Bone conduction speech audiometry is a complementary tool required by many otologists, particularly in assessing cochlear reserve and estimating postoperative results in patients undergoing stapedectomy. However, when clinical masking of the non-test ear is needed for these tests, it introduces a significant methodological challenge. This study aims to establish a systematic approach for determining safe and effective masking levels in bone conduction speech audiometry. In this context, the proposed framework offers quantitative tools designed to help reduce the risk of masking dilemmas, which are a persistent challenge in audiologic practice. Adaptation and application of Lidén’s formulas to determine the minimum and maximum masking levels for bone conduction speech audiometry and analysis of four frequently encountered audiometric configurations. The minimum and maximum masking levels for each configuration were determined. In cases of large ear-bone gaps in the non-test ear, and/or good bone conduction thresholds in the test ear, masking at supra-threshold levels may be difficult due to the risk of overmasking. In one or more of these configurations, a masking dilemma is sometimes detected at levels close to the speech recognition threshold. In such challenging situations, we recommend the use of insert earphones to extend the range of safe stimulus levels and masking levels that can be presented to the patient. Speech audiometry holds considerable predictive value for otologic surgeons, so it is important to use techniques that minimise the risks of cross-hearing and inappropriate masking. These limitations are important when using bone-conduction stimulation and need to be carefully evaluated. This paper shows how Lidén’s formulas can be used for calculating safe masking levels.
Families with children with auditory processing disorder (APD) can experience stress when their child encounters difficulties in communication, speech and language development, and learning. Coping with these conditions depends, among other things, on the family’s cohesion and flexibility, and so it is important to understand these factors in order to provide effective psychological support. Currently, no research has explored how families with an APD child function. This study investigated family dynamics in cases where the child had APD. Based on Olson’s Circumplex Model, we studied how mothers perceived the situation and examined the relationships between family cohesion and flexibility, maternal trait anxiety, and a number of socio-demographic factors. There were 106 mothers of children with APD (child’s average age 10 years) who participated in the study. Three groups of families were distinguished: those where the child only had APD (APD1); those with APD and speech, language, and/or articulation disorders (APD2); and those with APD accompanied by other severe health conditions (APD3). Mothers completed the Flexibility and Cohesion Evaluation Scales (FACES-IV) in its Polish adaptation (SOR) and a State–Trait Anxiety Inventory (STAI X-2). The three groups of families differed significantly in terms of the ‘unbalanced’ dimensions of ‘disengaged’ and ‘rigid’. APD2 and APD3 families had higher disengaged and rigid scores compared to APD1; these scores were also higher than in the general Polish population. The mothers who had a lower education level expressed a lower level of family cohesion and had higher levels of the enmeshed and chaotic dimensions. The anxiety traits of the mothers correlated significantly with all dimensions of cohesion and flexibility, except for rigidity. Families which have children with APD, especially when accompanied by difficulties in speech and language development and/or articulation or other serious health problems, may experience changes in family cohesion due to increased level of disengagement between family members. Such families, including mothers with lower levels of education and/or higher trait anxiety, would benefit from various forms of psychoeducation and psychological intervention to improve family functioning.
Thanks to ongoing advancements in cochlear implant (CI) technology and surgical techniques, the eligibility criteria for CIs have expanded to include patients with various levels of low-frequency hearing. However, there is another group of patients with non-functional (or borderline functional) hearing at low frequencies but preserved residual hearing in the high-frequency range, thus making them off-label for a CI even though they get limited benefit from a hearing aid. This study presents a 47-year-old patient with residual hearing at the functional border (75 dB HL or better) for low and mid frequencies (125–1500 Hz) and functional residual hearing (70 dB HL or better) for high frequencies (2000–8000 Hz). CI surgery was performed using the Med-El Flex26 electrode via round window insertion. Hearing preservation (HP) was complete up to at least 24 months and partial up to 36 months. For the high-frequencies only (2000–8000 Hz) there was complete HP for the entire 36 months. At 12 months post-surgery, the patient’s word recognition scores (WRS) had improved by 75 percentage points in quiet and 70 points in noise. The patient’s results demonstrate that preserving functional residual hearing in the basal cochlea is possible after CI surgery, even though this region is very susceptible to insertion trauma. The presence of functional high-frequency hearing should not be the only reason for withholding CI surgery, especially if a hearing aid is ineffective.
