind of rating. Similarly, individual own-voice ratings did not significantly predict individual externalization ratings. The data obtained with hearing aid users wearing their own devices suggested that regularly worn devices can have positive effects on own-voice perception while disrupting externalization. CONCLUSIONS:Overall, compared with unaided listening, hearing aids negatively affected externalization and own-voice perception, with larger effects for closed than open fittings. However, at the individual level, measures of occlusion and sound externalization were not strongly related.
OBJECTIVES:Understanding the relationship between extended high-frequency (EHF) hearing and middle ear muscle reflex (MEMR) function may clarify how variations in cochlear health affect auditory reflexes, providing insight into subclinical auditory deficits and potential early markers of hearing loss. In this study, the authors examined whether elevated EHF thresholds are associated with reduced MEMR growth in adults with clinically normal audiograms. The authors hypothesized that individuals with higher EHF thresholds would exhibit shallower MEMR growth functions despite normal thresholds in the conventional frequency range. DESIGN:Eighty-three young adults (aged 18 to 34 years; 166 ears) completed audiometric testing, lifetime noise exposure assessment using the Noise Exposure Structured Interview, tympanometry, and ipsilateral MEMR measurements. MEMR thresholds and growth functions were measured using a broadband noise elicitor and modeled using both linear and segmented regression approaches. Linear mixed-effects models examined associations between standard and EHF hearing thresholds and MEMR outcomes, controlling for covariates. RESULTS:Age, but not lifetime noise exposure, was significantly associated with elevated EHF thresholds (p < 0.001). Neither standard frequency nor EHF thresholds were significantly related to MEMR thresholds. However, poorer EHF sensitivity was associated with significantly shallower MEMR growth functions, indicating reduced reflex strength in ears with EHF loss despite a clinically normal audiogram. Segmented regression revealed clear MEMR growth function breakpoints in both groups, with the EHF loss group showing a lower breakpoint and overall shallower growth. No significant effects of noise exposure were observed for MEMR threshold and slope. CONCLUSIONS:In young adults with clinically normal audiograms, elevated EHF thresholds were associated with shallower MEMR growth, while MEMR thresholds were relatively insensitive to variation in EHF hearing. As MEMR has been used to infer cochlear synaptopathy, these findings indicate that subclinical differences indexed by EHF hearing are significantly associated with MEMR growth characteristics. This pattern suggests that MEMR changes may not uniquely reflect synaptopathy but may also arise from basal cochlear influences.
OBJECTIVES:The objective of this study was to identify factors to adapt the design, implementation, evaluation, and scalability of the Specialty Telemedicine Access for Referrals (STAR) model, an evidence-based model for school hearing screening and telemedicine follow-up. DESIGN:The authors conducted a formative evaluation to adapt the STAR model using community feedback to codesign the intervention, implementation, and evaluation of the model in preparation for a mixed-methods, hybrid type 1 effectiveness-implementation trial in three distinct rural regions of Alaska. Using snowball sampling, the authors recruited individuals from participating regions who had experience with either school hearing screening or the ear and hearing healthcare pathway. After providing informed consent, participants completed virtual semi-structured interviews on the components of STAR (school hearing screening, telemedicine follow-up, and communication between schools, healthcare providers, and families). The authors used rapid analysis methodology to summarize the data and identify constructs. Data were then coded using four of five domains from the Consolidated Framework for Implementation Research: innovation (changes that are new to the people implementing them), individuals (attributes of people involved in the implementation), inner setting (characteristics of the organizations where the intervention is taking place), and outer setting (external factors that influence implementation). The authors developed action items to adapt the trial's design, implementation, evaluation, and scalability. RESULTS:From March to December 2022, study staff conducted 23 semi-structured interviews with individuals representing school staff, healthcare providers, and parents. The authors identified 19 Consolidated Framework for Implementation Research constructs across the four domains (innovation, individuals, inner setting, outer setting), yielding 43 actions in the following categories: STAR model adaptations, training materials, implementation plans, implementation evaluation, Community Advisory Board feedback, and scalability. Examples included revising parent forms to capture the primary care provider to support referrals, updating training materials with guidance on scheduling screening days, updating the implementation plan with guidance on privacy-compliant communication and documentation of screening results, adding measures to the implementation evaluation to document which communication platforms and pathways school staff use, seeking Community Advisory Board input on strategies to cultivate buy-in for evidence-based practices, and adding evaluation metrics to inform cost projections for scalability. CONCLUSIONS:This formative evaluation enabled community-informed design, implementation, and evaluation of the adapted school hearing screening and telemedicine follow-up model in an effectiveness-implementation trial. The evaluation also prompted changes to consider for expanding the reach of the model. Findings highlight the value of formative evaluations and rapid qualitative analysis methods for guiding codesigned, evidence-based interventions in hearing health research.
