Objective:To investigate the audiological characteristics of unilateral vestibular schwannoma（VS） and their correlations with disease duration and tumor size, and to evaluate the clinical value of pure-tone audiometry（PTA）, speech discrimination score（SDS）, and auditory brainstem response（ABR） in screening and prognostic assessment. Methods:A retrospective analysis was performed on 93 patients with unilateral VS confirmed by surgery and pathology in our hospital from May 2008 to March 2025. PTA, SDS, ABR, and tumor size were analyzed. Correlation analysis and group comparisons were conducted to explore the relationships between audiological parameters, disease duration, and tumor size. Results:The mean age was（47.1±11.3） years. Hearing loss occurred in 97.8% of patients, tinnitus in 63.4%, and vertigo in 37.6%. PTA showed normal hearing in 2 cases and varying degrees of loss in 91 cases, with descending（33.3%） and flat（29.0%） curves being most common. Hearing loss duration was positively correlated with PTA average（r=0.52, P<0.001）, and flat curves were more frequent in longer disease courses. SDS was significantly negatively correlated with PTA average（P=-0.81） and tumor size（P=-0.61）, with a faster decline than PTA. ABR abnormalities were detected in 82.0%-89.5% of cases, with prolonged wave Ⅲ latency, wave Ⅴ latency, Ⅰ-Ⅴ interpeak interval, and interaural Ⅴ wave interval difference being most frequent. The mean tumor size was （20.5±10.6） mm, with stage Ⅲ being most common（46.2%）. Tumor diameter was positively correlated with hearing loss severity（r=0.37, P=0.001）, and Ⅲ-Ⅴ interpeak interval abnormalities were significantly more frequent in tumors>15 mm（P=0.042）. Conclusion:Hearing curve patterns in VS patients are closely related to hearing loss severity, disease duration, and tumor size. ABR demonstrates high diagnostic sensitivity for VS, particularly when tumor diameter exceeds 15 mm, as indicated by increased Ⅲ-Ⅴ interpeak interval abnormalities. Multidimensional audiological assessment can assist in early detection and prognostic evaluation. ABR screening combined with MRI is recommended for patients with unilateral hearing loss.

To quantitatively characterize common cavity (CC) and cochlear aplasia (CA) deformities using three-dimensional(3D) shape radiomics, and to explore their morphological subtypes, continuous spectrum, and association with vestibulocochlear nerve (VCN) development. This retrospective study included 77 patients with 127 ears diagnosed with CC or CA. The malformed cavities were segmented from temporal bone CT images, and 3D shape radiomics features were extracted. Principal component analysis (PCA) and K-means clustering were used to identify major morphometric dimensions and subtypes. Uniform Manifold Approximation and Projection (UMAP) was applied to visualize morphological continuity. The VCN/facial nerve (FN) ratio was measured on MRI as an imaging surrogate of VCN development. Principal component analysis (PCA) identified two principal components that explained 91.7

Objectives To investigate the imaging characteristics, surgical approaches, and outcomes of cochlear implantation (CI) in patients with special inner ear malformations (IEMs) that show transitional forms between cochlear hypoplasia (CH) and common cavity (CC). Methods Twelve children (eight males, four females), aged 10 to 43 months, with special IEMs were enrolled, and their inner ear structures were analyzed using detailed segmentation. Two surgical approaches were employed: the transmastoid slot labyrinthotomy approach (TSLA) for cases requiring customized electrodes, and the round window or cochleostomy approach for the remaining cases. Outcomes were evaluated using Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and Meaningful Auditory Integration Scale (MAIS/IT-MAIS) at 12 months post-implantation. Results Two main types of malformed cochleae were identified: common cavity-like and primitive CH types. All patients exhibited cochlear nerve deficiency and significant bilateral differences in their inner ear structures. Four patients underwent TSLA with customized electrodes, while the remaining patients received lateral wall electrodes via the round window or cochleostomy approach. Most patients showed improvement in auditory and speech capabilities following implantation. Conclusion Inner ear malformations with transitional forms between CH and CC present unique challenges, requiring detailed preoperative evaluation and customized surgical plans. Even in severe cases, carefully planned surgery can lead to meaningful auditory rehabilitation.