This study aimed to: (1) quantify and compare middle ear status in two mice strains, C57BL/6J and CBA/CaJ, using wideband acoustic immittance (WAI) to measure wideband absorbance at ambient pressure (WBA) and at tympanometric peak pressures (WBT); (2) determine the percentage of mice with histologic evidence of otitis media (OM) after nasal inoculations with Bordetella hinzii; (3) assess how B. hinzii affects WBA and WBT; and (4) evaluate if antibiotic treatment reduces OM and restores absorbance to normal. Eight C57BL/6J and eight CBA/CaJ mice were used in Experiment 1. WBA and WBT (averaged across 0.5–8 kHz) were measured at baseline and 3 and 6 weeks after B. hinzii inoculation. Middle ear histopathology was performed to confirm the presence of OM. In Experiment 2, ten C57BL/6J mice with OM received antibiotics, and absorbance was tracked at baseline, during OM, and post-treatment. (1) Baseline absorbance responses were reliably measured in both strains and both showed similar results with peak WBA (~0.4) near 1 kHz and maximal WBT at –50 daPa near 6–8 kHz; (2) None of the CBA/CaJ developed OM, whereas 13 of 16 C57BL/6J ears showed OM histologically; (3) WBA and WBT remained normal in CBA/CaJ mice post-inoculation. In C57BL/6J mice, WBA at ambient pressure was insensitive to OM, but WBT was significantly reduced at 3 and 6 weeks post-inoculation (p = 0.001); (4) Antibiotic-treated C57BL/6J mice showed WBT recovery as OM resolved histologically. Wideband acoustic immittance provides reliable absorbance measures in mice. C57BL/6J mice are susceptible to OM induced by B. hinzii, whereas CBA/CaJ are resistant. WBT can be used to detect and monitor OM in mice. Limitations of the study include a modest sample size and relative rather than absolute values of WBA and WBT due to species differences in calibration.
The prevalence of tinnitus in veterans is higher than in the general population and can profoundly affect daily life. Tinnitus has been associated with psychological difficulties and may result in functional impairment. Currently, no sound therapy has been widely validated as an effective option for tinnitus management. Given the profound impact of tinnitus, and its economic burden and treatment barriers, it is important to explore new approaches. Sound therapy technologies are readily accepted due to their simplicity and non-invasiveness, but there is limited research exploring sound therapy in veterans. Here we explore the feasibility and acceptability of a non-invasive management option. This feasibility and acceptability study included 20 UK military veterans who trialled a non-invasive device, TinniSoothe, for 1 or 2 months. The device is a small sound-generating module designed to be worn on a lanyard or clip during the day and placed in a docking station at night. It allows users to adjust both frequency and volume according to personal preferences, and while docked at night it continues to emit sound into the nearby environment. Participants were instructed to complete a pre-intervention, post-intervention, and 2-month follow-up questionnaire which included measures of tinnitus, mental health, and physical health. All participants (20 veterans, mean age = 51.3, SD = 7.7, 80% male) used the device for the 1-month intervention period, with no dropouts or serious adverse events. The majority (75%) elected to keep the device after 1 month, and 80% said they would recommend it to friends and family. However, at 2 months, just 13 participants reported ongoing device use. From baseline to post-intervention and follow-up, participants reported significant reductions in tinnitus symptoms. Although there was a significant overall effect of time on sleep disturbances, pairwise comparisons did not show significant changes between specific timepoints. No significant differences were observed in the remaining outcomes. This study indicates that the TinniSoothe device shows a degree of feasibility and acceptability for tinnitus management in veterans and there is some evidence supporting its efficacy. However, after 2 months 65% of the participants were still active users, indicating that further research exploring its effectiveness is necessary.
This paper is concerned with loudness hyperacusis, a condition where sounds of medium and high levels appear to be louder than normal. The “normal” perception of loudness can be understood using a model that takes into account the processing of sounds in the peripheral auditory system, including the outer ear, middle ear, and cochlea. This model has been modified to take into account the perception of loudness by people with cochlear hearing loss. The model predicts the loudness recruitment typically associated with cochlear hearing loss, and also predicts that hearing loss can sometimes be associated with “over-recruitment,” so that some sounds appear louder than normal. However, the model does not account for the fact that loudness hyperacusis can occur for people with normal or near-normal audiograms. This suggests that factors associated with higher levels in the auditory system also need to be taken into account. Here, two such factors are considered: the functioning of the efferent system regulating the active mechanism in the cochlea, and effects of central plasticity and adaptation. Both may play a role in hyperacusis.
