This manuscript describes the computational workflow and normative data used within the newly released Version 2 of the Desired Sensation Level (DSL) Bone Conduction Device (BCD) Prescription. The previous version 1.1 of the DSL BCD prescription was an innovation in the field, allowing for the prescription of output levels from direct drive BCDs worn percutaneously on an osseointegrated abutment. Verification of these prescriptions has been possible using a clinically-available skull simulator. Version 2 of the DSL BCD prescription extends upon version 1.1 and now allows for the fitting and verification of some skin-drive BCDs, which is the primary coupling method used for infants and young children. DSL BCD 2 introduces a new age-specific audiometric-to-dial-level (ADL) correction to predict in-situ BCD thresholds from audiometric bone conduction thresholds, as well as other transforms that allow target generation for skin-worn devices. This implementation provides the option to base the output prescription on audiometric thresholds for patients who may not yet be capable of performing in-situ BCD audiometry, computational support for a wider range of device types and couplings, and prescriptive targets for use with either skull simulators or verification of on-head force levels.
Cochlear implant (CI) and electric-acoustic stimulation (EAS) device users vary in their early speech recognition. This variability may be due in part to factors related to the electrode array placement, including frequency-to-place mismatch and the array's proximity to the functional acoustic hearing region. The present study reviewed the association of factors related to electrode array placement and early speech recognition in quiet and noise in CI and EAS users. The sample included 34 adults with preoperative thresholds at 250 Hz of ≤ 70 dB hearing level (HL) who were implanted with a 23-mm straight electrode array. For those who lost functional acoustic hearing and listened with a CI device (n = 15), word recognition in quiet was significantly associated with frequency-to-place mismatch at 1.5 kHz, r(15) = 0.61, p = 0.015. For EAS users (n = 18), 14 had their electrode arrays placed outside the functional acoustic hearing region, and 4 had electrodes in the functional acoustic hearing region. For EAS users with the array outside the functional acoustic hearing region, speech recognition in noise was not significantly associated with frequency-to-place mismatch, r(9) = 0.33, p = 0.389. Performance in noise was significantly associated with proximity, r(9) = 0.96, p < 0.001, with poorer scores for EAS users whose electrode arrays were placed farther from the functional acoustic hearing region. These preliminary data suggest that factors related to electrode array placement may contribute to the variability in early outcomes in CI and EAS users and may be important to consider in device selection and mapping to help individuals achieve their best outcomes.
Artificial intelligence (AI) and machine learning (ML) are increasingly influencing clinical decision-making and rehabilitation strategies for cochlear implant (CI) users. This narrative review synthesizes representative research examining how AI- and ML-based approaches have been applied in CI rehabilitation, with particular emphasis on prediction modeling, speech enhancement, and therapy-oriented digital tools relevant to hearing and speech outcomes. Existing literature suggests that ML-based prediction models can support estimation of CI outcomes, offering opportunities for more personalized counseling and rehabilitation planning. Advances in deep-learning–based speech enhancement have demonstrated consistent improvements in speech intelligibility, particularly in noisy listening environments, which may facilitate the generalization of therapy gains to everyday communication. Additionally, tele-rehabilitation tools and AI-assisted therapy platforms have the potential to improve practice intensity, engagement, and accessibility for both adult and pediatric CI users. Despite these developments, the evidence base remains heterogeneous, and many approaches lack validation in real-world clinical settings. Overall, current research highlights the potential of AI to augment traditional speech therapy in CI rehabilitation, while underscoring the need for more standardized research designs and clinically grounded studies to support effective implementation.
