Background: Directionality algorithms are fundamental to modern hearing aids, enhancing speech perception in noisy environments by improving the signal-to-noise ratio. Conventional adaptive approaches rely on heuristic optimization criteria and often improve speech understanding from specific directions, typically the front, at the expense of spatial awareness. A deep neural network (DNN)-based directionality system was developed that dynamically optimizes spatial filtering through a data-driven framework capable of representing complex acoustic scenes. The system intelligently enhances target speech while preserving awareness of environmental sounds. Methods: The proposed DNN-based directionality system was evaluated against conventional directionality algorithms by assessing word recognition performance, perceived speech clarity, and listener preference across diverse acoustic scenarios. To complement subjective measures, an artificial intelligence (AI)-based objective intelligibility metric was additionally developed using automated speech-to-text analysis, enabling scalable and consistent benchmarking across devices. Results: Results across the behavioral and objective assessments indicate improved speech intelligibility outcomes together with maintained access to environmental sounds. Mean SRT50 improved by 1.4 dB relative to legacy directionality for target speech presented at 90° and by 4.7 dB relative to an omnidirectional pattern when frontal target speech was accompanied by a rear interfering talker. Spatial adaptation further improved environmental sound audibility in three out of four conditions and significantly improved the detection threshold for speech presented at 135° by 2.42 dB. Conclusions: These results show that the system can preserve speech originating away from the front while using acoustic context and spatial filtering to attenuate competing speech that interferes with a frontal conversation.
Background/Objectives: Tinnitus has been linked to hemodynamic changes. Objective measures capable of monitoring hemodynamic changes during tinnitus treatment remain limited. This study investigated hemodynamic changes during combined acupuncture and moxibustion treatment in patients with subjective tinnitus using photoplethysmography (PPG) and pulsed-wave Doppler ultrasound (PW Doppler). Methods: A retrospective review of 10 patients with subjective tinnitus treated with acupuncture and moxibustion was conducted. Hemodynamic changes were assessed using acceleration photoplethysmogram (APG) indices and PW Doppler parameters. Results: The c/a ratio in APG increased significantly after acupuncture, indicating an acute change in arterial pulse wave characteristics.. Combined acupuncture and moxibustion significantly increased peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MV), while decreasing the resistive index (RI) in the superficial temporal artery. However, improvements in the Tinnitus Handicap Inventory (THI) scores did not consistently align with changes in APG and PW Doppler parameters. Conclusions: These findings suggest that APG and PW Doppler may be useful for objectively assessing acute hemodynamic changes during acupuncture and moxibustion treatment in patients with subjective tinnitus.
Objectives: This study aimed to analyze in a comprehensive systematic review the hearing rehabilitation strategies for single-sided deafness (SSD) and asymmetric hearing loss (AHL) in children. Current rehabilitative options include contralateral routing of signal (CROS) devices, bone conduction devices, and cochlear implantation (CI). Methods: A systematic review of PubMed/MEDLINE was performed to identify studies on pediatric SSD and AHL rehabilitation published up to 7 July 2025. Reviews, meta-analyses, case reports, and animal studies were excluded. Eligible studies included pediatric populations treated with rehabilitative devices, with outcomes focused on speech perception, auditory performance, binaural hearing, quality of life, and questionnaire-based measures. Study selection followed PRISMA principles. Results: A total of 1527 records were identified by three authors through PubMed/MEDLINE (2003–July 2025) after duplicate removal. Title screening retained 581 studies, and abstract screening retained 267 studies. Fifty-eight full-text papers were assessed for eligibility; 10 were excluded due to overlapping patient cohorts, leaving 48 papers for the qualitative synthesis. Overall, 1622 children were analyzed; 43 studies focused on SSD and five on AHL. Conclusions: Available evidence supports rehabilitation in pediatric SSD and AHL. CROS systems offer a non-surgical and reversible option with benefits in selected listening situations but limited effects on localization. Bone conduction devices may improve hearing in noise and some functional outcomes, especially in conductive indications. CI appears to provide the greatest opportunity to restore bilateral auditory input, particularly when performed early in congenital SSD.
