Cochlear implants restore hearing in patients with moderate to profound sensorineural hearing loss by electrically stimulating the auditory nerve. This includes individuals with residual low-frequency acoustic hearing, which can enhance auditory rehabilitation if preserved despite implantation. However, residual hearing is lost in approximately half of these patients due to surgical trauma and subsequent inflammatory and fibrotic tissue response. To support hearing preservation, electrocochleography and electrode impedance measured via the implant provide objective feedback on cochlear health, but each with limited accuracy. Although combining electrocochleography with impedance has been proposed to address the constraints of each individual biomarker, it remains unclear whether a joint analysis improves monitoring of residual hearing. Here we present prospective longitudinal data from 31 implanted cochleae (108 observations) collected perioperatively and over 24 weeks of follow-up. Combined analysis of electrocochleography and impedance in a linear model improved monitoring performance for residual hearing (averaged low-frequency air-conduction pure-tone thresholds; R2marg= 0.71) compared with electrocochleography alone (R2marg = 0.63) or impedance alone (R2marg = 0.48). Findings indicate that electrocochleography and impedance are complementary biomarkers of cochlear health, and that multimodal analysis can improve telemetry-based objective monitoring of residual hearing after cochlear implantation.

BACKGROUND:Non-implantable bone conduction (BC) hearing systems are well-established for individuals with conductive or mixed hearing loss. OBJECTIVE:To evaluate the audiological performance of two wearing options-an adhesive adapter and headband-worn unilaterally and bilaterally using the same non-implantable BC hearing device Contact Forte (BHM Inc., Grafenschachen, Austria). MATERIAL AND METHODS:Fifteen normal hearing adults with simulated bilateral conductive hearing losses participated in the study. Speech understanding in quiet and in noise were measured unaided and with BC devices worn unilaterally, bilaterally, with adhesive adapters, and mounted on headbands. Sound quality was rated using a questionnaire. RESULTS:At 50 dB SPL word recognition scores in quiet improved, on average, by 58% (unilateral), and 69% (bilateral) with adhesive adapters and by 65% and 74% with headbands. At 65 dB mean scores were above 95% in all aided conditions. In noise, speech presented speech reception thresholds decreased by 2.3-3.6 dB. With two devices, an additional benefit of 4.4 dB SNR (p<.001) was observed for speech from the side of the second device. Participants favored the bilateral configurations. CONCLUSION AND SIGNIFICANCE:Both wearing options showed comparable improvements in speech understanding. Bilateral fittings led to better speech understanding for one configuration and were favored subjectively.

BACKGROUND:Childhood cancer survivors (CCS) have an increased risk of long-term health complications, including treatment-related hearing loss. Although early detection is important, many adult survivors do not attend hearing screenings in clinical centers because visits can be logistically or emotionally burdensome. The HEAR study tested an alternative, community-based audiological screening delivered in hearing aid shops in Switzerland. We evaluated its effectiveness, including clinical outcomes and survivor engagement, and developed a plan for potential implementation in clinical practice. METHODS:Adult CCS registered in the Childhood Cancer Registry and diagnosed before age 21 were invited to a free pure-tone audiogram at hearing aid shops across Switzerland. Participants completed a baseline questionnaire before testing and two follow-up questionnaires evaluating feasibility and user experience. We gathered qualitative insights through semistructured interviews with participants and hearing aid shop employees, and group discussions with healthcare professionals. We evaluated the program according to the RE-AIM framework, incorporating both quantitative and qualitative data. RESULTS:Of 1604 invited CCS, 476 (30%) consented, and 319 (20%) completed audiometric testing. The program identified clinically relevant hearing loss in 71 participants (22%) using the SIOP-Boston ototoxicity scale. Five participants acquired hearing aids. Both CCS and clinicians were open to this alternative screening option and provided predominantly positive feedback. Together with clinicians, we developed an implementation plan detailing how this screening could be integrated into follow-up care. CONCLUSION:This simple, accessible community-based screening option could complement existing follow-up care, particularly for CCS who are no longer engaged in structured follow-up care.