IntroductionNormally hearing (NH) listeners experience the strongest pleasurable urge to move to music (PLUMM) when listening to rhythmic patterns of medium complexity compared to high and low complexity, reflected by an inverted U-shaped relationship. This relation is strongest when these patterns consist of more rhythmic layers (e.g., snare and bass drum vs. snare only). In cochlear implant (CI) users, the sensation of PLUMM remains unexplored. In this study, we investigated CI users' perception of rhythm, and their PLUMM, compared to NH listeners. Given some of the technical limitations of the implant, we hypothesized that CI users would prefer rhythms consisting of fewer rhythmic layers.MethodsAn online study (29 CI users and 31 NH listeners) was conducted, asking participants to rate “wanting to move” and “experienced pleasure” while listening to drum patterns that varied both in terms of degree of syncopation (i.e., rhythmic complexity) and the number of rhythmic layers (snare only, SN; snare and hi-hat, SN+HH; snare and bass drum, SN+BD; snare, bass drum and hi-hat, SN+BD+HH).ResultsBoth CI users and NH listeners preferred rhythmic patterns of medium complexity in terms of degree of syncopation. Further, both groups showed preferences toward rhythmic patterns consisting of more rhythmic layers, with the highest ratings and most prominent inverted U-shaped relationships for the versions containing all three layers (SN+BD+HH), and the single-layer versions showing almost no effect of syncopation (SN). There were no significant differences in PLUMM ratings between the two groups except for a significantly bigger difference between SN only and SN+HH in CI users compared to NH listeners, reflected by a flatter curve for SN only in the CI users.DiscussionOur findings indicate that CI users can still appreciate and respond to some musical elements, despite the technical limitations in pitch and timbre perception, with the underlying perceptual mechanisms for PLUMM remaining intact.
BackgroundHearing loss represents a significant and growing public health challenge in Africa, yet the legislative and regulatory frameworks underpinning preventive audiology remain fragmented, inconsistently operationalized, and insufficiently synthesized within the published literature.AimThis structured narrative review critically maps and analyses the legislative, regulatory, and policy instruments shaping preventive audiology across the African continent, highlighting systemic gaps, implementation barriers, and opportunities for advancing equitable hearing healthcare.MethodsA structured narrative review was undertaken. Comprehensive searches of PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar were conducted to identify peer-reviewed literature and key legislative and policy documents published between 2000 and 2025. Data were extracted using a standardized framework that captured study characteristics, legislative scope, institutional oversight, operationalization, and systemic factors. Thematic analysis was used to synthesize findings across national, continental, and global frameworks.ResultsThirty-one sources met inclusion criteria, although available evidence was geographically concentrated in South Africa, with comparatively fewer studies from West, East, and North Africa, alongside continental and global normative frameworks. The evidence revealed a pronounced implementation gap: continental instruments, such as the African Union (AU) Protocol on the Rights of Persons with Disabilities, provide a strong rights-based foundation, yet national translation is limited. Among the countries represented in the included literature, Egypt was the only country identified as having a mandatory, country-wide universal newborn hearing screening program, whereas most sub-Saharan African countries rely on fragmented pilot projects or professional guidelines. Hearing care is frequently deprioritized relative to communicable diseases. Occupational noise regulations exist but enforcement is weak, particularly in high-risk industries such as mining. Key systemic barriers include workforce shortages, high out-of-pocket costs, lack of statutory early hearing detection and intervention (EHDI) mandates, and low public awareness. Emerging opportunities include tele-audiology, task-shifting, integration into universal health coverage (UHC), and alignment with locally driven research priorities.ConclusionThe available evidence suggests that many African countries would benefit from strengthening legislative and regulatory frameworks for preventive audiology. National laws should consider explicitly integrating ear and hearing care into UHC benefit packages, where appropriate, supporting tele-audiology and task-shifting, and strengthening enforcement of occupational standards.
IntroductionHearing loss (HL) is a major modifiable risk factor for cognitive decline and dementia, particularly Alzheimer's disease (AD). However, the relationship between hearing loss and cognitive decline as influenced by common biological factors, i.e. genetic predisposition, is not fully understood. Furthermore, auditory behavioral tests may be potential biomarkers of cognitive decline. This retrospective study examined whether hearing abilities were associated with cognition among older adults, after controlling for genetic predisposition for HL and AD.MethodsIn a longitudinal cohort of 3,232 older adults (M = 78.0 ± 8 years; mean cognitive follow-up, 6.9 years) cognition was assessed annually across five domains. Self-reported hearing loss was assessed using questions about hearing in a quiet environment and difficulty understanding speech on the phone. In a subset of the participants (n = 113; M = 76.0 ± 6 years, mean cognitive follow-up, 8.6 years), hearing abilities were also measured at a single time point, using four different hearing assessments, including tasks assessing central auditory processing abilities.ResultsLinear mixed effects modeling results showed that self-reported hearing ability was not associated with cognitive level or rate of cognitive change during follow-up. In the measured-hearing subset, global hearing ability was associated with cognitive level at the analytic baseline, but not with subsequent cognitive change. Specifically, two tests of complex spectral pattern discrimination were significantly associated with global cognition at the analytic baseline, but not with the rate of subsequent cognitive change. In contrast, pure-tone audiometry and speech-in-noise ability were not associated with global cognition at the analytic baseline or longitudinally.DiscussionCurrent findings support the utility of central auditory processing tests as screening tools for cognitive ability in older adults. However, large-scale auditory and neurophysiological studies are needed to fully assess the feasibility of novel central auditory processing tests and to clarify relationships between genetics, hearing loss and cognitive decline/dementia.
