Search Results (1,154)

Objectives: Dysphagia is a major complication of acquired brain injury (ABI) in children; however, its trajectory and prognostic indicators remain insufficiently characterized. This study aimed to identify predictors of dysphagia and its recovery following pediatric ABI. Methods: This retrospective study included all children admitted with ABI to tertiary pediatric rehabilitation center between 2014 and 2017. Data were collected from electronic medical records. Results: One hundred children aged 2:00–17:11 years were included; 61% had dysphagia at admission. Participants with dysphagia received speech–language pathology (SLP) treatment, with a recovery rate of 78.68%. Treatment duration was significantly shorter among children who recovered (36 days) compared with those who did not (136 days; p < 0.001). Dysphagia at admission was associated with mechanical ventilation, duration of unconsciousness, duration of acute hospitalization, CNS tumor etiology, cranial nerve impairment (V, IX, X, XII), voice and speech impairments, and cognitive and behavioral impairments. Logistic regression showed that reduced consciousness, cranial nerve impairment, voice disorders, and CNS tumors explained 70.6% of dysphagia likelihood. Non-recovery was associated with unconsciousness, enteral feeding, hypoglossal injury, and dysphagia severity at admission. Level of consciousness at admission explained 33.7% of recovery likelihood. Conclusions: Dysphagia was highly prevalent among children with ABI. Recovery rates following SLP treatment were high and were associated with level of consciousness at admission to rehabilitation. Full article

Background: Cholesteatoma is a destructive middle ear lesion that compromises hearing and quality of life, for which endoscopic ear surgery (EES) has emerged as a minimally invasive alternative to microscopic approaches. While recurrence and audiological outcomes are frequently reported, patient-centered evaluations using validated patient-reported outcome measures (PROMs) remain limited. Objective: This study aimed to assess postoperative quality of life in patients undergoing exclusive endoscopic cholesteatoma surgery, using validated patient-reported outcome measures. Methods: We conducted a prospective observational cohort study in a tertiary referral center, enrolling 41 patients who underwent exclusive endoscopic cholesteatoma surgery over 20 months. Pre- and postoperative QoL was assessed using the Chronic Otitis Media Questionnaire-12 (COMQ-12) and the Glasgow Benefit Inventory (GBI). Results: COMQ-12 scores improved significantly from baseline (54.0 ± 4.2) to 12 months (10.2 ± 3.3; mean difference −43.8, 95% CI: −46.1 to −41.5; p < 0.001). GBI scores were consistently high, increasing from 82.6 ± 4.8 at 6 months to 84.1 ± 4.9 at 12 months (p < 0.001). Audiometric evaluation demonstrated a significant postoperative improvement, with the mean air–bone gap (ABG) decreasing from 52.1 ± 5.3 dB preoperatively to 26.4 ± 4.7 dB postoperatively (p < 0.001), indicating substantial closure of the conductive gap. Conclusions: Exclusive endoscopic cholesteatoma surgery yields robust QoL improvement, favourable hearing outcome, and recurrence rates similar to classic techniques at short-term evaluation. Full article

Clinical Relevance and Background: Motion sickness is a common manifestation of autonomic dysfunction. Increasingly induced by modern technology, such as virtual reality (VR), it presents a pressing challenge that warrants investigation. However, the relationship between binocular function, visual perception, and motion sickness remains largely unexplored. Therefore, this study investigated the correlations between binocular visual functions, visual perception, and motion sickness susceptibility in adults. Methods: Adults aged 20 to 25 years were recruited. Based on a background and motion sickness susceptibility questionnaire, participants were divided into two groups: the Sick Tendency (ST) group (n = 21) and the Normal group (n = 33). Clinical assessments included habitual distance prescription and visual acuity (VA), phoria, fixation disparity (FD), positive/negative fusional vergence (PFV/NFV), vertical fusional vergence (VFV), positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), vergence facility (VF), stereopsis, contrast sensitivity (CS), near point of convergence (NPC), and near point of accommodation (NPA). Additionally, motor-free visual perception test (MVPT), peripheral awareness (PA), and body balance (center of pressure) were assessed. Results: The ST group exhibited significantly higher distance NFV, distance VFV, and near PFV. Conversely, their NPA, stereopsis, and body balance (center of pressure) were significantly poorer than those of the Normal group. These deficits may be attributed to the accommodation–convergence conflict. Conclusions: Motion sickness susceptibility is closely associated with specific binocular functions. Individuals susceptible to motion sickness exhibit poorer postural stability, likely due to diminished stereopsis and accommodative amplitude (NPA). Future research should further investigate the underlying mechanisms and their clinical implications. Full article

