Hearing loss in older adults increases the risk of depression, loneliness, social isolation, cognitive impairments, and dementia; negative impacts that can be potentially attenuated by the adoption of a hearing aid. While objective hearing loss is a good predictor of hearing aid adoption, the subjective impact of hearing-related issues is typically a stronger predictor. We recently found that the subjective experience of hearing loss is worse for individuals with a relatively greater tendency to experience boredom and failures of attention. Thus, we now explore these cognitive-affective individual-difference factors as potential mediators of the predictive link between subjective hearing loss and hearing aid purchase. A sample of older adults (aged 50+) recruited through hearing-care clinics (Connect Hearing Canada) completed an objective hearing assessment (audiometric thresholds) and completed self-report questionnaires on their subjective hearing-related difficulties (hearing handicap, effortful exertion while listening), tendency to experience boredom and mind-wandering, and self-perceived cognitive functioning. While neither boredom proneness nor spontaneous mind-wandering significantly predicted hearing aid adoption on their own over the next 5 years, parallel-mediation models revealed that boredom proneness and spontaneous mind-wandering did partially mediate the relation between hearing handicap and hearing aid adoption, as well as effortful exertion while listening and hearing aid adoption. That is, while greater hearing handicap and effortful exertion while listening predicted higher likelihoods of hearing aid adoption, higher proneness to boredom and spontaneous mind-wandering predicted lower likelihoods of hearing aid adoption. This suggests that the subjective experience of hearing loss has cognitive-affective components that also affect hearing aid adoption.
 Noise-induced hearing loss (NIHL) results from prolonged or intense exposure to loud sounds, causing permanent auditory damage often accompanied by tinnitus, reduced hearing sensitivity and difficulty understanding speech. Use of appropriate hearing protection is essential to minimizing exposure, preventing cochlear injury and reducing the long-term impact of NIHL.  This study aimed to assess noise exposure experiences, their effects on hearing sensitivity and the use of hearing protection among Saudi military personnel.  This cross-sectional study used a self-administered Arabic questionnaire developed after a literature review and consultation with a focus group. Copies were distributed to military personnel visiting the audiology clinic at King Abdulaziz Medical City in Riyadh from 2024 to 2025 and shared via social media nationwide. The questionnaire included 14 items across three sections: demographics, experience with noise exposure and hearing protection and awareness of noise-related impacts.  A total of 256 participants completed the questionnaire; the majority were male (97.3%), lived in Riyadh (85.2%), and were aged 31 years-40 years with a high school education. Most reported no hearing loss across years of experience and exposure to loud sound sources. Notably, 130 participants (50.8%) did not use hearing protection despite being aware that loud noise can cause hearing loss and tinnitus (p = 0.01). Significant associations were found between reported hearing loss and involvement in shooting or use of weapons (p = 0.01) as well as noise source types (p = 0.02).  Although most participants were aware of the harmful effects of loud noise and related symptoms, only one-third consistently used hearing protection. Training to enhance awareness of NIHL risks, along with periodic hearing assessments for early detection, is recommended.Contribution: This study highlights a gap between awareness of noise-induced hearing loss and the use of hearing protection among Saudi military personnel. It identifies weapon-related noise exposure as associated with reported hearing loss, emphasizing the need for targeted hearing conservation strategies.
The digits-in-noise (DIN) test is a validated tool for assessing speech reception thresholds in noise and is widely used in hearing screening. The diotic DIN condition presents identical digits and noise to both ears, whereas the antiphasic condition uses phase-inverted digits, which may enhance sensitivity to specific types of hearing loss. This study aimed to evaluate whether the antiphasic DIN condition better predicts various types of hearing loss than the diotic condition, with a particular focus on its value in identifying patterns suggestive of noise-induced hearing loss in adolescents. This was a cross-sectional study conducted among 2851 adolescents aged 16 to 22 years participating in a population-based cohort study. All participants underwent pure-tone audiometry, tympanometry, and both diotic and antiphasic DIN tests. Hearing loss was categorized based on audiometric criteria into unilateral or bilateral sensorineural hearing loss (SNHL), conductive hearing loss, notched audiograms, and high-frequency hearing loss (HFHL). Logistic regression models were used to examine associations between DIN outcomes and hearing loss categories. Receiver operating characteristic curve analyses were conducted to assess the discriminative ability of the diotic and antiphasic conditions. Mean DIN speech reception thresholds were -9.0 dB for the diotic condition and -16.1 dB for the antiphasic condition. The antiphasic condition showed stronger correlations with audiometric thresholds and steeper regression slopes, indicating greater sensitivity to hearing loss. It more accurately predicted unilateral SNHL (odds ratio [OR] = 2.48 versus 1.34 for diotic) and conductive hearing loss (OR = 3.42 versus 2.07). Although there was an association with notched audiograms (OR = 1.09), the discriminative ability of the antiphasic condition for detecting this pattern was low (area under the curve [AUC] = 0.515). Predictive values for HFHL were comparable between the two conditions (OR = 1.23 antiphasic versus 1.60 diotic). Overall, the antiphasic DIN condition showed a higher AUC (0.789) for detecting any hearing loss than the diotic condition (0.613). Both DIN conditions were associated with hearing loss, but the antiphasic condition demonstrated superior sensitivity, particularly for detecting unilateral SNHL and conductive hearing loss. Its association with notched audiograms was statistically significant, yet the low discriminative value limits its practical use in screening for noise-induced hearing loss. For HFHL, both DIN conditions performed similarly, possibly due to the mild degree of hearing loss in most cases. These findings support the use of the antiphasic DIN condition as a more effective screening tool for specific types of hearing loss in adolescents, though its utility for identifying early signs of noise-induced damage remains limited.
