Audiology Research

Background/Objectives: Aural toilet using microsuction is a common procedure in ENT clinics, and vertigo is a frequent complaint during this procedure. This study aimed to investigate the characteristics and incidence of microsuction-induced nystagmus and vertigo based on the appearance of the tympanic membrane (TM). Methods: In 85 patients with various TM appearances, microsuction-induced vertigo and nystagmus were assessed. Results: Microsuction elicited nystagmus in 95% (81 of 85) of patients and vertigo in 36% (31 of 85). The nystagmus direction was towards the ipsilateral ear in a bowing position and towards the contralateral ear in a leaning position. The proportion of patients who complained of rotatory vertigo was significantly higher in those with TM perforation, open cavity mastoidectomy, and adhesive otitis media (74%, 26 of 35) compared to those without TM perforation (10%, 5 of 50) (p < 0.001, X² test). Conclusions: Aural toilet using microsuction commonly induces vertigo due to convection in the lateral semicircular canal endolymph caused by the cooling effect. While microsuction-induced nystagmus was observed in most patients, the incidence of vertigo varied depending on the TM condition. Clinicians should closely monitor patients for vertigo during the procedure, and methods to prevent microsuction-induced vertigo should be explored. Full article

Objectives: This study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of the Persian version of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA) in elderly Iranian adults. Methods and Materials: This cross-sectional study was conducted in Tehran, 2021. Following translation and cross-cultural adaptation, the face validity, content validity, and reliability of the questionnaire were assessed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire was used to assess concurrent validity. Study participants included 300 hearing-aid users aged 60 years and older who completed the research instruments. Data were analyzed using Confirmatory Factor Analysis (CFA), Cronbach’s alpha coefficient, Pearson correlation coefficient, independent t-tests, and analysis of variance (ANOVA) in SPSS and AMOS version 24. The significance level was set at p ≤ 0.05 for all tests. Results: The mean (SD) age of the participants was 71.38 (8.05) years. The face and content validity of the questionnaire were confirmed by ten experts (CVI > 0.91). The CFA supported the four-factor structure of the questionnaire, and the goodness-of-fit indices indicated that the final model had a good fit. The Cronbach’s alpha for the total questionnaire was 0.93, and for the subscales, it ranged between 0.83 and 0.93. The Pearson’s correlation analysis results showed a positive and significant correlation between MARS-HA and SADL scores (r = 0.61, p < 0.05), supporting criterion validity. Conclusions: The P-MARS-HA questionnaire demonstrates good validity and reliability and can be used as an appropriate tool for assessing self-efficacy in hearing-aid use among elderly Iranian adults. Full article

Family-centred early hearing detection and intervention (FC-EHDI) is an established framework globally recognized for its emphasis on family involvement in supporting children who are deaf and hard of hearing (DHH). In the African context, unique sociocultural and systemic challenges necessitate tailored approaches to ensure effective implementation. This narrative review explores the relevance of FC-EHDI in Africa, highlights barriers to its implementation, and offers recommendations for creating sustainable and culturally aligned interventions. A narrative review methodology synthesizing evidence from African countries to examine the intersection of FC-EHDI with cultural practices, systemic barriers, and opportunities for innovation was adopted. Databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed journal articles, books, and reports published between 2000 and 2024. Keywords included “family-centred care”, “EHDI”, “Africa”, “cultural responsiveness”, and “early hearing detection and intervention”. Studies were included if they addressed EHDI in African contexts, explored family-centred approaches, or provided barriers and recommendations specific to the region. Thematic analysis was employed to synthesize findings into barriers, evidence, and strategies for FC-EHDI implementation. Data were extracted and analysed thematically to identify patterns and gaps in knowledge. Key challenges identified include resource limitations, economic constraints, linguistic and cultural diversity, and fragmented healthcare systems. Evidence highlights the effectiveness of community-based care, linguistic inclusivity, and culturally tailored interventions in enhancing family engagement and programme outcomes. Recommendations focus on leveraging technology, interdisciplinary collaboration, and policy advocacy. FC-EHDI offers a transformative approach to addressing DHH African children by integrating family involvement, cultural responsiveness, and systemic innovations. Future efforts should emphasize technology, scalable models, and family empowerment to create sustainable and equitable services. Full article