Purpose: Growing interest in music perception among cochlear implant (CI) users has led to increasing research in this area. To support cross-cultural studies, this work aimed to adapt and validate the Music-Related Quality of Life (MuRQoL) questionnaire into German (MuRQoL-De). Methods: The MuRQoL was translated and culturally adapted into German following established guidelines for hearing-related instruments. The final version (“Fragebogen zu Musik und Lebensqualität”) was completed by 32 adult CI users and 43 normal-hearing (NH) individuals. Internal consistency was assessed using Cronbach’s alpha. Construct validity was evaluated through group comparisons and exploratory regression analyses examining demographic and clinical factors. Results: The MuRQoL-De demonstrated high internal consistency, with Cronbach’s alpha values exceeding 0.80 for both Frequency and Importance scales and their subdomains. NH participants reported significantly higher scores than CI users on the Frequency scale, especially in the Music Perception subscale (p < 0.01). No significant group differences were observed for the Importance scale. Regression analyses did not identify statistically significant predictors of MuRQoL scores, though trends suggested potential associations with age, education, and musical experience. Conclusions: The MuRQoL-De is a reliable and valid instrument for evaluating music-related quality of life in German-speaking adults. It effectively differentiates between CI users and NH individuals in terms of musical participation, while also emphasizing the shared importance of music. Its application may support individualized rehabilitation strategies that include musical engagement, addressing an important but often neglected aspect of auditory well-being.
Objectives: Extracochlear electrodes (EEs), defined as electrode contacts located outside the cochlea, can degrade cochlear implant (CI) performance. We present and validate an Electric Field Imaging (EFI)-based algorithm that helps detect EEs and can be used intra- or post-operatively. Methods: An algorithm for detecting EEs from EFI data was developed. Validation and testing were performed using three datasets: (a) bench models with known EE conditions (saline and resistive load model), (b) clinical EFI recordings from CI recipients with imaging confirmation (CT or plain X-ray), and (c) EFI recordings without imaging. Primary outcomes included the ability to differentiate extracochlear conditions from fully inserted electrode arrays, as well as the concordance between the number of EE contacts identified by the algorithm and those determined from controlled bench configurations or available imaging data. Results: The algorithm reliably differentiated full insertion from EE conditions on bench models and clinical EFI recordings from CI recipients with imaging confirmation. In the imaging-confirmed clinical cohort (6 EE cases among 226 CI recipients), the algorithm achieved 100% sensitivity and specificity. In clinical cases without imaging, the algorithm flagged 3.94% as having extracochlear electrodes, within the range of prevalence reported in the literature. Furthermore, the lateral-wall electrode arrays were associated with a significantly higher extracochlear electrode occurrence compared to the pre-curved arrays. Conclusions: This EFI-based algorithm may provide a useful screening tool for EEs using routine clinical measurements, supporting intra-operative and post-operative detection while reducing reliance on imaging and thereby aiding clinical decision-making. The method can be integrated into existing clinical fitting software workflow and complements recent work on EFI-based tip fold-over detection. The observed sensitivity and specificity suggest that this approach may provide a valuable tool for identifying EEs in situations where imaging is unavailable or impractical.