Everyday listening ability is essential for individual health and well-being. Age-related hearing loss (ARHL) is associated with reduced communication engagement, social isolation, loneliness, cognitive decline, and increased dementia risk. Interventions that simultaneously target auditory processing and cognitive function, particularly within engaging and ecologically valid contexts, may offer greater benefits than unimodal approaches. However, culturally adapted, web-based, gamified auditory-cognitive dual-task training (ACDT) tailored for older adults with ARHL remains underexplored. At the time of this writing, few auditory or auditory-cognitive training programs are available in Chinese languages, creating linguistic and cultural barriers for older adults. This study aimed to (1) assess the feasibility and acceptability of home-based ACDT among older Chinese adults with ARHL and (2) examine its preliminary effects on global cognition, hearing, social engagement, and loneliness. It was hypothesized that the intervention group would demonstrate greater improvements in global cognition, hearing, and social engagement than the control group. Sixty community-dwelling older adults with mild-to-moderate ARHL were randomized 1:1 to either the ACDT group or a waitlist control group in a single-blinded pilot randomized controlled trial. Demographic data and outcome measures were collected at baseline, week 6, and week 12. Postintervention interviews were conducted to assess the feasibility and acceptability of ACDT. A total of 60 participants were randomized (mean age 67.65, SD 4.78 years; 45/60, 75% male). ACDT demonstrated high feasibility and acceptability. The ACDT group showed significant improvements in focused attention (mean change=-0.15; P=.02; d=-0.46) and divided attention (mean change=-0.21; P=.002; d=-0.63). Significant cognitive improvements on the Hong Kong-Montreal Cognitive Assessment were identified in naming (r=0.37; P=.05) and visual cognition (r=0.44; P=.02) in the intervention group, while no significant improvements were found in the control group. Both groups reported significant decreases in emotional hearing handicap, with slightly greater improvement in the intervention group (r=0.39; P=.03) than in the control group (r=0.37; P=.04). Linear mixed model analysis revealed a small to moderate group effect (Cohen d=0.38) for 5-minute delayed recall on the Auditory Verbal Learning Test, with the fixed effects explaining 69% of the variance (marginal R²=0.69). A significant time×group interaction was observed for left-ear thresholds (P=.01). Qualitative analysis identified three key themes: (1) intervention coherence and participants' affective attitude toward ACDT; (2) perceived benefits in cognition, information acquisition, and self-awareness from ACDT; and (3) perceiving ACDT as less burdensome with enhanced self-efficacy. Future iterations should incorporate artificial intelligence-enhanced personalization. Large-scale randomized controlled trials involving diverse samples and active control conditions are needed to confirm sustained effects on auditory and cognitive health, dual-task listening-cognitive abilities, and real-world functioning.
Noise-induced hearing loss (NIHL) is a leading occupational illness globally. This study aimed to identify factors related to hearing protection device (HPD) use that were associated with NIHL and to quantify the relationship between the duration of HPD use and NIHL risk. In a cross-sectional study, 845 noise-exposed manufacturing workers in China underwent health examinations and surveys. The associations between hearing protection devices use duration, related factors, and hearing loss were analyzed using multivariable linear regression and restricted cubic spline model. Providing hearing protection and training in its use at the enterprise level were associated with less hearing loss. At the individual level, consistent full-day use of hearing protection and using earplugs instead of earmuffs were linked to significantly less hearing loss. Lower hearing thresholds were linked to longer HPD use: each additional year of use was associated with a modest (~0.3 dB) reduction in the increase of hearing thresholds. Greater protective associations were observed after approximately 3 years of continuous use. Longer duration of HPD use is associated with milder hearing loss, particularly among workers reporting sustained use for three or more years, underscoring the importance of long-term hearing protection in noisy workplaces.
