OBJECTIVE:Investigate the benefits of using the Hearing Stages tool to raise awareness, and uptake of appropriate hearing loss management options. DESIGN:The tool was introduced into hearing aid clinics (n = 16) during a 12-month pilot study. Hearing Health Care providers (HHCPs) discussed the tool and recorded a hearing stage for adults attending hearing appointments. Experience using the tool was assessed via online surveys. A subgroup of individuals whose hearing results suggested potential benefit from cochlear implants (CI) were reviewed to determine if using the tool increased referrals for CI evaluation. STUDY SAMPLE:Adults (≥18 years) attending 19,102 hearing appointments. Adult HHCPs using the tool in clinic (n = 35). RESULTS:Hearing stages were recorded during 2057 of 19,102 hearing appointments. A subset of clients completed a pre-appointment (n = 188) and post-appointment (n = 58) experience survey. Seven HHCPs completed a separate online experience survey. The tool prompted discussion about hearing management options prior to and during appointments and significantly improved referral rates for CI evaluation. Clients found the tool useful and easy to use. Further work is required to integrate the tool into the clinical setting. CONCLUSION:The Hearing Stages tool is an easy-to-use, useful tool facilitating consideration of various hearing management options.
OBJECTIVE:This study explores the potential impacts of natural hazards for people who use hearing devices. DESIGN:A cross-sectional online survey was used, based on the Emergency Preparedness Survey of People with Disability. STUDY SAMPLE:124 deaf, Deaf or hard-of-hearing adults living in Australia completed the survey; of these, 114 respondents used at least one hearing device. RESULTS:Findings reveal significant dependence on hearing devices among some deaf, Deaf or hard-of-hearing people. One-third of respondents who could communicate effectively with their hearing device/s reported complete communication loss without their device; this also impacted abilities to make spoken emergency calls. Losing or damaging a device negatively impacted many respondents, who also relied on power for charging batteries and smartphones, which may control hearing devices. CONCLUSIONS:Hearing device reliance impacts how natural hazard emergencies are experienced when devices may be lost, damaged, or unable to be powered - highlighting the need for targeted emergency preparedness strategies. This study demonstrates the importance of integrating considerations for assistive devices into emergency planning and response frameworks. There are vital roles for device manufacturers and suppliers in ensuring device resilience during natural hazard emergencies, and for professionals in supporting people to develop emergency preparedness plans that reflect their reliance on and connection to their assistive devices.
OBJECTIVE:To characterise temporal patterns in over-the-counter (OTC) hearing-aid research before and after U.S. Food and Drug Administration (FDA) implementation of the OTC category (effective October 2022), using bibliometrics and large language model (LLM)-assisted abstract-level annotation. DESIGN:Bibliometric analysis combined with abstract-level LLM content analysis using the GABRIEL framework. The pipeline combined human screening, bibliometric analysis, GABRIEL-based abstract-level LLM annotation, and cross-model concordance assessment in a proof-of-concept workflow. Pre- and post-implementation cohorts were compared on eight predefined dimensions using Mann-Whitney U tests with Benjamini-Hochberg correction; cross-model concordance assessed robustness to model choice rather than criterion validity. STUDY SAMPLE:106 OTC hearing aid-related articles indexed in Web of Science, screened by human raters and divided into pre-implementation (n = 45, 1995-2022) and post-implementation (n = 61, 2023-2026) cohorts. RESULTS:In the primary analysis, the only dimension reaching Benjamini-Hochberg-adjusted significance was reduced older-adult emphasis (p_adj = .050, r = .266); consumer perspective and mild-to-moderate hearing-loss focus increased directionally, with the consumer increase reaching adjusted significance only in an exploratory sensitivity analysis. Evidence type shifted from commentary-dominated to empirical research (χ2 = 13.32, Monte Carlo p = .014, Cramér's V = .385). Descriptive temporal patterns were consistent with reorientation beginning during the 2017-2022 legislative and rulemaking period rather than at market entry. CONCLUSIONS:This proof-of-concept suggests that LLM-assisted abstract-level annotation, paired with human screening and bibliometric analysis, can support rapid mapping of research agendas in fast-evolving fields. Findings represent temporal associations within a high-precision Web of Science corpus rather than causal effects of the FDA rule or expert-validated content measurements. Persistent gaps in low-income/underserved population research and geographic asymmetries point to priorities for targeted investigation.