Background: Hearing aid (HA) outcome is a multidimensional construct that requires not only the analysis of auditory function improvement, but also a subjective evaluation of benefits from HAs. Indeed, subjective satisfaction of patients with HAs is not entirely predictable from audiometric outcomes such as real ear gain or functional gain. In light of this possible discrepancy the 1990 Consensus Statement for “Recommended Components of a Hearing Aid Selection Procedure for Adults” suggested that verification of hearing aids benefit also incorporate the subjective satisfaction with amplification. Objectives: The aim of this study was to test the validity and reliability of the Italian version of International Outcome Inventory for Hearing Aids (IOI-HA-It). Methods: Ninety-eight outpatients were randomly recruited to participate in this study. They all made regular use of HAs and were supplied with three different self-administered questionnaires. The International Outcome Inventory for Hearing Aids (IOI-HA), the Hearing Handicap Inventory for Adults (HHIA) or for elderly (HHIE) and the Italian translation of the MOS 36-Item Short Form Health Survey (SF-36). The epidemiological features and results were analyzed as descriptive statistics. Continuous variables were expressed as means with standard deviations (SDs). Reliability of the Italian version was assessed by the following two parameters: internal and test–retest consistencies. Internal consistency reliability was measured by Cronbach’s alpha coefficient. Results and Conclusions: This study evidenced that the IOI-HA-It is proved to offer adequate subjective outcome measures to better appreciate the integral evaluation of a patient’s rehabilitative experience. Furthermore, since it is a very brief questionnaire with low demand on time and cost involved in its compilation, it should be recommended in clinical practice. Full article

Background/Objectives: Speech understanding in noise relies on both temporal fine structure (TFS) and temporal envelope (ENV) cues. While TFS primarily conveys interaural time differences (ITDs) at low frequencies, ENV cues can also support ITD processing, especially when TFS is unavailable or degraded. Expanding the ENV by increasing modulation depth has been proposed to improve speech perception, but its effects on spatial release from masking (SRM) and binaural temporal processing in normal-hearing listeners remain unclear. The goal of this study was to evaluate the effect of ENV enhancement on SRM in young adults with normal hearing and its influence on ITD sensitivity and interaural coherence (IC). Method: Thirty normal-hearing native Kannada speakers (19–34 years) participated. Speech stimuli consisted of Kannada sentences embedded in four-talker babble at −5, 0, and +5 dB signal to noise ratio (SNR). Target and masker were spatialized using head-related transfer functions at 0°, 15°, and 37.5° azimuths. Stimuli were presented with and without ENV enhancement (compression–expansion algorithm). Speech recognition scores were analyzed using generalized linear mixed models, and SRM was calculated as performance differences between co-located and spatially separated conditions. Cross-correlation analyses were performed to estimate ITDs and IC across SNRs. Result: ENV enhancement yielded significantly higher SRM values across all SNRs and spatial separations. Benefits were greatest at lower SNRs and wider target–masker separations. Cross-correlation analysis showed enhanced IC and more reliable ITD estimates under the expanded condition, particularly at moderate SNRs. Conclusions: Temporal ENV enhancement strengthens spatial unmasking and binaural timing cues in normal-hearing adults, especially under adverse listening conditions. These findings highlight its potential application in auditory rehabilitation and hearing technologies where ENV cues are critical. Full article

