BACKGROUND:High-frequency bone-conducted vibration (BCV) and skull vibration-induced nystagmus (SVIN) are widely used to probe vestibular function, yet their physical nature and physiological targets remain incompletely defined. In particular, the relationship between vibration physics and jerk, the time derivative of acceleration, and their relevance to vestibular activation has not been systematically explored. OBJECTIVE:To develop an engineering-informed framework for high-frequency vestibular stimulation, linking jerk-rich transient stimuli to otolithic biomechanics and vestibular signal processing, and translating this framework into practical guidance for interpreting BCV-evoked vestibular-evoked myogenic potentials (VEMPs) and SVIN. METHODS:This narrative review integrates: (1) mechanical analysis of sinusoidal motion, quantifying how displacement, velocity, acceleration and jerk scale with frequency; (2) contemporary vestibular physiology on Type I and Type II hair cells, calyx synapses and irregular versus regular afferents; and (3) experimental and clinical data on BCV, high-frequency sound, oVEMPs, cVEMPs and SVIN in health and vestibular disease. RESULTS:For a sinusoid of fixed displacement amplitude, velocity scales with angular frequency (ω), acceleration with ω² and jerk with ω³. At 60-100 Hz, jerk becomes a prominent macroscopic descriptor of the stimulus, not a directly encoded neural variable, reflecting rapid temporal transients and the dynamic filtering of otolithic macular mechanics. In parallel, Type I hair cells, calyx endings and irregular afferents form a transient, high-bandwidth vestibular pathway characterized by high gain, phase leads at higher frequencies and strong phase locking to high-frequency BCV and sound. The Type I-calyx complex supports multiple transmission modes, including ultra-fast resistive coupling, capable of transmitting rapid receptor-potential changes generated by mechanical transients at the sensory epithelium. Animal and human data indicate that BCV and high-frequency sound preferentially activate irregular otolithic and canal afferents. Accordingly, BCV-evoked oVEMPs, cVEMPs and SVIN provide complementary readouts of this rapid-transient vestibular pathway. In unilateral vestibular loss, Ménière's disease and third-window syndromes, this framework helps explain why vibratory responses may remain abnormal, or even exaggerated, despite partially normal caloric or vHIT findings. CONCLUSIONS:High-frequency BCV should not be interpreted simply as "very high-frequency rotation", but as a rapid transient mechanical stimulus shaped by otolithic biomechanics and high-bandwidth afferent pathways. BCV-evoked oVEMPs and cVEMPs reflect rapid transient otolithic activation recorded in extraocular and neck muscles, while SVIN reflects the time-integrated imbalance of rapid transient vestibular signals across canal-otolith pathways. Incorporating this dual-channel, biomechanics-informed perspective may improve test selection, pattern recognition and disease-specific interpretation in vestibular clinics.
INTRODUCTION:Given that today's cochlear implant (CI) candidates frequently present with substantial residual low-frequency hearing, the preservation of residual hearing is becoming an increasingly crucial but as yet inadequately resolved aspect of CI surgery. A recent study has shown that a 15-minute treatment with light in the red to near-infrared range (NIR) before the insertion of a CI array resulted in a significant reduction of hearing loss, especially in the frequency range of residual hearing, accompanied by significant conservation of outer hair cells. Given that the total number of rescued hair cells was insufficient to account for the substantial reduction in hearing loss observed, the present study aims to investigate the potential protective effect of NIR on spiral ganglion neurons and ribbon synapses in the context of CI surgery. METHODS:Guinea pigs underwent initial auditory brainstem response (ABR) recordings separately for each ear. Subsequently, unilateral NIR irradiation of the cochlea was performed, followed by bilateral insertion of guinea pig-sized electrode arrays. After 4 weeks, the ABR measurement was repeated and the cochleae were collected for histological analysis of spiral ganglion neurons and ribbon synapses. RESULTS:A significant reduction of hearing loss was found on the NIR treated side across the entire frequency range tested. The number of ribbon synapses was not affected by the insertion of an electrode array, and could therefore, not be influenced by NIR treatment. Spiral ganglion neurons were significantly reduced 4 weeks after implantation. This effect was rescued by NIR treatment, specifically in the basal portion of the cochlea. CONCLUSION:These findings show a neuroprotective effect of NIR on SGNs, which may be crucial not only for the protection of residual hearing but also for the electrical stimulation of SGNs via a CI.
