Ear & Hearing

Bilateral cochlear implantation (BCI) can improve spatial hearing in adults with bilateral hearing loss, but the early development of spatial hearing following sequential BCI remains poorly understood. This prospective longitudinal study investigated changes in spatial hearing experience in 23 adults undergoing sequential BCI, assessed before and at ~1, 3, and 8 months after bilateral implantation under two conditions: spontaneous and restrained head movements. Using a motion-tracking system combined with virtual reality, sound localization was assessed through absolute and signed errors, along with self-reported localization confidence and listening effort. Subjective spatial hearing was also assessed using the Speech, Spatial and Qualities of Hearing Scale (SSQ). Localization performance improved by 1 month after bilateral implantation, as evidenced by a reduction of absolute error and in the bias toward the first-implanted ear. Participants reported greater localization confidence and lower listening effort at 1 month, although these changes were not consistently maintained at later follow-ups. SSQ scores showed improved spatial hearing at 1 month, speech perception at 3 months, and sound clarity and discriminability at 8 months. Compared with head-restrained condition, accuracy and confidence improved when spontaneous head rotations were allowed. The temporal trajectories of localization bias, confidence, and effort were modulated by the duration of experience with the first CI. These findings indicate that changes in spatial hearing can emerge soon after second CI activation. They further highlight the contribution of spontaneous head movements and previous CI experience, and support the use of complementary measures to monitor the early development of bilateral listening.

The pure-tone audiogram remains the cornerstone of hearing assessment, yet it captures only part of the functional consequences of cochlear damage. Most phenotyping schemes rely solely on the audiogram, which cannot detect hidden suprathreshold dysfunction when thresholds are normal. How best to represent audiological data - as discrete phenotypes or as a continuous space - remains unresolved. Using a retrospective database from the Copenhagen Hearing and Balance Centre, Rigshospitalet (Denmark; 1995-2022; 251986 ear-session units from 81883 adults with normal or sensorineural audiograms), we compared linear (PCA) and non-linear (UMAP) embeddings of the audiogram alone and with word recognition in quiet (WRSmax-Q). Here we show that a linear embedding suffices for the audiogram, but a non-linear one becomes advantageous once suprathreshold measures are added. PCA compressed the audiogram onto two interpretable axes, overall level and slope, explaining 91.5% of the variance, with ears forming a continuous cloud that published reference schemes tiled into overlapping regions. For the audiogram alone, UMAP recovered the same organisation. WRSmax-Q varied widely among ears with similar audiograms; adding it left the PCA unchanged but reorganised the UMAP. A synthetic experiment illustrated this: ears with identical audiograms but different WRSmax-Q separated under UMAP, not PCA. Combining thresholds with WRSmax-Q, UMAP yielded a continuous representation - a prototype Hearing Loss Map - where each ear's position reflects threshold and suprathreshold measures. Representing hearing loss as a location in a continuous space rather than as discrete categories may better reflect its graded nature, with clinical relevance for individual patients.

Distinct auditory nerve (AN) fiber populations with varying thresholds and vulnerabilities to synaptopathy are observable in animal models, but standard non-invasive human measures lack the resolution to differentiate these groups of fibers. This fundamental limitation hinders the translation of findings in animals to human auditory pathologies. To overcome this, we developed a novel refractoriness-masking paradigm to non-invasively isolate threshold-specific AN fiber responses in humans. By presenting rapid click trains with cumulatively rising levels (45 to 105 dB peSPL) at a 250-microsecond inter-click interval, we sequentially masked lower-threshold fibers. Using a tympanic membrane electrode, we recorded compound action potentials (CAPs) in adults with normal hearing and isolated threshold-specific responses via waveform subtraction. Our results demonstrated that the isolated CAPs exhibited decreased latencies with increasing levels and a non-linear amplitude growth, plateauing at 90 dB peSPL before sharply increasing at 105 dB peSPL. This pattern reflects the sequential recruitment of AN fiber that were not effectively recruited by the preceding clicks. Validate conditions, in which the final two clicks had equal levels, produced substantially smaller CAPs, consistent with response suppression by refractoriness. Overall, this paradigm establishes a human measurement approach for characterizing level-threshold-dependent AN responses, providing a potential way to better investigate different AN pathologies, such as cochlear synaptopathy or auditory neuropathy.