Objective: To critically synthesize the available evidence on the pathophysiological variants of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) and to propose an integrative model based on otoconial location and cupular dynamics to explain their clinical presentation and therapeutic implications. Methods: A scoping review was conducted through a search of PubMed/MEDLINE, Scopus, and the Cochrane Library for studies published between January 1996 and May 2026. Studies describing pathophysiological variants, biomechanical mechanisms, nystagmus patterns, or therapeutic maneuvers in HSC-BPPV were included. A total of 26 studies met the inclusion criteria and underwent qualitative analysis. Results: Six principal mechanical configurations of horizontal canal positional vertigo were identified: long-arm canalolithiasis, short-arm canalolithiasis, canal-side cupulolithiasis, utricular-side cupulolithiasis, canalith jam, and light cupula. The available evidence suggests that these variants represent different mechanical states determined by otoconial location, otoconia-cupula interaction, canal obstruction, or alterations in cupula-endolymph density. This model explains the direction, intensity, and duration of positional nystagmus, the findings observed during the supine roll test and the bow and lean test, as well as the variability in response to repositioning maneuvers. A practical classification integrating pathophysiology, clinical findings, and treatment is proposed. Conclusions: HSC-BPPV may be more appropriately understood as a spectrum of mechanical states in which the configuration of otoconial debris and its interaction with the cupula influence the nystagmus pattern, clinical presentation, and therapeutic response. This integrative model may improve diagnostic accuracy and guide treatment selection, although prospective validation is required.
Background/Objectives: The variability of the internal acoustic meatus (IAM) and its morphological peculiarities are of high clinical significance in otologic interventions and neurosurgery. Considering the complexity of the neurovascular structures housed by the IAM, including passage of the facial nerve, the aim of the study was to highlight the morphological peculiarities of the IAM and their clinical significance. Methods: The age peculiarities of the IAM course were studied on 18 serially, transversely sectioned human embryos and fetuses, as well as on 20 newborn and 20 adult formalin-fixed hemiheads. The morphometric parameters of the IAM (width, height, length, and angles between the anterior and posterior walls of the IAM and the longitudinal axis of the petrous ridge (LAPR) were evaluated on 82 dry temporal bones. Results: In embryos and early fetal stages of development, the course of the IAM formed an acute, posteromedially open angle with the longitudinal axis of the petrous part of the temporal bone (LAP); in newborns, it was a right angle; in adults, it was an acute, anteromedially open angle. Various shapes of the IAO, such as oval (51.2%), semioval (23.2%), quadrangular (13.4%), heart-like (3.7%), and triangular (8.5%), were highlighted. The mean width of the internal acoustic opening (IAO) was 7.7 ± 2.11 mm (right/left—8.2 ± 2.22 mm/7.2 ± 1.89 mm), with a statistically significant difference (p = 0.031). The mean height of the IAO was 5.3 ± 1.43 mm (right/left—5.6 ± 1.58 mm/5.0 ± 1.22 mm), p = 0.082. The mean length of the IAM was 10.1 ± 2.83 (right/left—10.5 ± 2.96 mm/9.7 ± 2.67 mm), p = 0.214. A partial septum was revealed in 3.6% of cases, while total septation of the IAM was observed in 2.4%. The mean angle between the anterior wall of the IAM and the longitudinal axis of the petrous ridge (AWIAM/LAPR) was 21.4 ± 13.67° (right/left—22.2 ± 14.62°/20.5 ± 12.78°), p = 0.564. The mean angle between the posterior wall of the IAM and the longitudinal axis of the petrous ridge (PWIAM/LAPR) was 82.4 ± 8.02° (right/left—84.3 ± 7.93°/80.5 ± 7.76°); p = 0.032. Conclusions: In the initial stages of an individual’s ontogenesis, the IAM forms an acute, posteromedially open angle with the LAP; in newborns—a right angle; in adults—an acute, anteromedially open angle. Both morphological characteristics and morphometric parameters of the IAO and IAM vary bilaterally. The oval, semioval, quadrangular, heart-like, and triangular shapes of the IAO were highlighted. Partial and total septation of the IAM were revealed. Only the TDAIO and PWIAM/LAPR angle were statistically significant, p < 0.05, while the bilateral correlation was negligible. The established morphological variants of the IAM could predispose to facial and vestibulocochlear nerve impairments.