Introduction Despite advances in soft surgery, intra-cochlear trauma during CI electrode insertion still occurs, potentially damaging cochlear micro-structures and affecting hearing outcomes or future treatments. While the round window membrane (RWM) approach is generally less traumatic, the hook region's complex anatomy can still cause mechanical injury, often due to limited visual guidance. Preoperative imaging and intraoperative Optical Coherence Tomography (OCT) could reduce trauma by offering high-resolution, real-time visualization of cochlear micro-structures. Methods Eight fresh-frozen human temporal bones (TB1-TB8) were included. The first six specimens (TB1-TB6) underwent micro-CT scanning with manual segmentation to establish detailed anatomical baselines and served for OCT-micro-CT co-registration. Following a standard cochlear implantation approach, intra-cochlear structures behind the round window membrane (RWM) were visualized using a microscope-integrated OCT system, with additional imaging performed via an anteroinferior cochleostomy to compare access routes. Electrode insertions were performed under OCT guidance in selected specimens, while feasibility of intraoperative workflow and insertion dynamics was assessed in TB7-TB8 under fluoroscopic control. Results OCT images were successfully obtained for each TB, with proper RWM exposure being crucial. The OCT microscope enabled scanning of the RWM and scala tympani (ST) from various axes, depths, and angles at a surgical working distance, improving assessment of proximal ST anatomy. OCT appears reliable for evaluating micro-anatomy through the RWM, guiding CI electrode selection, approach, and proximal array course modification during insertion. By visualizing critical structures and inferring deeper ones, it supports preoperative imagery-based planning and may reduce the risk of intracochlear damage. Conclusion Intra-operative OCT imaging enhances the precision of cochlear opening site and electrode insertion axis. By integrating OCT, CI surgery could shift from a largely blind procedure to one with significant visual guidance, reducing surgical trauma and improving postoperative hearing preservation.
BACKGROUND AND OBJECTIVE:Cisplatin exhibits a steep dose-response relationship, wherein its therapeutic efficacy increases significantly with higher doses. This dose escalation, however, is limited by severe adverse effects, notably ototoxicity, which can lead to permanent and disabling hearing loss. The objective of this review was to evaluate the potential efficacy of intratympanic steroid administration (ITD) in preventing cisplatin-induced hearing loss (CiHL). MATERIALS AND METHODS:A systematic literature search was conducted using PubMed, Cochrane Library, and Scopus databases for evidence-based research articles published between January 2004 and July 2023. The search strategy focused on intratympanic steroids for cisplatin-related ototoxicity. Two independent reviewers performed the search, screening, and study selection according to predefined PICOS (Population, Intervention, Comparison, Outcome, Study design) criteria. Only randomized controlled trials (RCTs) involving patients receiving cisplatin and treated with an intratympanic steroid regimen were included. The review process adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS:The initial database and manual searches identified 383 records. Following title and abstract screening, 42 articles underwent full-text review. After applying the eligibility criteria, 38 studies were excluded, resulting in four RCTs for qualitative synthesis. Risk of bias (RoB) assessment revealed a high-risk concerning allocation concealment in all four studies. Additionally, a substantial risk of detection bias was present in three RCTs. According to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, the overall quality of evidence was rated as high in one study, moderate in two, and low in one. CONCLUSION:This review did not confirm a consistent otoprotective benefit of intratympanic steroid administration against CiHL. None of the included studies demonstrated high-quality evidence for a significant protective effect. The available RCTs report inconsistent outcomes and collectively fail to establish a definitive therapeutic advantage for ITD in this context. These discrepancies may be attributable to methodological variations across studies, including differences in steroid dosage, concentration, timing of administration relative to cisplatin therapy, and patient populations. Further rigorously designed RCTs with standardized protocols are warranted to definitively assess the potential role of ITD in mitigating cisplatin ototoxicity.