Globally, more than 1.6 billion individuals are affected by hearing loss. Aspirin (acetylsalicylic acid, ASA), an inexpensive and widely available drug, has demonstrated a complex dual role in hearing loss, with its effects potentially influenced by dosage and individual variability. In this article, we aimed to provide an overview of the pharmacological properties of aspirin, followed by an in-depth discussion of its mechanisms of action and its toxic and protective effects in different types of pathology-induced hearing loss. Finally, the development of novel drug delivery systems that may enhance the use of this drug in preventing hearing loss was also discussed. Aspirin exerts both ototoxic and protective effects via cyclooxygenase (COX)-dependent and COX-independent signaling pathways, including Wingless/Integrated (Wnt) signaling, nuclear factor kappa-B (NF-κB), and Prestin-related mechanisms. Low-dose aspirin appears to reduce hearing damage from noise exposure or ototoxic drugs through anti-inflammatory and antioxidant actions that limit cochlear oxidative stress and inflammation. Conversely, higher doses of aspirin may induce reversible auditory changes, such as temporary hearing threshold shifts, tinnitus, and synaptic damage. These effects are primarily associated with cochlear ischemia, excessive activation of N-methyl-D-aspartate (NMDA) receptors, impaired prostaglandin signaling, and altered outer hair cell function resulting from Prestin modulation. This dose-dependent paradox presents a major challenge for the clinical application of aspirin in hearing protection. Nanotechnology-based delivery systems and personalized dosing strategies are promising, although they remain largely at the preclinical stage. Future work should concentrate on optimizing doses and targeting drug delivery to cochlear blood vessels or outer hair cells. Particular attention should be given to aspirin's role in COX signaling pathways and Prestin structural regulation. Overall, these findings provide a theoretical basis for precision-based ear protection strategies, pending clinical validation.
Hearing loss is a significant public health concern that is often under recognized globally, with mild impairment accounting for the largest share of the burden. In Kazakhstan, little is known about national patterns of hearing loss or the utility of simple screening tools for detecting it. This study assessed the burden of hearing loss via Global Burden of Disease (GBD) data and evaluated the diagnostic performance of the Hearing Handicap Inventory for Adults-Screening version (HHIA-S) relative to audiometric testing. We analyzed GBD 2021 data to estimate the prevalence and years lived with disability (YLDs) from 1990 to 2021. Additionally, a cross-sectional survey was conducted among 506 adults recruited from primary healthcare facilities in Astana and nearby areas. All participants completed the HHIA-S questionnaire and underwent audiometric testing. Diagnostic accuracy was assessed via sensitivity, specificity, predictive values, and the area under the ROC curve (AUC). In 2021, the age-standardized prevalence of hearing loss in Kazakhstan was 17,212 per 100,000 population (95% UI: 16,469-18,048), with mild hearing loss accounting for 71.9% of the cases. The YLD rate was 512 per 100,000 (95% UI: 346 s-732), showing stable trends since 1990. In the cross-sectional study, 20% of the participants had audiometrically confirmed hearing loss, with the prevalence rising sharply after the age of 60 years. Women composed 74% of the sample. The HHIA-S demonstrated a sensitivity of 70.2%, a specificity of 94.1%, a positive predictive value of 77.7%, a negative predictive value of 91.6%, and an AUC of 0.82, indicating good diagnostic performance. Hearing loss remains an important but under recognized health problem in Kazakhstan. Integrating simple screening tools such as the HHIA-S into primary care alongside strengthened audiological services and public awareness campaigns could facilitate early detection and reduce the long-term burden of untreated hearing impairment.
This study investigates the relationship between speech perception and production, focusing on consonant error patterns in children using cochlear implants (CIs), children with normal hearing (NH), and NH children listening to vocoder simulations (NHV). The goals were to determine how perception and production errors align within and across groups, to identify feature- and consonant-specific error patterns, and to assess the relative contributions of developmental constraints, signal degradation, and auditory experience. The study included three groups: 20 children with CIs, ages 5 to 9 years, implanted before the age of three; and two hearing-age-matched control groups of 20 children each, ages 4 to 8 years, presented with natural speech (NH) or listening to nine-channel tone vocoder simulations (NHV). To evaluate their speech perception and production abilities, participants were assessed using a modified version of the California Consonant Test. Relationships between perception and production: Moderate correlations were observed between perception and production across all groups, with slightly weaker correlations in the NHV group, supporting the interconnected nature of these processes. Error rates across groups: No statistically significant differences were observed in mean error rates between the CI and NH groups. However, the NHV group exhibited significantly poorer perception abilities, with higher error rates compared with both the NH and CI groups. NHV listeners also showed significantly higher error rates in perception than in production. This diminished perception in the NHV group likely reflects limited adaptation to the vocoder's degraded auditory signal. Error patterns across consonant features: All groups made fewer errors for stop consonants compared with fricatives in perception and production. In addition, all groups demonstrated fewer errors with voiceless consonants compared with voiced ones in perception and production, with some variability across groups. These results indicate that consonant features such as manner and voicing systematically influence performance. Individual consonant errors: The study revealed discrepancies between perception and production errors for individual consonants. Fricatives (e.g., /v/, /θ/, /z/) were associated with the highest error rates across groups. CI children frequently substituted [d] for /ɡ/, a rare pattern among NH children. Their most common production error was substituting [f] for /θ/, while NH children often confused /θ/ and /f/ or substituted [f] for /v/. These findings indicate that CI children's errors are more variable and sometimes atypical compared with NH peers, whereas NHV errors were broader and less systematic. The study's results emphasize that while overall error rates are similar between CI and NH groups, the error patterns for individual consonants can differ considerably. This indicates that interventions for children with CIs should focus on the specific error patterns observed. The poorer performance of the NHV group in perception underscores the limitations of vocoder simulations and suggests they may not fully capture the complexities of CI use. Clinical practices should incorporate these insights to develop more effective techniques tailored to the specific needs of children with CIs. Further research is needed to deepen our understanding of the interplay between perception and production errors in CI users to refine clinical protocols accordingly.