Misophonia or selective ‘hatred of sound’ is a newly recognized mental disorder characterised by negative emotional reactions, feelings, and thoughts with or without impulsive behavior to specific irritating triggering sounds. The term misophonics has been used to refer to misophonia sufferers. A major effect reported by misophonics is a negative, or even ruinous, impact on close romantic relationships. The aim of our study was to evaluate the quality of sexual life (QoSL) in misophonics of both sexes and their close partners. We enrolled 91 misophonics aged 25.1 ± 5.4 years old (24 males and 67 females) and 91 opposite-sex partners aged 27.3 ± 4.9 years old. Their misophonia was confirmed by use of the Amsterdam Misophonia Scale (A-Miso-S) questionnaire. For evaluation of the QoSL in male misophonics, we used the International Index of Erectile Function (IIEF) and the Sexual Quality of Life–Male (SQoL-M) self-report questionnaires. For female misophonics we used the self-report questionnaire Sexual Quality of Life–Female (SQoL-F) and the Female Sexual Function Index (FSFI). For comparison, the total scores from the misophonics were compared with scores from controls, who were healthy peers (91 males and 91 females who were loving couples) without misophonia. We found that the total SQoL-F scores in female misophonics were statistically lower than in controls (62.7 ± 3.5 vs 89.4 ± 4.7 in controls, p = 0.004). In males with misophonia, the SQoL-M total score was 38.3 ± 4.2 vs 60.7 ± 4.6 in controls (p = 0.002), while IIEF total scores were correspondingly 40.6 ± 5.8 and 68.1 ± 6.3 (p = 0.001). Erectile function score in males with misophonia was 16.3 ± 2.4 vs 27.2 ± 2.8 in controls (p = 0.003). Partners of misophonics of both sexes also demonstrated decreased scores in total IIEF, SQoL-M, SQoL-F, and FSFI. In female partners of misophonic males, SQoL-F total score was 71.4 ± 4.6 vs 89.4 ± 4.7 in controls (p = 0.007). Erectile function score in male partners of misophonic females was 20.1 ± 3.2 vs 27.2 ± 2.8 in controls (p = 0.015). In misophonics of both sexes who had comorbid mental disorders, the scores that characterized QoSL were even lower. Misophonia decreases the quality of sexual life in sufferers of both sexes as well as their partners.
Hyperacusis is a loudness intolerance disorder associated with many medical conditions. To investigate the biological bases of hyperacusis in animals, we developed an auditory reaction time-intensity (RT-I) paradigm to assess the growth of loudness in rats treated with sodium salicylate, a drug suspected to cause hyperacusis. Loudness growth was unaffected by low-dose salicylate; however, high doses significantly reduced reaction times at high intensities, resulting in behavioral evidence of hyperacusis. To identify the neural correlates of salicylate-induced hyperacusis, neural activity was monitored along the auditory pathway. Salicylate significantly reduced the neural output of the cochlea. Paradoxically, neural responses were progressively amplified when relayed towards the central auditory pathway resulting in responses 2x larger than normal in auditory cortex (ACx), evidence of enhanced central gain. Because salicylate dose-dependently increased corticosterone stress hormone levels, rats were chronically fed corticosterone stress hormone to determine its behavioral and electrophysiological effects. This led to enhanced sound-evoked neural response in ACx without altering the neural responses from the cochlea and auditory brainstem. Patients with autism often suffer from sound tolerance issues (i.e., hyperacusis). Fragile X (FX) syndrome is a leading genetic cause of autism. To determine if rats with the FX mutation suffered from hyperacusis, we compared loudness growth functions in FX rats with littermate controls. FX rats had normal hearing thresholds but exhibited behavioral evidence of loudness hyperacusis and abnormal temporal and spectral integration of loudness. These behavioral models of hyperacusis can guide the search for biological bases of hyperacusis.
Individuals with autism spectrum disorder (ASD) frequently experience decreased sound tolerance (DST), which reduces their social interaction and engagement. The purpose of this perspective piece is to look at the gap in the literature concerning the possible genetic and functional bases for the comorbidity of ASD and two distinct types of DST, hyperacusis and misophonia.