Telemedicine may facilitate multidisciplinary cochlear implant (CI) candidate evaluation in settings where access to specialized otologic and audiologic care is limited. This study evaluated an online, multidisciplinary preoperative workflow for CI candidate selection and surgical planning during a high-volume humanitarian campaign supported by the King Salman Humanitarian Aid and Relief Centre (KSrelief). In this descriptive study, 142 children with severe-to-profound hearing loss underwent online review by a committee of otologists, audiologists, and speech-language pathologists, based on audiologic data, caregiver-submitted speech and communication videos, and high-resolution CT/MRI imaging. The primary outcome was the adequacy of online assessment for preoperative planning and case preparedness. Online assessment provided sufficient information for surgical planning across all evaluated domains, with sufficiency rates of 100% for audiologic data, 97.2% for speech-language data, and 95.1% for imaging data. Cochlear implantation was completed over three consecutive operative days (30 cases on day 1, 66 on day 2, and 46 on day 3). Preoperative online imaging review enabled early recognition of anatomical complexity and supported efficient resource preparation (including electrode availability and surgical planning), facilitating successful implantation of all scheduled children. A small proportion of cases required intraoperative electrode plan adjustment. Postoperative radiography confirmed correct array placement in all but one case, and surgical complications were infrequent and manageable. A structured online multidisciplinary preoperative workflow was essential to enabling surgical planning and coordinated cochlear implant delivery at this scale and pace in a humanitarian setting.
OBJECTIVE:Hearing loss affects 60-70% of elderly people, with ∼10% of these potentially eligible for cochlear implantation (CI). While outcomes in older adults have been positive, concerns remain regarding long-term auditory performance due to higher incidence of comorbidities, reduced cortical plasticity, and cognitive decline. This study evaluates 10-year speech perception outcomes and potential mediating factors in adults ≥60 years old at implantation. METHODS:A retrospective chart review identified 98 patients implanted between 2006 and 2014 who were ≥60 years old at surgery with ≥10 years of follow-up. The primary outcome was unilateral (CI-only) Consonant-Nucleus-Consonant (CNC) word scores in quiet at 10 years, also measured preoperatively and at one and 5 years postoperatively. RESULTS:Mean age at implantation was 70.2 years (standard deviation [SD]: 6.4, range: 60.1-85.3), and mean CI experience was 12.6 years (SD: 2.5, range: 10.0-20.1). CNC scores improved significantly from preoperative levels at one (d: 54.2%, q = 31.70, p < 0.001), five (d: 56.5%, q = 31.8, p < 0.001), and 10 years (d: 60.0%, q = 34.67, p < 0.001), without significant differences among postoperative time points. CNC scores did not differ significantly between patients implanted ≥70 versus <70 years old (F(1, 96) = 1.1, p = 0.306). Greater average daily CI use at most recent appointment correlated with higher CNC scores at all postoperative intervals (r = 0.435-0.595, p < 0.001). Inability to live independently was associated with significantly lower scores at 5 years (d = 15.2, p = 0.003). CONCLUSION:Speech perception outcomes were stable in most elderly CI users 10 years post-implantation. Performance was not associated with age at implantation but was positively related to consistent device use and independent living. Limitations include some missing data, especially 10 years postoperatively, and inability to assess the impact of cognitive function on outcomes.
Introduction: Noise trauma may induce auditory symptoms and temporary or permanent shifts in hearing thresholds, assessed with a tone audiogram. Until recently it has been assumed that primary changes after noise trauma exclusively represent damage to the sensory hair cells. Contrary, animal studies have now shown early alterations in auditory brainstem response (ABR) characteristic of auditory neuropathy (AN), as reduction or absence of wave I, following noise trauma. AN involves a variety of disease mechanisms in the cochlea and auditory nerve, affecting the synaptic encoding and/or neural transmission of auditory information. The aim of this study was to evaluate whether patients exposed to noise trauma exhibit click ABR alterations characteristic of AN. Method: Thirty-one adult patients who attended an ear-nose and throat clinic, after a noise trauma, were included and an age- and gender-matched control group of 31 adults was constructed. To evaluate audiologic hearing impairment pure tone audiometry, speech intelligibility, click ABR and transient evoked otoacoustic emissions (TEOAE)/cochlear microphonics (CM) were performed. A full linear mixed model including the interaction between sex and group was tested. Results: Our study showed that individuals exposed to sudden and distinct traumatic noise exhibit a statistically significant reduction (81.1 nV, p < 0.001) in the amplitude of wave I in ABR. Conclusion: We suggest that the hearing investigation after sudden traumatic noise exposure should therefore be expanded with ABR to confirm or exclude AN.