Purpose: Stimulability testing involves the evaluation of multiple aspects of a patient's behavior, but the results are most frequently consolidated into a single domain (i.e., "stimulable"). The current study performs preliminary content, construct, concurrent, and predictive validation for the Multidimensional Stimulability Profile for Voice (MSP-V), a rating scale designed to measure multiple domains during stimulability testing (Degree of Change, Rapidity of Change, Generalization, Patient-rated Voice Quality, Patient-rated Voice Feel, and an overall rating of Stimulability Level). Methods: 78 patients with voice disorders (24 functional, 15 structural, 39 neurological) were administered the MSP-V by five speech-language pathologists (SLPs). Content validity was evaluated via the Content Validity Index (CVI) completed by nine voice-specialized SLPs. Construct validity was evaluated via exploratory factor analysis. Concurrent validity was assessed by determining whether MSP-V domains scaled in the expected direction compared to categorical stimulability ratings (e.g., "Highly stimulable" vs. "Stimulable"). Predictive validity was assessed by examining the relationship between MSP-V domains and voice disorder diagnosis, return to voice therapy, and patient-reported practice outside of therapy. Results: The CVI reached the critical value for clinician-rated and patient-rated domains. Two distinct factors were identified during EFA, one consisting of clinician-rated domains and the other of patient-rated domains. All MSP-V domains showed the expected directional relationships as categorical stimulability ratings. No domains differed significantly between disorder etiologies. The Rapidity of Change and Stimulability Level domains both significantly predicted return for voice therapy, where participants who rated lower on each domain were more likely to return to for voice therapy. No domains were predictive of patient-reported practice. Conclusions: The MSP-V is a clinically feasible tool with emerging content, construct, concurrent, and predictive validity that could be used to provide increased clarity and precision in stimulability testing documentation for research and practice.

Standard hearing tests miss cochlear neural degeneration (CND), the loss of synapses between inner hair cells and auditory nerve fibers that may underlie unexplained hearing difficulty in roughly one in ten adults. Envelope following responses (EFRs) can index this neural loss noninvasively, but conventional protocols are too slow for clinical use. We tested a dynamic amplitude-modulated (dAM) EFR that sweeps the full modulation spectrum in a single brief stimulus. In Mongolian gerbils with histologically verified CND, dAM EFRs revealed selective deficits at fast modulation rates without threshold elevation. A machine-learning classifier distinguished young from middle-aged animals with high accuracy; additionally, its most informative feature, power near 400-500 Hz, tracked synapse counts, indicating a readout of cochlear neural health rather than age. Applied without retraining to 56 human listeners, the gerbil-trained classifier separated age groups above chance. dAM EFRs thus offer a rapid, objective and clinically viable marker of CND.

Hearing loss and deafness as a result of hair cell loss cannot be restored due to the incapacity of spontaneous regeneration of these cells. Compounds that manipulate key signaling pathways can potentially regenerate cochlear hair cells. In order to test different compounds that promote hair cell regeneration in vitro models can be used. Three-dimensional cultures have allowed the expansion and experimentation of human and mouse inner ear organoids. This is mainly performed in the embryonic or the early postnatal developmental stage. However, since the majority of patients with hearing loss are adult, it is crucial to understand the adult inner ear regenerative capacity. Here, we evaluated progenitor cell markers in the adult human and mouse inner ear and the generation, expansion and differentiation of cochlear organoids derived from the adult human and mouse inner ear. Cochlear and vestibular sensory epithelium from adult humans; and from adult and aged mice express the progenitor markers SOX2 and LGR5; and can generate organoids in vitro. By optimizing the culture conditions, organoids derived from the cochlea and vestibular organ from adult human and adult and aged mouse differentiated to Myosin 7A positive cells. This indicates that the adult inner ear has regenerative capacity. These findings are encouraging for future regenerative therapies to cure hair cell-related hearing loss and deafness.