Objectives: This study aimed to analyse the potential influence of abnormalities detected through carotid–vertebral ultrasonography and brain MRI on pure-tone averages (PTAs) and the frequency and intensity of tinnitus. Methods: 423 participants with subjective tinnitus were enrolled in this investigation. All patients underwent carotid– vertebral ultrasonography, brain MRI, and pure-tone audiometry, including tinnitus matching. Results: The median values for tinnitus onset indicated chronic tinnitus in most cases. Regarding tinnitus location, left-sided symptoms (32%) and bilateral symptoms (44%) were the most prevalent. In analysing the effects of abnormalities detected by carotid–vertebral ultrasonography on PTAs, a statistically significant difference was found between the groups (p = 0.0037). Specifically, individuals with intimal hyperplasia had significantly higher PTAs (p = 0.02), as did those with carotid artery plaques (p = 0.005). However, no significant differences in PTAs were noted in relation to carotid artery stenosis (p = 0.07). Similar trends emerged regarding tinnitus intensity (p = 0.013), with significantly higher values observed in the presence of any carotid–vertebral ultrasonography abnormalities. In contrast, tinnitus frequencies were not significantly affected (p = 0.401). Regarding brain MRI findings, Fazekas scores of 2 (p = 0.02) and 3 (p = 0.0052) significantly influenced PTAs. For tinnitus intensity, Fazekas scores of 2 (p = 0.0027) and 3 (p = 0.0005), and the presence of acoustic neuromas (p = 0.019), significantly impacted the intensity values. However, tinnitus frequencies were not significantly (p = 0.36) influenced by brain MRI abnormalities. Conclusions: The findings of this study show that carotid–vertebral ultrasonography and brain MRI abnormalities significantly influence PTAs and tinnitus intensities. Full article

Vestibular paroxysmia (VP) is a disabling medical condition characterized by a high recurrence rate of vertigo. VP is classically associated with the presence of contact between a vascular structure and the cochleovestibular nerve, a neurovascular cross compression (NVCC). Antiepileptic drugs are the first-line treatment for disabling symptoms. We conducted a systematic review to evaluate their efficacy in patients with VP, and whose imaging shows NVCC. All published studies in PubMed databases until October 2024 were included. A total of seven studies were selected. Carbamazepine and oxcarbazepine are by far the most widely used drugs, but there is still a lack of data showing the efficacy of antiepileptic drugs in a large sample of patients. This suggests that a future randomized controlled trial with a satisfactory sample size of VP patients with NVCC and comparing several drugs with neuroprotective properties is needed. Further, as imaging in some of the patients with obvious clinical signs does not always support this diagnosis, we discussed VP physiopathology and the different types of VP published in the literature, including those with no radiological support for NVCC. Full article