INTRODUCTION:Language influences speech perception in bilingual listeners, with non-native languages often requiring higher signal-to-noise ratios (SNRs) for comprehension. Structural features, such as phonology and syllabic rhythm, make Spanish easier to perceive in noise compared to English, which relies more heavily on high-frequency cues and complex consonant clusters. These differences have clinical implications, particularly for individuals with hearing loss, as speech-in-noise tasks guide treatment decisions, including amplification and cochlear implant candidacy. However, most assessment tools were developed for English speakers, limiting their accuracy for individuals with limited English proficiency. Spanish-language tests, such as the AzBio, often use low-context Spanish sentences presented with English babble, creating a linguistic mismatch that increases informational masking and cognitive load. This can reduce speech intelligibility, misrepresent actual hearing abilities, and potentially contribute to healthcare disparities. Addressing these limitations requires evaluation of how target language, masker language, and sentence structure influence speech perception in bilingual populations to ensure valid assessment and equitable access to hearing healthcare. METHODS:Twenty normal-hearing bilingual adults (mean age 32 years, 65% male) who were fluent in both English and Spanish participated in the study. Participants were classified as English- or Spanish-dominant based on self-report and proficiency measures. Speech-in-noise testing was assessed using the English and Spanish versions of the Hearing in Noise Test (HINT) and AzBio sentence test. An additional condition was included using the Spanish AzBio sentences presented with Spanish multi-talker babble. RESULTS:Bilingual listeners required significantly higher SNRs for English than Spanish tests (HINT mean difference = 2.77 dB, 95% Highest Density Interval [HDI]: 1.64-3.88; AzBio mean difference = 2.5 dB, 95% HDI: -3.54 to -1.53). No overall differences emerged between Spanish AzBio with English versus Spanish babble; however, subgroup analyses revealed language-dominant effects. Spanish-dominant listeners performed worse when target and masker were both Spanish (mean difference = -1.64 dB, 95% HDI: -2.78 to -0.48), whereas English-dominant listeners showed greater difficulty with English stimuli. Higher self-reported proficiency in a given language correlated with lower SNRs on corresponding measures. CONCLUSIONS:Language dominance and structural features of Spanish versus English significantly affect bilinguals' speech perception in noise. These findings underscore the need for linguistically appropriate test materials, as reliance on English-only tools may misrepresent communication abilities and contribute to disparities in hearing healthcare.
INTRODUCTION:Cochlear implantation is the standard of care for children with severe-to-profound sensorineural hearing loss, offering substantial improvements in speech intelligibility, tonal audiometry perception, language acquisition, and overall quality of life. While robotic-assisted insertion systems may enhance surgical precision and minimize complications, their impact on auditory outcomes has not been definitively established. METHODS:This retrospective study compared audiometric results of 20 cochlear implantations between August 2017 and September 2023. Twenty procedures were reviewed, including 10 manual insertions (n = 10) and 10 robot-assisted insertions using RobOtol (n = 10). Secondary outcomes included operative time and perioperative complications. RESULTS:Results showed comparable hearing outcomes at both 1 month (p = 0.82) and 1 year (p = 0.36) postoperatively. Operative durations did not differ significantly between manual and robotic approaches (p = 0.198). No major complications or adverse events were recorded. CONCLUSION:Although audiometric results were not significantly different, a prospective multicenter randomized study would be required to confirm the absence of any effect of robot-assisted insertion on hearing results. This study confirmed that robot-assisted cochlear implantation was a safe and effective alternative to the manual technique in the pediatric population.