Reports from Asian populations have suggested that chronic hepatitis B virus (HBV) infection may predispose patients to hearing impairment, particularly sudden sensorineural hearing loss, yet evidence from Europe has been lacking. To address this gap, we conducted a nationwide, retrospective analysis of the prevalence of ear and hearing disorders among patients hospitalized with HBV infection in Poland between 2012 and 2023, using the national hospital discharge database. Hospital records with ICD-10 codes for acute or chronic HBV infection were examined, and cases with concomitant ear or hearing disorders were identified. In total, 80,181 HBV-related hospitalizations were recorded, of which 36.6% represented first-time admissions, while the remainder were repeat hospitalizations. Diagnoses of hearing loss were rare, occurring in only 0.05% of first-time and 0.04% of all hospitalizations, and all affected patients were adults. Hearing loss diagnoses, including those encompassing both conductive and sensorineural forms, were exceptionally uncommon. Notably, conditions most frequently discussed in the context of HBV, such as sensorineural hearing loss, were rare and showed no tendency to recur across repeated admissions. Importantly, the prevalence of hearing disorders in this HBV-infected cohort was substantially lower than that reported for the general population, suggesting no increased prevalence of auditory disorders among patients with HBV infection in this setting. These findings indicate that, in contrast to observations from parts of Asia, chronic HBV infection is not associated with an increased prevalence of hearing impairment in this European population. Discrepancies with Asian studies likely reflect multiple regional factors, including differences in HBV genotype distribution, disease characteristics, healthcare practices, and host or environmental influences, rather than genotype alone.
This systematic review of clinical practice guidelines summarizes key recommendations and interventions related to the prevention, diagnosis, and management of acute otitis externa. The interventions identified in this review will contribute to the development of the World Health Organization (WHO) Package of Ear and Hearing Care Interventions (PEHCI). We searched PubMed, CINAHL, Clinical Key, and TRIP databases to identify clinical practice guidelines related to otitis externa. We hand-searched professional organization websites to identify additional clinical practice guidelines that were not identified from the database search or that were published in languages other than English (Spanish, French, Chinese, and Russian). Publications were required to be clinical practice guidelines and published between 2014 and 2024. All review processes were performed by 2 independent reviewers, including the quality assessment with the AGREE II tool. We identified 6 clinical practice guidelines, 4 of which met our prespecified inclusion criteria based on the AGREE II assessment. The 4 included guidelines were published in the United States, Colombia, and 2 in Russia, and in 3 languages. Key interventions focused on prevention (avoiding injury, keeping the ear canal dry, and timely cerumen management), patient education and counseling, comprehensive diagnostic assessment, and pharmaceutical interventions and ear cleaning. The clinical practice guidelines identified key interventions related to the prevention, diagnosis, and management of otitis externa. These interventions will be used to inform the development of the PEHCI, which will identify priority ear and hearing care interventions that can be integrated into national health services packages and policies.