Background: Early intervention approaches play a critical role in shaping the communication outcomes of children with hearing loss, influencing their language development and overall learning trajectory. Objectives: The main objective of this study was to compare the communication outcomes of children with hearing loss who received Listening and Spoken Language-South Africa (LSL-SA) with those who received Traditional Speech-Language Therapy (TSLT). Methods: A retrospective record review was conducted to gather data on communication outcomes from participants’ speech-language therapy records. Communication outcomes were measured using standardized assessments evaluating speech intelligibility, expressive vocabulary, receptive language, expressive language, audition, and cognitive–linguistic skills. The data were analyzed using quantitative statistics. Key statistical methods included measures to determine associations, identify statistical significance, determine outcomes, and compare differences between the two groups. Results: The study found that children in the LSL-SA group had statistically significant better communication outcomes, with 63% achieving age-appropriate speech intelligibility compared to 45% in the TSLT group (p = 0.046). Similar trends were observed for expressive vocabulary (LSL-SA: 58% vs. TSLT: 39%, p = 0.048) and receptive language (LSL-SA: 60% vs. TSLT: 39%, p = 0.043). Additionally, 66% of children in the LSL-SA group were recommended for mainstream schooling, compared to 39% in the TSLT group (p = 0.0023). These findings highlight the importance of early amplification and structured intervention in improving communication outcomes. The results also emphasize the importance of Early Hearing Detection and Intervention (EHDI) in decreasing the odds of delay in communication outcomes, irrespective of the type of communication approach, although a higher proportion of children in the LSL-SA approach group achieved age-appropriate communication outcomes than those in the TSLT group. Conclusions: This study highlights that communication intervention approaches aligned with the LSL-SA practice promote better communication development and enhance spoken language outcomes in children with hearing loss, facilitating successful transitions to mainstream schooling. Contribution: This study provides contextually relevant evidence for implementing an LSL-SA intervention approach for children with hearing loss. The implications of these findings for clinical practice and future research are discussed in detail. Full article

Background: The Music-Related Quality of Life (MuRQoL) was launched in 2017 as a valid psychometric measure of Cochlear Implant (CI) users’ music experience and its impact on Quality of Life (QoL). This scoping review aimed to explore the implementation and effectiveness of the instrument since its introduction. Methods: PubMed and Google Scholar databases were searched for publications written in English reporting a translation, validation or application of the MuRQoL. Results: Eleven publications were found, including three validated versions and eight studies that applied the MuRQoL in Italy, Turkey, Spain and the US in research and clinical settings for various purposes. The review showcases the reliability, validity and potential clinical utility of the tool underscoring its growing adoption and integration with other assessment tools. Based on the findings, we make recommendations and provide a roadmap for optimizing the use of MuRQoL globally, including naming and terminology conventions. Anecdotal evidence, such as forthcoming or non-English publications offer further insights into the tool’s future potential. Conclusions: The MuRQoL is currently available in four languages and applicable across diverse cultural contexts, populations and settings. It is a versatile, patient-centered tool providing a deep understanding of CI users’ music experiences. As research and validation efforts continue, the instrument has the potential to set a benchmark for assessing the broader impacts of CIs beyond speech perception, emphasizing the significance of music in enriching the lives of individuals with Hearing Loss (HL). Full article

Dr. Epley has been instrumental in defining the mechanisms and treatment of BPPV variants, including those of the horizontal canals. Cupulolithiasis is a horizontal canal BPPV variant usually defined as direction-changing apogeotropic nystagmus. In recent years, the favored cupulolithiasis mechanism of otoconia adhering persistently to the cupula has been called into question. Epley was the first to propose mechanistic theories which better match the most recent evidence. From the beginning, he has demonstrated mastery over the semicircular canal pathology and otoconial mechanics. Full article

In our clinical setting, we have identified a novel pattern of Trans-Impedance Matrix (TIM) measurement that we call ’scatter’, a measure characterised by a loss of definition in the heat and line maps. Objective: the aim of this study was to describe the basic characteristics of the anomaly pattern. The secondary purpose is to evaluate correlations between the “scatter” pattern and normal TIM by considering different parameters. Methods: the experimental sample, therefore, consisted of 565 patients (81.1% of people with a checked TIM at follow-up; M: 279, F: 286 and mean age: 27 years (sd 26). The scatter pattern was found in 55 devices (9.7%). We classified this pattern as severe (20 devices) or mild (35 devices) according to the visual extent of the abnormality. We considered the visual extension of the pattern, device lifetime, type of internal part of the CI, and auditory performance (speech audiometry in quiet at 65 dB and in noise—Ita Matrix Sentence Test). We also analysed two quantitive parameters: Shannon entropy and exponential decay. Results: a difference was found in these two quantitative parameters between the severe scatter, mild scatter, and normal TIM groups (p-value < 0.0001). The severe scatter group seems to be related to the type of device (CI24RE and CI512) and long device life (average 133 months); it did not show differences in audiology performances compared to the other groups. Conclusions: this result gives a numerical validation to the more subjective visual inspection approach. The scatter pattern is a novel, previously undescribed abnormality of TIM. It can vary from moderate to severe. A numerical basis to validate the inspection approach is described here. Full article