OBJECTIVES:Prior research has shown that, among normal hearing college students, Hispanic-identifying participants experience higher levels of environmental noise and lower signal to noise ratios as compared with White non-Hispanic participants. The primary objective of this study was to examine whether these differences extend to cochlear implant (CI) users by using CI datalogging to quantify characteristics of the listeners' auditory environments. The authors further examined whether differences in auditory environments between groups persisted after controlling for demographic and socioeconomic factors. The primary socioeconomic variable of interest was population density, as it strongly correlates with other socioeconomic factors (e.g., education and income) and is more likely to directly influence auditory environments. DESIGN:A retrospective chart review of CI patients at a tertiary medical center in New York City identified 80 adults (38 Hispanic, 42 White non-Hispanic) for further review. Demographic variables were compiled, and home addresses were used to obtain population-based socioeconomic data via the U.S. Census. Datalogging information extracted from the CI speech processor included hours of total use and time spent in different auditory environments, classified by the CI software into sound levels (in dBA) and sound scenes ("noise," "quiet," "speech in noise," "speech in quiet," "music," and "other"). RESULTS:Despite similar levels of device usage, there was a statistically significant group difference in the percentage of time spent in each scene: Hispanic-identifying participants spent more time in "speech in noise," "music," and "noise"; White non-Hispanics spent more time in "quiet" and "other." The Hispanic participants lived in census tracts with higher population density, which correlated with higher sound levels (>70 dBA) in the environment. Group differences in auditory environments remained statistically significant after controlling for age, CI experience, and population density (median daily level difference ~2.4 dB). CONCLUSIONS:Even after accounting for demographic and socioeconomic factors, the two groups showed distinct auditory environments, indicating a possible cultural contribution to these differences. Audiologists counseling CI patients regarding auditory environments should be conscious of their patients' cultural background and may consider the impact of listening preferences when advising on which environments to seek out or avoid.
OBJECTIVES:Adults with hearing loss experience poorer health outcomes than their hearing counterparts. As hearing loss becomes more prevalent in the United States, research examining how to reduce health disparities among this population is needed. This study aimed to estimate the associations between hearing loss and each of poor physical and mental health, evaluate health literacy as a mediator of these relationships, and estimate the proportion of cases of poor physical and mental health that are attributable to having lower health literacy among adults with hearing loss. DESIGN:The 2016 Behavioral Risk Factor Surveillance System survey included cross-sectional data on self-reported hearing difficulty, health literacy, and number of days of poor physical and mental health in the past 30 days in a subpopulation of adults aged 18 and over among 17 US states and territories (N = 104,792). The number of days of poor physical and mental health was split into 5 categories (0, 1 to 10, 11 to 20, 21 to 29, and all 30 days). Age-stratified weighted complex survey logistic regression models estimated the total and direct effects of hearing difficulty on poor physical and mental health, and the indirect effects mediated by health literacy. Outcomes for poor physical and mental health were modeled separately as 1+ days versus 0 days, 11+ days versus ≤10 days, 21+ days versus ≤20 days, and all 30 days versus <30 days. Models were adjusted for age, sex, race/ethnicity, education, income, marital status, and health insurance coverage. Population attributable fractions were used to estimate the proportion of adults with hearing difficulties who experienced poor physical and mental health due to having lower health literacy. RESULTS:Compared with those without hearing difficulties, those with hearing difficulties had a higher prevalence of lower health literacy (70.3% versus 56.2%), 30 days of poor physical health (16% versus 6.4%), and 30 days of poor mental health (10.7% versus 5.3%). Odds ratios for the total effect of hearing difficulty ranged from 1.68 (95% confidence interval [CI]: 1.44 to 1.92) to 1.87 (95% CI: 1.66 to 2.08) for poor physical health and 1.68 (95% CI: 1.51 to 1.85) to 2.20 (95% CI: 1.81 to 2.59) for poor mental health. The indirect effect of hearing difficulty mediated through health literacy explained between 3.8 and 4.8% of the total effect for poor physical health and 2.3 and 6.6% for poor mental health. When stratified by age, the total effect generally declined as age increased, while the indirect effect stayed relatively consistent. Over 218,000 cases of poor physical health lasting 30 days and over 115,000 cases of poor mental health lasting 30 days were attributable to having lower health literacy. CONCLUSIONS:The results show that those with hearing difficulties experience significantly poorer physical health, poorer mental health, and lower health literacy. Health literacy was determined to be a significant mediator between hearing difficulty and both poor physical and mental health. Findings suggest that improving health literacy among this population would reduce the number of days of poor physical and mental health in the past month experienced by adults with hearing difficulty in the United States.