OBJECTIVE:This study aimed to investigate the long-term auditory and speech outcomes of sequential bilateral cochlear implantation (BiCI) in children with cochlear nerve deficiency (CND). METHODS:Sixteen CND children who underwent sequential BiCI were retrospectively reviewed. Auditory and speech abilities were evaluated using questionnaire-based rating scales, including the Categories of Auditory Performance (CAP), the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), and the Speech Intelligibility Rating (SIR). Closed-set and open-set speech recognition abilities were also measured. RESULTS:The first cochlear implantation (CI) was performed at a median age of 12 months. The mean age at contralateral CI was 43 months, and the mean inter-implant interval time was 26 months. All patients showed continuous auditory and speech improvement over time. Of the sixteen patients, nine completed closed-set and/or open-set speech recognition assessments. After contralateral CI, all nine patients showed improved closed-set speech recognition scores. Four patients achieved closed-set test scores of more than 90% and open-set disyllable recognition scores ranging from 44 to 85%. In addition, two patients demonstrated better performance with bilateral CI than with unilateral CI. CONCLUSIONS:CND children showed favorable long-term auditory and speech outcomes after sequential BiCI, and some demonstrated bilateral benefit in speech perception. These findings suggest that BiCI may be a viable option for selected CND children.

For cochlear implant (CI) users, differences in peripheral input patterns across ears may disrupt binaural fusion, thereby limiting binaural perception. The present study investigated factors affecting binaural fusion for speech segregation. Speech recognition thresholds (SRTs) were adaptively measured in 11 simultaneously implanted (SIM) and 10 sequentially implanted (SEQ) bilateral CI (BiCI) users, as well as in 16 CI users with substantial acoustic hearing (AH) in the non-implanted ear (acoustic-electric hearing; “AEH”). Target sentences, spoken by a male talker, were presented alongside two competing sentences spoken by two different male talkers (same-sex maskers) or female talkers (different-sex maskers). The target speech was delivered to one ear, while masker speech was presented either to the same ear as the target (monaural) or to both ears simultaneously (bilateral). The difference in SRTs between bilateral and monaural listening (bilateral-monaural difference; “BMD”) was used to indirectly estimate binaural fusion. Results showed higher (poorer) SRTs with bilateral than with monaural listening in SEQ-BiCI, but not in SIM-BiCI users. Across BiCI users, the BMD was negatively correlated with the inter-implant interval. Across AEH CI users, SRTs were statistically significantly better with bilateral than with monaural listening when the target speech was presented to the AH ear, but statistically significantly poorer when the target speech was presented to the CI ear. The impact of binaural fusion on speech segregation was highly asymmetric in SEQ-BiCI and AEH CI users, with a relative advantage when the target speech is presented to the first-implanted ear or the AH ear, respectively.

Middle ear adenoma, also known as middle ear adenomatous neuroendocrine tumors (MEANTs), is a rare neoplasm, accounting for < 2% of all middle ear tumors. It is characterized by slow growth, non-invasive behavior, and nonspecific symptoms, which often complicate preoperative diagnosis. This review summarizes our clinical experience in the diagnosis and treatment of 11 cases of MEANT. In this cohort, four cases were preoperatively diagnosed as cholesterol granuloma, five as cholesteatoma, and two as middle ear tumors. The median age at diagnosis was 36.7 years, with all patients (100%) experienced progressive conductive or mixed hearing loss. Additional symptoms included tonal tinnitus (9/11, 81.8%), aural fullness (6/11, 54.5%), otalgia (4/11, 36.4%), pulsatile tinnitus (2/11, 18.2%), otorrhea (2/11, 18.2%), and facial nerve paresis (1/11, 9%). None of the patients exhibited carcinoid syndrome or bloody otorrhea. All patients underwent surgical treatment, and postoperative histopathology confirmed the diagnosis of MEANTs. Immunohistochemical analysis showed positivity for CK and SYN in all cases, S-100 was positive in 91% (10/11) of patients. All patients were followed up for 1.5 to 10 years postoperatively. These findings highlight the nonspecific presentation of middle ear adenoma, which may lead to misdiagnosis as chronic inflammatory disease or other middle ear neoplasms. For differential diagnosis of MEANTs, high-resolution computed tomography (HRCT) of the ear or MRI with non-echo-planar diffusion-weighted imaging (non-EPI DWI) are valuable. Complete surgical resection remains the mainstay of treatment, and ossicular chain reconstruction should be considered when appropriate.

