Ear & Hearing

The human auditory system decomposes complex sounds into distinct components via a collection of processing steps. Knowing whether Spiral Ganglion Cells (SGCs) play an active role in the decoding of complex sounds can facilitate the development of Cochlear Implant (Cl) coding strategies and clinical assessment tools. Early animal studies reported SGCs being similar across different characteristic frequencies (CFs). In this study, human electrically evoked compound action potentials (eCAPs) were analysed to probe the relationship between the reciprocal of CF and the duration of the eCAP. A significant relationship could indicate that SGCs may not simply be passive cables. eCAP datasets from 6 published studies (175 Cl users, 1243 recordings) were analysed and their peaks were automatically labelled. The nlp2 latency was derived for each recording as a proxy of the action potential duration. The CF of each recording was estimated by mapping the average insertion angle of the electrode to the human SGC map. A weak but statistically significant relationship was observed between the n1p2 latency and the reciprocal of CF (random-effects model with random intercepts for subject, r = 0.09, p = 0.024, n= 450) supporting the hypothesis that lower CF is associated with slower repolarisation (longer n1p2 latency) in human spiral ganglion cells.

In conventional hearing-aid personalisation, clinicians cannot hear what their patients hear, and patients cannot often reliably detect or describe what they hear. Self-adjustment avoids this issue but requires user controls that adjust hearing-aid signal processing parameters to be effective, efficient and easy. In this study, we explored (a) the roles of interface complexity and stimulus type in the self-adjustment of hearing-aid gain, and (b) how well individuals can adjust one sound to match another to assess the same interfaces and stimuli. Adult hearing-aid users with mild to moderate symmetrical sensorineural hearing loss repeatedly adjusted the gain (a) to their preference from individual prescription (n = 41) and (b) to match their previous preferences from a random starting point (n = 32) using three interfaces representing different bass/mid/treble configurations and three stimuli (music, speech and speech-in-noise). The large interindividual variability in self-adjusted gains clustered into three patterns of deviation from initial prescription: increased relative bass, overall gain reduction, and close to initial prescription. There were no substantial effects of interface nor stimulus on self-adjustment reliability (median {sigma} = 2.8 dB), whereas absolute sound-matching error increased with increasing interface complexity and centre frequency. Neither individual matching accuracy nor questionnaire responses predicted either self-adjusted gains or reliability. Overall, these results show that many - but not all - hearing-aid users can adjust gains with reasonable reliability, and while it can be difficult to predict the behaviour from the individual, the individual applies a similar self-adjustment behaviour across different interfaces and stimuli.

PurposeThis research sought to develop a low-cognitive-load speech-in-noise test based on consonant confusions with the potential for assessing hearing-aid benefit. MethodsVowel-consonant-vowel (VCV) stimuli with added speech-shaped noise were presented as a closed-set consonant identification task. Initially, consonant-confusion matrices were used to select, from a larger set of consonants and vowel contexts, a set of ten consonants and associated signal-to-noise ratios (SNR) that were sensitive to hearing loss. The sensitivity of the qVCV test to hearing loss was validated by comparing predicted pure-tone average (PTA) hearing thresholds with their audiometric PTA. Clinical viability of the qVCV test was assessed by comparisons to the QuickSIN test. Hearing-aid benefit was assessed by comparing test scores in unaided and aided conditions. ResultsThe consonants most sensitive to hearing loss were /b d g t k v z s [esh] n/ in the vowel context /[a]/. A cross-validated prediction of PTA had a mean-absolute error of 5.7 dB. The repeatability of qVCV at 50 trials was equivalent to the QuickSIN average of two lists. Hearing-aid benefit was quantified as a decibel reduction in hearing loss. ConclusionsqVCV and QuickSIN performed similarly when test times are equated. The advantages of qVCV include lower cognitive demand, fewer learning effects, and automated scoring. PTA predicted by qVCV which greatly exceeds audiometric PTA may indicate either cognitive deficits or cochlear neural degeneration. The qVCV quantification of hearing-aid benefit may have clinical value.