Hearing aids are the primary technology used to compensate for hearing loss, yet conventional signal treatment algorithms often fall short of providing optimal performance in noisy situations. The rise of Artificial Intelligence (AI) is opening new avenues for more powerful hearing aids. However, information available for patients regarding AI and hearing aids is scarce. The purpose of this study was to evaluate the availability of online information on AI-enhanced hearing aids for patients, focusing on the social media platform Reddit. Data were collected on October 1st 2023 following the use of pre-determined keywords. Based on a final sample of 5046 comments distributed amongst 378 threads, the main topics of interest related to AI and hearing aids discussed by users (including patients, relatives and hearing health professionals) were identified. Out of 43,376 threads generated by our searches, 2678 were relevant to the topic of AI in hearing aids. Interestingly, a strong involvement of hearing health professionals was evidenced within the platform, with 52.1% self-identifying as such in some sub-communities (e.g.,r/audiology). In each user group, AI accounted for 3.3% or less of discussion topics, with most conversations instead focusing on practical aspects such as programming, physical features, costs, and connectivity. Overall, this study demonstrates both the potential and the limits of social media platforms as vectors for patient information on AI-derived medical devices, by identifying the paucity of information useable by uninformed patients, and emphasising the need for digital literacy, patient education. Social media discussions are useful vectors to inform healthcare professionals about their patient's concerns. More research is required to assess the quality of information shared online, however, professionals' presence in social media interaction with patients is essential to improve the accuracy of provided information.
Given the inconsistent evidence regarding hearing aid use and reduced dementia risk, this study evaluates whether hearing aid use, particularly effective use, is associated with lower probable dementia risk among hearing-impaired older adults. Using harmonized longitudinal data from 61,089 hearing-impaired participants (aged 55+ years) from seven cohorts (CHARLS, KLOSA, SHARE, ELSA, TILDA, HRS, and MHAS), we employ IPTW-corrected Cox models stratified by country income. Over a 6.5-year average follow-up (8,911 events), hearing aid use is associated with reduced dementia risk (hazard ratio [HR] = 0.91, 95% confidence interval [CI] 0.88-0.94). This association is confined to participants reporting effective hearing improvement (HR = 0.86, 95% CI 0.80-0.93), whereas those reporting poor hearing improvement show no reduced risk (HR = 0.98, 95% CI 0.90-1.07). The association is stronger in middle-income countries (HR = 0.76) and among subgroup populations, including those aged <70 years, women, those who are unmarried, and those with lower education. Quality hearing rehabilitation is a potential public health priority for addressing the dementia burden.
Conversations are an important part of our social lives, although for people with hearing impairment (HI), conversations can pose a considerable challenge and can often lead to miscommunications. In conversations recorded from 25 groups consisting of one HI interlocutor and two normal hearing (NH) interlocutors, all miscommunications were identified to evaluate how HI, background noise level, and hearing-aid signal processing affected miscommunications. A subset of miscommunications is so-called other-initiated repairs (OIRs) where one interlocutor signals a communication breakdown, using unspecific open requests (e.g., "What?") or increasingly more specific restricted requests or offers (e.g., "Who?" or "Did you say blue?"). An "open request" signals a problem without specifying what is misheard/understood, while the restricted request specifies what part of the sentence is not heard, and finally, the most specific "restricted offer" is asking the conversation partner to confirm the supposed word/phrase. With increasing communication difficulty, open OIRs are expected to be more frequently used due to poorer speech understanding. The results showed that HI interlocutors generally had more miscommunications and that, across interlocutors, open OIRs were mostly used. At low noise levels, the HI interlocutor had fewer miscommunications and used more specific OIRs when wearing a hearing aid relative to being unaided. At the high noise level, all interlocutors had more miscommunications. When listening to directional sound processing (dir) at the high noise level, the HI interlocutor produced fewer open OIRs. It is interesting that the NH interlocutors were also affected by having more miscommunications and more open OIRs when the HI interlocutor listened to dir. The speech levels of the HI interlocutors were reduced in dir, and a relationship was found between the HI speech levels and the number of OIRs made by the NH interlocutors. Our results highlight how sensitive the number and nature of miscommunications and OIRs in conversations are, not only to the sound environment, but also to the experience of a single (HI) interlocutor, even in triadic interactions, where only two interlocutors are strictly needed to keep the conversation going.