AIM:This study aimed to evaluate the diagnostic accuracy of the smartphone Weber test compared with the traditional tuning fork Weber test (TFWT) in patients with unilateral conductive and sensorineural hearing loss, and to determine whether the smartphone-based method can serve as a practical screening tool in clinical and remote settings. METHODS:This prospective study was conducted at the Otorhinolaryngology Clinic of Ankara Bilkent City Hospital between April 2023 and March 2024. A total of 150 participants were enrolled, including patients with conductive hearing loss (n = 50), sensorineural hearing loss (n = 50), and healthy controls (n = 50). Both the TFWT and a smartphone vibration test (iPhone 13, 512 Hz equivalent) were performed. The smartphone vibration was validated for functional comparability, rather than acoustic identity, using accelerometer measurements. Diagnostic performance was evaluated by accuracy, sensitivity, specificity, Cohen's Kappa coefficient, and receiver operating characteristic analysis with 95% confidence intervals (CIs). A binary logistic regression identified independent predictors of test accuracy. RESULTS:The smartphone Weber test demonstrated an overall accuracy of 83.3% (95% CI: 76.8-89.7%), comparable to the TFWT (84.0% [95% CI: 78.1-90.2%]). Agreement between tests was "moderate" (κ = 0.488, 95% CI: 0.39-0.57, p < 0.001). The smartphone test showed an area under the curve of 0.74 (95% CI: 0.67-0.81), while the TFWT had 0.78 (95% CI: 0.71-0.84), with no significant difference between them (p = 0.34). Logistic regression identified interaural difference as the only independent predictor of correct smartphone test results (p = 0.009). CONCLUSION:The smartphone Weber test shows moderate diagnostic accuracy and comparable, but not statistically superior, performance to the traditional tuning fork. While not a replacement for audiometry, it may serve as a convenient preliminary screening tool in primary care, emergency, and telemedicine settings. Further multicenter research should standardize calibration, improve specificity, and validate its clinical utility across devices and populations.
Introduction: Intratympanic corticosteroids (ITCs) are used to treat patients with idiopathic sudden sensorineural hearing loss (ISSNHL) when systemic therapy has been unsuccessful. However, the efficacy of this treatment remains uncertain. METHODS:We retrospectively analysed ISSNHL patients at a tertiary reference centre, who received ITC injections following unsuccessful systemic corticosteroid therapy administered either orally or intravenously. Patients were eligible for ITC if they showed insufficient improvement after systemic treatment, defined as a remaining hearing loss of ≥30 dB HL in at least three frequencies. They received three intratympanic injections of 0.3-0.5 mL dexamethasone (4 mg/mL) within 10-14 days from first to last injection. Changes in pure-tone audiometry were assessed. RESULTS:A total of 34 patients met the inclusion criteria for the study. The mean pure tone average (PTA) improvement was 10.62 dB HL. A total of 18 (53%) patients showed hearing improvement of ≥10 dB HL (of these: n = 11 (32%) ≥20 dB HL, n = 2 (6%) ≥30 dB HL). Sixteen (47%) patients had an improvement of less than 10 dB HL. In addition to the PTA analysis, individual frequencies at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz were examined and showed significant improvements, with p values ranging from 0.007 to 0.037. Regarding the World Health Organization grading of hearing impairment, 13 (38.2%) patients improved by at least one category. Concomitant vestibular syndrome (n = 5) showed a marginally non-significant trend (p = 0.066) towards less improvement. There was no significant correlation between age and degree of hearing loss (p = 0.123). Complications of ITC were minimal, with only 1 patient reporting a temporary headache following injection. CONCLUSION:In patients with persistent ISSNHL after systemic corticosteroid therapy, ITC injections resulted in limited hearing improvement. Despite the low risks associated with this therapy, its routine use should be considered on a case-by-case evaluation. .
INTRODUCTION:Hearing aid (HA) outcomes vary substantially despite similar hearing loss severity. We tested whether audiometric configuration improves outcome prediction beyond traditional measures. METHODS:We conducted a retrospective analysis of 22,694 adults (aged 50-90 years) fitted with HAs across 780 French audiology centers (2018-2021). Eight audiometric profiles were defined a priori based on pathophysiological classifications. Machine learning models identified predictors of speech reception threshold improvement in quiet (SRTQ, ≥6 dB) and noise (SRTN, ≥2 dB). RESULTS:Overall, 93% of participants showed demonstrated meaningful improvement in SRTQ and/or SRTN. Adding profile membership variable increased prediction accuracy by 6% for SRTN and 5% for SRTQ. Profile-stratified analysis revealed distinct optimization pathways: Profile A (moderate presbycusis) benefited from 4 kHz amplification and follow-up appointments; Profile C (ski slope) required premium technology and high compliance; Profile D (advanced presbycusis) responded exclusively to frequency-specific precision, resisting behavioral interventions. Mid-to-high frequencies (2-6 kHz) drove noise outcomes; low frequencies (250-1,000 Hz) and clinical support predicted quiet performance. Globally, the amplification of both low and high frequencies are beneficial for both SRTQ and SRTN, and high frequencies especially for SRTN. CONCLUSION:Audiometric profiling adds significant predictive value beyond traditional severity measures, identifying profile-specific intervention levers (amplification strategy, technology; choice, compliance, follow-up appointments) for personalized optimization. This configuration-aware approach supports precision audiology, where treatment is guided by an audiometric profile and expected outcomes.