IntroductionHealthcare systems contribute up to 5% of global greenhouse gas emissions, with impacts varying across medical specialties. Otorhinolaryngology (ORL) and hearing care must address their specific environmental footprint to meet emerging sustainability goals. This study assessed ORL professionals’ awareness, engagement, and perceived opportunities for implementing sustainable practices.MethodsA 17-item survey was conducted from May 31 to July 25, 2024, among members of the HEARRING group, an international association of ORL experts.Results37 responses from 26 hospitals across 16 countries were collected. While 89.2% of participants expressed interest in sustainability, only 29.7% felt confident explaining sustainable development. Key opportunities included waste reduction (70%), policy development (25%), transportation improvements (20%), and energy efficiency (15%). Major barriers were lack of collective action (59.5%), uncertainty (35.1%), and insufficient workplace support (35.1%). Hospitals commonly engaged in recycling (83.3%), waste reduction (80.6%), and energy conservation (74.3%), but green purchasing and toxic-waste reduction were limited. Awareness of Green Teams was low (30.6%), though those familiar recognized their value.DiscussionDespite strong interest, gaps in knowledge and systemic barriers persist in ORL care. Targeted education, leadership support, and adoption of Green Teams could accelerate sustainable practices and reduce environmental impact.

Purpose: This study aimed to compare speech-in-speech recognition between Mandarin-speaking (“Chinese”) and English-speaking (“American”) normal-hearing adult listeners under monaural and binaural listening conditions. Method: Speech recognition thresholds (SRTs) in competing speech were measured in 20 Chinese and 20 American listeners using a modified coordinate response measure task. Target sentences spoken by a male talker were presented alongside two competing sentences spoken by two different male talkers (same-sex maskers) or by two female talkers (different-sex maskers). The target speech was delivered to one ear, while masker speech was presented either to the same ear (“monaural listening”) or simultaneously to both ears (“binaural listening”). Sex-based masking release was defined as the difference in SRTs between same-sex and different-sex maskers. Binaural unmasking was defined as the difference in SRTs between monaural and binaural listening. Results: SRTs were lower with binaural than monaural listening and with different-sex than same-sex maskers. Under binaural conditions, Chinese listeners showed lower SRTs than American listeners (tonal-language benefit), and right-ear targets yielded lower SRTs than left-ear targets (right-ear advantage [REA]). Robust sex-based masking release and binaural unmasking were observed across listeners. Sex-based masking release was greater with monaural than binaural listening, with a significant interaction between language and listening mode. American listeners showed greater release with monaural than with binaural listening relative to Chinese listeners. In contrast, binaural unmasking was larger for Chinese than for American listeners, particularly with same-sex maskers and right-ear targets. Tonal-language benefits emerged only with different-sex maskers, whereas REAs were restricted to same-sex maskers. Conclusion: Significant tonal-language benefits and REAs emerged only under binaural listening conditions, suggesting that binaural processing plays a critical role for segregation of competing speech. Supplemental Material: https://doi.org/10.23641/asha.32137030

Objective:To quantitatively characterize the spatial relationships between intratemporal facial nerve segments and key cochlear implantation (CI) landmarks in cochlear hypoplasia (CH), and to compare these features with age-matched CI recipients with normal inner ear anatomy, thereby informing preoperative planning and facial nerve preservation strategies. Methods:CI recipients were reviewed retrospectively, and high-resolution temporal bone CT datasets were reconstructed. The measured parameters comprised cochlear-facial partition width (CFPW) of the labyrinthine segment, the distance between the tympanic facial nerve and oval window (FN‑OW), the distance between the mastoid facial nerve and round window (FN‑RW), the angle between the FN‑RW line and the anteroposterior axis (α), and the distance from the mastoid facial nerve to the posterior external auditory canal wall (FN‑EAC). Results:The CH cohort included 48 patients (91 ears: 40 CH‑Ⅱ, 43 CH‑Ⅲ, 8 CH‑Ⅳ); controls comprised 45 patients (90 ears). The median CFPW was larger in CH patients than in controls (0.7 vs. 0.57 mm; p < 0.01). Cochlear-facial dehiscence occurred at similar rates (CH 4.40% vs. controls 4.44%). FN-OW did not differ significantly between the two groups (2.33 vs. 2.37 mm; p = 0.198). A low‑lying tympanic segment was observed in 23.07% of CH ears but in none of the control ears. For the mastoid (vertical) segment, the CH group exhibited a shorter FN-RW (5.74 vs. 6.08 mm; p < 0.05) and a larger angle α (60.4° vs. 57.8°; p < 0.05). FN-EAC was slightly smaller in the CH group without reaching statistical significance (4.08 vs. 4.35 mm; p = 0.087). Conclusion:In CH, intratemporal facial nerve segments exhibit substantial positional variability. Anterior displacement of the vertical segment is common and may impede round window exposure via the facial recess. Preoperative HRCT should systematically assess nerve courses to reduce intra- and postoperative facial nerve complications.