Congenital nystagmus (CN) has long posed challenges for the study of vestibular function, particularly in the semicircular canals (SCCs). The authors recently reported for the first time the use of the video head impulse test (vHIT), including head impulse (HIMP) and the suppression head impulse (SHIMP) protocols, in a patient with pseudopendular CN and vertigo resulting from vestibular neuritis. Here, the authors describe the case of a new patient with jerk CN, vestibular migraine, and vertigo using vHIT and videonystagmoscopy. They report the following findings: (a) successful assessment of peripheral vestibular function in all SCCs; (b) confirmation of previously observed and newly detected selective dysfunction of the lateral SCCs, including deficient vestibulo-ocular reflex (VOR); (c) sparing of the vertical SCCs, allowing the diagnosis and treatment of posterior SCC benign paroxysmal positional vertigo (BPPV) reported for the first time in CN; (d) the utility of videonystagmoscopy in detecting vertical SCC BPPV in this patient; (e) the necessity of SHIMP to clarify severe lateral HIMP abnormalities for accurate interpretation; and (f) the interaction of the CN with a deficient VOR, fostering visuo-vestibular compensatory mechanisms through training. These findings support the value of vHIT and videonystagmoscopy, providing new perspectives for assessing and managing the most frequent vertigo syndromes in CN and vertigo.
ObjectiveIdentification of fitting and programming considerations for sound therapy in hearing aids based on electroacoustic characterization across brands, including assessment of interactions between sound therapy and other digital signal processing (DSP) features.MethodsThe study was conducted in two parts: (1) electroacoustic characterization of default sound therapy settings, and (2) analysis of interactions between the sound generator, feedback cancellation, and noise reduction features. Five receiver-in-the-ear hearing aids from different manufacturers were assessed using the Ahead Simulations Clinical Assistant for Research and Learning (CARL) manikin and the Audioscan Verifit 2 hearing aid analyzer. Devices were programmed for two standard audiograms using both dome and custom earmold couplings.ResultsDefault sound therapy outputs varied significantly across brands, influenced primarily by audiogram and coupling type. Feedback testing revealed that enabling sound therapy caused devices to exceed their stable gain limits, resulting in audible feedback. Noise reduction algorithms reduced sound therapy signals in open-fit configurations.ConclusionsSound therapy features differ across hearing aids and can interact with other DSP functions counterproductively. These interactions are measurable using standard clinical verification tools, highlighting the importance of verification of hearing aid programs. Five clinical fitting practices were developed to address these considerations.
BackgroundDespite global recognition of the rights of Deaf and hard-of-hearing (DHH) children, significant gaps persist between policy commitments and service delivery, particularly in low- and middle-income countries (LMICs). International frameworks such as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) mandate early intervention, inclusive education, and linguistic access; however, implementation remains uneven.AimTo critically examine policies governing services for DHH children, with a focus on alignment between international rights instruments and national implementation realities across Africa and other LMICs.MethodsA systematic narrative review of peer-reviewed literature published between 2000 and 2025 was conducted across PubMed, Scopus, Web of Science, ScienceDirect, and EBSCOhost, with supplementary searches via Google Scholar. Data were extracted using a structured framework and synthesized using deductive thematic analysis. Particular attention was paid to policy implementation processes, contextual influences on service delivery, and factors shaping the translation of rights-based commitments into practice.ResultsTwenty-five studies were included, predominantly from LMIC contexts. Findings revealed strong rights-based policy commitments aligned with international frameworks; however, implementation was consistently limited. Six key themes emerged: (1) robust policy commitments with weak operationalisation; (2) fragmented or absent early hearing detection and intervention (EHDI) systems; (3) an “inclusion paradox” in education, characterized by placement without adequate support; (4) emerging but under-resourced sign language recognition; (5) pervasive structural barriers, including resource constraints, workforce shortages, and inequities; and (6) a persistent policy–practice gap across sectors.ConclusionWhile rights-based frameworks are well established, their translation into practice remains constrained by structural inequities, contextual implementation challenges, epistemic injustice, and unadapted policy transfer. Contextually responsive, equity-driven implementation, grounded in local realities rather than imported models, is required to realize meaningful outcomes for DHH children.
