INTRODUCTION:Hearing loss is linked to cognitive decline, yet its relation to specific executive functions remains unclear. This study examines associations between planning ability, pure-tone audiometry and speech-in-noise performance. METHODS:Data were drawn from the Gutenberg Health Study (GHS), a large population-based cohort at the University Medical Center Mainz. Participants with complete pure-tone audiometry and planning ability data were included (N = 4,458; 2,314 males (51.9%), 2,144 (48.1%) females; mean age 58.0 ± 10.1 years, range 40-80). Audiologic testing included air- and bone-conduction pure-tone audiometry; hearing impairment was defined by WHO threshold. Speech-in-noise perception was measured using the German Matrix Test "Oldenburg Satztest". Planning ability was assessed using the Freiburg version of the Tower of London. Associations were analyzed with linear and logistic regression. RESULTS:Hearing loss (HL ≥ 20 dB; both ears) revealed a significant negative association with planning ability total score (β = -0.346, p < 0.01), but not significantly with clinical executive dysfunction (<16. Percentile total TOL) (OR=1.109, p = 0.43). Higher planning ability reduced the likelihood of hearing impairment (OR=0.97, p = 0.006) and was linked to better speech-in-noise perception (lower OLSA SRT, β = -0.035, p = 0.001). CONCLUSION:Hearing loss is linked to reduced planning ability, while higher planning ability decreases the likelihood of hearing impairment and increased speech perception in noise. These findings support models proposing that hearing loss imposes additional demands on working memory and attention. Longitudinal studies are needed to clarify causal directions and the potential role of interventions.

Kinder mit Schwerhörigkeit haben ein erhöhtes Risiko für vestibuläre Störungen. Aufgrund diagnostischer Herausforderungen wird eine entsprechende Untersuchung bei Kindern nur selten durchgeführt, sodass Daten zur Prävalenz in Deutschland weitgehend fehlen. Dabei könnten die Befunde Einfluss auf weitere Diagnostik, therapeutische Maßnahmen sowie Prävention haben. Die vorliegende Arbeit untersucht die Machbarkeit einer Gleichgewichtsdiagnostik für Kinder aller Altersstufen und betont die Notwendigkeit ihrer routinemäßigen Anwendung bei Kindern mit Schwerhörigkeit. Zudem wurde die Prävalenz von Gleichgewichtsstörungen in dieser Population erfasst. Es wurde eine retrospektive Analyse von 124 Kindern mit Hörstörungen durchgeführt, die im Zeitraum von 12 Monaten im Alter zwischen 6 Monaten und 17 Jahren (Median 5,5 Jahre) im Rahmen einer Hördiagnostik neurootologisch untersucht wurden. Die Untersuchung umfasste eine ausführliche Anamnese, eine Leuchtbrillentestung, die Ableitung zervikaler und okulärer vestibulär evozierter myogener Potenziale (cVEMP, oVEMP) sowie einen Video-Kopfimpulstest (vKIT). Bei 52

BACKGROUND:Children with hearing impairment are at an increased risk of vestibular disorders. Due to the diagnostic challenges associated with pediatric populations, corresponding assessments are rarely performed, resulting in a lack of prevalence data in Germany. The findings, however, could have significant implications for subsequent diagnostic processes, therapeutic interventions, and preventive measures. OBJECTIVE:This study investigated the feasibility of balance diagnostics for children of all age groups and emphasizes the necessity of their routine application in children with hearing impairment. Additionally, the prevalence of balance disorders in this population was assessed. MATERIALS AND METHODS:A retrospective analysis was performed on 124 children with hearing disorders who had undergone neurootologic assessment over a 12-month period. The children were aged between 6 months and 17 years (median age 5.5 years). Diagnostic workup included a detailed medical history, examination with Frenzel glasses, cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP), and a video head impulse test (vHIT). RESULTS:Vestibular dysfunctions were identified in 52% of the 122 children with hearing impairment who underwent instrumental assessment, with 4.5% exhibiting isolated semicircular canal abnormalities (5/110), 34.5% showing otolith dysfunctions (38/110), and 20.4% presenting with combined dysfunctions (20/98). Instrumental diagnostics could not be performed in two children. Additionally, a diagnosis of bilateral vestibulopathy was established for the first time in seven children. CONCLUSION:This study demonstrates that vestibular diagnostics are feasible in children with hearing impairment of all age groups and advocates for their routine integration into clinical practice. Future longitudinal studies are needed to better understand the long-term consequences of vestibular dysfunctions and the effectiveness of therapeutic interventions.