The benefit of binaural summation (“summation”) is often measured in co-located steady-state noise; summation for competing speech is less understood. The goal of the present study was to evaluate how the target-masker acoustic properties and binaural listening mode affect summation for speech-in-speech recognition. Recognition of target speech in two-talker speech maskers was measured with each ear alone and with both ears in bilateral CI users (BiCI), CI users with asymmetric hearing loss (AHL), CI users who were single-sided deaf (SSD), and normal-hearing listeners (NH). Target and masker speech was co-located; the talker sex of the maskers was either the same as or different from the target. With same-sex maskers, significant binaural summation was observed only in the BiCI group. In contrast, with different-sex maskers, significant summation was observed only in the SSD and NH groups, where binaural summation was significantly greater with different-sex than with same-sex maskers. A significant but weak correlation between interaural performance asymmetry and binaural summation was observed in some within-group comparisons, but not in across-group comparisons. For the BiCI group, summation was significantly correlated with SRTs from the better-performing CI ear, but not with performance asymmetry. The findings can be partly accounted for by psychometric-function slope and performance asymmetry within a probability-summation model. However, the probability-summation model generally overestimated the observed summation, suggesting that the assumption of independent processing across ears may not hold for CI users, possibly due to the variability in binaural fusion across individuals.

BACKGROUND:Cochlear hypoplasia type I (CH-I) is a severe inner ear malformation often deemed a relative contraindication for cochlear implantation (CI), posing unique challenges for patients. OBJECTIVES:This study aimed to evaluate surgical techniques, challenges, and postoperative auditory outcomes in CH-I patients undergoing CI, identifying key prognostic factors. MATERIAL AND METHODS:A retrospective analysis of six CH-I patients (11-222 months old) who underwent CI between 2012 and 2023 was conducted. Five patients used the transmastoid facial nerve recess approach (TFNRA) with a short straight electrode, while one employed the transmastoid slot labyrinthotomy approach (TSLA) with a customized electrode. Outcomes were assessed via Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and both closed-set and open-set speech tests, including the Mandarin Lexical Neighborhood Test (MLNT). RESULTS:Five patients achieved useable auditory function, with three demonstrating good open-set speech recognition. No significant differences were observed between unilateral and bilateral implantation. CONCLUSIONS AND SIGNIFICANCE:CI is viable for CH-I patients when TFNRA are combined with systematic auditory training. Preoperative cochlear morphology assessment and short straight electrodes are crucial for optimizing outcomes, emphasizing the need for long-term rehabilitation.

PURPOSE:The goal of the present study was to investigate how monaural performance, interaural asymmetry, and the timing of bilateral implantation (simultaneous, sequential) contribute to binaural spectral ripple discrimination and binaural summation in bilateral cochlear implant (BiCI) users. METHOD:Twenty Mandarin-speaking adult BiCI users participated in the study. Of the 20 participants, 10 underwent sequential bilateral cochlear implantation, and 10 underwent simultaneous bilateral cochlear implantation. Spectral resolution was assessed using the Spectral-temporally Modulated Ripple Test (SMRT) under both monaural and binaural listening conditions. Binaural summation benefit was quantified as the difference between binaural SMRT scores and monaural SMRT scores in the better performing ear. Interaural performance asymmetry was quantified as the difference in monaural SMRT scores between each cochlear implant (CI) ear tested individually. Binaural and monaural spectral resolutions were compared in terms of SMRT scores, with binaural summation further examined as a function of interaural performance asymmetry. RESULTS:There was no significant difference in binaural or monaural SMRT scores between the simultaneously implanted BiCI (SIM-BiCI) and sequentially implanted BiCI (SEQ-BiCI) groups. Greater interaural performance asymmetry was strongly associated with reduced binaural summation in the SIM-BiCI group (r = -.91, p < .001) and the SEQ-BiCI group (r = -.89, p < .001). SMRT scores with both CIs were significantly correlated with SMRT scores with the poorer performing CI (r = .70, p < .001). Binaural SMRT scores were significantly predicted by a linear combination of SMRT scores with the poorer ear (p < .001) and the laterality of the poorer ear (right or left ear; p = .022). CONCLUSIONS:While there was no significant difference in binaural summation between SIM-BiCI and SEQ-BiCI users, binaural summation was strongly and negatively associated with interaural performance asymmetry. This suggests that the binaural benefit for spectral resolution is primarily limited by interaural differences in spectral resolution. Binaural SMRT performance was largely dependent on the spectral resolution of the poorer performing CI, with additional improvement associated with better spectral resolution in the right CI.