INTRODUCTION:Pitch patterns are essential for speech perception in prosodically rich languages like Malayalam. This study investigated how various auditory maskers influence the perception of these pitch patterns in low-frequency bisyllabic Malayalam words among young adults, focusing on how different noise types interact with linguistic prosody. METHODS:Twenty validated, low-frequency, phonetically balanced Malayalam words were recorded with three distinct pitch patterns: rising, falling, and flat. Stimuli were presented to participants across five masking conditions: 2-talker babble, 4-talker babble, a similar-gender masker, a different-gender masker, and speech-shaped noise (SSN). Speech perception thresholds (SNR-50) were measured using an adaptive procedure within the Smirti Shravan software environment. RESULTS:Results indicated that rising pitch patterns yielded superior perception in multi-talker babble due to higher acoustic salience, whereas falling patterns were more susceptible to interference. The different-gender masker resulted in significantly lower (SNR-50) values than the similar-gender masker, suggesting more effective stream segregation. While speech-shaped noise primarily produced energetic masking with minimal variation across patterns, linguistic maskers showed significant modulation of masking release. This suggests that listeners successfully utilized temporal dips and amplitude valleys in linguistic maskers, particularly when paired with specific pitch contours. CONCLUSION:Pitch patterns significantly influence speech perception in noisy environments, especially when the background interference is linguistic in nature. These findings highlight the importance of prosodic cues in overcoming informational masking and can help guide future auditory training and rehabilitation strategies for Malayalam speakers.
Introduction: This study aims to reevaluate the reference value of the FraMatrix test under routine administration conditions used by hearing aid specialists. The reference value currently in use (SRT50 = -6.0 dB signal-to-noise ratio [SNR]) was established under conditions that differ substantially from those encountered in clinical practice. In routine assessments, hearing aid specialists administer three lists of 20 sentences in free field (FF), retain the result of the final list, and present the word lists in an open-set condition (i.e., patients are not informed of all possible target words). In contrast, the existing reference value was derived under monaural headphone conditions, following 40 lists of 10 sentences, and using a closed-set condition. Developing a standard value suitable for clinical practice is important, as reimbursement for hearing aids depends on it. Methods: A total of 44 normal-hearing subjects completed the FraMatrix test under conditions similar to those used in clinical settings: binaurally in FF, in an open-set condition, after two training lists. Monaural results using headphones were also collected. Results: In FF, the average SRT50 value is -5.1 dB, with a 95% confidence interval around the mean of [-5.5; -4.7] dB, and a median of -5 dB. This speech-in-noise performance is statistically and clinically poorer than the standard value used until now. This difference is likely to be attributed to the distinct testing conditions between our study and the study that established the current standard value. In the latter, participants were considerably more trained, having completed 400 sentences (40 lists) in a closed-set condition, whereas our subjects completed only 60 sentences (3 double lists) in an open-set condition. However, we cannot exclude another possible explanation for this discrepancy: calibration differences between the transducers used in our study and those used in the study that established the current standard value. Conclusion: When taking the FraMatrix test under clinical conditions (FF, open-set, after two double training lists), we recommend adopting a new standard value of -5.1-dB SNR, accompanied by the 95% confidence interval to support clinical interpretation. This updated value is more representative of the conditions under which hearing aid specialists administer the test and enables a more accurate assessment of auditory performance in noisy environments.