Objective: This paper describes the development of a speech intelligibility test in Swiss German dialects, designed for children aged four to nine who are not yet familiar with standard German. Method: Suitable monosyllabic words and trochees in different Swiss German dialects were compiled, illustrated, and evaluated. Picture-pointing test procedures appropriate for children were developed. The selected test words and the pictures representing them were evaluated in a preliminary trial with forty-six normal-hearing children between two and nine years of age. Results: A set of 60 monosyllabic words and 40 trochees was recorded in four different Swiss German dialects as well as in standard German, resulting in a total of 500 recordings. Drawings were created to illustrate each word and found to be appropriate for children aged four years old or older. A non-adaptive and an adaptive test procedure using a weighted up-down method to measure speech reception thresholds in quiet and in noise were developed. Conclusions: A novel test to determine speech intelligibility in children in four different Swiss dialects was developed and evaluated in a pilot study. A validation study with more participants was designed to evaluate the test material and procedures.

BackgroundHearing loss is a common late effect in childhood cancer survivors, caused by ototoxic cancer treatments, such as platinum chemotherapy, cranial radiation with doses of ≥30 Gray, and surgery involving the auditory system. Early recognition of hearing loss as part of follow-up care allows for therapeutic support to mitigate consequences. However, hearing tests are usually only repeated in childhood cancer survivors with abnormal hearing during or right after treatment ends, leaving hearing loss undetected in childhood cancer survivors with late onset or when missed during cancer treatment. Further, general follow-up care attendance may be low after childhood cancer survivors transition to adult care, contributing to missing hearing screening posttherapy. Low attendance may be attributed to childhood cancer survivors finding follow-up care burdensome and time-consuming, lacking awareness of their risk for certain late effects, or the absence of suitable interdisciplinary follow-up clinics. A low-threshold, easily accessible screening program requiring minimal participant effort may address these barriers and improve access to hearing loss screening for childhood cancer survivors. ObjectiveThe HEAR study aims to develop, conduct, and evaluate the feasibility of a low-threshold, community-based screening program for hearing loss in childhood cancer survivors, using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, a tool to plan and evaluate health interventions. Within the screening program, participating childhood cancer survivors completed a standardized hearing assessment at a local Swiss hearing aid provider’s shop. This approach provides low-threshold access to detect hearing loss as it is easily and conveniently accessible for everyone. MethodsEligible childhood cancer survivors were identified through the Childhood Cancer Registry Switzerland and included those diagnosed with cancer between 1976 and 2019 before 21 years and who were ≥2 years post diagnosis. We invited eligible childhood cancer survivors by post. Participants scheduled a hearing test appointment at a hearing aid shop. They completed a baseline questionnaire before the hearing test, and 2 follow-up questionnaires afterward to assess program feasibility and participant experiences. Semistructured interviews with participants, hearing aid shop staff, and group discussions with health care professionals will provide qualitative insights. The RE-AIM framework will guide the program evaluation using the quantitative and qualitative data collected. ResultsAs of February 2025, all participants have been recruited, and all steps of the study up to the group discussions and the RE-AIM evaluation have been completed. ConclusionsThe HEAR study introduces a novel, simple, and low-threshold approach to screening for hearing loss after cancer treatment through hearing aid shops located in the community and close to participants’ homes. This approach has the potential to supplement existing follow-up care programs by reducing the burden of hearing screening for adult childhood cancer survivors and reaching those who might otherwise be lost to follow-up. Trial RegistrationClinicalTrials.gov NCT06036407; https://clinicaltrials.gov/study/NCT06036407 International Registered Report Identifier (IRRID)DERR1-10.2196/63627

OBJECTIVES:The International Guideline Harmonization Group recommends childhood cancer survivors (CCS) exposed to ototoxic treatments be aware of the risk of hearing loss. We assessed awareness among adult CCS. METHODS:We identified adults diagnosed with cancer < 20 years who received ototoxic treatments through the Swiss Childhood Cancer Registry (ChCR) and invited them to the HEAR-study. Participants completed a questionnaire and underwent pure-tone audiometry. Cancer and treatment data were obtained from the ChCR. We used logistic regression to explore factors influencing awareness. RESULTS:Of 424 invited, 105 CCS participated (25 %). Fifty-seven percent did not remember receiving information on hearing loss prior to the study. CCS who remembered being informed were more likely diagnosed after 1995 (OR: 4.5, 95 % CI: 1.3-15.4), reported hearing problems (10.9, 2.6-45.1) and other late effects (4.1, 1.3-13.2), and treated with platinum chemotherapy only (10.8, 2.2-53.2) versus cranial radiotherapy only. 44 % of participants presented clinically relevant hearing loss. CONCLUSIONS:Over half of CCS exposed to ototoxic treatments were unaware of their risk of hearing loss. PRACTICE IMPLICATIONS:Educating CCS about potential late effects of ototoxic treatments is important to allow early diagnosis and treatment, especially for those who had cancer longer ago and those exposed to cranial radiation.