Tinnitus patients frequently complain about Decreased Sound Tolerance (DST) as well. Based on the observations of several hundred patients with Decreased Sound Tolerance the existence of unrecognized earlier auditory disorder with distinctive and different from hyperacusis characteristics has been identified. Patients with this disorder exhibited negative emotional and autonomic reactions evoked by a specific for a given patient patterns of sound. Consequently, the name misophonia for this previously not described disorder and its definition based on data gathered from our patients was proposed in 2001. It is possible to have tinnitus, hyperacusis, and misophonia in combination or as isolated conditions. On the basis of analysis of characteristic features of patients with DST, and general neuroscience, the neurophysiological model for both misophonia and hyperacusis has been proposed. The key characteristic of misophonia is the formation of inappropriate, pattern-specific, subconscious connections, between the auditory system and other systems of the brain, governed by the principles of conditioned reflexes. Notably, the brain systems and connections involved in misophonia are the same as in the case of tinnitus. The mechanism of hyperacusis is based on abnormally increased gain within the subconscious part of the auditory pathways. This yields a high level of neuronal activity, equivalent to activity evoked by a much stronger sound in normal subjects. The activation of the other systems in the brain is a consequence of spreading this abnormally enhanced sound-evoked activity by normally functioning neuronal connections from the auditory to other systems in the brain. In misophonia, sound-evoked signals within the auditory pathways are normal, but development of incorrect pattern-specific connections yield abnormally strong activations of various systems in the brain. In hyperacusis and misophonia reactions evoked by bothersome sound are very similar, even identical and cannot be used to differentiate these two disorders. Importantly, both clinical observations and predictions of the model point out that misophonia requires a different approach for diagnosis and treatment than hyperacusis.
This article presents the results of some of my informal surveys and speculations from my private clinical psychotherapy practice regarding causes of misophonia and its possible relationship to family dynamics and other non-auditory factors. My hope is that researchers might take these as a starting point and conduct formal studies to verify or dismiss my informal results. My observations and relevant surveys address ten key questions and speculations about the root causes of misophonia. Understanding the causes of this complex disorder will lead to better treatments and possibly even prevent its development. Following a brief section on context and background of existing research, ten proposed topics are presented for possible future research: Ancient brain; Genetics/ twins; Epigenetics/ family; Religion; Personality type; Trauma; Intelligence/ neural pruning; Gender expectations; Perinatal factors; Other considerations. The background for each of the ten topics is followed by a rationale for further exploration. In the short number of years since misophonia was first identified as a distinct disorder, there has been increasing interest into more clearly defining the condition, and many studies have looked for potential causes. There is now ample evidence that it exists, but it is not yet clear why. So as to better understand this complex condition, this article proposes fertile avenues for future research.
The complaints of patients with hyperacusis and misophonia are very similar, and frequently identical. However, there are distinctive differences between these conditions. The recognition of these differences is crucial to properly diagnose and treat hyperacusis and misophonia. Audiological evaluation, while helpful, is not sufficient for differential diagnosis. Specific patient interview is critical. The treatment for hyperacusis is based on the desensitization of auditory subconscious pathways and it is aimed at decreasing abnormally increased gain within the auditory system. For misophonia the treatment involves utilization of passive and active extinction of subconscious conditioned reflexes as well as purposefully creating and modifying complex conditioning stimuli. The treatments for both conditions include counseling and sound therapy but they are distinctively different. The treatment effective for hyperacusis is not successful for misophonia and the treatment for misophonia has limited effectiveness for hyperacusis. The treatment of Decreased Sound Tolerance (DST), based on the Neurophysiological Model of Tinnitus and Decreased Sound Tolerance, showed over 80% success rate of clinically significant improvement and can even provide a cure for hyperacusis and misophonia.
Hyperacusis is a specific auditory disorder characterized by an increased sensitivity to sounds, which is often accompanied by a significant psychological component. Some studies suggest that individuals with hyperacusis exhibit greater anxiety compared to the general population. However, it remains unclear whether gender affects the relationship between hyperacusis and anxiety. The aim of this study was therefore to investigate the role of gender in the interplay between hyperacusis, tinnitus, and anxiety. The study group consisted of 106 patients with hyperacusis and tinnitus. There were 55 women and 51 men. The women were aged between 20 and 72 years (M = 44.9; SD = 12.8); the men were aged between 19 and 72 years (M = 45.4; SD = 12.0). A clinical interview, an audiological examination, and three questionnaires – State-Trait Anxiety Inventory (STAI), Hyperacusis Assessment Questionnaire (HAQ), and Tinnitus Handicap Inventory (THI) – were applied. The levels of anxiety in women and men were similar, but exceeded normative values established for the general population. In women, hyperacusis was not a significant predictor of anxiety (β = 0.13, p = 0.34), whereas tinnitus severity was (β = 0.47, p = 0.002). In men, both hyperacusis (β = 0.36, p = 0.004) and tinnitus severity (β = 0.48, p < 0.001) significantly predicted anxiety. This study highlights the complex interplay between gender, hyperacusis, tinnitus, and anxiety. The findings suggest that interventions for subjects with hyperacusis and tinnitus should be gender-specific.