BACKGROUND:Hereditary hearing loss is one of the most common disabling disorders in children and lacks effective pharmacological treatments. Recent breakthroughs in OTOF gene therapy clinical trials necessitate standardized frameworks to guide emerging therapies. This study aims to establish the first international consensus on the clinical application of gene therapy for hereditary hearing loss. METHODS:A modified Delphi process was conducted from March 2024 to March 2025, involving 46 multidisciplinary experts from several countries across otology, genetics, audiology, gene therapy, and hearing rehabilitation. After a systematic literature review, as well as integration of research and clinical expertise and experience, three iterative voting rounds (two anonymous surveys and one online consensus meeting) were performed. Statements required ≥75% agreement for inclusion. FINDINGS:From 9,093 publications, 69 were used to draft and support the consensus statements. A total of 30 statements relevant to six domains achieved consensus on gene therapy for hereditary hearing loss, including ethical review (1 statement), patient selection criteria (12 statements), diagnosis and preoperative evaluation (9 statements), gene therapy drug delivery (4 statements), follow-up (3 statements), and post-treatment auditory and speech rehabilitation (1 statement). CONCLUSIONS:This consensus provides the first globally endorsed framework for gene therapy in hereditary hearing loss. It standardizes clinical trial design and patient management, accelerating translation from research to practice while ensuring safety. The guidelines are immediately applicable to OTOF-related hearing loss and adaptable to other genetic forms. FUNDING:This work was supported by the National Natural Science Foundation of China, the German Research Foundation (DFG) via the Cluster of Excellence, and others.

Objective:The aims of this study were to investigate the clinical applicability of 3D segmentation in measuring cochlear anatomical parameters, explore factors that influence the insertion angle of cochlear implant electrodes in patients with inner ear malformations, and determine the value of 3D segmentation in predicting cochlear implant electrode insertion depth by simulating electrode implantation in a reconstructed 3D model. Methods:Data from 208 temporal bone CT scans of patients with a variety of inner ear malformations (including the CH, IP-I, IP-II, and IP-III types) who underwent cochlear implantation at our center were retrospectively analyzed. Preoperative temporal bone CT data were subjected to three-dimensional (3D) segmentation of the cochlea with a 3D slicer. Results:Cochlear malformation types, including IP types I (42 ears), II (278 ears), III (20 ears), and CH (65 ears), were diagnosed and measured in 208 preoperative CT datasets. Cochlear anatomical parameters and electrode length were correlated, which partially explained the variations in electrode insertion angle. The mean angle of implantation among the enrolled patients was 564.33°, and the mean implantation angle prediction error in the 3D segmentation was |23.74|°. Conclusion:Three-dimensional segmentation from temporal bone CT is valuable for surgeons, especially in treating patients with inner ear malformation. Such insights will help surgeons understand overall anatomical variations, predict electrode implantation depth, and complete preoperative imaging assessments for cochlear implant insertion depth in patients with inner ear malformations.