Tinnitus can negatively impact quality of life for many who experience it, leading to an urgent need for viable treatment options. Tinnitus treatments can vary in quality, validity, and success rates. One method that has shown prior success in clinical trials to reduce the bothersome degree of tinnitus is bimodal neuromodulation, such as with the Lenire treatment device. However, this is not without certain barriers when looking at access to care. Clinicians who treat tinnitus may not be in convenient locations for patients to frequently travel or may not have experience working with people who have tinnitus. One way to reduce this problem, would be to provide fully virtual follow-up sessions, limiting the need for patients to come to clinics. Additionally, another way would be to not “fit” treatment devices based on hearing loss, but to use standard settings for all while allowing suprathreshold adjustments by the user based on comfort. This usability assessment study investigates how making these clinical modifications to the previous Lenire device impacts compliance to the treatment and satisfaction in using the device, as well as tinnitus severity outcome measures. After 12 weeks of device use, compliance and satisfaction remained high as seen in previous studies and many participants had changes that met the level of minimal clinically important difference on tinnitus severity questionnaires. The positive therapeutic outcomes of the study did not differ from previous reports using bimodal neuromodulation for tinnitus, despite simplifying the fitting process for the bimodal neuromodulation treatment, not requiring personalized audiogram settings, and use of virtual follow-up sessions instead of requiring in-person visits. These findings open up opportunities for broader accessibility and scalability of treatment options, such as bimodal neuromodulation, for tinnitus patients.Clinical trial registrationclinicaltrials.gov/study/NCT05518682, identifier: NCT05518682.
The elephant's middle ear (ME) boasts ossicles approximately nine times more massive than humans', with eardrums seven times larger. These anatomical features contribute to enhanced low-frequency sensitivity to air-conducted (AC) sound, but their contribution to bone-conduction (BC) hearing is less understood. To characterize BC hearing in elephants, we employed 3D laser Doppler vibrometry to measure ossicular motion in cadaveric temporal bones from both African and Asian elephants, as well as humans in response to BC stimulation. We analyzed velocity measurements projected along the piston direction at the umbo, stapes, and cochlear promontory across a frequency range of 12–11,000 Hz. Differential velocity (Vdiff) was calculated as the difference in the velocity of the piston (Vpist) and the velocity of the promontory (Vprom) divided by the velocity of the promontory [(Vpist-Vprom)/Vprom]. Vdiff plateaued above the BC resonant frequency−1.2 kHz for humans, reflective of prior studies, and 400 Hz for elephants. Below their respective resonant frequencies, the stapes Vdiff magnitude for elephants was three to four times greater than that of humans, and both decreased at approximately 12 dB/octave until about 200 Hz. Surprisingly, both elephant and humans exhibited a plateau in their stapes Vdiff below 200 Hz, rather than continuing to decrease at the 12 dB/oct rate. This suggests that both species have better low-frequency sensitivity for bone conduction than previously predicted. These results indicate that the larger ossicular and eardrum mass distributions play a crucial role in lowering BC resonance and enhancing low-frequency sensitivity. Elephants may further enhance BC hearing below about 200 Hz by contracting a skeletal muscle that occludes the ear canal, achieving a similar result to the occlusion effect in humans. These mechanisms may explain elephants' ability to detect ground-borne acoustic signals over long distances.
ObjectiveIdentify opportunities to reduce adverse events of magnetic resonance imaging (MRI) with hearing implants that require head wraps.MethodsRetrospective review of MRIs ordered for patients with MR Conditional devices between June 2022 and October 2024 at a tertiary center.ResultsThirty-one patients (27 cochlear and four Osia implants) had 38 MRIs ordered. Nine orders (24%) were canceled because discussion clarified that imaging was not needed (two orders, 5%), could be substituted by CT imaging (six orders, 16%), or patient declined (one order, 3%). Twenty-nine (76%) orders resulted in scans performed with head wraps, 5 (17%) of which resulted in magnet site pain without long term complication and early termination of four scans (14%).ConclusionA quarter of MRI orders were avoidable through pre-imaging review, and among scans performed, magnet site pain and early termination were not infrequent. The mnemonic “MRI” offers a practical framework to reduce these adverse events: Minimize unnecessary MR imaging through multidisciplinary pre-authorization, Reprioritize critical sequences early in case of early termination, and Immobilize the internal magnet to reduce pain and device displacement.