Background/Objectives: Cochlear implants (CIs) constitute a viable method for auditory rehabilitation in patients with profound sensorineural hearing loss after temporal bone fractures (TBFs). These patients comprise a challenging population due to the anatomical deformity and neural injury. Methods: By performing this systematic review, we attempted to evaluate the viability of CIs in the context of TBF. The literature search, across Pubmed/MEDLINE, Scopus and Google Scholar, was performed under the PRISMA guidelines. The selected time period was from December 1995 to September 2025. The final analysis included 11 manuscripts. The majority of the studies were retrospective case series with a moderate risk of bias. Results: The primary outcome was postoperative auditory function, evaluated with speech perception tasks and aided sound-field pure-tone audiometry. The secondary outcomes were the report of radiological and electrophysiologic prognosticators of implants’ viability, timing of surgery, procedural feasibility and complications. Across the studies, CIs conferred meaningful auditory benefit when the cochlear nerve was intact. High-Resolution Computed Tomography (CT) was utilized for TBF classification and cochlear patency, whereas Magnetic Resonance Imaging (MRI) and a promontory test were crucial for the assessment of neural integrity. Prompt placement, optimally within 12 months after trauma, was related to improved outcomes by limiting cochlear fibrosis and ossification. Despite patients’ impedance fluctuation, restricted speech perception in noise and frequent abnormal facial nerve excitation, the overall audiologic and speech discrimination results are comparable to non-trauma recipients. Conclusions: A CI appears to be the choice of treatment over auditory brainstem implants, as long as the cochlear nerve remains intact. Rapid implantation in well-selected patients coupled with ordinal mapping and follow-up can restore dysfunctional hearing and improve patients’ quality of life. Full article

Background/Objectives: The present study examined the effect of age on sentence recognition in noise in different noise conditions among adults with normal hearing sensitivity throughout the adult lifespan. Methods: A total of 113 adults aged between 21 and 65 years participated in the study; based on age, they were categorized into five groups. The sentence recognition was assessed in five noise conditions: speech-shaped noise (SSN), amplitude-modulated speech-shaped noise (AM-SSN), two-male-talker babble (2MB), four-male-talker babble (4MB), and four-female-talker babble (4FB). The sentences were presented at a signal-to-noise ratio of −5 dB in all noise conditions. Results: The sentence recognition scores declined with increasing age in all noise conditions. In addition, age had a differential effect on the sentence recognition scores in the AM-SSN and 2MB conditions compared with the SSN, 4MB, and 4FB conditions. In the AM-SSN and 2MB conditions, the scores were significantly different in the fourth decade compared with young adults. In other noises, the scores were significantly different after 30 years compared with younger adults. Further, across noise conditions, greater scores were obtained in the AM-SSN and 2MB conditions, and the lowest scores were obtained in the 4FB condition. Partial Spearman correlations revealed a moderate-to-strong negative correlation between age and sentence recognition scores across noise conditions. Conclusions: The findings of the present study showed that sentence recognition is negatively affected by age. In addition, age has a differential effect on sentence recognition in different noises. Full article