Neural tracking of speech is a well-established phenomenon in neuroscience. However, for speech signals with a fixed structure, significant correlations between speech envelopes and neurophysiological representations occur even for unheard sentences. We exploit a structured speech-in-noise matrix hearing test (Oldenburger Sentence Test, OLSA) to systematically quantify the relationship between acoustic sentence similarity and neural tracking. Simultaneous magnetoencephalography (MEG) and 76-channel electroencephalography (EEG) data, including 16 channels positioned directly around the ears (ear-EEG), were recorded from 21 young adults with normal hearing during the presentation of clean-speech audiobooks and OLSA sentences at six signal-to-noise ratios. A linear decoder trained on audiobooks reconstructed OLSA sentence envelopes. Reconstruction accuracies were compared using a linear mixed model across heard (matched) and unheard (mismatched) sentences of varying acoustic similarity. Significant reconstruction accuracies were achieved across MEG, EEG, and ear-EEG for both matched and mismatched sentences. For mismatched sentences, these accuracies gradually increased with their acoustic similarity to the heard speech data. The high similarity between sentences, which is especially prominent in matrix tests, can cause significant spurious tracking for mismatched stimuli. This effect can reach levels comparable to those of matched sentences and can be mistaken for true neural tracking. Robust neural tracking across modalities further supported the established viability of ear-EEG compared to whole-head systems.

Objective: Kabuki syndrome type 2 (KS2) is a rare X-linked disorder caused by pathogenic variants in KDM6A and is frequently associated with hearing impairment. Because auditory phenotypes include sensorineural, conductive, and mixed hearing loss, we examined whether Kdm6a deficiency directly impairs cochlear morphology or auditory function in mice. Methods: We generated Nestin-Cre; Kdm6a conditional mutants and a germline-derived global Kdm6a deletion model using Sox2-Cre-mediated germline recombination. Auditory function and cochlear morphology were assessed by auditory brainstem responses (ABRs), distortion product otoacoustic emissions (DPOAEs), and histological analyses. Results: Whole-body hemizygous or homozygous Kdm6a deletion resulted in embryonic lethality. Analyses therefore focused on Nestin-Cre; Kdm6aflox/Y males and females carrying a germline-derived heterozygous Kdm6a deletion. In Nestin-Cre mutants, ABR thresholds, wave I amplitudes and latencies, and DPOAE measures at 8, 16, and 32 kHz were comparable with littermate controls at 4 and 8 weeks. In heterozygous deletion females, ABR thresholds, wave I amplitudes and latencies at 4-64 kHz and DPOAE measures at 8, 16, and 32 kHz were comparable with male and female wild-type controls. No overt cochlear pathology was observed in either model. Conclusion: Kdm6a deficiency in the viable mouse models examined did not produce overt cochlear pathology or baseline auditory dysfunction. These findings suggest that partial Kdm6a loss alone is insufficient to produce a robust primary cochlear phenotype in young mice and highlight the potential contributions of non-cochlear, developmental, central, and later-onset mechanisms to hearing impairment in KS2. Clinically, these findings support careful evaluation for potentially treatable middle-ear disease.

Aging has profound effects on sensory systems, such that older adults can report problems in hearing despite having normal audiometric thresholds. While it is known that older listeners have poorer temporal processing than younger listeners, there is limited understanding of how these deficits interact with effects of sound level, in particular when they are above conversational level (e.g., > 65 dB SPL). Here we wanted to investigate the link between temporal processing and sound level as a function of age in normal-hearing listeners. Using a forward-masking paradigm, auditory brainstem responses (ABRs) and behavioral detection thresholds were measured at different masker levels. It was found that with increasing age and masker sound level, the Wave V amplitudes of older listeners decreased and directly correlated with behavioral detection thresholds of the probe stimulus in the forward-masking paradigm. These results elucidate the fundamental effects of aging on temporal processing and its interactions with sound level in the central auditory system. The results of this study have clinical implications for the concept of normal hearing in the aging population and how older listeners may struggle in different listening environments that are not captured by simple audiometry. Further delineating the important effects of aging will pave the way for earlier clinical diagnosis of hearing disorders and personalized treatments for different forms of age-related hearing loss.