IntroductionAuditory steady-state responses (ASSRs) objectively estimate hearing thresholds in individuals unable to provide behavioral responses. Bone conduction (BC) testing differentiates conductive from sensorineural hearing loss. Accurate BC ASSR threshold estimation relies on correction values, which are not yet well established. The reliability of BC ASSR thresholds to estimate hearing thresholds at 500, 1,000, 2,000, and 4,000 Hz is evaluated.MethodsA systematic search was conducted to identify studies involving normal-hearing (NH) and hearing-impaired (HI) participants of all ages. Outcomes were (1) the difference between ASSR behavioral and ASSR thresholds, and (2) ASSR thresholds. The risk of bias was evaluated using the Newcastle-Ottawa Scale. The certainty of the evidence was assessed using GRADE approach.ResultsTwelve records met the inclusion criteria, yielding a total of 29 studies. Sample sizes ranged from 60 to 271 participants across frequencies and age groups. Record quality ranged from low to high. Data were synthesized using random-effects models due to heterogeneity. In NH adults, the mean differences between BC ASSR thresholds and behavioral thresholds were 17.0, 15.5, 13.4, and 12.1 dB at 500, 1,000, 2,000, and 4,000 Hz, respectively. In NH infants, mean BC ASSR thresholds were 17.2, 10.5, 26.1, and 19.9 dB HL at the same frequencies. In infants with conductive HL, BC ASSR threshold was 20.3 at 500 Hz. The certainty of the evidence was very low.ConclusionsAge and frequency impact BC ASSR thresholds, highlighting the need to develop correction values to accurately predict BC behavioral thresholds.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023422150.
Subjective tinnitus—the perception of sound in the absence of an external acoustic stimulus—remains one of the most debated phenomena in auditory neuroscience. In 2016, the stochastic resonance (SR) model was introduced as an alternative account of tinnitus-related neuronal hyperactivity, proposing that internally generated neural noise is adaptively upregulated to restore information transmission after hearing loss. Rather than interpreting increased spontaneous activity as purely maladaptive, the model reframed it as a functional mechanism that enhances signal detection near sensory thresholds, with tinnitus emerging as a perceptual side effect of adaptive sensory optimization. Over the past decade, this framework has evolved from a phenomenological hypothesis into a broader neuro-computational theory integrating information theory, adaptive signal detection, multichannel auditory processing, and cross-modal plasticity. The available literature spans different levels of evidence: computational simulations establish proof of principle, whereas animal experiments, observational analyses, and early clinical studies test distinct and partially overlapping predictions of the model. The framework has also motivated a specific parameterization of sound-based interventions using spectrally matched near-threshold noise. Established tinnitus maskers and sound therapies were developed independently of the SR model. Their comparative clinical efficacy has yet to be systematically evaluated. Recently, the SR framework has been embedded within a unified theory of auditory (phantom) perception that integrates stochastic resonance, central gain, homeostatic plasticity, and predictive coding. This review provides a chronological account of the development of the stochastic resonance model of tinnitus, summarizes theoretical refinements and empirical evidence, and outlines future directions for mechanistic validation and clinical translation. By redefining tinnitus as an emergent consequence of adaptive sensory computation, the model shifts the conceptual focus from pathological dysfunction to principles of information optimization in neural systems.
IntroductionThe acoustic change complex (ACC), a cortical auditory evoked potential, reflects the brain's ability to detect changes in an ongoing sound. This study investigates the influence of pre-change stimulus duration on the ACC in normal-hearing adults.MethodologyTwenty normal-hearing adults (10 men, 10 women) participated. ACC N1-P2 responses were recorded using a 1,000 Hz base tone that increased by 12% in frequency with pre-change durations ranging from 1,000 to 5,000 ms. Linear mixed models were used to evaluate effects of pre-change duration and sex on ACC amplitude and latency.ResultsACC N1-P2 amplitudes significantly increased with longer pre-change durations, with 5,000-ms stimuli yielding amplitudes 2.3 times larger compared to those evoked by a duration of 1,000 ms. Female participants showed significantly larger ACC N1-P2 amplitudes and shorter N1 latencies compared to male participants across all durations.ConclusionLonger pre-change stimulus durations increased ACC N1-P2 amplitudes while latencies remained stable. Durations ≥3,000 ms produced consistently robust responses, but duration choice should balance response strength with testing efficiency. Further work is needed to determine how these effects generalize across populations and clinical settings.