Background/Objectives: Diabetes mellitus (DM) has been proposed as a potential risk factor for vestibular dysfunction, although the evidence remains heterogeneous. This review was prompted by the increasing recognition in clinical practice of a frequent coexistence between DM and recurrent vestibular disorders. It aims to examine the most recent available literature investigating the association between DM and the most common causes of recurrent vestibular disorders, thereby providing clinicians with additional insights for early diagnosis and risk stratification. Methods: A systematic review was conducted according to PRISMA guidelines with SWiM-based narrative synthesis. PubMed, Scopus, and Google Scholar were searched for studies (2016-2026) including adult diabetic patients with vestibular disorders. Risk of bias was assessed using NOS, RoB2, and JBI tools. Results: Twenty-nine studies met the inclusion criteria, but only nineteen were focused explicitly on recurrent vestibular disease. Diabetes was consistently associated with higher prevalence and recurrence of benign paroxysmal positional vertigo (BPPV), more persistent vestibular symptoms, and worse balance outcomes. Associations with other recurrent vestibular disorders was scarce and high heterogeneity limited quantitative synthesis. Conclusions: The available literature suggests that DM increases the vulnerability of the vestibular system in BPPV cases while data regarding other vestibular disorders, including VM and MD, are still limited. More prospective studies investigating the link between diabetes and recurrent vestibular disorders are needed, particularly through specific indicators of evolutionary picture of diabetes.
Background/Objectives: Even with the use of hearing aid or cochlear implant technologies, adults who are deaf or hard of hearing (DHH) exhibit difficulty perceiving musical characteristics compared to peers with typical hearing, but do not necessarily report a consistent decrease in appreciation of musical activities. This study addresses a gap in the literature by examining the effect of both hearing status (i.e., DHH versus typical hearing) and hearing technology (i.e., hearing aids versus cochlear implants) on both behavioral and subjective music abilities and ratings of music importance. Methods: Adults with typical hearing (n = 20), hearing aids (n = 10), or cochlear implants (n = 10) completed tasks on (a) behavioral measures of music perception including pitch perception, melody recognition, and timbre recognition; and (b) the Music-related Quality of Life questionnaire to assess subjective ratings of music abilities and music importance. Results: Adults with typical hearing outperformed the cochlear implant group on all behavioral music perception tasks, but they performed similarly to the hearing aid group. Although the two DHH groups subjectively rated their musical abilities less positively than adults with typical hearing, all three groups appraised the importance of music in their lives similarly. Conclusions: Music importance and appreciation do not depend on music abilities, implying that clinicians and researchers should incorporate metrics of subjective music quality of life to comprehensively assess and treat adults who are DHH to foster more positive quality of life.
Background: Positional torsional downbeating nystagmus elicited during diagnostic maneuvers for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) may indicate either ipsilateral apogeotropic PSC-BPPV or contralateral anterior canal BPPV, making differential diagnosis challenging. This retrospective study evaluated whether ipsilateral 100 Hz mastoid vibration could facilitate conversion to a geotropic nystagmus pattern, thereby supporting both diagnosis and treatment. Materials and Methods: Ten patients with apogeotropic PSC-BPPV underwent standard diagnostic and therapeutic maneuvers combined with ipsilateral 100 Hz mastoid vibration. The primary outcome was the rate of nystagmus geotropization. Secondary outcomes included the number of repositioning maneuvers required to achieve complete symptom resolution. Outcomes were compared with those of two control groups: one consisting of patients with apogeotropic PSC-BPPV treated without mastoid vibration and another consisting of patients with typical PSC-BPPV treated using standard repositioning maneuvers alone. Results: Mastoid vibration induced geotropization in 7 out of 10 patients (70%). The mean number of liberatory maneuvers required for symptom resolution was lower in vibration-responsive patients than in vibration-non-responsive patients (1.7 ± 0.49 vs. 3.0 ± 1.41;). Compared with patients with apogeotropic PSC-BPPV treated without mastoid vibration, vibration-responsive patients required significantly fewer maneuvers (2.1 ± 0.87 vs. 2.9 ± 0.74; p = 0.036). No significant difference was observed when compared with patients with typical PSC-BPPV (2.1 ± 0.87 vs. 2.1 ± 0.52; p = 0.82). Conclusions: Mastoid vibration may represent a useful adjunctive tool in the management of apogeotropic PSC-BPPV by facilitating conversion to the typical geotropic pattern. This conversion may provide useful diagnostic information, and potentially reduce the number of repositioning maneuvers required to achieve symptom resolution.