Cochlear implants (CIs) restore hearing by stimulating auditory neurons to encode amplitude envelopes across frequency bands, providing essential cues for speech recognition. This study investigated how stimulation pulse rate constrains temporal envelope processing and speech cue perception in ten post-lingually deaf CI users by evaluating amplitude modulation (AM) detection thresholds and consonant identification performance across pulse rates. The effects of pulse rate on temporal processing and speech perception were examined using both standard clinical multi-channel strategies and single-channel strategies designed to isolate within-channel envelope representations. Results revealed a significant decline in AM detection and consonant recognition performance at the lowest tested pulse rate of 125 pulses per second (pps), consistent with perceptual constraints on temporal processing at low carrier rates, rather than inadequate envelope sampling. At the highest pulse rate of 4000pps, a non-significant reduction in AM detection was observed which may be consistent with previously reported reductions in amplitude discrimination at high pulse rates. Consonant recognition performance remained stable across clinically relevant pulse rates (250-2000pps), though listener-specific pulse rate effects were observed. Notably, significant correlations were found between single-channel and multi-channel performance in AM detection and consonant recognition tasks. These findings support an important contribution of within-electrode temporal envelope processing to multi-channel speech perception and highlight the clinical relevance of individual variability in pulse rate effects.

ObjectivesOutcomes following cochlear implantation vary substantially across adult recipients, and the cognitive and perceptual factors contributing to this variability are not fully understood. This poses a challenge for developing strategies to improve cochlear implant outcomes, as such approaches require a clearer understanding of the mechanisms underlying individual listening difficulties. In this study, we investigated auditory cognitive measures in cochlear implant (CI) users to further elucidate the origins of this variability. DesignThirty-seven adult cochlear implant users completed measures of auditory cognition, comprising auditory working memory (AWM) and sound segregation ability, measured using an auditory figure-ground task (AFG), as well as measures of peripheral temporal and spectral processing, comprising the temporal modulation detection threshold (TMDT) and spectral ripple discrimination threshold (SRDT). Speech perception outcomes were assessed using word-in-noise (WIN) and sentence-in-noise (SIN) tasks. Separate multiple linear regression models evaluated the unique contribution of the auditory cognition measures to WIN and SIN performance, after accounting for the peripheral measures. ResultsBoth regression models explained a substantial proportion of variance in speech-in-noise outcomes (WIN: adjusted R{superscript 2} = 0.55; SIN: adjusted R{superscript 2}=0.57, both p < 0.001). For WIN performance, AFG and AWM were significant predictors. A similar pattern was found for SIN performance, where lower AWM ability and poorer AFG segregation were linked to poorer sentence listening in noise. No significant effects of spectral ripple discrimination or temporal modulation detection were observed in either model, even though both were significantly correlated with WIN performance. ConclusionsThese findings indicate that auditory working memory and sound segregation ability are robust predictors of speech-in-noise outcomes in adult cochlear implant users, across both word- and sentence-level measures. Together, the results may help explain why speech-in-noise outcomes remain highly variable among CI users, even when basic sensory encoding abilities are taken into account. Incorporating measures of auditory working memory and fundamental sound segregation may therefore improve outcome prediction and help in developing more individualised rehabilitation strategies.

Acoustic cues such as pitch and spatial location allow listeners to attend to a target speaker and ignore competing talkers, aiding speech recognition in background noise. Diminished ability to utilize acoustic cues for speech stream segregation may thus contribute to older adults' challenges hearing in noise. Adults aged 18-74 completed a speech-in-speech identification task with three conditions containing 1) only pitch cues (fundamental frequency), 2) only spatial cues (interaural time differences; ITDs), and 3) both pitch and spatial cues for segregating a target talker from competing talkers. Hearing thresholds at standard and extended high frequencies (EHFs), auditory brainstem responses (ABRs), and digit span scores were acquired to examine the influence of sensory and cognitive factors on use of each acoustic cue for speech-in-speech recognition. Significant differences were observed between cue condition scores indicating that use of the available cue(s) drove performance. ABR metrics were not a significant predictor but digit span scores significantly predicted scores on all three cue conditions. Working memory abilities therefore set a baseline for participants' speech-in-speech recognition regardless of the acoustic content. Hearing thresholds at standard frequencies significantly predicted scores on the Pitch condition. EHF hearing thresholds better predicted Spatial and Both Cue condition performance, suggesting that EHF thresholds represent auditory processing important for coding ITDs. Age group analysis revealed that older adults (aged 40+) performed significantly more poorly on all cue conditions of the speech-in-speech recognition task relative to younger adults. Age-related changes in auditory sensory processing may therefore impair older adults' speech-in-noise perception by reducing their ability to use acoustic cues for segregating target and competing speech.