Purpose: Posterior pharyngeal wall (PPW) thickening is a common structural manifestation of treatment-related internal lymphedema in patients with head and neck cancer and can be evaluated using lateral videofluoroscopic images acquired during modified barium swallow (MBS) studies. However, no standardized method currently exists for quantitative measurement. Methods: This two-phase methodological study first conducted a scoping review to characterize existing approaches to PPW thickness measurement and identify the principal factors contributing to variation in PPW thickness measurement. Eight studies were identified with variation observed across these measurement factors. An empirical reliability study was then performed using 107 MBS studies from 93 Head and Neck Cancer patients. Two independent raters annotated 10 anatomical landmarks on pre-swallow and post-swallow resting frames, and a computer-assisted algorithm quantitatively generated seven candidate PPW thickness measurements based on different vertebral reference points and measurement directions. Reliability was assessed intraclass correlation coefficients (ICCs). Results: Inter-rater reliability was highest for the measurement originating from the midpoint of C3 and extending perpendicular to the anterior C3 surface (ICC, 0.78; 95% CI, 0.72-0.83). Among the normalization references, C2-C4 vertebral length demonstrated greater reliability than C3 vertebral length, with an ICC of 0.88 (95% CI, 0.85-0.91). No significant differences were observed between pre-swallow and post-swallow PPW thickness measurements across the evaluated approaches. Conclusions: These findings provide a methodological foundation for more standardized and reliable quantification of PPW thickness, with potential to expand the role of MBS from the functional evaluation of swallowing to include quantitative characterization of pharyngeal structural abnormalities.

Computed tomography (CT) interpretation requires recognition of the anatomical level of each slice. Classification may facilitate preprocessing and AI-assisted fracture diagnosis. We developed deep learning models to classify craniofacial CT slices into six anatomical categories. A total of 11,769 images were collected from a multicenter database involving 10 Japanese university hospitals and the public Head-Neck-Radiomics-HN1 dataset. Patients were divided into training (70%) and evaluation (30%) sets. Five CNN architectures were trained from scratch, and hard- and soft-voting ensembles were evaluated. Individual-model accuracy ranged from 94.72% to 96.09%; the hard-voting ensemble achieved 96.46% accuracy (Cohen's k = 0.954). Although performance differed among individual models (Cochran's Q = 99.29, p < 0.001), the ensemble did not significantly outperform EfficientNetV2B1 (McNemar's p = 0.163). Errors occurred mainly between adjacent anatomical regions. Deep learning can classify craniofacial CT slices accurately and may support automated dataset organization and AI-assisted fracture diagnosis. External validation is needed.

Introduction: Resection margins in oral squamous cell carcinoma (OSCC) are frequently inadequate. This study investigated the accuracy and diagnostic performance of ex-vivo 7T MRI against histology. Methods: Fifty OSCC specimens underwent ex-vivo 7T MRI. Tumours were segmented on corresponding histology and twice on MRI: blinded to histology (radiologist segmentation; clinical practice) and using histology (histology-MR segmentation; MR-based ground truth). Resection margins were measured in five regions and compared with histology. Results: Anterior and posterior margins were generally smaller on MRI than on histology (maximum mean difference -2.5 mm), whereas cranial, caudal and deep margins were generally larger on MRI (mean differences <1 mm). For close margins (<5 mm), sensitivity was 95% for histology-MR segmentations and 91% for radiologist segmentations, with 75% specificity for both. Conclusion: Ex-vivo 7T MRI accurately measures resection margins and detects close margins with high sensitivity. A future clinical trial will determine whether intraoperative implementation reduces inadequate margins and adjuvant treatment.