Hearing loss affects over 1.5 billion individuals worldwide and is associated with significant challenges, including social isolation and cognitive decline. Emerging evidence suggests a link between hearing loss and cardiovascular diseases. Comprehensive epidemiological studies exploring these associations remain limited. Using data from the Gutenberg Health Study, a population-based cohort of 15,010 participants aged 35–74 years at baseline, we investigated the relationship between hearing loss, cardiovascular diseases and risk factors, and all-cause mortality. Participants underwent extensive audiometric assessments and clinical evaluations. Logistic regression and Cox proportional hazards models were applied to determine associations between hearing loss, cardiovascular health, and mortality, adjusting for potential confounders. Among the 8886 participants with complete hearing data, 35.1% exhibited some degree of hearing loss. Crude models revealed significant associations between hearing loss and various cardiovascular diseases and risk factors. However, these associations lost significance after adjustments for confounders, except for diabetes (adjusted odds ratio 1.24, 95% confidence interval (CI) 1.01–1.51). Hearing loss coincided with higher mortality in unadjusted analyses (hazard ratio 5.64, 95% CI 4.24–7.49), but this relationship disappeared after full adjustment. Hearing loss may serve as an early marker of systemic vascular dysfunction, particularly in diabetes, rather than an independent predictor of cardiovascular disease or mortality. It needs to be determined whether incorporating auditory health into broader cardiovascular assessments could improve early detection and prevention strategies.

Background and Objectives: Tinnitus is a common symptom in otolaryngologic practice. Although its pathophysiology is multifactorial and remains mostly unclear, it can be correlated to stress and psychological comorbidities. The aim of this study was to assess the correlation between the occurrence of tinnitus and psychosocial work stress (measured using the German COPSOQ-III, a validated instrument) in a large working population. Materials and Methods: The Gutenberg Health Study is a single-center, prospective, observational cohort study. Participants of working age were included and surveyed using the German COPSOQ-III; they were interviewed regarding the occurrence of tinnitus (yes/no) and stratified according to their resilience (measured using the Brief Resilient Coping Scale). Results: A total of 4933 participants of working age were included in the study cohort, in which tinnitus was reported with a prevalence of 26.3%. Participants with tinnitus answered more negatively in all COPSOQ scales, although not all differences were statistically significant. The scales Emotional Demands, Work Privacy Conflicts, Work Environment/Physical Demands and Insecurity over Working Conditions showed especially high differences in means. In addition, all effect scales showed significant differences between participants with and without tinnitus. The prevalence of tinnitus decreased with increasing resilience. Conclusions: Tinnitus is a symptom highly correlated with psychosocial work stress. As such, it represents a significant health burden within the working community.