ObjectivesObjective and ecologically valid measures of speech processing can complement conventional audiologic assessments. Phoneme-related potentials (PRPs), derived by averaging listeners electroencephalography (EEG) responses time-locked to phonemes in continuous speech, have emerged as a promising approach for capturing cortical processing of speech in naturalistic listening conditions. Importantly, PRPs reveal speech perception challenges even when conventional audiograms are clinically normal, positioning them as a promising neural marker for suprathreshold listening difficulties that standard audiometry often misses. As a critical step toward clinical translation, this study examined the extent to which PRP-derived measures remain stable across real-world contexts relevant to clinical implementation, including monaural versus binaural presentation, stimulus intensity level, and repeated testing sessions. The study also assessed cortical tracking of lower-level speech acoustics to determine whether the PRP findings could be attributed to acoustic processing. DesignEEG was recorded from 18 young adults with normal hearing as they listened to audiobook speech presented monaurally or binaurally at 60 or 75 dB across two sessions separated by approximately one week. Neural differentiation of phoneme manner-of-articulation classes (vowels, nasals/approximants, fricatives, and stops) in PRPs was quantified using two measures: an F-statistic reflecting between-manner relative to within-manner variability, and classification accuracy from a machine-learning model trained to predict manner class from PRPs. Temporal response function modeling assessed neural tracking of continuous acoustic envelope and onset features of the audiobook speech. ResultsNeither PRP-derived measure of manner differentiation showed significant effects of session, presentation modality, intensity level, or their interactions. Intraclass correlation analyses further indicated moderate-to-good reliability across all three factors. In contrast, neural tracking of the acoustic envelope and acoustic onsets was stronger under binaural than monaural presentation, with binaural presentation eliciting more pronounced cortical responses to the envelope. ConclusionsPRP-derived measures remained relatively stable across modest procedural variations that are common in clinical testing contexts, positioning PRPs as a potent objective index of naturalistic speech processing. This stability may reflect cortical processing of abstract, linguistically relevant speech categories and suggest that PRPs provide complementary information beyond audiologic assessments of peripheral auditory functions and EEG measures that primarily capture lower-level acoustic processing.

Modern cochlear implants (CIs) use pulsatile stimulation to restore hearing for individuals with severe hearing loss. CIs provide robust speech recognition in quiet but poorly represent temporal fine structure (TFS), needed for challenging listening situations. Analog stimulation preserves the acoustic waveform and may better encode TFS, yet it has not been evaluated combined with modern current-focusing strategies. We compared neural responses in the inferior colliculus (IC) evoked by CI stimuli consisting of 100 pulses/s biphasic pulse trains and 100 cycles/s sinusoidal analog stimulation with monopolar, bipolar, and tripolar electrode configurations in urethane-anesthetized guinea pigs. Following cochlear implantation, multiunit activity was recorded from the tonotopic axis of the central nucleus of the IC using 16-channel silicon probes. Detection thresholds, spread of excitation, vector strength, sustained response percentage, and temporal response properties were quantified. Analog stimulation consistently evoked significantly lower activation thresholds than pulsatile stimulation while maintaining comparable or sometimes narrower spatial selectivity across stimulation modes. In contrast, analog stimulation generated lower vector strength, larger tonic response components, and a pronounced level-dependent polarity effect. At low stimulus levels, responses were dominated by the cathodic phase of the sinusoidal waveform, whereas increasing stimulus level responses were elicited by both phases, producing synchronization at twice the stimulus frequency. These findings demonstrate that stimulation waveform strongly influences temporal coding while having relatively little effect on the spatial distribution of neural activation. These results provide a physiological basis for reexamining analog stimulation as an alternative strategy for cochlear implant sound coding.