In individuals with normal hearing, tinnitus may be the initial manifestation of cochleovestibular lesions. Tinnitus is a multifactorial symptom arising from complex interactions within the auditory pathway and related neural networks. Anatomically, the auditory and vestibular system is one unit and functions as an integrated whole; therefore, tinnitus should be approached not only from the auditory perspective but also from the vestibular perspective, in particular, the otolith organs. This study aimed to assess the sacculo-collic, utriculo-ocular, and vestibulo-masseteric reflex pathways to investigate potential vestibular involvement in normal-hearing individuals with tinnitus. Two age-matched groups of 35 participants each were included: normal-hearing individuals with unilateral tinnitus (group I) and normal-hearing individuals without tinnitus (group II). In group I, 14 participants had right-ear tinnitus, and 21 had left-ear tinnitus. The mean duration of tinnitus in group I was 16.2 ± 3.2 mo. Around 37.14% of the individuals of group I demonstrated a moderate level of tinnitus-related handicap, and 62.86% exhibited a severe level of handicap, as assessed using the Tinnitus Handicap Inventory. Cervical, ocular, and masseter vestibular evoked myogenic potentials (VEMP) were recorded in all participants in both groups. Response rates for all 3 VEMP modalities were 100% across both groups. No significant interaural differences in amplitude or latency were observed in group II. However, group I showed significantly reduced peak-to-peak amplitudes in tinnitus ears across all three VEMPs, compared with non-tinnitus ears within the same group and with group II. In addition, group I demonstrated significantly higher interaural amplitude asymmetry ratio for all three VEMPs compared with group II. Latency parameters did not differ significantly between groups or between ears within group I. Spearman's rank correlation revealed a significant negative correlation between the duration of tinnitus and tinnitus ear amplitude of all three VEMPs. Also, there was a significant correlation observed between the duration of tinnitus and the interaural amplitude asymmetry ratio obtained using all three VEMPs. There is an evident abnormality of the peripheral vestibular apparatus in the ears with tinnitus among normal-hearing individuals with tinnitus. Longer duration of tinnitus appears to be linked with progressive peripheral vestibular deterioration in the ear with tinnitus. The present study affirms that the cervical, ocular, and masseter VEMPs can be used as a clinical biomarker to signify the presence of peripheral vestibular abnormality among normal-hearing individuals with tinnitus.
Sensory loss is associated with cognitive decline in later life, but little is known about how biological factors such as frailty alter this relationship. This study examined whether trajectories of hearing, vision, and frailty progression independently predicted cognitive trajectories over 6 years, and whether frailty progression moderated the associations between sensory and cognitive trajectories. Data came from three waves of the Canadian Longitudinal Study on Aging, including 19,378 participants aged 45 to 86 years at baseline. Latent growth curve modeling was used to estimate trajectories of sensory performance, frailty, and cognitive function (executive function and memory), examining the main and moderating effects of frailty. All analyses were adjusted for key baseline covariates, including age, sex, education, household income, ethnicity, and lifestyle factors, and were stratified by sex. Frailty was measured using a modified 40-item Canadian Longitudinal Study on Aging frailty index. Hearing loss was assessed using pure-tone threshold averages, and vision was assessed via binocular visual acuity. Memory function was assessed using the Rey Auditory Verbal Learning Test (delayed recall), and executive function was derived from verbal and animal fluency, mental alternation, and Stroop interference tasks. Lower baseline sensory performance and frailty were associated with lower baseline cognitive performance. Frailty progression was associated with declines in both executive function and memory over time. Declines in hearing were specifically linked to declines in memory, whereas declines in vision were more strongly associated with declines in executive function over time. Participants with both declining vision and increasing frailty exhibited the steepest declines in executive function (β = -0.066, 95% confidence interval [CI] = -0.121, -0.011) over 6 years. In addition, baseline poor hearing was associated with lower baseline executive function among individuals with higher baseline frailty (β = -0.032, 95% CI = -0.062, -0.002). Frailty progression moderated the association between worsening hearing and executive function trajectories over 6 years (β = -0.039, 95% CI = -0.073, -0.004); however, simple slope analyses were not statistically significant across levels of frailty progression. Among females, baseline frailty significantly moderated the association between poor baseline hearing and executive function (β = -0.052, 95% CI = -0.095, -0.009), indicating stronger effects in females with higher frailty. This longitudinal study suggests that frailty progression may play a role in the association between sensory decline and executive function over 6 years, particularly in the context of vision decline. Public health policies targeting (pre)frailty among individuals experiencing sensory decline could promote healthy cognitive aging.
Over-the-counter (OTC) hearing aids are available as self-fitting and preset-based devices. Preset-based devices may be more accessible to older adults with limited technological literacy, but it is unclear whether users prefer settings from larger preset collections that incorporate individual preference deviations or if simpler collections based only on prescriptive targets are sufficient. This study investigated whether potential OTC hearing aid users prefer gain-frequency configurations from larger preset collections, and whether these preferences impact speech perception in quiet and noise. A within-subjects design was used to compare user preferences and speech perception outcomes across four hearing aid preset collections: small (4 presets), medium (16 presets), and large (32 presets) collections, as well as individualized NAL-NL2 targets. Presets were derived using NAL-NL2 real-ear insertion gain (REIG) targets for a 65 dB SPL input based on a large database of audiograms representing the OTC hearing aid market. The large (32) preset collection also incorporated empirically derived preference deviations away from prescription targets. A double-elimination tournament identified preferred settings, followed by speech testing. Forty-one older adults with mild-to-moderate sensorineural hearing loss matching OTC eligibility criteria participated. Participants listened to speech stimuli using presets delivered via a research hearing aid with eight-channel linear gain. Participants completed double-elimination style tournaments to determine their most preferred configuration in quiet and noise within each collection and overall. Preference rankings were analyzed using the Friedman and Conover tests. Speech reception thresholds were measured in quiet and noise. Linear mixed-effects models evaluated differences in speech reception thresholds, and regression analyses examined individual predictors of gain preferences and deviations from targets. Participants significantly preferred presets from the 32-preset collection in quiet, with 49% ranking it highest and 44% ranking NAL-NL2 last. Preferences in noise showed similar trends but were more variable, and preference ranks were not statistically different. Speech reception thresholds differed slightly across collections in quiet but not in noise. Experienced hearing aid users preferred more gain and were less likely to prefer presets over NAL-NL2. When participants preferred a preset over NAL-NL2, the difference between their preferred preset and NAL-NL2 primarily reflected differences in overall gain (more or less than NAL-NL2 prescription gain), rather than differences in the spectral shape of the configuration. Larger preset collections that incorporate user preference deviations away from prescription targets were more preferred, especially in quiet, without significant detriment to speech perception. Results suggest that users may prefer preset hearing aids with more preset options or at least the ability to adjust presets.