Background/Objectives: The Speech-Language Pathologists (SLP) are an integral part of the multidisciplinary team approach to rehabilitation of persons with aphasia (PWA). However, the efficacy of treatment provided by SLPs can vary due to several factors related to clinicians, patients, and the availability of services. The present study was conducted with the aim of investigating current practices in aphasia rehabilitation, key challenges, and future directions as perceived by the SLPs in the Indian context. Methods: The study was conducted using a web-based survey comprising a 32-item questionnaire to gather information related to demographic and professional details, knowledge and use of aphasia rehabilitation approaches, patient education, counselling, bilingual & multilingual contexts, and challenges faced by SLPs. A total of 142 responses were analyzed after initial screening to assess the knowledge, use, and confidence of aphasia rehabilitation along with challenges faced by SLPs in the Indian context. Results: The results indicated significant challenges in the assessment of aphasia due to a lack of formal screening and diagnostic languages in several languages. Further, the results also indicated variations in the knowledge level and confidence in the use of various approaches to aphasia rehabilitation, which warrants the urgent need for organizing short-term training programs for SLPs. The participants also self-reported significant challenges in managing bilingual and multilingual patients with aphasia due to differences in their knowledge and confidence in the selection of language for treatment. On the other side, major patient-related challenges include inadequate logistics, lack of funding, unavailability of speech and language therapy services, social acceptance, and support from family members. The participants also reported the necessity of improving tele-rehabilitation services and developing materials and mobile apps for rehabilitation in Indian languages as future directions for aphasia rehabilitation. Conclusions: The present study through a self-reported questionnaire identified key challenges in aphasia rehabilitation related to the clinician and PWA in the Indian context. The results of the study warrant the need for immediate action to overcome the challenges to enhance the rehabilitation services to PWAs. Full article

Background/Objectives: Although genetic testing is recommended for pediatric hearing loss, referral rates within otology and audiology practices remain low. This study evaluated referral rates, referral pathways, and genetics appointment completion before and after implementation of a quality improvement (QI) referral protocol in an ethnically diverse pediatric cohort. Methods: Phase 1 (January–August 2023) included chart reviews of 88 pediatric patients with hearing loss to assess whether genetics referrals were made and completed. Data collected included demographics, referral modality (clinical note documentation, routed note to genetics, or direct referral order), and appointment status. In Phase 2 (September 2023–September 2024), a standardized referral protocol was implemented requiring all newly diagnosed patients to be referred using one of three predefined pathways. Providers received brief training and reminder cards. Chart reviews were then conducted for an additional 114 patients. Results: A total of 202 patients were included (Phase 1: n = 88; Phase 2: n = 114). Following protocol implementation, the proportion of patients with any documented genetics referral increased significantly (35.2% vs. 68.4%, χ² = 22.03, p < 0.001). Referral order placement, documentation, and note routing increased across all referral modalities (all p < 0.001). Genetics appointment completion also improved significantly, from 11.4% in Phase 1 to 38.6% in Phase 2 (p < 0.001). Conclusions: Genetic referrals for pediatric hearing loss remain underutilized but improved substantially following implementation of a standardized referral protocol. These findings highlight the importance of optimizing referral pathways and providing ongoing provider education. QI initiatives represent a practical strategy to enhance access to genetic evaluation and support precision care. Full article

Aim: This study compared spectral profile analysis thresholds, speech-in-noise perception, and cerebral asymmetry among Carnatic musicians, Bharatanatyam dancers, and non-trained individuals and examined the influence of training duration on these measures. Method: A total of 105 right-handed adults (18–30 years) with normal hearing were divided into Carnatic musicians (n = 35), Bharatanatyam dancers (n = 35), and non-trained controls (n = 35). Spectral stream segregation was measured using the spectral profile analysis task, and speech-in-noise perception was evaluated using the Kannada QuickSIN under right, left, and binaural conditions. Cerebral asymmetry was derived from the Laterality Index. As data were non-normally distributed, non-parametric tests were used. Results: Significant group differences emerged for spectral profile thresholds, with dancers outperforming musicians and controls. Both trained groups showed superior speech-in-noise performance compared to non-trained individuals across all listening conditions, though no differences were observed between musicians and dancers. Non-trained listeners displayed a clear right-ear advantage, whereas trained groups showed minimal or no hemispheric asymmetry. Training duration negatively correlated with selected spectral profile thresholds in both trained groups and with binaural SNR-50 in dancers, indicating training-related auditory enhancement. Conclusions: Musicians and dancers demonstrate better spectral discrimination, improved speech-in-noise perception, and reduced cerebral asymmetry compared to non-trained peers. These findings underscore training-induced auditory neuroplasticity and suggest that long-term engagement in music or dance promotes efficient auditory processing and greater bilateral hemispheric involvement. Full article