BACKGROUND:Speech reception thresholds (SRTs) can be estimated with speech in noise tests using adaptive procedures. Since these tests are time-consuming, it is preferable to use as few trials as possible to identify reliable results. AIMS/OBJECTIVES:To estimate the impact of early test termination in a German matrix speech test in noise (Oldenburger Satztest) on SRT estimation after 20 instead of after 30 sentences and to identify groups of subjects, for who such a tradeoff between measurement time and accuracy might be useful and acceptable. MATERIAL AND METHODS:Retrospective analysis of 789 tests from cochlear implant users and from simulated tests in 10000 virtual subjects. RESULTS:Early test termination results in increased estimation errors of the SRT in both real, and simulated listeners. Average test time is reduced from 5.0 to 3.6 min. For estimated SRT's above approximately +2 dB after 20 test sentences, the expected average difference to the result after 30 trials becomes higher than 0.5 dB. CONCLUSIONS AND SIGNIFICANCE:If adaptive speech in noise tests are terminated already after 20 sentences, time can be saved, but it should be considered only in listeners with relatively favourable SRT-estimates after 20 trials, preferably below +2 dB.

Hearing loss is a common late effect in childhood cancer survivors (CCS) caused by ototoxic cancer treatments, such as platinum chemotherapy, cranial radiation with doses of ≥ 30 Gray and surgery involving the auditory system. Early recognition of hearing loss as part of follow-up care allows for therapeutic support to mitigate consequences. However, hearing tests are usually only repeated in CCS with abnormal hearing during or right after treatment end, leaving hearing loss undetected in CCS with late onset or when missed during cancer treatment. Further, general follow-up care attendance may be low after CCS transition to adult care, contributing to missing hearing screening post-therapy. Low attendance may be attributed to CCS finding follow-up care burdensome and time-consuming, lacking awareness of their risk for certain late-effects, or the absence of suitable interdisciplinary follow-up clinics. The HEAR-study aimed to develop, conduct, and evaluate a low-threshold, community-based screening program for hearing loss in CCS, following a participatory research approach within the RE-AIM framework, a tool to plan and evaluate health interventions. We included CCS diagnosed with cancer between 1976-2019 before age 21 years who were ≥ 2 years post-diagnosis and registered in the Childhood Cancer Registry Switzerland (ChCR). We invited participants to receive standardized hearing assessment at a Swiss hearing aid provider. Results were handed out to CCS for discussion with their health care professional of choice. Participants completed a baseline questionnaire before the hearing test, and two follow-up questionnaires afterwards. We also invited a sub-sample of participants for semi-structured interviews. Questionnaires and interviews investigated experiences with and opinions about the screening program. We also interviewed hearing aid shop employees and will conduct a focus group interview with health-care professionals. We plan to evaluate the screening program based on the RE-AIM evaluation framework for community-based interventions. This manuscript describes the protocol of the HEAR-study. As of June 2024, all participants have been recruited and all steps of the study up to the RE-AIM evaluation have been completed. The results will be evaluated based on the RE-AIM framework. The HEAR-study introduces a novel, simple, and low-threshold approach to screen for hearing loss after cancer treatment through hearing aid shops located in the community and close to participants’ homes. This approach has the potential to supplement existing follow-up care programs by reducing the burden of hearing screening for adult CCS and reaching those who might otherwise be lost to follow-up. ClinicalTrials.gov “NCT06036407”

Abstract Background Vestibular function (VF) in patients with cochlear implantation (CI) performed during childhood is underinvestigated Objective To study VF in patients receiving CI during childhood Material & Methods Sixty patients (22 females) from 7–34 years old, unilaterally (n = 21) and bilaterally (n = 39) implanted, were included. Deafness was congenital (n = 45), consequential to meningitis (n = 3), skull fracture (n = 1), perinatal CMV infection (n = 1), ototoxic drugs (n = 1), unknown etiology (n = 9). VF was measured between 1 to 22 years after implantation, including calorics, v-HIT, c-VEMPS. Dizziness handicap inventory (DHI), age at independent walking(IW), sport activities were also investigated. Results Nine CI-patients (15%) reported dizziness/vertigo either prior or months to years after surgery. Comparison between symptomatic (15%), asymptomatic (85%), uni-bilaterally CI-patients showed no significant difference on VF’s impairment for calorics (p = .603) and v-HIT (p = 1). Symptoms were not related to vestibular impairment. Age at implantation (p = 0.956), uni- bilateral (p = .32), simultaneous versus sequential (p = .134) did not influence IW age. DHI showed a tendency for being symptomatic at higher implantation age. Interval between CI, IWage, current age between surgery and vestibular evaluation did not have a significant effect on symptomatology. Conclusion & Significance This first middle to long-term evaluation of the VF in CI-patients, implanted in childhood, pointed out that 85% of patients were asymptomatic, with a mean time of >10 years after surgery. Vestibular impairment and symptoms seem to be mainly due to the underlying inner ear’s disease rather than surgery.