OBJECTIVES:Accurate identification of the specific inner ear malformations can assist the otologist in anticipating surgical challenges and potentially optimizing postoperative hearing outcomes. In this study, we explored the feasibility of applying similar cochlear morphology principles, that is, ones based on easily quantifiable measurements of the basal turn, to differentiate normal lateral wall geometry from malformed variants. DESIGN:We retrospectively collected 60 patients who underwent cochlear implantation in our center between 2005 and 2023 in the presence of a preoperatively recognized inner ear malformation. Of the 120 analyzed cochleae, 111 were eligible for segmentation, which included 8 cochlear hypoplasia type II, 15 cochlear hypoplasia type III, 2 cochlear hypoplasia type V, 38 Incomplete partition type I, 44 Incomplete partition type II, and 4 incomplete partition type III. A control cohort of 141 normal cochleae was selected. Using manual segmentation of the cochlea on preoperative cone beam computed tomography scans, three-dimensional lateral wall spirals were obtained. The spirals were then used to compute simple anatomical measures of the basal turn, namely the cochlear diameter A and width B, the basal turn length computed based on A and B using the elliptic circular approximation approach, the ratio B/A and the B ratio, and cochlear height (H). Initially, two-sided Mann-Whitney-Wilcoxon tests were conducted to derive statistical differences in the aforementioned geometrical parameters between normal and malformed anatomies. Second, logistic regression analyses were performed to define whether the derived geometrical parameters may be used to predict if a specific cochlear morphology is normal or malformed, and to subsequently investigate if such a model may even be capable of distinguishing between different malformation types. RESULTS:Four geometrical basal‑turn parameters easily assessable in clinical imaging, namely the basal turn length along the lateral wall, cochlear height (H), B/A ratio, and B‑ratio, provide enough information to reliably distinguish normal cochleae from malformed variants. The binary logistic model achieved 94% overall accuracy with precision and recall ≥0.92 across classes, with cochlear height H emerging as the dominant predictor. In our models, H and Bb/B were the strongest discriminants for normal versus malformed anatomies and for incomplete partitions versus cochlear hypoplasia, respectively. Moving beyond binary discrimination, the three‑class model (normal versus IP versus CH) retained 90% accuracy. In summary, the models reliably recognize normal versus malformed, incomplete partition versus cochlear hypoplasia, and CHIII among individual subtypes due to reduced height. They are less reliable for IPI versus IPII differentiation, where basal‑turn measures alone appear insufficient, and IPIII, CHII, CHIV, where very small sample sizes depress recall. CONCLUSIONS:Simple, basal‑turn measurements of the lateral wall were demonstrated to provide a fast, interpretable, and accurate means to detect cochlear malformations on clinical imaging and to differentiate IP from CH. The approach reliably flags abnormal cases, offers actionable preoperative information for patient‑tailored implantation, and identifies domains where additional features or larger cohorts are needed (IPI versus IPII; rare subtypes). Such a model could lay the groundwork for future automated recognition of cochlear malformations during preoperative planning.
OBJECTIVES:Sodium thiosulfate (STS) has recently been approved as an otoprotectant for systemic use in pediatric cancer patients receiving cisplatin treatment for localized, nonmetastatic solid tumors by the Food and Drug Administration, European Medicines Agency, and Medicines and Healthcare Products Regulatory Agency. While incorporating STS into the current standard of care pediatric practice, questions about uniform, timely, and safe administration are raised that may benefit from additional guidance. DESIGN:Recognizing that advancing clinical practice presents multiple challenges, an international onco-ototoxicity prevention task force, including experts in pediatric oncology, audiology, and pharmacology, was established to identify potential barriers to the implementation of otoprotection and to offer practical solutions for clinical services for children exposed to cisplatin, based on available evidence, as well as consensus where data are less robust. This task force held several online meetings and a working group session at the annual SIOPE meeting in Milan in May 2024, where the challenges for implementing STS were outlined and addressed. RESULTS:Nine key challenges were identified, including, for example, the timing of both cisplatin infusion and STS administration, the optimal integration of STS into existing treatment protocols, potential drug interactions, and relevant economic considerations. CONCLUSION:In this article, we propose practical steps to address these challenges, informed by the existing literature and expert opinion, incorporating recommendation statements from the international onco-ototoxicity prevention task force on behalf of the SIOP Supportive Care Network, to facilitate the implementation of STS in children with localized, nonmetastatic disease.