OBJECTIVES:The study compared stapedius reflex thresholds during presentation of acoustic stimuli in an open sound field (sf-SRT) in paediatric cochlear implant (CI) users with the MED-EL system and children with bilateral normal hearing sensitivity. DESIGN:The sf-SRT was measured using open-sound-field acoustic stimulation with narrow-band noise (NBN) centred at 0.5, 1, 2, and 4 kHz, and broad-band noise (BBN). The sf-SRTs were measured twice in two different sessions. STUDY SAMPLE:Nineteen unilateral paediatric CI users and twenty children with bilateral normal hearing sensitivity, with an age range from 3 to 12 years. RESULTS:The sf-SRT levels ranged from 65 to 103 dB HL and 70 to 90 dB HL across stimulus types in the CI and normal-hearing groups, respectively. Mann-Whitney U test revealed that the CI group had significantly higher sf-SRT levels for 2 kHz NBN than the normal-hearing group. In the CI group, repeated-measures ANOVA revealed significantly higher sf-SRT levels for NBN centred at 2 kHz than for 0.5 kHz and BBN. The sf-SRT measurements were reported to be reliable in the CI group. CONCLUSION:High test-retest reliability was demonstrated, supporting the use of sf-SRT measurements to confirm upper stimulation levels in paediatric CI users.
OBJECTIVE:To examine how clinical goal-setting is used in routine audiological practice and the extent to which practice aligns with evidence-informed elements of person-centred goal-setting. DESIGN:Multi-method exploratory study comprising semi-structured interviews, in-clinic observations, and an international online survey. STUDY SAMPLE:Survey responses from 97 hearing health professionals from 16 countries; interview transcripts from eight audiologists; observations from 12 adult hearing assessment appointments conducted by four audiologists. RESULTS:Goal-setting was widely endorsed as best practice in audiological rehabilitation, with the Client Oriented Scale of Improvement commonly used to structure discussions. However, findings identified several convergent barriers to effective goal-setting: clients were not consistently active partners and were often unaware of formal goals; clinicians reported difficulty eliciting specific, personally meaningful goals, particularly with communication or cognitive barriers; time pressure constrained goal discussions; structured tools to support goal elicitation and client access to goals were limited; goals were frequently documented but not used as an ongoing rehabilitation focus. CONCLUSIONS:Goal-setting in audiology is practised frequently but appears to be enacted inconsistently as an iterative rehabilitation process. Strengthening client ownership, goal specificity, strategy planning, and structured review would likely improve its clinical utility.
OBJECTIVE:This review synthesises economic evidence for pre-school hearing screening, a debated strategy for detecting hearing loss missed by newborn programs. DESIGN:Following PRISMA guidelines, A comprehensive search of the Cochrane Library, EMBASE, and PubMed was performed from database inception through March 2025. The review included full economic evaluations (cost-effectiveness analyses) reporting cost per Quality-Adjusted Life Year (QALY) or Disability-Adjusted Life Year (DALY). STUDY SAMPLE:Four decision-analytic modelling studies included. The studies were from the United Kingdom, Iran, and Australia, focusing on screening children at or before primary school entry. RESULTS:Evidence synthesis revealed significant heterogeneity. Three studies were cost-effective, while one suggested it was not. This divergence was strongly influenced by methodological factors: the modelled time horizon, the choice of outcome metric (QALY vs. DALY), and the baseline coverage of UNHS. For instance, the Incremental Cost-Effectiveness Ratio for pure-tone screening fell from $5,814/QALY over one year to $401/QALY over an 11-year horizon. CONCLUSIONS:The cost-effectiveness of pre-school hearing screening is highly context-dependent. Key determinants include existing UNHS infrastructure, the chosen screening technology, and the evaluation time horizon. Policymakers must consider these local factors to implement the most economically viable strategy.
OBJECTIVE:We examined the Tinnitus Functional Index (TFI), a commonly-used scale assessing the impact of tinnitus disorder on daily activities using network psychometrics. DESIGN:Nodes represented the 25 TFI items, and connections represented correlations between items, forming a web-like network of tinnitus disorder. STUDY SAMPLE:931 people with tinnitus who completed the TFI. RESULTS:Metrics at the micro-level (measuring individual nodes) identified 5 "important" items with high closeness centrality to target for future interventions. Metrics at the meso-level (subsets of nodes in the network) identified communities of well-connected items that recreated the original 8 subscales of the TFI. Further analysis at the meso-level suggests the Auditory subscale may be an important factor for future research on tinnitus disorder. CONCLUSIONS:Other ways the network approach may advance the speech-language-hearing sciences are discussed.