OBJECTIVES:Hearing loss is a prevalent factor contributing to reduced quality of life and has been linked to various comorbidities, with potential significant implications for psychosocial and cognitive health. The aim of this study was to give current information about the prevalence of hearing loss, loneliness and depression, and to examine the association between these. STUDY DESIGN:Cohort study. METHODS:The Gutenberg Health Study, a large representative cohort study for the general population, was initiated in 2007 at the University Medical Center Mainz, Germany. Hearing loss was assessed using pure-tone audiometry, with severity graduated in percentages according to the World Health Organization (WHO). Loneliness and depressive symptoms were assessed using self-report measures: Loneliness Scale (≥2) for loneliness and the PHQ-9 (≥10) for depressive symptoms. RESULTS:Among 5,948 participants (25-86 years), the prevalence of hearing loss was 38.7%. Loneliness was reported by 9.5% of the participants and the prevalence of significant symptoms of depression was 9.9%. The risk of loneliness was found to be significantly higher in participants with severe to complete hearing loss (OR = 3.92, p = 0.011). In addition, the odds ratio (OR) for depressive symptoms was significantly higher in those with a mild to severe hearing loss compared to those with normal hearing (OR = 1.3; p = 0.025). There was no association with hearing aid use. CONCLUSION:Hearing loss is associated with both loneliness and depressive symptoms. Longitudinal studies are required to clarify the causal relationships and to further investigate the direct impact of early hearing aid fitting on the progression of loneliness and depression. LEVEL OF EVIDENCE:2 Laryngoscope, 135:2497-2505, 2025.

Background and aimsTinnitus, characterized by the conscious perception of sound without external acoustic stimulation, presents a multifaceted challenge. Recent research suggests a potential association between tinnitus and cardiovascular health. To elucidate these associations further, we examined the prevalence of tinnitus alongside its distress levels and their associations with cardiovascular risk factors, diseases, and risk of death within a general population cohort.Methods and resultsThis study analyzed data from the prospective Gutenberg Health Study (GHS), a population-based cohort of 15,010 individuals aged 35-74, who underwent baseline assessments from 2007 to 2012. We focused on the 10-year follow-up (2017-2020) of the GHS, including otologic testing with 8539 subjects, of whom 2387 (28%) reported tinnitus, allowing for a comprehensive cross-sectional and prospective analysis. Participants completed a questionnaire on hearing-related symptoms, including tinnitus presence ("Do you suffer from ringing in the ears (tinnitus)?" yes/no) and distress ("How much do you feel bothered by it?"), rated on a six-point scale from 0 ("not bothersome") to 5 ("very bothersome"). Outcomes were assessed based on observed prevalent cardiovascular conditions (i.e., cardiovascular risk factors and diseases) and deaths. Additionally, calculated cardiovascular risk was assessed using the SCORE2 algorithm. Significant differences in baseline characteristics emerged between participants with and without tinnitus, with the former exhibiting advanced age, male predominance, and a higher prevalence of cardiovascular risk factors and diseases. Tinnitus displayed associations with various prevalent cardiovascular diseases including atrial fibrillation (odds ratio 1.48, 95% confidence interval 1.11-1.96), peripheral artery disease (1.43, 1.05-1.95), coronary artery disease (1.49, 1.09-2.04), and any cardiovascular disease (1.31, 1.11-1.56), persisting even after adjustments for demographic, socioeconomic, and cardiovascular risk factors. While crude associations with several prevalent cardiovascular risk factors were observed, these associations diminished upon comprehensive adjustment. Tinnitus presence was associated with elevated 10-year cardiovascular disease risk (incidence rate ratio 1.11, 1.09-1.13), as indicated by higher SCORE 2 values, yet did not predict all-cause mortality risk.ConclusionsIn the present study, tinnitus was associated with prevalent cardiovascular disease. However, no association with cardiovascular risk factors and mortality was found.