OBJECTIVES:To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes.DESIGN:We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry.RESULTS:We assessed 71 AVS patients, 17 of whom had a central and 54 a peripheral cause of dizziness. 12.7% had an objective hearing loss. 'HINTS' had an accuracy of 78.9% to diagnose stroke, whereas 'HINTS' plus audiometry 73.2%. 'HINTS' sensitivity was 82.4% and specificity 77.8% compared to 'HINTS' plus audiometry showing a sensitivity of 82.4% and specificity of 70.4%. The four patients with stroke and minor stroke had all central 'HINTS'. 55% of the patients did not perceive their new unilateral hearing loss.CONCLUSIONS:We found that almost one-eighth of the AVS patients had a new onset of hearing loss and only half had self-reported it. 'HINTS' plus audiometry proved to be less accurate to diagnose a central cause than 'HINTS' alone. Audiometry offered little diagnostic accuracy to detect strokes in the ED but might be useful to objectify a new hearing loss that was underestimated in the acute phase. Complete hearing loss should be considered a red flag, as three in four patients suffered from a central cause.

Purpose The SAMBA 2 BB audio processor for the BONEBRIDGE bone conduction implant features a new automatic listening environment detection to focus on target speech and to reduce interfering speech and background noises. The aim of this study was to evaluate the audiological benefit of the SAMBA 2 BB (AP2) and to compare it with its predecessor SAMBA BB (AP1). Methods Prospective within-subject comparison study. We compared the aided sound field hearing thresholds, speech understanding in quiet (Freiburg monosyllables), and speech understanding in noise (Oldenburg sentence test) with the AP1 and AP2. Each audio processor was worn for 2 weeks before assessment and seven users with single-sided sensorineural deafness (SSD) participated in the study. For speech understanding in noise, two complex noise scenarios with multiple noise sources including single talker interfering speech were used. The first scenario included speech presented from the front (S 0 N MIX ), while in the second scenario speech was presented from the side of the implanted ear (S IPSI N MIX ). In addition, subjective evaluation using the SSQ12, APSQ, and the BBSS questionnaires was performed. Results We found improved speech understanding in quiet with the AP2 compared to the AP1 aided condition (on average + 17%, p = 0.007). In both noise scenarios, the AP2 lead to improved speech reception thresholds by 1.2 dB (S 0 N MIX , p = 0.032) and 2.1 dB (S IPSI N MIX , p = 0.048) compared to the AP1. The questionnaires revealed no statistically significant differences, except an improved APSQ usability score with the AP2. Conclusion Clinicians can expect that patients with SSD will benefit from the SAMBA 2 BB by improved speech understanding in both quiet and in complex noise scenarios, when compared to the older SAMBA BB.

BACKGROUND:The aim of this study was to investigate real-life speech levels of health professionals during communication with older inpatients in small group settings.METHODS:This is a prospective observational study assessing group interactions between geriatric inpatients and health professionals in a geriatric rehabilitation unit of a tertiary university hospital (Bern, Switzerland). We measured speech levels of health professionals during three typical group interactions (discharge planning meeting (n = 21), chair exercise group (n = 5), and memory training group (n = 5)) with older inpatients. Speech levels were measured using the CESVA LF010 (CESVA instruments s.l.u., Barcelona, Spain). A threshold of <60 dBA was defined as a potentially inadequate speech level.RESULTS:Overall, mean talk time of recorded sessions was 23.2 (standard deviation 8.3) minutes. The mean proportion of talk time with potentially inadequate speech levels was 61.6% (sd 32.0%). The mean proportion of talk time with potentially inadequate speech levels was significantly higher in chair exercise groups (95.1% (sd 4.6%)) compared to discharge planning meetings (54.8% (sd 32.5%), p = 0.01) and memory training groups (56.3% (sd 25.4%), p = 0.01).CONCLUSIONS:Our data show that real-life speech level differs between various types of group settings and suggest potentially inadequate speech levels by healthcare professionals requiring further study.