Despite representing a substantial public health burden in India, ear and hearing disorders remain a low-priority area within primary healthcare services. The National Health Mission's initiatives on Comprehensive Primary Health Care (CPHC) and Health and Wellness Centers provide an opportunity to integrate ear and aural health services. This review aims to map the evidence and policy interventions related to ear health in India's primary care system over the past two decades and identify opportunities for strengthening integration under CPHC. The objective of the study was to map the evidence and policy interventions related to ear health within India's primary care framework and identify opportunities to enhance its integration under CPHC. A scoping review was conducted, including 19 studies and policy documents published between 1993 and 2025. Sources comprised peer-reviewed literature, program evaluations, and health policy frameworks. Data were extracted on study design, population characteristics, ear health focus, and relevance to primary healthcare delivery. Ear problems, chronic suppurative otitis media, impacted cerumen, and hearing loss have been reported to be prevalent among children and older people in rural areas. Still, there exist large knowledge and service delivery gaps for ear health at the primary care level, which have resulted from a lack of equipment and professional human resources and low focus while offering these services. Blending ear and aural healthcare services under the primary healthcare setup of India will help to decrease preventable hearing impairments. Support and research are required for the integration of services under CPHC.
Sensory deprivation during childhood not only disrupts sound perception but may also alter central auditory processing and auditory development. While the effects of severe hearing loss in childhood are relatively well recognized, the impact of minimal-to-mild sensorineural hearing loss remains less clear. Animal models suggest that even transient auditory deprivation during development can impair central mechanisms that support perceptual skills. This study examined how minimal-to-mild sensorineural hearing loss affects temporal processing in children. In a case-control design, children (4 to 12 years; n = 121) participated in psychoacoustic tasks using a three-alternative forced-choice adaptive procedure to assess sensitivity to amplitude modulation and frequency modulation in a diotic mode. Amplitude modulation detection thresholds were measured using a 20-Hz modulation rate, and frequency modulation detection thresholds were obtained at 2 and 20 Hz. Statistical analyses included between-group comparisons (normal hearing, unilateral hearing loss, and bilateral hearing loss) and regression modeling with age, pure-tone average, and interaural asymmetry entered as continuous independent variables. Analyses revealed that children with minimal-to-mild hearing loss did not exhibit deficits in amplitude or frequency modulation sensitivity. However, interaural asymmetry in hearing sensitivity was associated with reduced sensitivity to frequency modulation. These findings indicate that asymmetric hearing loss within the minimal-to-mild hearing loss range has an adverse effect on basic measures of auditory perception. This study underscores the need for early identification and intervention, as even minimal hearing loss during childhood can disrupt auditory perception in subtle yet developmentally significant ways.