Zusammenfassung Hintergrund Biologika ergänzen durch gezielte, hemmende Mechanismen der Typ-2-Entzündung die Standardtherapie für unzureichend kontrollierte schwere Formen der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP). Trotz Standardisierung mithilfe papierbasierter Checklisten stellen Dokumentation von Anamnese und notwendigen Befunden zur Erfüllung aktueller Verordnungskriterien eine große Herausforderung für Ärzt:innen dar. Ziel der vorliegenden Studie war es, mithilfe von strukturierter Befunderhebung („ structured reporting “, SR) die Qualität jener Dokumentation und den Therapieentscheidungsprozess effizienter zu gestalten. Als Vergleich dienten hierzu die bisher erhältlichen Papier-Checklisten. Methoden Für diese Studie wurde ein inkrementelles Tool programmiert, um aktuelle Befunde zu erfassen und die Erfüllung der Indikationskriterien zu überprüfen. Das Tool wurde in puncto Vollständigkeit, Zeitaufwand und Lesbarkeit mit anderen Checklisten verglichen Ergebnisse Für jede der 3 Dokumentationsmöglichkeiten wurden 20 Befunde erhoben und in die Analyse einbezogen. Die Dokumentation auf den papierbasierten Checklisten hatte einen vergleichbaren Informationsgehalt: 17,5 ± 5,1 bzw. 21,7 ± 7,6 von maximal 43 möglichen Punkten; p > 0 ,05. Die Dokumentation mit der digitalen Anwendung führte zu einem signifikanten Anstieg des Informationsgehalts im Vergleich zu allen papierbasierten Dokumentationen. Die durchschnittliche Punktzahl betrug 38,25 ± 3,7 (88,9 % der Maximalpunktzahl; p < 0,001). Die Nutzerzufriedenheit war im Durchschnitt hoch (9,6/10). Die Nutzung der digitalen Anwendung war anfangs zeitaufwendiger, verringerte sich aber mit zunehmender Anzahl der dokumentierten Fälle erheblich. Schlussfolgerung Die strukturierte Befundung mittels (Web‑)Apps könnte in Zukunft die papierbasierte Befundung zur Indikation einer Biologikatherapie bei CRSwNP-Patient:innen ersetzen und zusätzliche Vorteile in Bezug auf die Datenqualität und Nachvollziehbarkeit der Ergebnisse bieten. Das zukünftig steigende Dokumentationsvolumen, die fortschreitende Digitalisierung und die Möglichkeit der Vernetzung zwischen einzelnen Zentren machen die Einführung einer App in naher Zukunft wahrscheinlich und wirtschaftlich.

Einleitung Tinnitus ist ein häufiges Symptom in der HNO-ärztlichen Praxis. Die Pathophysiologie hinter seiner Entstehung wird als multifaktoriell angenommen und ist noch nicht abschließend geklärt. Resilienz wird als die Fähigkeit angesehen, schwierige Lebenssituationen ohne dauerhafte Beeinträchtigung zu überstehen. Je nach Blickwinkel wird sie als dynamischer Prozess oder persönliches Merkmal verstanden. Als solches kann Resilienz die Anpassung an chronische Gesundheitszustände fördern. Ziel dieser Studie war es zu untersuchen, welchen Einfluss die Resilienz auf die Prävalenz von Tinnitus in der deutschen Bevölkerung hat.

Einleitung Hören gilt als grundlegende Fähigkeit zur Teilnahme am täglichen Leben und Hörverlust beeinträchtigt die Lebensqualität erheblich. Zudem wurde Hörverlust mit Einsamkeit und Depression in Verbindung gebracht und kann Auswirkungen auf die psychosoziale und kognitive Gesundheit haben. Ziel der Studie war es die Prävalenz von Hörstörungen, Einsamkeit und depressiven Symptomen in einer großen deutschen Kohorte zu untersuchen und über den Zusammenhang zu berichten.

Background Few data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups. Methods 20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting. Results Propensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01). Conclusion These are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.

Introduction Hearing loss is one of the most common impairments of quality of life. Furthermore, hearing loss has been associated with loneliness and depression and may have important implications for the psychosocial and cognitive health. This study´s objective was to give current information about the prevalence of hearing loss, loneliness and depressive symptoms in a large population-based cohort. Furthermore, hearing loss was correlated with loneliness and depression.