Background/Objectives: Children with congenital or early onset sensorineural hearing loss (SNHL) are at a greater risk of vestibular dysfunction (VD), hypothesized to occur from the close embryological relationship between the cochlear and vestibular systems. Even with increasing focus on early detection and rehabilitation through Universal Newborn Hearing Screening (UNHS) programmes in many countries, few studies have focused on the prevalence and feasibility of vestibular assessment in infant populations. The objectives of this review are to 1. identify the prevalence of VD infants with congenital or early onset (<12 months old) SNHL, 2. identify which vestibular assessment tests/protocols are conducted on this population, 3. report sensitivity and specificity values for identified vestibular assessment tests/protocols. Methods: Studies that included infants aged 0–12 months, with congenital or early onset SNHL of any laterality, degree, or configuration, and who underwent any method of vestibular assessment were included. The review adhered to the Joanna Briggs Institute (JBI) guidance and the PRISMA-ScR extension statement. Results: A total of 18 studies were included in the review. All articles reported that infants with congenital or early onset SNHL are at a greater risk of VD, particularly those with bilateral severe–profound SNHL. The cervical vestibular-evoked myogenic potentials (cVEMP) test was the most frequently identified vestibular assessment tool for this age demographic. Conclusions: Results from the included articles coincide with results from literature assessing older paediatric populations. cVEMPs have been reported to be a feasible, sensitive, and specific screening tool in infants with congenital or early onset SNHL. The prevalence of VD in infants with congenital or early onset SNHL justify further investigation on the feasibility of establishing a pathway for vestibular assessment for all infants referred by UNHS programmes. Full article

Background: Cisplatin, a widely used chemotherapeutic agent, is associated with significant ototoxicity, leading to progressive and irreversible sensorineural hearing loss in up to 93% of patients. Cisplatin generates reactive oxygen species (ROS) in the cochlea, activating apoptotic and necroptotic pathways that result in hair cell death. Inflammatory processes and nitrative stress also contribute to cochlear damage. Methods: This literature review was conducted to explore the mechanisms underlying cisplatin-induced ototoxicity and evaluate protective strategies, including both current and emerging approaches. A structured search was performed in multiple scientific databases, including PubMed and ScienceDirect, for articles published up to November 2024. Results: Current otoprotective strategies include systemic interventions such as antioxidants, anti-inflammatory agents, and apoptosis inhibitors, as well as localized delivery methods like intratympanic injection and nanoparticle-based systems. However, these approaches have limitations, including potential interference with cisplatin’s antitumor efficacy and systemic side effects. Emerging strategies focus on genetic and biomarker-based risk stratification, novel otoprotective agents targeting alternative pathways, and combination therapies. Repurposed drugs like pravastatin also show promise in reducing cisplatin-induced ototoxicity. Conclusions: Despite these advancements, significant research gaps remain in translating preclinical findings to clinical applications and developing selective otoprotective agents that do not compromise cisplatin’s efficacy. This review examines the mechanisms of cisplatin-induced ototoxicity, current otoprotective strategies, and emerging approaches to mitigate this adverse effect. Full article