Auditory brainstem responses (ABRs) are a core part of objective functional evaluations of hearing sensitivity and subcortical auditory transmission. Manual assessments of ABR waveforms are still a primary means by which thresholds and peak amplitudes and latencies are measured, which is time-consuming and prone to user variability. Automated methods have offered promising alternatives for ABR classification, but they have sometimes been limited in accuracy or robustness. Here, we developed and tested a supervised convolutional neural network (CNN) based ABR peak classifier that works across sound levels and sound frequencies that can be run quickly on a personal computer using single or dual-channel ABR inputs. For ABR peaks I, III, IV, and V, the classifier achieved over 95% accuracy. High accuracy was maintained even after noise-exposure causing temporary or permanent threshold shifts, and over 90% of peaks were within 0.041 ms (1 sample) of the manually identified peak. Only a few hundred samples were needed to train the network, making it widely amenable to smaller data studies or where the number of subjects or sessions may be low.

The middle ear muscle reflex (MEMR) and medial olivocochlear reflex (MOCR) are increasingly studied for their role in suprathreshold auditory processing. However, recording these reflexes in humans is potentially complicated by age-related (sub)clinical hearing loss and co-activation. This study investigates (1) the influence of age-related (sub)clinical hearing loss, (2) methodological differences between conventional and wideband MEMR techniques, and (3) how MEMR activation contaminates MOCR recordings. Three test groups were included: young normal-hearing adults, middle-aged normal-hearing adults, and middle-aged adults with audiometric hearing loss. Cochlear status and neural encoding was assessed using distortion-product otoacoustic emissions (DPOAEs) and envelope following responses (EFRs). MEMR recordings were compared using conventional tonal stimuli and wideband stimuli. MOCR was recorded at elicitor levels of 60 and 75 dB to evaluate MEMR co-activation. MEMR was related to age, suggesting sensitivity to subclinical cochlear damage. Wideband stimuli were beneficial as elicitor (noise vs. tone), while changing the probe stimuli added no significant benefit (click vs. tone). MOCR strength did not correlate with age-related subclinical hearing, suggesting that MOCR measurements may reflect efferent function relatively independently of afferent sensorineural status in audiometric normal hearing subjects. However, reliable recordings were challenging in participants with audiometric hearing loss due to poor OAE baselines. MEMR co-activation was detectable in the click response and could alter MOCR-induced suppression. These findings suggest that, in cases of normal hearing thresholds, MEMR amplitude may be a marker of subclinical cochlear damage and MOCR measurements may more specifically reflect efferent function. Clinical measurements can be improved using broadband stimuli, accounting for outer-hair-cell damage, and defining criteria for reflex co-activation.

Pure tone audiometry (PTA) remains the clinical standard for evaluating hearing ability, yet individuals with similar audiometric profiles often exhibit substantial variability in their capacity to understand speech in everyday listening environments. Growing evidence suggests this variance is related to contributions from cognitive ability and auditory processing that standard threshold measures do not capture. To investigate how PTA, cognitive factors, and demographics such as age jointly predict real-world speech perception, 116 veteran adults 20-70 years old spanning a range of normal to moderate sensorineural hearing losses completed a spatial auditory attention task. Target color words were embedded within naturalistic short-story narratives presented under two conditions: a mono-talker speech-in-quiet (SIQ) condition and a dual-talker speech-in-noise (SIN) condition with a spatially separated competing narrative. Behavioral performance was quantified via color word hit accuracy, reaction time, and comprehension question accuracy. Participants also completed pure tone audiometry, the Montreal Cognitive Assessment (MoCA), and the Speech, Spatial and Qualities of Hearing Scale (SSQ12). Mixed-effects regression models were used to evaluate the contributions of PTA, age, cognitive ability, and self-reported hearing difficulty (SSQ12) to task performance across conditions. Results demonstrate a complex interplay between age, PTA, MoCA, and/or listening condition (SIQ vs. SIN) in predicting identification accuracy, reaction time, and comprehension. Age and condition significantly predicted hit accuracy and reaction time, with older participants showing improved accuracy in quiet but declining accuracy and slower responses in noise. PTA did not emerge as a significant main effect predictor but interacted with cognitive ability and condition to modulate performance, in some cases exhibiting a paradoxical inverse relationship with accuracy dependent on MoCA score. MoCA scores significantly predicted comprehension across conditions, and SIN hit accuracy was positively correlated with SSQ12 scores, validating the task against participants real-world listening experiences. These findings highlight the importance of incorporating cognitive screening and ecologically valid speech perception tasks into audiological assessment to better identify individuals at risk for functional hearing impairment in complex listening environments.