OBJECTIVE:To investigate the relationship between daily manual abilities, as measured by the ABILHAND questionnaire in hearing aid users, and their hearing aid handling skills, independently assessed by a panel of Hearing Care Professionals (HCPs) using a dedicated questionnaire. The study aimed to assess the potential of the ABILHAND questionnaire as a tool to guide HCPs in hearing aid choices. DESIGN:A cross-sectional study design was conducted. STUDY SAMPLE:Two hundred and twenty-one adult patients who had been wearing hearing aids for at least one year were recruited during routine follow-up visits. Participants completed the self-administered ABILHAND questionnaire, evaluating manual dexterity through everyday manual tasks. Twenty HCPs completed a non-standardised questionnaire assessing patients' manipulation abilities related to hearing aid use. RESULTS:ABILHAND Light-7, a shortened version of the ABILHAND questionnaire, was developed. The two ABILHAND questionnaires showed a negative correlation with age and a positive correlation with the HCP questionnaire. Threshold scores were established for both ABILHAND questionnaires to guide recommendations on hearing aid type and battery size. CONCLUSIONS:Both ABILHAND and ABILHAND Light-7 are valuable tools for prosthetic orientation, as they help identify devices, batteries, or earpieces that may be too complex for patients to manage.
OBJECTIVES:This study evaluated valence ratings in response to recorded media under a variety of listening situations. DESIGN AND STUDY SAMPLE:Younger adults with normal hearing (n = 20), older adults with typical hearing (n = 20), and older adults with hearing loss (n = 20) provided ratings of valence (the degree to which they felt pleasant) for audio-only (Experiment 1) and audiovisual (Experiment 2) recorded media clips. Clips varied by dialogue-to-background ratio and loudspeaker configuration (television, stereo, surround sound). RESULTS:In both experiments, older listeners with hearing loss provided significantly lower valence ratings than their typical hearing peers, but only when the surround sound loudspeakers were used or when the dialogue-to-background ratio was +7 dB. Older listeners provided lower valence ratings when the loudspeaker was either stereo or surround sound or when dialogue-to-background ratio was +12 dB, but only when visual cues were not available. CONCLUSION:Older adults with hearing loss exhibit disrupted ratings of valence to recorded media. The effect could be mitigated with improved dialogue-to-background ratios of television shows and movies, but not with surround sound systems.
Objective: To explain improved hearing in more recently born cohorts of 70-year-olds in Sweden by examining mediating roles of educational level, occupational group, systolic blood pressure, and smoking. Design: A repeated cross-sectional analysis using two age-homogeneous birth cohorts from the Gothenburg H70 Birth Cohort Studies. To investigate mechanisms underlying cohort differences in hearing, mediation analyses were used to assess direct and indirect effects of cohort via educational level, occupational group, smoking, and systolic blood pressure. Study sample: Two samples of 70-year-olds were included (mean age 70.5 years), four decades apart (1901-1907, n = 674; 1944, n = 1114). Participants underwent standardized health examinations, including audiometric testing. Results: Educational level was the primary mediator, accounting for 1.19 dB of the 6.16 dB difference in PTA4 between cohorts, followed by occupational group (0.74 dB) and smoking habits (0.28 dB). In sex-stratified analyses, educational level was the dominant mediator among women (1.63 dB of 4.8 dB), whereas occupational group played a larger mediating role among men (0.75 dB of 7.7 dB). Conclusions: This study found that changes in lifestyle and socioeconomic factors, specifically education, occupation, and smoking, explain some of the trend of better hearing in recent generations of 70-year-olds, underscoring their relevance for preventive strategies.
OBJECTIVE:The study aimed to measure the effect of speaker voice quality on acceptable noise level (ANL) and to introduce the Signal Degradation Degree (SDD) to quantify within-listener sensitivity to voice-related signal degradation. DESIGN:The participants listened to five voice quality conditions that ranked from the highest-ranked to the lowest-ranked voice quality. The SDD, the difference between the ANL when the voice was of the highest-ranked (Q1) and the lowest-ranked voice quality (Q4), was calculated. STUDY SAMPLE:Sixty-seven adults with normal hearing (NH) and thirty-five with hearing loss (HL) participated. RESULTS:As the voice quality deteriorated, there was a significant increase in the ANL for both groups, which demonstrated a reduction in their ability to tolerate noise. Compared to HLs, the NHs were found to have greater ANL and SDD with each decrease in voice quality, indicating that the NH adults were much more sensitive to decreases in speech clarity than the HL adults. CONCLUSIONS:Voice quality is an intrinsic speech signal factor that influences ANL in both NH and HL listeners. As perceived voice quality declined, tolerance for background noise decreased. SDD may complement ANL by quantifying how much an individual listener's noise tolerance changes when target speech quality deteriorates; however, its clinical utility, reliability, and predictive value require further validation against speech-in-noise performance, hearing aid benefit, and real-world communication outcomes.