Objectives:The causal association between presbycusis and changes in cerebral cortex structure was evaluated through Mendelian randomization (MR). Methods:Presbycusis data, serving as the exposure trait, was analyzed using data from the ninth release of the FinnGen biobank. Genome-wide association study (GWAS) datasets for cortical surface area (SA) and thickness (TH) were sourced from the ENIGMA Consortium, whereas cortical volume (V) GWAS data came from the UK Biobank. The inverse-variance weighted (IVW) approach was adopted as the principal analytical method. To ensure robustness, sensitivity analyses were systematically implemented to evaluate potential heterogeneity and pleiotropic effects. Results:Following rigorous filtering through IVW and sensitivity analyses, eleven robust MR associations emerged, offering preliminary evidence for a causal link between presbycusis and cortical architecture, including frontal pole SA with global weighted (GW) (β=1.858 mm2, P=0.004) and without GW (β=1.778 mm2, P=0.012), pars orbitalis SA with GW (β=2.717 mm2, P=0.042), transverse temporal SA with GW (β=2.349 mm2, P=0.033), pars orbitalis TH with GW (β=-0.009 mm, P=0.008) and without GW (β=-0.011 mm, P=0.008), rostral middle frontal TH with GW (β=-0.005 mm, P=0.020) and without GW (β=-0.007 mm, P=0.012), precuneus TH without GW (β=-0.006 mm, P=0.049), left hippocampus V (β=-12.296 mm3, P=0.033) and right hippocampus V (β=-11.991 mm3, P=0.049). Conclusion:From a genetic standpoint, our findings indicate region-specific neuroanatomical modifications in presbycusis patients, supporting the notion of neurodegenerative or adaptive alterations in brain structure from a genetic perspective.

Objective To assess the effectiveness of machine learning in automating the prediction of vestibular abnormalities after cochlear implantation (CI) in patients with sensorineural hearing loss (SNHL), with the goal of developing a practical model that can accurately predict long-term vestibular function outcomes and identify associated risk factors. Methods Clinical data, including imaging, vestibular evoked myogenic potentials (VEMPs), and auditory information, were collected from patients with sensorineural hearing loss (SNHL) before and after CI. The decision tree algorithm was employed to address missing values and screen pre-CI clinical features. Six machine learning methods were subsequently utilized to predict the relationships between the extracted features and post-CI vestibular dysfunction. The best-performing method determined the ranking of feature importance, which was regarded as risk factors for predicting symptoms and VEMPs results after CI. Results Logistic regression models effectively predicted both post-CI vestibular dysfunction and abnormal cervical VEMP (cVEMP), with accuracies of 80% and 78%, respectively. The relative importance of the features, in descending order, was as follows: cVEMP latency, cVEMP amplitude, and residual hearing threshold. Moreover, the support vector machine (SVM) model attained an accuracy of 88% in predicting abnormal ocular VEMP (oVEMP) post-CI. For the SVM model, the feature importance ranking was as follows: oVEMP latency, oVEMP amplitude, and residual hearing threshold. Conclusions This study successfully leverages machine learning techniques, specifically support vector machines (SVM) and logistic regression models, to predict the impact of CI on vestibular function. These predictive models provide valuable insights for presurgical planning and decision-making in CI procedures. Moreover, the findings highlight the critical risk factors associated with vestibular dysfunction, offering a robust reference for guiding vestibular rehabilitation strategies.

Objective:To evaluate the improvement in bone conduction (BC) thresholds after stapes surgery for otosclerosis, compare the outcomes of surgical techniques, and analyze the short- and long-term results to inform treatment strategies. Methods:We retrospectively reviewed data from 173 patients (188 ears) who underwent total stapedectomy, partial stapedectomy, or stapedotomy for otosclerosis between 2009 and 2024. Medical histories, preoperative evaluations, and operative records were analyzed, focusing on pre- and postoperative pure-tone audiometry. Results:Postoperatively, mean thresholds improved by 20.3 dB for air conduction (AC) and 2.0 dB for BC, leading to a mean air-bone gap (ABG) of 18.3 dB. An ABG of less than 10 dB was achieved in 79 ears (42.0%), and full ABG closure (ABG ≤ 20 dB) was achieved in 145 ears (80.4%). Compared with the preoperative levels, the BC thresholds at 0.5, 1, and 2 kHz improved by 1.3, 3.7, and 4.9 dB, respectively. However, the 4-kHz BC threshold increased by 1.7 dB. Postoperative AC thresholds at 0.5-4 kHz decreased significantly by 27.1, 26.5, 18.3, and 9.2 dB, respectively (p < 0.001). Conclusion:Stapes surgery significantly improved BC thresholds at 0.5, 1, and 2 kHz in patients with otosclerosis, with resolution of the CN at 2 kHz, indicating correction of the CHL. Although a slight increase in the BC threshold was observed at 4 kHz, the overall AC threshold improvement and ABG closure were substantial. These findings highlight the clinical relevance of the postoperative BC threshold dynamics.