The aim was to investigate sound tolerance in schoolchildren aged 9–14 years, examine differences across age groups, and identify possible associated factors. This was a cross-sectional exploratory study. An internet-based survey was conducted with children aged 9 to 14 years and their parents/guardians, recruited via social media. Parents/guardians and children completed separate questionnaires; the one developed for children has not been formally validated although it has been applied in prior pediatric studies. Hyperacusis was classified as present when both parent and child report were positive. Associated factors were analyzed using Fisher’s exact test to compare individuals with auditory hypersensitivity in terms of whether they were also sensitive to lights, odors, or motion sickness. Inter-rater agreement between parents and children was evaluated with the kappa coefficient (κ). From the 75 parents recruited, there were just 60 questionnaires that had been completed by their children (age range 9–14 years; mean 12 years; 61.7% male). Listening difficulties were more frequently reported in children aged 9–10 years (p = 0.010), while earphone use was significantly higher among adolescents aged 13–14 years (p = 0.010). Motion sickness was more prevalent in children aged 11–12 years (p = 0.033). Tinnitus was reported by 20% of children, and hyperacusis by 10.3%, with no significant differences across age groups. Sensitivity to light and odors was significantly associated with hyperacusis according to parents’ reports (p = 0.007) and to children’s reports (p = 0.020). No association was observed between motion sickness and hyperacusis. Although the prevalence of hyperacusis among schoolchildren was relatively low, the occurrence of sound-related discomfort was notable. Sound tolerance should be considered in clinical evaluations. The findings should be interpreted with caution due to the small sample size and the use of non-validated questionnaires.
Estrogen plays a vital role in various physiological processes. While its impact on peripheral hearing sensitivity has been explored, limited attention has been given to its effect on central auditory processes, particularly during menopause. The present study examines the effects of both natural and surgical menopause on temporal processing of sound, speech perception in noise (SPIN), and working memory. Three groups of women aged 49–60 years were recruited: 20 women with natural menopause, 20 with surgical menopause, and 20 premenopausal women. Temporal processing was assessed using the modulation detection threshold (MDT) and gap detection threshold (GDT) tests, SPIN abilities were evaluated using the Speech Perception in Noise Test in Kannada (SPIN-K), and working memory was assessed through digit span and sequencing tasks. The group of women with surgical menopause had significantly poorer temporal processing abilities, as reflected in higher MDT and GDT thresholds than the other two groups. No significant differences in SPIN or working memory were observed among the groups. The findings highlight the adverse effects of surgical menopause on auditory temporal processing, likely due to an abrupt decline in estrogen levels. These results underscore the importance of estrogen in auditory health and call for targeted interventions and further research to confirm and expand these findings.
The 2025 World Tinnitus Congress (WTC) and XIV International Tinnitus Seminar (ITS), held in Warsaw, Poland, brought together leading researchers and clinicians to share the latest advances in tinnitus and hyperacusis care. This article reviews key developments presented at the conference and explores the implications for research and clinical practice. Major themes included progress in cognitive behavioural therapy (CBT), neurophysiological mechanisms, somatosensory modulation, pharmacology, and digital health interventions. Highlights included validated paediatric assessment tools, stratified pharmacotherapy, and precision surgery for pulsatile tinnitus. Presentations underscored the expanding role of tele-audiology and digital self-help platforms, reflecting a shift toward decentralised and personalised care. The need for biomarker-guided trials, improved patient stratification, and wider access to psychological therapies are priorities for both research and clinical delivery.