BACKGROUND:Adults experiencing dizziness or vestibular disorders frequently encounter barriers to help seeking and healthcare engagement. However, the behavioural determinants underlying these behaviours have not been systematically synthesised. OBJECTIVE:This scoping review aimed to identify behavioural determinants influencing vestibular help seeking and healthcare engagement among adults with dizziness or vestibular disorders and map these determinants to the Capability-Opportunity-Motivation Behaviour (COM-B) framework. DESIGN AND STUDY SAMPLE:A systematic search of PubMed/MEDLINE, Scopus, CINAHL, and Web of Science was conducted from database inception to 22 January 2026. Sixteen studies were included and synthesised narratively in accordance with PRISMA-ScR guidelines. RESULTS:Determinants influencing vestibular healthcare engagement were identified across multiple stages of the care pathway, including help seeking, healthcare access, diagnosis, treatment engagement, and vestibular rehabilitation. Determinants were mapped across all six COM-B domains. Physical and social opportunity were most frequently reported, followed by reflective motivation and psychological capability. Automatic motivation and physical capability were less frequently examined. CONCLUSIONS:Vestibular healthcare engagement is shaped by structural, social, motivational, and capability-related determinants across the care pathway. The COM-B framework provides a useful structure for identifying stage-specific behavioural targets to improve access to vestibular assessment, rehabilitation participation, and sustained engagement with care.
OBJECTIVES:1. To describe a standardised process for filtering and processing musical sounds for use in hearing assessments. 2. To compare hearing thresholds to warble tones and one-third-octave filtered musical sounds. 3. To compare the variability of the differences between filtered musical sound and warble tone thresholds with the variability of differences between pure tone and warble tone thresholds. DESIGN:Monaural hearing thresholds to standard and filtered musical sounds were compared at three centre frequencies (0.5, 1 and 4 kHz). STUDY SAMPLE:Thirty otologically normal young adults participated at each frequency. RESULTS:At 0.5 kHz small mean differences (<2 dB) in thresholds were seen between some individual musical sounds and the warble tone, with musical sounds giving lower (better) thresholds. Otherwise, thresholds were equivalent. The variability seen between pure tone thresholds and warble tone thresholds was similar to that seen between musical stimulus thresholds and warble tone thresholds (limits of agreement were around +4 to -5 dB in all cases). CONCLUSIONS:Musical sounds, filtered and processed as described, show promise for use in hearing assessments. Further research should compare thresholds in infants, those with hearing losses, including sloping losses, and investigate different bandwidths of musical sounds.
OBJECTIVE:This study evaluated the preliminary clinical utility of the Paediatric Hyperacusis Questionnaire (P-HQ) for identifying auditory sensitivity in children with autism spectrum disorder (ASD) and assessed the initial psychometric properties of the Turkish version for ages 2-6 years. DESIGN:The study was conducted in two phases: cultural adaptation/psychometric evaluation and discriminative validity analysis. After removing one developmentally inappropriate item, a 10-item version was used. Validity was assessed via factor and ROC analyses. STUDY SAMPLE:The sample consisted of 101 typically developing (TD) children for the first phase and an additional clinical group of 30 children with ASD for the second phase (Total N = 131). RESULTS:A two-factor structure explained 53.85% of the variance (Cronbach's α = 0.81). Children with ASD had significantly higher scores than TD peers (p < 0.001). ROC analysis showed good accuracy (AUC = 0.814). A cut-off score of ≥9 yielded 60% sensitivity and 88% specificity, indicating its utility as a preliminary, sample-specific screening threshold for risk stratification rather than a standalone diagnostic tool. CONCLUSIONS:The Turkish P-HQ is a valid preliminary tool for identifying children at risk for hyperacusis. It serves as a practical aid for clinicians to identify cases requiring further, more comprehensive audiological and behavioural evaluation.