Background and Objectives: Chronic tinnitus in patients with bilateral sensorineural hearing loss (SNHL) is frequently linked to psychological distress and affective temperament traits. This study examined audiological characteristics, psychological profiles, and their interrelations in adults with tinnitus. Materials and Methods: In this cross-sectional single-centre study, 38 adults with chronic tinnitus and bilateral SNHL underwent otoscopy, tympanometry, and pure-tone audiometry. Participants were classified into two audiometric groups: high-frequency gently sloping (N = 19) and ski-slope hearing loss (N = 19). The audiological and psychological assessment included the THI, TFI, TEMPS-A, and STAXI-2. Groups were compared using non-parametric statistics (Mann–Whitney U, Chi-square). Relationships between anger and psychological variables were examined using Spearman correlations. Results: Females were more frequently represented in the gently sloping group (p = 0.044) and showed greater quality-of-life impairment (p = 0.045) and lower hyperthymic scores (p = 0.004). Patients with gently sloping loss had longer tinnitus duration (p = 0.026), while cyclothymic temperament was higher in the ski-slope group (p = 0.013). THI scores differed significantly between audiometric groups (p = 0.011). State and trait anger were strongly associated with several affective temperaments, and sleep disturbance correlated with both anger and anxious temperament. THI correlated positively with anxious temperament and sleep impairment. Conclusions: Audiometric phenotype, affective temperament, and anger-related traits are closely intertwined with tinnitus severity and its psychological burden. These findings support the need for multidisciplinary assessment in the management of tinnitus. Full article

Background/Objectives: Congenital cytomegalovirus (cCMV) is a leading non-genetic cause of childhood sensorineural hearing loss (SNHL), characterized by heterogeneous and dynamic hearing outcomes. Hearing impairment may be present at birth or emerge later in childhood. This study aimed to characterize hearing trajectories and laterality patterns in children with cCMV, with emphasis on congenital versus delayed-onset SNHL. Methods: We conducted a retrospective study of children with confirmed cCMV who underwent longitudinal audiologic follow-up. Hearing loss was classified as congenital SNHL or delayed-onset SNHL. Better- and poorer-ear thresholds, bilateral involvement, longitudinal changes, and follow-up duration were analyzed. Results: Of 195 included children, 59 (30%) developed SNHL. Congenital SNHL was present in 34 children (17%), while delayed-onset SNHL developed in 25 of 161 children (16%) who were born with normal hearing. Of these delayed-onset cases, 20 (80%) were asymptomatic at birth, while 5 (20%) presented with non-audiological neonatal symptoms. Longitudinal observation of the delayed-onset subgroup revealed that 36 ears developed SNHL during follow-up, spanning infancy through later childhood, including one case identified in early adulthood. Better-ear thresholds were significantly better preserved in delayed-onset SNHL, while poorer-ear thresholds were comparable across groups. Children with SNHL had substantially longer follow-up duration (60 ± 44.5 months) compared with those with normal hearing (37 ± 24.4 months). Conclusions: Children with cCMV-related SNHL exhibit dynamic and asymmetric hearing trajectories with clinically relevant differences between congenital and delayed-onset SNHL. These findings underscore the necessity of a risk-stratified, long-term surveillance framework that ensures individualized long-term monitoring and promotes sustained adherence to follow-up. Full article