Objective: To investigate the practicality of the M-Quick SIN for hearing screening in elderly individuals during physical examinations and to evaluate its consistency with pure-tone audiometry (PTA). Methods: The study is a cross-sectional study, a total of 980 elderly individuals (586 males, 394 females; Age range: 60-90 years old, with an average of 66.4±5.8 years old) who underwent physical examinations at the Peking Union Medical College Hospital​ physical examination center from February to December 2023, were screened using PTA and M-Quick SIN. We performed statistical analysis using SPSS 27.0, and the practicality of M-Quick SIN was determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results: The signal-to-noise ratio loss (SNR loss) in the poorer ear measured by M-Quick SIN showed a statistically significant gender difference, with males demonstrating greater loss than females (Z=2.859, P<0.05), and increased withage and the average hearing threshold across 500, 1 000, 2 000, and 4 000 Hz frequencies (4-frequency pure-tone average, 4fPTA) in the poorer ear. Multiple linear regression analysis showed, age (β=0.163, P<0.001) and poorer ear 4fPTA (β=0.729, P<0.001) have a significant positive predictive effect on poorer ear M-Quick SIN SNR loss, while gender has no significant effect on poorer ear M-Quick SIN SNR loss (P=0.642). ROC curve analysis demonstrated that the M-Quick SIN signal-to-noise ratio loss in the poorer ear predicted a poorer-ear 4fPTA>35 dBHL with an AUC of 0.89±0.01, and the optimal cut-off value was>11 dB. Concordance between poorer ear M-Quick SIN SNR loss>11 dB and poorer ear 4fPTA>35 dBHL was substantial (Kappa=0.611, P<0.001). Conclusions: As a speech-in-noise test, M-Quick SIN can serve as a supplementary screening tool for hearing loss in the elderly. A bilateral M-Quick SIN SNR loss≤11 dB may be considered the pass criterion for hearing screening, demonstrating high practicality and accuracy. 目的： 探讨普通话快速噪声下言语测试（M-Quick SIN）用于老年体检人群听力筛查的实用性，并评估其与纯音听阈测试的一致性。 方法： 本研究为横断面研究，对2023年2—12月在北京协和医院体检中心进行体检的980名老年人［男性586名，女性394名；年龄（66.4±5.8）岁，范围60~90岁］进行纯音听阈测试及M-Quick SIN测试。应用SPSS 27.0统计软件对数据进行统计学分析，根据受试者工作特征（ROC）曲线及曲线下面积（AUC）值，判断M-Quick SIN的实用性。 结果： 听力较差耳M-Quick SIN信噪比损失（signal-to-noise ratio loss）在不同性别间存在差异，男性大于女性，差异有统计学意义（Z=2.859，P<0.05）；信噪比损失随受试者年龄以及较差耳500、1 000、2 000、4 000 Hz四个频率的平均听阈（4-frequency pure-tone average，4fPTA）的增加呈上升趋势。多元线性回归分析显示，年龄（β=0.163，P<0.001）和较差耳4fPTA（β=0.729，P<0.001）对较差耳M-Quick SIN信噪比损失具有显著的正向预测作用，而性别对较差耳M-Quick SIN信噪比损失无明显影响，差异无统计学意义（P=0.642）。ROC曲线分析显示，较差耳M-Quick SIN信噪比损失预测较差耳4fPTA>35 dBHL的AUC值为0.89±0.01，最佳截断值为>11 dB。较差耳M-Quick SIN信噪比损失>11 dB与较差耳4fPTA>35 dBHL的筛查结果一致性较好，Kappa值=0.611（P<0.001）。 结论： M-Quick SIN可作为老年听力损失的补充筛查方法，双耳信噪比损失≤11 dB可视为听力筛查通过的标准，具有较高的实用性和准确性。.
To explore factors influencing clinician-interpreter collaboration in hearing health care for culturally and linguistically diverse communities with limited English proficiency. A concurrent multilevel mixed-methods approach was used to examine collaboration between clinicians (audiologists/audiometrists) and spoken language interpreters. Data collection involved online surveys and qualitative interviews. The study surveyed 241 participants across Australia, including 83 clinicians (mean age = 37.6 years, 87.8% female) and 158 interpreters (mean age = 51.0 years, 69.0% female). In addition, 33 in-depth semi-structured interviews were conducted with 18 clinicians and 15 interpreters. The Interprofessional Collaborative Practice framework guided qualitative analysis, while descriptive statistics and chi-square (χ2) tests assessed relationships between key variables and collaboration experiences. During hearing appointments, interpreters reported difficulties with specialized audiology terminology (14.9% of interpreters) and patient comprehension (20.1% of interpreters). Face-to-face communication was preferred by both clinicians (63.0%) and interpreters (70.0%) over telephone or video interpreting. In addition, a higher proportion of interpreters (75.0%) than clinicians (53.0%) indicated they wanted pre-consultation briefings. Clinicians working without interpreters struggled with taking patient histories (59.0%) and understanding patients (56.6%). Access to free interpreting services (χ2 = 16.18, p < 0.001) and positive prior experiences with interpreters (χ2 = 25.30, p < 0.001) were associated with interpreter engagement. Qualitative analysis identified four key themes: (a) structural and cultural barriers limit patients' interpreter choices and compromise trust in interpreter-mediated care; (b) role confusion and deficits in interprofessional communication disrupt service delivery; (c) breakdowns in interpreting accuracy, adaptability, and interpreting modalities affect appointment efficiency and quality of care; and (d) gaps in workforce training, access to interpreter services, and systematic support impede interprofessional collaboration. Effective interprofessional collaboration between interpreters and clinicians to facilitate equitable hearing health care necessitates specialized training, adequate funding, accessible multilingual audiology resources, and structured feedback on interpreter engagement and patient satisfaction.