OBJECTIVE:This study investigated how audiologists interpret empowerment dimensions (knowledge, skills and strategies, participation, self-efficacy, and control) in relation to their patients and practice, and how these dimensions are integrated into practice. DESIGN:A qualitative focus group study with five groups. Data were thematically analysed. STUDY SAMPLE:Audiologists engaged in hearing rehabilitation in Sweden, representing public and private sectors, with minimum three months' full-time experience. RESULTS:The results highlight audiologists' role in individualised knowledge transfer. They facilitate development of essential skills and strategies through proactive assessment, tailored communication, and guidance. Patient participation is viewed as important yet complex, shaped by readiness and contextual factors. Approaches are adapted to promote meaningful engagement, recognising participation is not always straightforward or beneficial. Self-efficacy and sense of control are acknowledged as important but remain less emphasised in daily practice compared to knowledge, skills and strategies. CONCLUSIONS:Audiologists view empowerment as a shared goal between clinician and patient. To support empowerment, both should reflect on its dimensions and ensure each is addressed in care. Findings underscore the multifaceted nature of empowerment and the nuanced clinical role required to foster it. No single approach fits all, highlighting the need for person-centred care to support patient outcomes.
OBJECTIVE:The objective of this study was to determine whether listening difficulties (LiD), defined as difficulties in understanding speech in noisy environments despite normal hearing, reflect cross-modal attentional limits under visual load in adults. DESIGN:This cross-sectional study used a dual-task paradigm (1-back visual plus visual-audio digit-matching) that required focused visual attention while monitoring auditory stimuli. Errors and reaction times were analysed. STUDY SAMPLE:Twenty adults with listening difficulties and 20 adult controls with normal hearing were enrolled. RESULTS:The participants with LiD performed significantly worse than the controls in the 1-back visual (U = 88.5, p = 0.002) and visual-audio matching tasks (U = 38.0, p < 0.001), with a larger effect size observed for the latter. The receiver operating characteristic analysis showed high discriminative accuracy for the visual-audio matching task (cut-off = 6 errors, sensitivity = 85%, specificity = 90%). The median reaction times did not differ (U = 149.0, p = 0.17), although they increased with errors (LiD: r(18)=0.79, p < 0.001; controls: r(18)=0.45, p = 0.05). CONCLUSIONS:The participants with LiD demonstrated limited cross-modal attentional capacity under visual load, which disproportionately disrupted auditory monitoring. The dual-task paradigm may serve as a sensitive tool for clinical differentiation of LiD and underscores the importance of evaluating cognitive contributions to LiD.
OBJECTIVE:To compare personal listening device (PLD) listening behaviours, leisure noise exposure, audiometric outcomes, hearing protection (HP) usage and self-reported hearing loss (HL) symptoms at Time 1: 2009/2010 and Time 2: 2022/2023. Mean hearing thresholds (HTs), pure-tone average HL prevalence, PLD volume levels, durations, earbud/headphone tightness, and sex among matched pairs, at Time 1 and 2, were compared. DESIGN:Longitudinal design. Questionnaire evaluating PLD listening behaviours, leisure noise exposure and HL symptoms. Multivariate regression analysis used to determine relationship between variables and audiometry. STUDY SAMPLE:59 Participants, aged 22-30, of original cohort (n = 237, aged 10-17) were re-tested (Time 2). RESULTS:Over time, tinnitus following leisure noise tripled, HP doubled and higher average PLD listening time was observed (7 vs. 18 h/week); longer durations for males. High volume listening was 20% at both timepoints. Leisure noise exposure and HL prevalence were similar across time, however mean HTs were higher at Time 1. Among matched pairs, more Time 2 participants created tight-fitting earbuds/headphones and responded affirmatively to some HL symptom questions. CONCLUSIONS:Subtle auditory changes, such as hidden HL, may be occurring over time. Educational outreach regarding HL prevention would be beneficial. Further longitudinal research needed due to the small follow-up sample.
OBJECTIVE:To explore stakeholder perspectives on current adult cochlear implant services and potential integration of remote assessment tools. DESIGN AND STUDY SAMPLE:Semi-structured focus groups were conducted with four stakeholder groups: adult cochlear implant users with (n = 5) and without (n = 5) experience using a remote assessment tool, implant audiologists (n = 8), and implant clinic administrative staff (n = 4). Participants were asked what they valued most in CI aftercare and how remote care could be integrated to meet their needs. Transcripts underwent inductive qualitative analysis. RESULTS:Stakeholder perspectives coalesced around four themes: bias towards the status quo (connection to current practices, resistance to change); opportunities for change (willingness to incorporate improvements for quality and accessible aftercare); complexity as a barrier (grappling with diverse and complex considerations for implementation); influence from external networks (support and information from outside the direct patient-clinic relationship). All groups acknowledged the benefits of current services and remote care, while attitudes about implementation and accessibility differed between groups. CONCLUSIONS:This study juxtaposes stakeholder preferences to both embrace and restrict uptake of remote care in CI services. The potential for remote care to address shortfalls in existing service delivery will remain unfulfilled unless organisational and financial aspects of implementation are resolved.