Background: Prosodic cues play a critical role in marking syntactic boundaries and guiding sentence interpretation. However, Turkish clinical language batteries lack dedicated measures targeting linguistic prosody and the syntax-prosody interface. Consequently, subtle auditory-prosodic comprehension difficulties may go undetected in stroke populations who perform within normal limits on standard aphasia assessments. This study presents the development and initial psychometric evaluation of the Prosodic Comprehension Test (PCT), a Turkish sentence-picture matching tool designed to isolate prosodic contributions to meaning under controlled syntactic conditions. Methods: A total of 440 neurologically healthy native Turkish-speaking adults participated. An initial pool of 80 sentences (40 minimal pairs), identical in segmental and syntactic structure but differing in interpretation through prosodic boundary placement, was created. Audio stimuli were recorded by a professional actor, and corresponding visual stimuli represented alternative interpretations. Following expert review, 32 sentences (16 pairs) were retained and organized into three subcomponents: In situ Prosody, Focus-Topic Marking, and Pragmatic Disambiguation. Administration included fixed-intensity auditory presentation and a structured learning phase. Results: Internal consistency was acceptable (Cronbach's α = 0.73). Principal component analysis was consistent with the theoretically proposed three-component structure (KMO = 0.74; Bartlett's test significant, p < 0.001), with the three components collectively accounting for 28.2% of the total variance. Convergent validity was supported by a significant positive correlation with MoCA-TR (r = 0.23, p < 0.001, 95% CI [0.14, 0.32]). Conclusions: The PCT appears to be a linguistically grounded and psychometrically promising tool for assessing prosodic comprehension in Turkish. The present findings are based on a healthy adult sample and should be interpreted as preliminary normative evidence. Further research should address test-retest reliability, confirmatory factor analyses, and validation in clinical populations.
Background/Objectives: This study evaluated the intra-session repeatability, reliability, and clinical consistency of resonance frequency derived from pressure-less acoustic immittance (PLAI), and compared the results with those obtained using conventional multifrequency tympanometry under identical clinical conditions. Methods: In this pilot methodological comparison study, resonance frequency (RF) measurements were obtained in 15 subjects (30 ears) using multifrequency tympanometry (MFT) and pressure-less acoustic immittance (PLAI). Three consecutive measurements were performed for each ear using both methods. Agreement between methods was evaluated using Bland-Altman analysis. Within-method repeatability was assessed using range, coefficient of variation, repeatability coefficient, and intraclass correlation coefficients. Results: PLAI demonstrated lower intra-session variability than MFT. The mean within-series SD was 96.6 Hz for MFT and 10.5 Hz for PLAI. The coefficient of variation was 9.3% for MFT and 3.2% for PLAI, while intraclass correlation coefficients were 0.60 and 0.83, respectively. The repeatability coefficient was ±367 Hz for MFT and ±47 Hz for PLAI. Bland-Altman analysis revealed a systematic difference between the two methods, with a mean bias of 580.7 Hz and 95% limits of agreement between 247.5 Hz and 913.9 Hz, indicating that the two methods are not interchangeable. Conclusions: PLAI demonstrated higher repeatability than MFT. Its lower variability may support a more consistent clinical interpretation; PLAI-derived RF may therefore represent a stable method-specific parameter for middle ear assessment. However, RF values should be interpreted within method-specific frameworks.