IntroductionVestibular migraine (VM) is one of the most frequent causes of recurrent episodic vertigo and is often misdiagnosed in emergency departments. Despite its high prevalence, its pathophysiology remains incompletely understood. In contrast, Acute Unilateral Vestibulopathy (AUVP) represents the prototypical peripheral acute vestibular syndrome, classically associated with vestibular neuritis, peripheral vestibular deafferentation, and gradual symptom recovery.Case descriptionA 40-year-old woman with a history of migraine with aura presented with recurrent episodes of severe vertigo over 2 months, associated with nausea, vomiting, and intense photophobia, often triggered by stress, sleep deprivation, and sweets. Interictal neurotological examination was normal, and VM was initially suspected. The following day, she presented to the emergency department with acute vertigo. Bedside examination, video-oculography, and video head impulse test demonstrated spontaneous left-beating nystagmus and reduced right horizontal canal gain, mimicking AUVP. The symptoms resolved on the same day while the patient was still under observation and repeated tests demonstrated restoration of vestibular function.ConclusionThis case highlights the hypothesis that migraine manifests as transient unilateral vestibular hypofunction, closely mimicking AUVP. Rapid recovery and atypical vestibulo-ocular reflex patterns may help distinguish migrainous deficits from viral vestibular neuritis, emphasizing the importance of neurotological evaluation during acute attacks.
IntroductionMusic is one of the few routinely-experienced sounds present well-attended environments at hazardous listening levels. As such, music listening has potential to affect hearing sensitivity for individuals both occupationally and recreationally. MusiCares, in collaboration with the Tuned organization, supports access to hearing health services, financial assistance, and basic human services for members of the music community. This study evaluated responses from self-identified at-risk or injured individuals seeking assistance from MusiCares and Tuned on an in-house health-related survey.MethodsStarting in August, 2022 the MusiCares/Tuned survey was available for individuals from the music industry; responses included in the current analysis considered those surveys received by July, 2025. The survey includes a wide range of health-related questions, however only those items related to hearing, such as for example the use of hearing protection, self-assessments of hearing status, and presence of auditory disorders such as tinnitus were considered herein. Surveys were de-identified and descriptive statistics were employed for analysis of participant responses. The survey appears in Supplemental Materials.Results1,138 participants accessed the survey. Most hearing-related questions garnered responses from the entire group, although a few participants indicated that some questions were not relevant for their specific case. Findings of note included nearly a 70% prevalence rate among the participants for tinnitus, while 24 % reported loudness tolerance issues. Forty-one percent indicated difficulties understanding speech in noise and/or quiet either as a standalone problem or in combination with other hearing issues. Although 59% of participants indicated careers in music of greater than 20 years, 53% of participants indicated using hearing protection for fewer than 10 years, even as 57% of respondents indicated having experienced acoustic trauma.DiscussionIndividuals in the music industry have the potential, routinely, to experience exposures at hazardous occupational and recreational sound levels. Issues regarding hearing healthcare for music listeners is complicated by job requirements as well as by the thrill experienced and reported upon by music enthusiasts who consume music at levels that most people would consider loud. Audiologists and hearing healthcare specialists must improve consumers' understanding of music's unique capability to damage the organ necessary for its enjoyment.
IntroductionOver-the-Counter (OTC) hearing devices were introduced for adults with perceived mild to moderate hearing loss, and can be purchased without a hearing assessment or device prescription from a hearing health care provider. The Nuance AudioTM Glasses are approved as software as a medical device OTC hearing aids in the United States, but come in a novel form factor, with the components of digital hearing aids embedded in the frames of eyeglasses, without any components entering the ears themselves. This in-lab study applied an outcome test battery, typically used for traditional hearing aid studies, to evaluate the device with a group of OTC candidates.MethodA total of 21 adult participants with mild to moderate sensorineural hearing loss completed the test battery. Speech recognition in noise was assessed in steady-state noise using the American English Matrix test and in multi-talker babble at two signal-to-babble ratios (0 dB and −3 dB) using the Connected Speech Test. Participants provided ratings of subjective listening effort in multi-talker babble using a 7-point scale. Real ear measures of the device were completed as a means to evaluate the aided response and speech-intelligibility-index value for the participants.ResultsSpeech recognition, measured by the Matrix and the CST, was significantly better with the Nuance device than in the unaided condition. Listening effort in noise was significantly reduced with the device on compared to the unaided condition. Real ear measures showed the device provided gain from 750-6,000 Hz and the measured Speech Intelligibility Index scores were significantly better in the aided conditions compared to the unaided condition.DiscussionThe findings suggest that Nuance Audio Glasses provide improved access to speech, leading to significantly better speech recognition and reduced listening effort in noise. These outcomes suggest this device may be an effective strategy for adults with perceived bilateral mild to moderate sensorineural hearing loss.