Background/Objectives: This study aims to evaluate the feasibility of the angular vestibulo-ocular reflex (aVOR) function assessment in children with cerebral palsy (CP) using the video Head Impulse Test (vHIT) and to investigate how vestibular impairments correlate with functional motor ability. Methods: This cross-sectional study included children diagnosed with CP who attempted a vestibular function assessment with the vHIT. Descriptive statistics and a subgroup analysis based on clinical expression were performed. Finally, the correlation between aVOR gain and functional motor ability was investigated. Results: Thirteen children underwent assessments of the horizontal semicircular canals. Six out of thirteen children presented at least one dysfunctional canal; overall, eight out of twenty-six horizontal semicircular canals were dysfunctional in the HIMP paradigm. A subgroup analysis revealed a dysfunctional aVOR gain in all the children presenting ataxia. The correlation analysis demonstrated a strong negative association between aVOR gain and the Gross Motor Function Classification System (−0.73 and −0.68 for the left and right horizontal canal, respectively; p < 0.05). Conclusions: Vestibular dysfunctions are prevalent in children with CP and strongly correlate with motor function. An instrumental vestibular assessment in children with cognitive-motor disability seems feasible, in particular for horizontal canals and the HIMP paradigm. This could be important for better framing a child’s function and enhancing the management of balance and motor impairments with more specific strategies for children with CP. Full article

Bilateral vestibulopathy (BV) is a known cause of chronic vestibular syndrome. With the video head impulse test (VHIT), we can now evaluate all six semicircular canals independently and establish BV subgroups based on canal gain patterns. Background/objectives: To assess canal gain patterns for BV with VHIT, and evaluate subgroups with regard to sex, age, and hearing loss. Methods: A retrospective chart review was performed of all patients who underwent a VHIT between January 2021 and July 2024. Patients with decreased lateral canal gains, bilaterally, were included. Results of canal gains, VHIT patterns, audiometry, and videonystagmography (VNG) results were reviewed. Results: 101 cases were included. Patients were 75.5 ± 13.1 years old and 64.4% were women. Various VHIT patterns were observed; the most frequent being decreased canal gains across all six canals (44.6%), followed by a mix of canals with decreased gains with no clear pattern (34.7%). Decreased gains limited to the lateral canals were rare. We did not observe any significant difference between subgroups with regard to gender or age. Concomitant hearing loss was common (89.6%). A trend was noted, suggesting that severity of hearing loss increased with the number of affected canals. An abnormal VNG test was common (73.3%). Conclusions: Various patterns of canal gains were observed for patients with BV. Audiometry and VNG should be considered as part of BV studies since abnormalities are commonly found. Further research is needed to understand VHIT patterns in BV. Full article

Purpose: The purpose of this study was to evaluate the clinical and audiological outcomes in long-term cochlear implant (CI) users, focusing on hearing performance and device failures. Methods: A retrospective study was conducted on patients who underwent CI surgery, with a minimum follow-up of 10 years. Device survival was analyzed using Kaplan–Meier curves, and failure rates were classified as device failure explants or medical-related explants. The time to revision and causes of reimplantation were assessed. Statistical analyses included Pearson correlation for audiological outcomes, Student’s t-test for group comparisons, and the log-rank test for survival comparisons among implant brands. Results: In this study, data from a total of 211 CIs were collected. Fourteen major postoperative complications were reported in this series, resulting in a global major complication rate of 6.6%: 5.2% due to hard failure and 1.4% due to medical problems and soft failure. The revision rate was 4.1% for the children’s group and 10% for the adult group. The overall device survival rates were more than 96% at 10 years and 91% at 20 years. The median postoperative follow-up was 16.3 years. Moreover, a highly significant correlation was observed (r = 0.669, p < 0.0001) between pure tone average (PTA) thresholds at implant activation and those at the last follow-up, as analyzed using Pearson’s correlation coefficient. Conclusions: The CI is a lifelong device; however, the technology is constantly evolving. Therefore, careful patient counseling (or counseling of parents in the case of pediatric patients) is necessary. The device may wear out over time, requiring revision surgery. These data are essential for audiologists and ENT specialists when selecting patients and determining surgical indications. Full article