Background: With the advent of cochlear implants, tactile aids for the profoundly deaf became obsolete decades ago. Nevertheless, they might still be useful in rare cases. We report the case of a 25-year-old woman with Bosley–Salih–Alorainy Syndrome and bilateral cochlear aplasia. Methods: After it was determined that cochlear or brainstem implants were not an option and tactile aids were not available anymore, a bone conduction device (BCD) on a softband was tried as a tactile aid. The usual retroauricular position and a second position close to the wrist, preferred by the patient, were compared. Sound detection thresholds were measured with and without the aid. Additionally, three bilaterally deaf adult cochlear implant users were tested under the same conditions. Results: At 250–1000 Hz, sounds were perceived as vibrations above approximately 45–60 dB with the device at the wrist. Thresholds were approximately 10 dB poorer when placed retroauricularly. Differentiation between different sounds seemed difficult. Nevertheless, the patient uses the device and can perceive loud sounds. Conclusions: Cases where the use of tactile aids may make sense are probably very rare. The use of BCD, placed, e.g., at the wrist, may be useful, but sound perception is limited to low frequencies and relatively loud levels.

Matrix sentence tests in noise can be challenging to the listener and time-consuming. A trade-off should be found between testing time, listener’s comfort and the precision of the results. Here, a novel test procedure based on an updated maximum likelihood method was developed and implemented in a German matrix sentence test. It determines the parameters of the psychometric function (threshold, slope, and lapse-rate) without constantly challenging the listener at the intelligibility threshold. A so-called “credible interval” was used as a mid-run estimate of reliability and can be used as a termination criterion for the test. The procedure was evaluated and compared to a STAIRCASE procedure in a study with 20 cochlear implant patients and 20 normal hearing participants. The proposed procedure offers comparable accuracy and reliability to the reference method, but with a lower listening effort, as rated by the listeners ([Formula: see text] points on a 10-point scale). Test duration can be reduced by 1.3 min on average when a credible interval of 2 dB is used as the termination criterion instead of testing 30 sentences. Particularly, normal hearing listeners and well performing, cochlear implant users can benefit from shorter test duration. Although the novel procedure was developed for a German test, it can easily be applied to tests in any other language.

Objective: The transmastoid plugging of a superior semicircular canal is considered a safe and effective technique for the management of superior semicircular canal dehiscence (SSCD). The aim of this meta-analysis is to assess the postoperative hearing outcomes after the transmastoid plugging of the superior semicircular canal. Search method and data sources: A systematic database search was performed on the following databases until 30 January 2023: MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, ICTRP, and clinicaltrials.gov. A systematic literature review and meta-analysis of the pooled data were conducted. We also included a consecutive case series with SCDS for those who underwent transmastoid plugging treatment at our clinic. Results: We identified 643 citations and examined 358 full abstracts and 88 full manuscripts. A total of 16 studies were eligible for the systematic review and 11 studies for the meta-analysis. Furthermore, 159 ears (152 patients) were included. The postoperative mean air conduction threshold remained unchanged (mean difference, 2.89 dB; 95% CI: −0.05, 5.84 dB, p = 0.58), while the mean bone conduction threshold was significantly worse (mean difference, −3.53 dB; 95% CI, −6.1, −0.95 dB, p = 0.9). Conclusion: The transmastoid plugging technique for superior semicircular canal dehiscence syndrome, although minimally worsening the inner ear threshold, is a safe procedure in terms of hearing preservation and satisfactory symptom relief.