Background The pathophysiology of tinnitus is not yet fully understood. Although there is a large amount of evidence associating traffic noise exposure with non-auditory health outcomes, there is no evidence regarding the impact of noise annoyance on auditory disorders such as tinnitus.Objective Thus, we aimed to investigate the association between noise annoyance due to different sources and tinnitus presence and distress in the general population.Methods Data of 6813 participants from a large German population-based cohort were used (Gutenberg Health Study). Participants were asked about the presence of tinnitus and how much they were bothered by it. In addition, information on annoyance from road traffic, aircraft, railways, industrial, and neighborhood noise during the day and sleep was collected through validated questionnaires.Results The prevalence of tinnitus was 27.3%, and the predominant sources of noise annoyance in these subjects were aircraft, neighborhood, and road traffic noise. Overall, logistic regression results demonstrated consistent positive associations between annoyance due to different noise sources and prevalent risk of tinnitus with increases in odds ratios ranging from 4 to 11% after adjustment for sex, age, and socioeconomic status. Likewise, consistent increases in odds ratios were observed for tinnitus distress in subjects with prevalent tinnitus. For instance, neighborhood noise annoyance during the sleep was associated with a 26% increase in tinnitus distress (OR 1.26, 95% CI 1.13; 1.39).Impact This is the first study investigating the association between noise annoyance and tinnitus presence and distress in a large cohort of the general population. Our results indicate consistent and positive associations between various sources of noise annoyance and tinnitus. These unprecedented findings are highly relevant as noise annoyance and tinnitus are widespread. The precise etiology and locus of tinnitus remain unknown, but excessive noise exposure is thought to be among the major causes. This study suggests that transportation and neighborhood noise levels thought merely to contribute to annoyance and non-auditory health effects may be sufficient to cause or exacerbate tinnitus.

Introduction Tinnitus is a common symptom in otolaryngologic practice. The pathophysiology behind its development is assumed to be multifactorial and has not yet been fully understood. Resilience is seen as the ability to survive difficult life situations without permanent impairment. Depending on the perspective, it is understood as a dynamic process or a personal characteristic. As such, resilience can promote adaptation to chronic health conditions. The aim of this study was to investigate the influence of resilience on the prevalence of tinnitus in the German population.

The Oldenburg Sentence Test (OLSA) is a German matrix test designed to determine speech recognition thresholds (SRT). It is widely used for hearing-aids and cochlear implant fitting, but an age-adjusted standard is still lacking. In addition, knowing that the ability to concentrate is an important factor in OLSA performance, we hypothesized that OLSA performance would depend on the time of day it was administered. The aim of this study was to propose an age standardization for the OLSA and to determine its diurnal performance. The Gutenberg Health Study is an ongoing population-based study and designed as a single-centre observational, prospective cohort study. Participants were interviewed about common otologic symptoms and tested with pure-tone audiometry and OLSA. Two groups—subjects with and without hearing loss—were established. The OLSA was performed in two runs. The SRT was evaluated for each participant. Results were characterized by age in 5-year cohorts, gender and speech recognition threshold (SRT). A time stamp with an hourly interval was also implemented. The mean OLSA SRT was − 6.9 ± 1.0 dB (group 1 male) and − 7.1 ± 0.8 dB (group 1 female) showing an inverse relationship with age in the whole cohort, whereas a linear increase was observed in those without hearing loss. OLSA-SRT values increased more in males than in females with increasing age. No statistical significance was found for the diurnal performance. A study with 2900 evaluable Oldenburg Sentence Tests is a novelty and representative for the population of Mainz and its surroundings. We postulate an age- and gender-standardized scale for the evaluation of the OLSA. In fact, with an intergroup standard deviation (of about 1.5 dB) compared to the age dependence of 0.7 dB/10 years, this age normalization should be considered as clinically relevant.

Obstructive sleep apnea (OSA) has been associated with various acute and chronic inflammatory diseases, as has serum ferritin, an intracellular iron storage protein. Little is known about the relationship between severity of OSA and serum ferritin levels in otherwise healthy subjects. In this study, all polysomnographic recordings, serum levels of ferritin, C-reactive protein (CRP), and hemoglobin, as well as patient files from 90 consecutive, otherwise healthy individuals with suspected OSA who presented to a tertiary sleep medical center were retrospectively analyzed. For comparison, three groups were formed based on apnea–hypopnea index (AHI; none or mild OSA: <15/h vs. moderate OSA: 15–30/h vs. severe OSA: >30/h). Serum ferritin levels were significantly positively correlated with AHI (r = 0.3240, p = 0.0020). A clear trend of higher serum ferritin levels was found when patients with severe OSA were compared to those without or with mild OSA. Serum CRP and serum hemoglobin levels did not differ significantly among OSA severity groups. Age and body–mass index (BMI) tended to be higher with increasing OSA severity. The BMI was significant higher in patients with severe OSA compared to those without or with mild (p < 0.001). Therefore, serum ferritin levels may provide a biochemical surrogate marker for OSA severity.