Introduction: Type 2 diabetes mellitus (T2DM) is associated with multiple systemic complications, including vascular and neuropathic changes that can affect the auditory pathway. These alterations may contribute to hearing loss and difficulty in speech perception, particularly in noisy environments. This study aimed to evaluate speech recognition in noise among patients with T2DM using the Signal-to-Noise Ratio 50 (SNR-50) and to examine its relationship with disease duration and glycemic control. METHODS:An analytical cross-sectional study was conducted at a tertiary care hospital. Ninety subjects aged 30-60 years were recruited, comprising 45 patients with T2DM and 45 age-matched nondiabetic controls. All participants underwent audiological evaluation including pure-tone average (PTA), tympanometry, speech reception threshold (SRT), speech identification score (SIS), uncomfortable loudness level (UCL), and SNR-50 testing. Data were analyzed to assess differences between groups and correlations with diabetes duration and glycemic control (HbA1c levels). RESULTS:PTA values were higher in patients with T2DM compared to controls, indicating worse peripheral hearing. Diabetic patients demonstrated poorer speech perception, confirmed by elevated SRT values. SNR-50 values were significantly impaired in T2DM patients relative to controls. Longer duration of diabetes (>10 years) was associated with reduced SIS and higher PTA and SRT values compared to patients with 5-10 years of disease. A statistically significant positive correlation was observed between SNR-50 and duration of diabetes. While PTA, SRT, and SIS did not show significant variation across HbA1c categories, SNR-50 values worsened significantly with poorer glycemic control. CONCLUSION:T2DM is associated with impaired speech perception and poorer hearing outcomes, with disease duration exerting a cumulative adverse effect. SNR-50 performance was significantly related to glycemic control, suggesting that subtle central auditory dysfunction may coexist with or precede peripheral hearing loss in diabetic patients. Early evaluation of auditory function in T2DM may aid in timely identification and management of communication difficulties. .
INTRODUCTION:Cochlear implant outcomes vary widely and are difficult to predict, with traditional methods explaining <20% of variance. This study tested whether machine learning approaches offer superior performance predicting outcomes and better identify key factors driving variability compared to traditional linear methods. METHODS:This retrospective observational study analyzed clinical data from 2,251 adult cochlear implant recipients (>18 years) with post-lingual hearing loss (onset >15 years) across fifteen centers in Australia, Europe, and North America. Data were collected between 2003 and 2011, with follow-up at 6 months and 2 years post-implantation. Linear regression was compared against seven other machine learning models: eXtreme Gradient Boosting (XGBoost), random forest, categorical boosting (CatBoost), Light Gradient Boosting Machine (LightGBM), support vector regression, ridge regression, and Lasso regression. Models were optimized using grid search with 5-fold cross-validation on an 80/20 training-test split. The primary outcome was prediction of percentile-ranked postoperative speech recognition scores in quiet, assessed using mean-squared error (MSE) and coefficient of determination (R2). SHapley Additive exPlanations values identified feature importance. RESULTS:XGBoost achieved the best performance with a modest but significant 4.11% reduction in prediction error compared to linear regression (MSE: 739.67 ± 19.27 vs. 771.41 ± 21.51, p = 0.003; R2: 0.114 ± 0.011 vs. 0.076 ± 0.012, p < 0.001). All ensemble methods significantly outperformed linear regression. Duration of cochlear implant use, age at implantation, duration of severe/profound hearing loss, and preoperative hearing scores emerged as the most influential predictors across all models. CONCLUSIONS:Machine learning models modestly improve cochlear implant outcome prediction, though substantial variance remains unexplained (>80%). Critical determinants of cochlear implant performance likely extend beyond variables routinely measured in clinical practice, highlighting the need for novel predictive factors.
BACKGROUND:The aging process is accompanied by sensory, motor, and cognitive declines that increase the risk of balance disorders. Fatigue is a prevalent yet often overlooked symptom among older adults. OBJECTIVE:This study examines the relationship between fatigue and balance in individuals 60 years and older to provide evidence for preventive and rehabilitative strategies. METHODS:Fatigue was assessed using the Fatigue Assessment Scale (FAS) and the Fatigue Impact Scale (FIS), while balance was evaluated with the Timed Up and Go (TUG) test, the Tinetti Balance and Gait Test (TBT-TGT), and the Single-Leg Stance Test (SLST). RESULTS:While fatigue had a negative impact on both static and dynamic balance, no statistically significant differences were detected between the fatigued and severely fatigued groups. Analyses revealed weak to moderate negative correlations between fatigue scales and measures of both static and dynamic balance, with mental fatigue demonstrating a comparatively stronger relationship with static balance. In the regression analysis, the model including age and mental fatigue overall explained 27.9% of the variance in single-leg stance duration. CONCLUSIONS:The results of our study indicate that fatigue markedly impairs both static and dynamic balance performance among older adults.