Today, many people are in the habit of listening to music, watching movies, and playing games via headphones or earbuds connected to devices such as cellphones, computers, and iPads, when studying or doing other activities. This study investigated the LAeq output of four different devices connected with two different earbud types. A GRAS 45CB Acoustic Test Fixture was used to measure the output of the earbuds. All devices were purchased in a regular store to mimic the natural process and usage of the products. Both earbuds have the same cable length and are of the same design. The findings indicated that one earbud brand produced varying output levels when connected to different devices, even when the same volume setting was used. Statistical analysis confirmed that the output differences across devices were significant, as reflected in the results: [F(3) = 805.08, p < 0.001], with a partial R2 of 89.7% for the right ear, and [F(3) = 805.08, p < 0.001], with a partial R2 of 89.7% for the left ear, based on measurements taken at five different volume levels. Likewise, the interactions were also found to be significant in both ears. Furthermore, the discrepancies between the left and right ear outputs for each earbud–device combination were found to be potentially unsafe, raising concerns about auditory risk. Notably, at the 60% volume setting, the sound output from both ears across all tested devices exceeded the exposure limits recommended by the U.S. Environmental Protection Agency (EPA). Findings showed that one size does not fit all. Findings from this study could help government intervention in headphone/ earbud manufacturing policy and standards and assist long-term users of earbuds to regulate the usage of earbuds.
The aim of the study was to assess the development of auditory behavior in Polish infants and young children with normal hearing who were attending childcare facilities. They were considered by their parents or guardians as being typically developing. The study participants included parents and other caregivers of 293 children attending various nurseries in Lublin, Poland. The children’s chronological age ranged from 2 to 35 months. The LittlEARS® Auditory Questionnaire was used as the assessment tool. Although the tool is designed to assess children up to 24 months of age, it was also used to evaluate somewhat older children to determine whether they had achieved an auditory development level equivalent to at least that of a 2-year-old. The study showed that all 25 children up to 12 months of age exhibited faster auditory development than the standard curve. Of the other 268 children 13 to 35 months old, delays were observed in 27% of them and faster development in 34%. Analysis of the responses to individual LittlEARS® Auditory Questionnaire items revealed that questions where children commonly encountered difficulties (i.e., “no” was the most frequent answer parents gave) involved questions 8, 14, 31, and 35. The LittlEARS® Auditory Questionnaire is both user-friendly and reliable for screening assessments, suggesting that standard 12- and 24-month developmental screenings for children may be helpful in identifying auditory problems at an early stage. There is also a need to adapt tools suitable for children over 24 months of age, such as the PEACH questionnaire, into Polish.
Due to the growing number of registered medicinal products, it is important to know about their mechanisms of action and adverse side effects. This also applies when diagnosing an otorhinolaryngology patient. The aim of this study was to review the literature and summarise various active substances and their relevant adverse effects. Available literature data and summary of product characteristics were analysed. The following adverse reactions were studied: dizziness, hoarseness, oral candidiasis, pharyngitis, ototoxicity, painful swelling of the salivary glands, nasal congestion, dysgeusia, nosebleeds, tinnitus, dry nose, and difficulty swallowing. To classify adverse reactions the MeDRA classification was used. A list of individual adverse reactions and active substances that may cause them was prepared, along with the mechanism of causing a given adverse reaction. Dizziness was found to be caused by the largest number of drugs analyzed. The most severe adverse effects were irreversible ototoxicity (e.g., caused by intravenous aminoglycoside antibiotics) and embryotoxicity. Adverse effects of medicinal substances important in otorhinolaryngology, audiology, and phoniatrics are multifactorial, but knowledge of them is necessary to make a correct diagnosis.
The perception of musical intervals is a fundamental component of melody and harmony. Intervals can be presented melodically (successive tones) or harmonically (simultaneous tones), with the latter playing a critical role in the perception of consonance and chordal structure. In the chromatic scale, intervals are measured in semitones, and their perceived pleasantness (i.e., consonance or dissonance) is determined by the frequency ratio between them. Cochlear implant (CI) users are likely to perceive harmonic intervals differently from normal-hearing individuals due to technological limitations in transmitting the spectral and temporal complexity of musical sounds. Factors affecting perception of sounds in CI users include placement of the electrode array inside the cochlea and spread of excitation along the auditory nerve. To explore differences in how harmonic intervals are perceived, this study presents three case studies of the ranked pleasantness of consonance and dissonance by (1) a normal-hearing individual without musical training; (2) a normal-hearing musician; and (3) a cochlear implant user. The findings provide a foundation for future investigations into interval perception and have implications for auditory rehabilitation and music-based therapy.