Metabotropic glutamate receptors (mGluR) are G-protein coupled receptors that regulate neuroplasticity and have been shown to play a role in auditory processing. However, not much is known about the expression of mGluRs during cochlear nucleus development in the context of Fragile X syndrome (FXS). FXS is the most common heritable form of intellectual disability and autism and is associated with auditory processing deficits including hypersensitivity. Audiogenic seizure is a notable feature of the Fmr1 knock-out (KO) mouse model for FXS, in which mGluR5 has been shown to be necessary. In this study, we investigated the expression of eight metabotropic glutamate receptors (mGluRs) in the cochlear nucleus at both young and adult ages and in wildtype and Fmr1 KO mice. While it is established that mGluR1 is the predominantly expressed mGluR in adult cochlear nucleus, we report the following new finding that mGluR5 is the more abundant receptor during early development. The expression of Group II and III mGluRs (2,3,4,6,7,8) was relatively stable during development. We show that mGluR1 and mGluR5 are co-expressed across multiple neuron types. Fmr1 genotype did not have statistically significant impact on the expression pattern of mGluRs in cochlear nucleus. Although hearing onset occurs during this mGluR5 to 1 transition period, mGluR expression patterns were not impacted by cochlear activity. We conclude that there is an mGluR5 is to mGluR1 transition that occurs within cochlear nucleus neurons during the critical period closure that is intrinsic to neuronal development.

Severe hearing impairment affects approximately 5% of the global population, with a prevalence projected to increase over the coming decades. Cochlear implant devices pose a neuroprosthetic treatment option to allow sound perception and speech comprehension. However, users are limited in the spectrum of auditory information they can regain because electrical stimulation of the auditory nerve generates a broad spread of current and limits the transmission of sound frequency information. Recently, optogenetic stimulation of the cochlear nerve has emerged as a promising alternative for hearing restoration. Because light can be precisely confined in space, optogenetic stimulation of the cochlea permits to activate auditory neurons within smaller tonotopic regions, thereby improving the encoding of sound frequencies compared to electrical stimulation. However, this approach is limited in terms of dynamic range and ability to follow rapidly varying inputs, thus preventing faithful transmission of auditory information. Here, we developed an alternative approach targeting directly sensory inner hair cells with optogenetics. We demonstrate that this approach decreases the amount of light energy necessary to evoke auditory responses. Direct stimulation of hair cells increases the dynamic range of intensities encoded by neurons in subcortical auditory areas and improves the temporal fidelity of optogenetic responses. Finally, a biophysical model of the auditory system suggests that preserving the synapses between inner hair cells and auditory neurons greatly improves the encoding performance of an optical cochlear implant. Together, our results suggest that targeting sensory inner hair cells is a promising approach for hearing restoration through an optical implant.

The relationship between neural processes supporting perception, deviance processing, and post-perceptual task demands during auditory processing is not well understood. We used multitone masking and a no-report inattentional deafness paradigm to dissociate neural correlates of auditory perceptual awareness, deviance processing, and task demands. Evoked responses to physically identical target-tone pairs were recorded across three phases differing only in task instructions. In Phase A, human participants remained nave to (and thus unaware of) the target tones. In Phase B, participants were informed about (and thus aware of) the target tones. In Phase C, participants remained aware of the target tones and judged the duration of the silent gap between them, rendering them task-relevant. When participants were aware of them, target tones elicited an auditory awareness negativity and an increased positivity in the P3 window), with larger responses when target tones were additionally task-relevant. Furthermore, though largest in Phase C, deviant stimuli elicited a mismatch negativity across all task conditions, while a significant P3 to deviants was only observed in Phase C. Thus, early and late responses can be independently modulated by awareness, deviance, and task-relevance, indicating that they do not necessarily rely on shared neural mechanisms despite overlapping spatiotemporal profiles.