ObjectivesSkin-drive bone conduction devices (BCDs) are indicated for individuals with conductive or mixed hearing loss. For individuals who are not surgical candidates (i.e., young children), non-surgical skin-drive systems are available. Prescriptive targets for abutment-worn, percutaneous systems are established; however, device-specific reference equivalent threshold force levels (RETFLs) are not available for some contemporary skin-drive systems. Equivalent threshold force levels (ETFLs) may serve as preliminary reference data to support prescriptive development. Because standardized RETFLs require multi-site validation and are not yet available for these coupling conditions, the values derived in the present study are referred to as ETFLs. This terminology is used to distinguish these preliminary, single-site estimates from formally established RETFLs used for clinical calibration. This study derived ETFL values for the MED-EL ADHEAR when coupled via a soft headband and adhesive adapter.MethodsThirty-six normal-hearing adults (18–25 years) underwent audiometric testing with a B-71 bone oscillator and in-situ threshold measurement using ADHEAR in the two coupling conditions. Force level output was measured on a skull simulator using the Audioscan® Verifit 2. Dial force levels (DFLs) and ETFLs were calculated across 250–8000 Hz.ResultsBoth ADHEAR coupling conditions produced significantly higher in-situ thresholds than the B-71 (p < 0.001). Threshold elevation was frequency-dependent, with a pronounced increase at 4,000 Hz. DFL patterns differed between the B-71 reference data (measured on the Artificial Mastoid) and ADHEAR measured on the Verifit Skull Simulator using a direct coupling adapter, particularly at higher frequencies. Derived ETFLs were higher for both ADHEAR coupling methods compared to the B-71 across most frequencies.ConclusionsThese findings provide preliminary, device-specific ETFL data for the ADHEAR system. While not constituting standardized RETFL values, these results may inform future multi-site validation and prescriptive fitting approaches for these non-surgical skin-drive BCDs.
IntroductionAlthough the relationship between vestibular function and cognition is well established, there is limited research on how cognitive status affects rehabilitation outcomes in people with peripheral vestibular disorders. This study primarily aims to explore this relationship and, secondarily, to assess how factors that influence cognitive performance may moderate these outcomes.MethodsThis retrospective study included middle-aged individuals (n = 100) who were referred for vestibular rehabilitation following a diagnosis of vestibular pathology. Participants underwent an individualized 8-week rehabilitation protocol. The cohort was stratified into two groups based on cognitive performance: a group (n = 54) exhibiting signs of Mild Cognitive Impairment (MCI), as screened by the Montreal Cognitive Assessment (MoCA), and a cognitively intact control group (n = 46). No statistically significant differences were observed between the two groups regarding sex, age, symptom duration, or medical diagnosis. All participants were assessed for dizziness severity and functional gait performance. Ethical approval was obtained (21179-01/12/2025).ResultsBaseline assessments revealed no significant differences between groups, except for cognitive function and educational level, which were correlated with MoCA scores. Within-group analysis demonstrated statistically significant improvements in both measures, dizziness severity (p < 0.001) and functional gait performance (p < 0.001), from pre- to post- treatment in both groups, with large effect sizes. However, the between-group analysis revealed a significantly greater improvement in dizziness severity in the non-MCI group (p = 0.038). The chance of reaching a minimally clinically important difference was 2.3 times greater in the cognitively intact group than in the MCI group. The variance in intervention efficacy with respect to dizziness severity appears to be associated with age, symptom duration, and cognitive status. Furthermore, a secondary exploratory analysis suggested that trail-making ability and efficient delayed recall may show diagnostic sensitivity to symptom severity.DiscussionCognitive function appears to significantly influence the efficacy of vestibular rehabilitation in middle-aged people with vestibular disorders, particularly regarding the perception of dizziness.