Introduction: Locally applied dexamethasone therapy of the inner ear is commonly used to treat disorders such as Meniere's disease and idiopathic sudden sensorineural hearing loss. Dexamethasone is also being used in conjunction with cochlear implantation to reduce electrode impedances and fibrous tissue formation around the implant. The variety of formulations currently in use makes it difficult to compare the dosing levels resulting from different therapies. METHODS:We have used the FluidSIM cochlear fluid simulation program to calculate perilymph and plasma dexamethasone levels achieved by a variety of dosing approaches used clinically in humans. Identical pharmacokinetic parameters for perilymph and plasma were used for each delivery condition. RESULTS:Each of the delivery protocols was calculated to generate therapeutic concentrations in perilymph, but the time course of influence differed markedly between them. Some protocols generate concentrations in the blood that are above therapeutic concentration, increasing the potential for systemic side effects. DISCUSSION:Detailed simulations of delivery procedures allow different approaches to be compared quantitatively, giving a measure of dosing efficiency and allowing the merits of each protocol to be compared. Cochlear implants provide the most efficient dosing, generating therapeutic concentrations in the cochlea with minimal systemic influence. For intratympanic delivery, Spiral Therapeutics SPT-2101 provides therapeutic concentrations in perilymph with minimal systemic dosing. Conventional IT therapy with dexamethasone phosphate provides brief therapeutic concentrations in perilymph but substantial systemic exposure, with plasma concentration calculated to exceed therapeutic levels. .
OBJECTIVE:This study aims to assess the effectiveness of the ForwardFocus (FF) feature in cochlear implant (CI) users by evaluating its impact on speech comprehension in noisy environments, potentially improving communication outcomes for individuals with hearing loss. METHODS:A prospective study was conducted on 48 CI users from an audiology clinic over a 7-month period, between July 2023 and February 2024. Native Arabic speakers, using either N7 or Kanso2 external processors with the FF feature, were recruited. The study measured aided audiometry, word recognition score, and speech comprehension in noise using the Arabic Matrix Test with and without the FF feature, along with a survey assessing ease of use and satisfaction among other factors. RESULTS:The impact of FF on speech perception and user experience in CI users were evaluated. FF significantly improved speech perception in noise (p < 0.001), with users reporting high satisfaction (54.3% very satisfied, 26.1% satisfied) and intention to continue using FF (97.8%). Most participants used FF 1-2 times a week (56.5%), with 17% using it daily. Most found its noise reduction to be adequate (82.6%). CONCLUSION:FF effectively enhanced speech understanding, with users expressing high satisfaction and intention to continue using the feature. This suggests FF's ability to improve communication and quality of life for CI users.
Introduction: Optimizing inner ear access is necessary for the genetic and regenerative treatment of sensorineural hearing loss. This is a descriptive histological study, with three-dimensional modeling of the microanatomy of minimally invasive transcanal access routes to the scala tympani through the round window, and suggested form and dimensions of injection needles for inner ear drug delivery. Methods: Three-dimensional models of eight human temporal bone histological sections were created to measure key anatomical relationships and optimal needle trajectories. Results: To spare the inner ear structures and reach the greatest depth in the scala tympani, the optimal trajectory via the round window is achieved with a needle leaned on and bent at the superiormost point of the round window niche operculum. The length of the needle’s medial part is between 1.375 mm (1.2–1.6 mm) and 3.49 mm (2.8–4.3 mm), with a bend angle of 147° (123–167°). The penetration point of the round window membrane is its vertical axis center, reducing the risk of damage to the inner ear structure and avoiding the crista fenestra. The crista may shift the penetration point inferiorly when visible and not found behind the round window membrane. In all eight temporal bones, the crista never reached the center of the round window membrane, with the horizontal distance between the crista edge and the center being 0.55 mm (0.4–0.75 mm). Conclusion: The data reveal the form and size factors for optimal transcanal access to the inner ear for structure- and function-preserving drug delivery.