Background/Objectives: For patients with profound deafness resulting from auditory nerve pathology, as in Neurofibromatosis type 2, auditory brainstem implantation (ABI) can restore meaningful acoustic input. The literature reporting real-world results for ABI users is limited, especially regarding patients with bilateral implants. Here, we provide an updated report on the audiologic outcomes among all ABI patients treated at a tertiary institution, including high-performing bilateral ABI users. Methods: In this updated and expanded retrospective case series, audiologic outcomes were reviewed in sixteen consecutive patients who underwent ABI placement by a single neurosurgeon-neurotologist team at our center since 2018. Implantation in four of these patients was on their second side after having undergone first side implantation prior to receiving care at our hospital. Main outcome measures were sound awareness (sound-field threshold testing) and speech understanding (pattern perception, spondee, open-set speech testing). Results: Sound awareness was achieved in 100% of patients (16/16) using an average of 12 electrodes (range 7-20). Persistent non-auditory sensations were reported by 12.5% (2/16). Postoperative speech differentiation (with or without lip-reading) was experienced in 87.5% (14/16). Two second-sided ABI recipients experienced exceptional outcomes as high-performing outliers: one achieved 57% audio only and 86% audio + visual hearing in noise test (HINT) sentence scores; the second bilateral user scored 92% with auditory-only input. Conclusions: ABI represents a viable option for patients who are at risk of developing bilateral profound deafness resulting from auditory nerve disruption. Second sided device implantation is safe and has the potential to significantly improve auditory outcomes.
Background/Objectives: Age-related hearing loss is one of the most prevalent chronic conditions in older adults and has emerged as a potentially modifiable risk factor for cognitive decline and dementia. Increasing evidence from epidemiological, neurobiological, and interventional studies has improved our understanding of the complex relationships between auditory dysfunction and cognitive aging. By highlighting findings in these areas, this review aims to aid clinicians and researchers gain a better understanding of the association between hearing loss, cognitive decline and dementia, and the importance of considering sensory decline during cognitive screening. Methods: This narrative review summarizes and integrates findings from epidemiological, neurobiological, and clinical studies examining relationships between hearing loss, cognitive decline, and dementia. Particular focus was placed on epidemiological associations, proposed mechanistic pathways, implications for screening and diagnostic assessment, and evidence regarding hearing rehabilitation interventions. Results: Accumulating evidence indicates that hearing loss is associated with accelerated cognitive decline and increased dementia risk. Proposed mechanisms include increased cognitive load, reduced sensory input, social isolation, depression, and shared neurodegenerative or vascular pathology, although causal pathways remain incompletely understood. Emerging evidence suggests that hearing rehabilitation may help preserve cognitive function in some groups, but findings remain heterogeneous. Clinical studies further support the importance of considering auditory function during cognitive assessment, as unrecognized hearing impairment may influence test performance, communication, and diagnostic accuracy. Conclusions: Current evidence supports hearing loss as an important factor in cognitive aging and dementia research and highlights the potential value of integrating hearing assessment and management into clinical and research settings.
BACKGROUND/OBJECTIVES:Tinnitus is a significant global health concern with substantial geographic variation in prevalence. However, data on tinnitus epidemiology in southern Saudi Arabia remain limited, despite emerging evidence suggesting a relatively high regional burden. Therefore, this study aimed to estimate the prevalence of tinnitus and identify its epidemiological determinants among adults in southern Saudi Arabia. METHODS:A community-based cross-sectional study was conducted among 501 adults from four regions in southern Saudi Arabia (Jazan, Aseer, Najran, and Al-Baha). Data were collected on sociodemographic characteristics, chronic medical conditions, noise exposure patterns, and clinical features of tinnitus. Multivariable logistic regression analysis was used to identify factors independently associated with tinnitus. RESULTS:The overall tinnitus prevalence was 31.1% (156/501). The mean age of participants was 30 ± 11 years, and 61.7% were female. Bilateral tinnitus was the most common (47.4%). Symptom duration was reported as <3 months in 31.4% of cases and between 3 months and 1 year in another 31.4%. The mean severity score was 3.7 ± 1.9. Most affected individuals (76.9%) did not seek medical care. Primary exacerbating factors included sleep deprivation (41.7%), noise exposure (41.0%), and stress (39.1%). Multivariable analysis identified two significant independent predictors: weekly noise exposure exceeding 5 h (odds ratio [OR] = 2.14; 95% confidence interval [CI]: 1.34-3.42; p = 0.001) and higher body mass index (BMI) (OR = 1.06; 95% CI: 1.02-1.10; p = 0.005). The most commonly associated underlying conditions were ear infections (25.6%) and hearing loss (24.4%). CONCLUSIONS:Tinnitus prevalence in southern Saudi Arabia (31.1%) substantially exceeds global estimates. Noise exposure and elevated BMI are key modifiable factors associated with tinnitus. The substantial healthcare gap, with most affected individuals not seeking treatment, represents a critical public health challenge requiring targeted prevention programs, provider education, and improved access to evidence-based care.