Introduction: This edition of the Audiology Research journal is dedicated to Dr. John Epley. For this reason, we would like to present a very unusual case involving the development of a bilateral abnormality of the otolith organs. The otoliths are the structures from which calcium particles detach to induce benign paroxysmal positional vertigo, the disorder for which Dr. Epley is famous for managing. Case report: This case report outlines an unusual presentation of vestibular pathology involving the otoliths. Discussion: We suggest that the atypical presentation may be related to a bilaterally asymmetrical insult to the otoliths. Conclusions: The central insult suffered by this patient resulted in bilateral peripheral otolithic pathology. Full article

Objectives: To investigate the gain provided by self-fitting over-the-counter (SF-OTC) hearing aids compared to clinical NAL-NL2 targets, the differences between various FDA-approved SF-OTC devices, and potential changes in gain over time. Methods: Two experiments were conducted: (1) a cross-sectional comparison of six SF-OTC hearing aids (n = 43) and (2) a longitudinal evaluation of gain within five days of self-fitting and four additional time points (n = 15). Real-ear measurements (REMs) were used to measure gain. Results: SF-OTC hearing aid gain corresponded with 10 dB SPL but not 5 dB SPL criteria from NAL-NL2 targets. Differences between NAL-NL2 targets and gain did not differ significantly between devices. There were no significant changes in gain over time for any input level. Conclusions: SF-OTC hearing aids generally provide user-selected gain levels lower than clinical targets, particularly at higher frequencies. The gain remains stable over time, indicating limited user adjustment after initial fitting. OTC hearing aid manufacturers should consider implementing fitting algorithms that allow for gradual user acclimatization. Full article

Background/Objectives: Early pediatric cochlear implantation positively impacts early language outcomes. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation and factors influencing variability among cochlear implant (CI) users. This article outlines participants’ background, early language outcomes, and multidisciplinary study protocol. Methods and Materials: Individuals aged 12–22 received CIs before 30 months of age, followed-up at the same hearing implant center, and adhered to a standard school curriculum were invited to participate. Out of 109 eligible CI users, 50 participated; 46 agreed to undergo clinical assessments, while four completed questionnaires only. Results: The mean age at the first CI was 15.63 months (SD = 6.0). All but one communicated with spoken language(s). Participants attended mainstream schools and had highly educated parents. Over half (56%) had received Auditory Verbal Therapy in early childhood. Earlier implantation correlated with better language understanding one year post-CI. Conclusions: Earlier implantation was associated with better early language outcomes, with parental education level and early family-centered intervention likely contributing. Future sub-studies will investigate multidisciplinary long-term effects of pediatric cochlear implantation in adolescents. Full article

Background/Objectives: Vestibular agnosia is characterized by a reduced or absent self-motion perception while demonstrating the presence of normal peripheral vestibular function following stimulation. This condition has previously been reported by previous authors in different populations and more recently in traumatic brain injury patients. However, the underlying mechanisms responsible for vestibular agnosia remain a matter of debate. The objective of this manuscript is to review and compare the behavioral and neuroanatomical findings in populations where vestibular agnosia has been demonstrated to better understand the underlying mechanism. Methods: A review of the literature was conducted using four databases: Medline, Embase, Google Scholar, and PubMed. A normal vestibulo-ocular reflex function with an impaired self-motion perception following vestibular stimulation represented the inclusion criteria used. Results: Behavioral data reviewed in the studies revealed a clear association with postural instability. However, no consensus can be drawn from neuroanatomical data due to variability in brain impairments in those populations even though impairments in the parietal cortex are often reported. Conclusions: In general, behavioral data and neuroanatomical data regarding vestibular agnosia have been poorly documented throughout the literature. However, vestibular agnosia can be observed in different populations and is present in concomitant postural control deficits, an important predictor of falls. Finally, even though the parietal cortex has been associated with vestibular agnosia, future studies are required to adequately identify the underlying mechanism. Indeed, the parietal cortex could be part of a larger network mediating vestibular agnosia. This review proposes various methods that future studies should use to overcome the present limitations. Full article