Hypoglossal-nerve stimulation (HGNS) is an established second-line therapy for patients with obstructive sleep apnea (OSA). Existing studies investigating the effect of preoperative drug-induced sleep endoscopic (DISE) findings on HGNS outcomes have mainly focused on the apnea/hypopnea index (AHI) among polysomnography (PSG) parameters, and have less frequently tested other PSG parameters such as the apnea index (AI), hypopnea index (HI), oxygen desaturation index (ODI), snoring index, and arousal index, or patient-reported excessive daytime sleepiness. The aim of this study was to investigate the correlation between DISE findings and the above-mentioned metrics after HGNS therapy. We only included patients with DISE findings providing detailed information about the degree of the anteroposterior velar (APV), oropharyngeal lateral wall (OPLW), or tongue-base (BT) obstruction based on the velum, oropharynx, base of tongue, and epiglottis (VOTE) classification. The data of 25 patients (9 female (36%)) were retrospectively evaluated. The mean age at the date of implantation was 54.52 ± 9.61 years, and the mean BMI was 29.99 ± 3.97 kg/m2. Spearman’s rho correlation coefficients were calculated. Significant correlations were found between the degree of APV obstruction and postoperative HI (r = −0.5, p < 0.05), and between the degree of OPLW obstruction and postoperative snoring index (r = 0.42, p < 0.05). BT obstruction was strongly correlated with postoperative metrics such as AHI (r = −0.57, p < 0.01), AI (r = −0.5, p < 0.05), ODI (r = −0.57, p < 0.01), ∆ AHI (r = 0.58, p < 0.01), ∆ AI (r = 0.54, p < 0.01) and ∆ ODI (r = 0.54, p < 0.01). No significant correlation was found between DISE findings and postoperative Epworth Sleepiness Scale values. These findings suggest that preoperative DISE findings, especially the degree of BT obstruction, are important for predicting an HGNS therapy outcome.

Evidence suggests an increasing apnea–hypopnea index (AHI) with aging. However, the effect of aging on sleep-related metrics, especially AHI, has been less frequently investigated within different gender-specific subpopulations by taking prominent confounding factors, e.g., obstructive sleep apnea (OSA)-related comorbidities and body mass index (BMI) into account. Therefore, we retrospectively analyzed 186 first-time polysomnographic (PSG) recordings and medical files of all patients presented to a tertiary university sleep center during a 1-year period. Six groups were formed based on age (over vs. under 55 years) and gender: PSG-related parameters (AHI, apnea-index, and hypopnea-index) were significantly higher in the older mixed-gender cohort (p = 0.0001, p = 0.0011, and p = 0.0015, respectively), and the older female cohort (p = 0.0005, p = 0.0027, and p = 0.001, respectively). Within the older male cohort, the AHI and apnea-index were significantly higher (p = 0.0067, and p = 0.0135, respectively). Inter-group comparison of the BMI showed no significant difference in any subpopulation. Within the older male cohort there were significantly more patients with arterial hypertension, diabetes mellitus, cardiovascular diseases, and chronic mental health disorders (p < 0.0001, p = 0.001, p = 0.0181, and p = 0.0454, respectively). Contrarily, within the female subpopulation there were no significant differences for the aforementioned comorbidities. In conclusion, all investigated sleep PSG-parameters increased among the older subpopulations. We suggest that Osa severity may increase with age due to the increasing accumulation of comorbidities in males, but not in females.