Background: The vestibular system has traditionally been interpreted within a reflex-based framework, mainly centered on gaze stabilization, vestibulo-ocular reflex pathways, and peripheral vestibular deficits. This model remains essential, but it is insufficient to explain the full spectrum of postural, perceptual, visual-motion, and self-motion complaints observed in contemporary clinical otoneurology. Objective: This conceptual narrative review examines selected representative works by Kathleen E. Cullen as landmarks in a broader transition from reflex physiology to predictive, multimodal, context-dependent, body-centered self-motion control. Methods: This is not a systematic or bibliometric review. Papers were selected because they mark distinct conceptual steps in Cullen’s work: neural encoding of self-motion, peripheral and central coding strategies, multimodal integration, active versus passive self-motion, reafference suppression, body-centered encoding, proprioceptive prediction, vestibular cerebellar internal models, sensory reweighting, and clinical translation. Synthesis: Angelaki and Cullen’s 2008 synthesis and Cullen’s subsequent work demonstrate that vestibular processing is inherently multimodal from the earliest central stages and that neural representations of self-motion depend on behavioral context. Vestibular nuclei, visual-vestibular networks, and vestibular cerebellar circuits integrate labyrinthine signals with optic flow, proprioceptive, oculomotor, motor, cerebellar, cortical, and contextual information. This architecture enables the brain to distinguish expected from unexpected motion, suppress predictable vestibular reafference during voluntary action, compute internal estimates of body motion, adapt to altered sensory reliability, and reweight sensory inputs according to task demands. Conclusions: The clinical relevance of this trajectory is substantial. Patients may show preserved high-acceleration vestibulo-ocular reflex responses while experiencing persistent instability, visually induced dizziness, defective self-motion perception, or abnormal sustained vestibular processing. Such dissociations are not paradoxical when the vestibular system is understood as a predictive, distributed, body-centered control system. Cullen’s long lesson offers a neurophysiological foundation for a modern vestibular grammar in which clinical findings are interpreted across the reflexive, perceptual, postural, visual-vestibular, sustained, and predictive domains.