Objectives: This study aimed to evaluate auditory cortical maturation in pediatric cochlear implant (CI) users using speech-evoked cortical auditory evoked potentials (CAEPs) and to compare P1 latency responses with age-matched normal-hearing (NH) peers. Secondary objectives included examining the relationship between P1 latency, age, and duration of implant use to assess experience-dependent cortical plasticity. Materials and Methods: Seventy children were enrolled, including 40 prelingually deaf CI users and 30 NH controls matched for age and sex. CAEPs were recorded using the HEARLab system with three speech tokens representing low (/m/), mid (/g/), and high (/t/) frequencies, presented at 55 dB SPL in a free-field setup. The P1 component was identified as the first positive deflection between 50 and 150 ms after stimulus onset. Group comparisons were performed using Student’s t-test, and correlations between P1 latency, age, and implant-use duration were analyzed using the Pearson correlation test (p < 0.05). Results: Mean P1 latencies were significantly longer in CI users than in NH peers for the /m/ and /t/ stimuli (p = 0.036 and p = 0.045, respectively), while no significant difference was found for /g/ (p = 0.542). In NH children, P1 latency negatively correlated with age (r = −0.44, p < 0.05), indicating maturation-related shortening. Among CI users, longer implant-use duration was associated with shorter P1 latencies across all speech tokens (/m/: r = −0.37; /g/: r = −0.49; /t/: r = −0.43; p < 0.05 for all). Conclusions: Speech-evoked CAEPs provide a sensitive and objective measure of auditory cortical development in children with cochlear implants. P1 latency reflects both chronological and hearing-age-related maturation, supporting its clinical use as a biomarker for cortical plasticity and rehabilitation progress in pediatric CI care. Full article

Background/Objectives: Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) or without NP (CRSsNP) are common upper airway diseases with major impact on healthcare utilization. Little is known about the overall national financial burden of CRS. We aimed to assess the excess financial burden of CRS from a countrywide perspective. Methods: Annual expenditure from healthcare, welfare transfers and foregone income was retrieved from national databases, annualized and compared to matched healthy comparators. Results: Of the 303,475 patients included with CRS (mean age 51, 55% female), 18,142 were subclassified as CRSsNP (24%) or CRSwNP (76%). For CRS patients, annual excess healthcare costs were €1315 (1296–1333) compared to comparators. Patients with CRS earned €1356 (1230–1479) less annually compared to comparators. Patients with CRS of working age (18–64 years) had excess welfare transfers (€816 (782–850) compared to comparators, driven by sick leave and disability. Increases in healthcare costs were seen for patients with CRSwNP (€5406 (4860–6012) annually) compared to CRSsNP (€4945 (4293–5696)) driven by increases in CRS-related costs. Total societal burden for the entire cohort was €686,052,898, of which systemic corticosteroid exposure-related conditions represented €20,332,825. Excess welfare transfers represented €174,394,048 annually. Conclusions: Chronic rhinosinusitis is associated with a significant financial burden, both in terms of societal healthcare and welfare expenditure and patients’ personal finances due to lost income. Full article

Background and objectives: Stapedotomy is the surgical treatment for otosclerosis, with excellent results in terms of hearing recovery. Various laser systems have proven to be an interesting alternative to the conventional technique, allowing for a more precise footplate fenestration with apparently less trauma to the inner ear. The diode laser, more recently introduced, seems to offer more controlled tissue interaction, potentially reducing thermal damage to surrounding structures. However, the literature remains limited. The aim of the present study was to evaluate the functional outcomes and clinical safety of diode laser stapedotomy by comparing the observed results with those previously reported. Materials and methods: A retrospective analysis of 105 patients who underwent diode laser stapedotomy was conducted. The audiological data and the complications were analyzed and compared with a cohort of patients who underwent stapedotomy performed using the conventional technique. Results: In patients who underwent diode laser stapedotomy, the postoperative air–bone gap (ABG) improved significantly at all frequencies. Hearing outcomes were excellent (ABG ≤ 10 dB) in 60.9% of cases, good (ABG ≤ 20 dB) in 89.5%, and poor (ABG > 20 dB) in 10.5% of patients. Intraoperative complications occurred in seven patients (6.7%), including two cases (1.9%) of footplate damage. Postoperatively, 13 cases of vertigo (12.4%), three cases of tinnitus (2.8%), and one case of sensorineural hearing loss (0.9%) were reported. Conclusions: Diode laser stapedotomy is an effective and safe procedure, providing excellent audiological outcomes without increasing the risk of surgical complications. The possibility of thermal damage to the inner ear must be considered, and appropriate laser parameters should be used to minimize these risks. Full article