Objectives: Intraoperative ultrasound (IOUS) is an increasingly valuable real-time imaging modality in neurosurgery, enabling visualization of brain parenchyma, tumor margins, ventricular anatomy, and vascular structures during cranial procedures. Despite its clinical relevance, the development of artificial intelligence (AI)-assisted interpretation tools for neurosurgical IOUS has been limited by the scarcity of large, annotated datasets. Manual pixel-level annotation of ultrasound video frames is labor-intensive, requires specialized neuroanatomical expertise, and scales poorly. To address this bottleneck, we developed a proof-of-concept interactive semi-automated annotation pipeline designed to explore the feasibility of scalable, expert-guided labeling for intraoperative neurosurgical IOUS. Methods: We implemented the system as a napari-based graphical interface coupled with a scikit-learn Random Forest (RF) pixel classifier. Real intraoperative neurosurgical ultrasound videos from five craniotomy cases were used as training material. A neurosurgical expert annotated a minimal set of representative frames using brush-based labeling to define anatomical classes of interest. For each labeled pixel, a feature vector was computed comprising raw intensity, multi-scale Gaussian filtering ({sigma} = 1, 2, 3), Laplacian of Gaussian, and Sobel edge magnitude. The RF classifier was trained on accumulated annotations using class-balanced weighting and out-of-bag (OOB) validation, then applied across full video sequences. An incremental accumulator module enabled multi-case training. Segmentation outputs were exported as TIFF overlays for expert quality review. Results: Across five intraoperative cases, sparse expert annotation of a small number of representative frames per case was sufficient to train case-specific Random Forest classifiers that propagated labels across the full video sequences. Out-of-bag estimation served as an internal coherence check during training, and the classifier additionally produced per-class probability maps that exposed regions of uncertainty at acoustic boundaries. On expert qualitative review, the auto-segmented frames were anatomically coherent, with the classifier reliably distinguishing anechoic fluid compartments from echogenic tissue interfaces; residual misclassification was concentrated in low-contrast boundary regions. Conclusions: This proof-of-concept study demonstrates that semi-automated, expert-guided annotation of intraoperative neurosurgical ultrasound is technically feasible using classical machine learning. By combining neurosurgical domain expertise with an interactive, incremental annotation workflow applied to real intraoperative acquisitions, this framework represents a foundational step toward scalable generation of labeled datasets for neurosurgical IOUS. Future directions include formal multi-rater validation, expanded multi-class anatomical labeling, and eventual migration to deep learning architectures as annotated datasets grow.

Semi-occluded vocal tract (SOVT) exercises are widely used in voice training and therapy, but their immediate electroglottographic (EGG) effects remain incompletely characterized. In this pilot methodological study, six female community singers completed a no-straw baseline recording and then 1-min straw-phonation exercises with four straws (Household metal, Metal VoiceStraw, plastic, and paper), each followed by a no-straw EGG recording. Thirty 1s recordings were analyzed with a standardized pipeline including contact quotient (CQ), waveform skewness, contact-phase rise/fall timing, temporal skewness (s_t), a normalized derivative asymmetry index (NDAI), average-cycle morphology, and EGG spectral descriptors. Relative to baseline, group-mean CQ was higher after all four straws (by 0.027-0.058), waveform skewness and NDAI were lower, and the EGG spectral centroid was lower (by 9.6-15.3%). Contact-phase timing asymmetry did not change consistently: s_t exceeded baseline after three straws and fell below it after one, and the rise/fall ratio decreased in three to five of six participants depending on the straw. Four participants ranked the Metal VoiceStraw first and two ranked paper first. Because every straw condition followed the baseline, warm-up and order effects cannot be separated from straw effects. These hypothesis-generating results identify CQ, waveform skewness, and EGG spectral centroid as candidate endpoints for a larger controlled study

Electrocutaneous stimulation provides a means to warn workers of potential hazards. Our previous parameter studies were conducted at rest or under controlled external influences such as vibration, temperature, and humidity, whereas actual work tasks have not yet been addressed. As a step towards greater practical applicability, we conducted two studies in which a circumferential electrocutaneous warning signal was applied to the upper right arm while participants performed a reading task, screw-driving, and polishing. In study 1 (n = 32), the pulse interval was adjusted individually to evoke a vibrating sensation, and the intolerance threshold was determined. In study 2 (n = 29), a fixed pulse interval of 36 ms was applied to all participants, the warning threshold was determined in addition to the intolerance threshold, and muscle twitches were documented both by participant report and by an independent observer. Study 1 demonstrated that electrocutaneous warning during work tasks is feasible, with a median intolerance threshold higher during polishing (16.5 mA) than during reading or screw-driving (14 mA each). In study 2, the fixed parameter setting elicited the intended pulsating or vibrating sensation at rest in 89 % of the participants in both presentations. The median warning threshold was 8 mA and did not differ between the three work tasks, whereas the intolerance threshold was lower during reading (18 mA) than during screw-driving and polishing (20 mA each). Muscle twitches were largely absent at the warning threshold and became frequent towards the intolerance threshold, with a ventral dominance of their location in both studies. An individual parametrization is therefore not required for the majority of users when a binary warning is to be conveyed, and operating the system slightly above the warning threshold provides a usable amplitude range while minimizing muscle twitches. Future work will focus on electrode optimization and on the objective measurement of motor responses.