BACKGROUND:Conversations are an important part of our social lives, although for people with hearing impairment (HI), conversations can pose a considerable challenge and can often lead to miscommunications. DESIGN:In conversations recorded from 25 groups consisting of one HI interlocutor and two normal hearing (NH) interlocutors, all miscommunications were identified to evaluate how HI, background noise level, and hearing-aid signal processing affected miscommunications. A subset of miscommunications is so-called other-initiated repairs (OIRs) where one interlocutor signals a communication breakdown, using unspecific open requests (e.g., "What?") or increasingly more specific restricted requests or offers (e.g., "Who?" or "Did you say blue?"). An "open request" signals a problem without specifying what is misheard/understood, while the restricted request specifies what part of the sentence is not heard, and finally, the most specific "restricted offer" is asking the conversation partner to confirm the supposed word/phrase. With increasing communication difficulty, open OIRs are expected to be more frequently used due to poorer speech understanding. RESULTS:The results showed that HI interlocutors generally had more miscommunications and that, across interlocutors, open OIRs were mostly used. At low noise levels, the HI interlocutor had fewer miscommunications and used more specific OIRs when wearing a hearing aid relative to being unaided. At the high noise level, all interlocutors had more miscommunications. When listening to directional sound processing (dir) at the high noise level, the HI interlocutor produced fewer open OIRs. It is interesting that the NH interlocutors were also affected by having more miscommunications and more open OIRs when the HI interlocutor listened to dir. The speech levels of the HI interlocutors were reduced in dir, and a relationship was found between the HI speech levels and the number of OIRs made by the NH interlocutors. CONCLUSIONS:Our results highlight how sensitive the number and nature of miscommunications and OIRs in conversations are, not only to the sound environment, but also to the experience of a single (HI) interlocutor, even in triadic interactions, where only two interlocutors are strictly needed to keep the conversation going.
OBJECTIVES:Musicians are routinely exposed to sound levels that place them at risk of hearing loss. Although the dangers of sound overexposure from music are well-known, less is known about which specific types of music activities contribute to this risk. Past study indicated that college musicians experience potentially hazardous sound levels during both musical and nonmusical activities. We now expand this line of investigation to a larger dataset to subtype musicians (based on instrument, ensemble type and number, and music-major status) and capture a wide array of musical engagement (total years of training, total hours of music engagement during the week). DESIGN:Descriptive study of college musicians with hearing thresholds <25 dB HL combining personal noise dosimetry, daily activity diaries, and musician subtyping. RESULTS:The college musicians in our sample showed a wide range of average daily sound exposure, spanning from 2 to 1638% of the National Institute of Occupational Safety and Health daily recommended exposure limit dose. It is important to note that ~70% of the cohort's average daily sound exposure exceeded the National Institute of Occupational Safety and Health recommended exposure limit dose. We found that total years of musical training did not predict daily dose, but weekly hours of music activities did. When subtyping musicians, we found that music majors and nonmajors experienced similar average daily sound exposure; that brass and woodwind players tended to experience more sound exposure than string musicians; that musicians in multiple ensembles experienced more sound exposure than those in only one ensemble; and that musicians in band ensembles experienced more sound exposure than those in orchestral ensembles. The musician subtypes at lowest risk were vocalists and string players. Musicians who engaged in more hours of musical activity during the week experienced higher levels of sound exposure. Marching band members were more likely to engage in high-sound-intensity nonmusic activities compared with music majors. But even within different musician subpopulations, average daily sound exposure varied across individuals and the type and extent of music engagement accounted for only about half of the variance in average daily sound exposure. CONCLUSIONS:The college musicians in this sample varied widely in their sound exposure profiles. Musician subtype accounted for some of this variation, as did total hours of music engagement. However, neither variable captured the full range observed. As such, relying on musician subtype or total hours of engagement as a proxy measure for exposure could lead to erroneous conclusions about risk at the individual level. This finding highlights the need for individualized sound-exposure assessment to evaluate risk and provide appropriate recommendations to musicians to maintain their hearing health.
OBJECTIVES:Prenatal exposure to the Zika virus may have an adverse effect on communicative functioning in children, even in the absence of microcephaly associated with Congenital Zika Syndrome. This study characterized cortical auditory neural function and communication abilities in normocephalic children with and without prenatal Zika virus exposure. DESIGN:Cortical auditory evoked potentials were recorded in response to naturally spoken consonant-vowel syllables in 117 Brazilian children with prenatal exposure to the Zika virus (M age: 6.29 ± 0.42 years) and a comparison group of 90 non-exposed children (M age: 5.54 ± 0.95 years). Language and communication abilities in daily life were evaluated using a battery of standardized behavioral measures and caregiver reports. RESULTS:Caregivers of exposed children reported significantly lower than typical adaptive functioning in the communication and socialization domains. Cortical auditory evoked potential analyses identified earlier speech sound differentiation in the non-exposed controls than in the exposed group (P1 versus N2 response). Exploratory analyses controlling for multiple postnatal factors indicated that greater cortical N2 speech sound differentiation was associated with more adaptive communication abilities. CONCLUSIONS:Normocephalic children with prenatal exposure to the Zika virus may exhibit subtle differences in auditory processing of speech that are associated with less adaptive communicative functioning in daily life. These results highlight the value of longitudinal follow-up of children with prenatal virus exposures and the utility of auditory evoked potentials in assessing populations at risk for altered neurodevelopment.