Background: Hearing health in Kazakhstan is documented through parallel administrative systems whose indicators are often conflated. We examined three administrative layers of hearing health during 2020-2025: dispensary registration of ear and hearing-loss diagnoses, disability certification as a severe administrative endpoint, and cochlear implantation (CI) as the specialised treatment response, with reference to Global Burden of Disease (GBD) 2021 estimates. Methods: We conducted a national ecological, region-year, multi-source administrative registry study across all 20 regions of Kazakhstan from 2020 to 2025. The dataset included 114 region-year observations and integrated Dispensary Report Form No. 12, the State Register of Persons with Disabilities, and the Electronic Register of Inpatient Patients. Dispensary indicators were interpreted as registered healthcare-utilisation measures, not population prevalence or incidence. Trends were assessed using Mann-Kendall tests with Benjamini-Hochberg false-discovery-rate correction. Regional patterns were examined using Spearman correlation, inequality metrics, and exploratory clustering. Results: Among adults, registered H60-H95 annual morbidity increased from 231,209 to 278,897 cases (CAGR +3.8%; FDR p = 0.016), and first-time registrations rose from 126,513 to 167,674 (CAGR +5.8%; FDR p = 0.016). Active dispensary observation declined modestly from 21,840 to 19,881. H65-H66 chronic otitis first-time registration remained stable, while active observation declined sharply. Paediatric H90-H91 registration was stable. In 2025, 31,560 persons were registered with hearing impairment-related disability, including 26,522 adults. CI procedures increased from 285 to 523. Adult CI activity was intermittent between 2012 and 2018 (peak 140 in 2013), ceased in 2019-2020, and was re-established from 2021 (14 → 129 procedures in 2025), reaching 24.7% of all CI. Most procedures were concentrated in Almaty and Astana. Compared with the GBD-2021 estimate of 17,212 per 100,000, administrative indicators captured much narrower service-utilisation and severe-certification layers. Conclusions: Kazakhstan's administrative data describe distinct hearing-health layers rather than competing prevalence estimates. Adult screening, regional audiology capacity, post-CI rehabilitation, and longitudinal outcome registries are priority areas.
Objectives: To collate subjective and objective outcome measures from cochlear implant recipients with asymmetric hearing loss. Methods: Forty-one CI recipients with asymmetrical hearing loss completed spatially separated speech in noise testing, speech in quiet testing, localisation testing, and tinnitus and quality of life questionnaires (SSQ and IOI-HA) pre-operatively and at 3, 12 and 24 months post-operatively. The results were used to generate a tool to help clinicians guide potential recipients through the counselling process. Results: Significant improvements in spatially separated SRT, localisation, tinnitus and the SSQ were observed for the group, with significant individual variability. CVC phoneme scores were not significantly different from those observed for CI recipients with bilateral hearing loss. The rates of non-use were consistent with those in the literature and were higher than for recipients with bilateral hearing loss. There was a significant correlation between PTA in the contralateral ear and localisation, and those recipients with a shorter duration of hearing loss were more likely to be satisfied with their CI. Discussion: Cochlear implantation for patients with asymmetrical hearing loss has the potential to offer improvements in head-shadow effects, localisation and tinnitus, with subjective measures also showing significant improvements post-operatively. There exists a large amount of individual variability across the group, however, which makes pre-operative counselling problematic for this patient cohort. Conclusions: The use of the study-generated counselling tool by clinicians may help patients make a more educated decision to proceed with implantation based upon realistic expectations of possible post-operative outcomes.
Background/Objectives: The present study aimed to verify the importance of different components of aural rehabilitation and evaluate their relevance and acceptability among the Kannada-speaking population in India. This evaluation is intended to inform the development of a tailored aural rehabilitation module for this population. Methods: A thorough literature review was conducted to gain insights into the components of aural rehabilitation in the Western context. The insights gathered from this review served as foundational information for a focus group discussion. The focus group discussion consisted of 15 participants, including audiologists, adults with hearing loss, and their significant others. The data were transcribed and analyzed using inductive thematic analysis. Results: The audiologists in our study confirmed that the components of aural rehabilitation presented in the literature are essential, including sensory management, informational counseling, perceptual training, and personal adjustment counseling. Perspectives of significant others are the highlight of this study as they are less explored in the context of aural rehabilitation in India. Other themes identified from the FGDs included the involvement of family, the impact of hearing loss, awareness of various management options, and challenges/barriers related to aural rehabilitation. Furthermore, most of the adults with hearing loss and their significant others primarily viewed hearing aids as the sole solution. Conclusions: This study highlights the importance of a comprehensive aural rehabilitation program for adults with hearing loss and their significant others in the Kannada speaking population. It emphasizes the importance of informational counseling, communication strategies, and psychosocial support. Involving significant others might foster understanding and support, aiding in the acceptance of hearing loss and its rehabilitation, ultimately improving everyday communication and addressing functional challenges.