We investigated how auditory and visual presentation of small numerical magnitudes and non- numerical magnitudes are passively processed at the neural level. Earlier research suggests automatic processing of quantities occurs rapidly in the brain. However, there are no studies on passive, pre-attentive change detection of magnitudes utilizing mismatch negativity (MMN) across sensory modalities in same participants, important to understand amodal processing of magnitudes. We recorded EEG in passive auditory and visual multi-feature oddball and control paradigms from the same adult individuals (N=104/105, respectively). In the auditory paradigm, the standard stimulus was a 2-part sound, while the deviant stimuli varied in frequency, intensity, gap length, and number of sounds (1-part and 3-part stimuli). In the visual paradigm, the standard stimulus was a dot array containing two medium-sized dots, while the deviant stimuli varied in numerosity (1 or 3 dots) and dot size (small or large). The results for the auditory paradigm showed significant MMN across all features, including comparisons with deviant-alone control stimuli, except for the 2-part vs. 1-part contrast. The results for the visual paradigm suggested differences in processing across all features apart from large and medium-size stimuli. These results replicate earlier MMN findings that the brain distinguishes pre-attentively changes in sound frequency, amplitude and gap. Auditorily presented small numerical magnitudes also showed pre-attentive processing but less robustly to the contrast 2 vs. 1. Visual pre-attentive processing of small numerical magnitudes was also observed. Together these findings could be interpreted to support the existence of abstract, pre- attentive processing of numerical magnitudes. Highlights* Auditory and visual processing of numerical and non-numerical magnitudes was examined with EEG * Auditory non-numerical magnitudes and medium vs. small dots replicated earlier MMN studies * aMMN and vMMN showed pre-attentive processing of changes in small numerosities 2 vs. 3 and 2 vs. 1 * 2 vs. 1 tone processing was less robust than 2 vs. 3 or the processing of the visual contrasts * The brain processes changes in small non-symbolic magnitudes pre-attentively

Introduction: Thyroid diseases are major health problems and among the most common endocrine disorders worldwide, including in Ethiopia. They are characterized by alterations in hormone secretion, enlargement of the thyroid gland, or both. Fine needle aspiration cytology is an important initial screening tool, and histopathologic examination is essential for the definitive diagnosis of thyroid disease. This study aimed to compare the diagnostic accuracy of fine needle aspiration cytology with histopathology in identifying thyroid diseases. Methods: A cross-sectional study was conducted at three health facilities in Hawassa City, Ethiopia, involving 304 patients who underwent both thyroid fine needle aspiration cytology and histopathologic examination of the same site between 30th October 2024 and 29th October 2025. FNAC results were classified using the Bethesda system, with histopathology as the gold standard. Data were entered into Kobo Toolbox, exported to SPSS version 27, and analyzed using cross-tabulation and chi-square ({chi}{superscript 2}) tests to determine diagnostic accuracy. Result: 304 patient records were included in the study. The fine needle aspiration cytology was determinate/diagnostic in 81.6% of cases. The study revealed the sensitivity and specificity of fine needle aspiration cytology to be 88.2% (CI 77.6-95.1%) and 94.4% (CI 90.6-97.1%), respectively. The false negative and false positive rates in this study were 2.4% and 4.4%, respectively. The positive predictive value was 80.3% (CI 68.7-89.3%), and the negative predictive value was 96.8% (CI 93.8-98.7%). The accuracy of fine needle aspiration cytology in differentiating benign from malignant thyroid lesions was 93.1%. Conclusion: FNAC demonstrated strong agreement with histopathology and remains a reliable, cost-effective first-line diagnostic tool for thyroid disease, particularly in resource-limited settings. Strengthening sample handling, ultrasound guidance, and adherence to Bethesda criteria may further improve diagnostic precision