BACKGROUND:Otosclerosis causes progressive hearing loss, with stapes surgery being the most effective treatment. However, the influence of age on postoperative outcomes remains debated. OBJECTIVE:To evaluate the impact of age on hearing outcomes following stapes surgery. METHODS:This retrospective study included patients who underwent primary stapes surgery (2010-2024), excluding those with revision surgeries or confirmed cochlear otosclerosis. Pre- and postoperative pure-tone audiometry assessed air conduction (AC), bone conduction (BC), and air-bone gap (ABG) across age groups. RESULTS:This study included 177 patients (188 ears) aged 18-68 years. Significant improvements in AC thresholds and ABG closure were observed across all age groups (p < 0.05). BC thresholds improved significantly in patients <50 years. Linear regression revealed a modest negative correlation between age and AC improvement (R2 = 0.18, p = 0.006). Despite smaller gains in older patients, both age groups demonstrated substantial improvements AC thresholds and ABG, with minimal changes in BC thresholds. No significant differences were found between younger and older groups in changes in BC, AC, or ABG closure (all p > 0.05). CONCLUSION:Stapes surgery significantly improves hearing outcomes across all ages, especially in AC thresholds and ABG closure. Age should not be a contraindication if audiological criteria are met.

BACKGROUND:Head trauma often leads to bilateral sensorineural hearing loss (SNHL), and determining the optimal side for cochlear implantation (CI) remains a critical issue that requires further investigation. Objective: To evaluate the role of preoperative aided threshold (AT) testing in selecting the optimal CI side for patients with bilateral SNHL caused by head trauma. METHODS:This study included 9 patients with bilateral SNHL resulting from head trauma. Preoperative audiological and radiological evaluations were performed. The correlation between preoperative AT, duration of deafness (DoD), radiological findings, and Nijmegen Cochlear Implant Questionnaire (NCIQ) scores was analyzed. RESULTS:Preoperative AT showed a tendency for a negative correlation with advanced sound perception scores (r = -0.740, p = 0.057), while DoD exhibited a significant negative correlation with auditory self-confidence (r = -0.803, p = 0.029). Imaging combined with AT provides a foundational framework for selecting the implantation side; however, the limited sample size restricts the generalizability of the findings. CONCLUSION:Lower preoperative AT and shorter DoD may predict better auditory rehabilitation outcomes following CI. It is recommended to integrate imaging and audiological evaluations for individualized decision-making. Future studies with larger sample sizes are necessary to validate these findings and explore the clinical implications of early CI.

BackgroundIn cases of congenital sensorineural hearing loss, testing for genetic etiologies and congenital cytomegalovirus (cCMV) infection have become common practice.Aims/ObjectivesThe purpose of this study is to determine which specific testing methodologies should be used and when.Material and methodsWe surveyed 20 practicing otolaryngologists across eighteen institutions in thirteen countries about their approach to cCMV, GJB2, and wider genetic testing.ResultsWe found 90% of respondents employ all three tests, either in routine or special cases. cCMV testing is widely used, with 95% of respondents incorporating it into their clinical practice. GJB2 testing was employed by 90%. In cases with negative GJB2 test results, a majority of respondents proceeded to wider genetic screening. Test reimbursement was also examined for each test. For cCMV testing, 63.1% reported reimbursement, 68.4% reported reimbursement for GJB2 variant testing and 52.6% reported reimbursement for wider genetic screening.Conclusions and significanceA common approach is to perform cCMV and GJB2 testing as the first tests, followed by wider genetic testing. This study offers insight into the prevalence, methodologies, and reimbursement status of these testing methodologies across multiple hearing centers and countries. Current consensus and future directions are described based on the current survey. (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) (cCMV) (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) 13 (sic)(sic)(sic)/(sic)(sic)18(sic)(sic)(sic)(sic)20(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)cCMV,GJB2(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic) 90% (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).cCMV(sic)(sic)(sic)(sic)(sic)(sic)(sic), 95% (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).90% (sic)(sic)(sic)(sic)(sic) GJB2 (sic)(sic).(sic) GJB2 (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic) cCMV (sic)(sic), 63.1% (sic)(sic)(sic)(sic)(sic)(sic)(sic), 68.4% (sic)(sic)(sic)(sic)(sic) GJB2 (sic)(sic)(sic)(sic)(sic)(sic)(sic), 52.6% (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) cCMV (sic) GJB2 (sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)/(sic)(sic)(sic)(sic)(sic)(sic)(sic),(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).