Zusammenfassung Hintergrund Ein vollständig intaktes Hörvermögen ist zentral für die Ausübung verschiedener Berufe wie Instrumentenbaumeister, Musiker, Tonmeister sowie für weitere Berufsgruppen ohne Bezug zu Musik wie beispielsweise Sonar-Techniker. Für Personen all dieser Berufsgruppen schlagen wir in Analogie zum „Professional Voice User“ den Begriff „Professional Ear User“ (PEU) vor. PEU haben spezielle Anforderungen an ihre Ohrgesundheit, da sie über eine überdurchschnittliche auditive Wahrnehmungsfähigkeit verfügen, von der sie beruflich abhängig sind. Fragestellung Die vorliegende narrative Übersichtsarbeit hat zum Ziel, die sich daraus ergebenden speziellen Aspekte der Prävention, Diagnostik und Therapie von Ohrerkrankungen bei PEU zusammenzufassen. Ergebnisse und Schlussfolgerung Die Prävention von Hörstörungen und weiteren Ohrerkrankungen umfasst den Schutz vor zu hohen Schallpegeln, die Vermeidung von Ototoxinen oder Nikotin sowie die korrekte Durchführung einer Gehörgangsreinigung. Die Abklärung von Hörstörungen kann sich bei PEU herausfordernd gestalten, da subklinische, jedoch einschränkende Veränderungen des Hörvermögens mit konventionellen audiometrischen Methoden nicht zuverlässig objektiviert werden können. Schließlich kann das Vorliegen einer Ohrerkrankung bei einem PEU Therapieentscheidungen beeinflussen. Weiter muss bei PEU auch eine hohe Wachsamkeit bezüglich nichtorganischer Ohrerkrankungen bestehen. Abschließend werden Möglichkeiten diskutiert, um bei PEU eine umfassende Ohrgesundheit im Rahmen eines edukativen Programms zu fördern und mittels einer spezialisierten ohrenärztlichen Sprechstunde zu erhalten. Im Gegensatz zu bestehenden Konzepten ist der Fokus dabei auf die Gesamtheit der Berufsgruppen gerichtet, welche in professionellem Rahmen speziell von der Ohrgesundheit abhängig sind. Außerdem soll der Schwerpunkt hierbei nicht nur auf Hörstörungen und deren Prävention, sondern auch auf der Erhaltung einer ganzheitlichen Ohrgesundheit liegen.

Background Hearing loss is a potential side effect from childhood cancer treatment. We described the severity of hearing loss assessed by audiometry in a representative national cohort of childhood cancer survivors (CCS) and identified clinical risk factors. Procedure We included all CCS from the Swiss Childhood Cancer Registry who were diagnosed <= 18 age and treated with platinum-based chemotherapy between 1990 and 2014. We extracted audiograms, treatment-related information, and demographic data from medical records. Two reviewers independently assessed the severity of hearing loss at latest follow-up using the Munster Ototoxicity Scale. We used ordered logistic regression to identify clinical risk factors for severity of hearing loss. Results We analyzed data from 270 CCS. Median time from cancer diagnosis to last audiogram was 5 years (interquartile range 2.5-8.1 years). We found 53 (20%) CCS with mild, 78 (29%) with moderate, and 75 (28%) with severe hearing loss. Higher severity grades were associated with (a) younger age at cancer diagnosis (odds ratio [OR] 5.4, 95% confidence interval [CI]: 2.5-12.0 for <5 years); (b) treatment in earlier years (OR 4.8, 95% CI: 2.1-11.0 for 1990-1995); (c) higher cumulative cisplatin doses (OR 13.5, 95% CI: 4.7-38.8 for >450 mg/m(2)); (d) concomitant cranial radiation therapy (CRT) (OR 4.4, 95% CI: 2.5-7.8); and (e) hematopoietic stem cell transplantation (HSCT) (OR 2.7, 95% CI: 1.0-7.2). Conclusion Three of four CCS treated with platinum-based chemotherapy experienced some degree of hearing loss. We recommend closely monitoring patient's hearing function if treated at a young age with high cumulative cisplatin doses, and concomitant CRT as part of long-term care.

Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.

Background Perfect hearing is crucial to the practice of various professions, such as instrument makers, musicians, sound engineers, and other professions not related to music, such as sonar technicians. For people of these occupational groups, we propose the term "professional ear user" (PEU) in analogy to "professional voice user". PEUs have special requirements for their hearing health, as they have well-known above-average auditory perceptual abilities on which they are professionally dependent. Objective The purpose of this narrative review is to summarize selected aspects of the prevention, diagnosis, and treatment of ear disorders in PEUs. Results and conclusion Prevention of hearing disorders and other ear diseases includes protection from excessive sound levels, avoidance of ototoxins and nicotine, and a safe manner of cleaning the outer auditory canal. Diagnosing hearing disorders in PEUs can be challenging, since subclinical but relevant changes in hearing cannot be reliably objectified by conventional audiometric methods. Moreover, the fact that a PEU is affected by an ear disease may influence treatment decisions. Further, physicians must be vigilant for non-organic ear diseases in PEUs. Lastly, measures to promote comprehensive ear health in PEUs as part of an educational program and to maintain ear health by means of a specialized otolaryngology service are discussed. In contrast to existing concepts, we lay the attention on the entirety of occupational groups that are specifically dependent on their ear health in a professional setting. In this context, we suggest avoiding a sole focus on hearing disorders and their prevention, but rather encourage the maintenance of a comprehensive ear health.