Understanding speech in noisy environments relies strongly on binaural cues such as interaural time differences (ITDs) and interaural level differences (ILDs), which support spatial hearing and the segregation of competing sound sources. When these cues are degraded, listeners experience substantial difficulty in complex acoustic environments. Behavioural measures of binaural benefit, such as binaural masking level differences (BMLDs), binaural intelligibility level differences (BILDs), and spatial release from masking (SRM), are well established in normal-hearing (NH) listeners, but they require an active behavioural response. Neural speech tracking using electroencephalography (EEG) has emerged as a promising approach for quantifying neural processing of continuous speech, yet its sensitivity to spatial hearing cues remains insufficiently characterised. In this study, we investigated the neural correlates of spatial release from masking in NH listeners using EEG-based neural speech tracking. Nineteen participants listened to continuous Dutch speech stories presented with masking noise under two spatial configurations, collocated (S0N0) and spatially separated (S0N90), across multiple signal-to-noise ratios (SNRs). Neural tracking of the speech envelope was quantified using both envelope reconstruction and temporal response function (TRF) analyses. Spatial separation enhanced neural tracking of the target speech envelope, particularly at challenging SNRs where behavioural SRM was also observed. TRF analysis further revealed condition-dependent morphologies, including increased amplitudes and decreased latencies of late cortical components consistent with spatial unmasking effects. These neural differences were most pronounced at low SNRs, where spatial cues provide the greatest perceptual benefit. Together, these findings demonstrate that neural speech tracking captures cortical signatures of spatial unmasking and closely reflects behavioural improvements in speech understanding. Establishing these relationships in NH listeners supports the development of objective neural measures for evaluating binaural benefit in difficult-to-test populations.

Selective auditory attention decoding (AAD) enables tracking which of multiple concurrent speakers a listener attends to and is a key building block for neuro-steered hearing devices. While AAD integrated in a closed-loop system with real-time neurofeedback (NFB) is hypothesized to improve decoding through neural adaptation and error-correction behaviour, the short-term behavioral and algorithmic impact of such a bilateral human-machine interaction remains poorly understood. Here we evaluated the effects of NFB on AAD accuracy and user experience in a single-session AAD paradigm with online NFB involving nineteen participants. They performed a selective listening task with enforced attention switches across four conditions: open-loop (OL), closed-loop with auditory gain feedback (CLA), closed-loop with visual feedback (CLV), and a condition with pseudo-auditory gain control (psCLA) decoupled from the participants individual neural activity. AAD was performed online using both subject-specific and subject-independent linear decoders on 5 s sliding windows, followed by Hidden Markov Model post-processing. Online analysis showed comparable decoding performance across all conditions. However, offline posthoc analysis using subject-independent decoders revealed that AAD accuracy in the CLA condition was significantly lower than in the OL baseline. Subjectively, participants reported that CLA was significantly more distracting and required higher switching effort. Crucially, a causal analysis of the psCLA condition found no robust evidence that higher audio gains inherently improve decoding accuracy. Our results demonstrate that within a single-session paradigm with rapidly varying feedback cues, auditory neurofeedback may degrade AAD performance by increasing cognitive load and distraction. These findings suggest that suboptimal feedback can impede rather than facilitate learning. We conclude that more accurate and stable decoders and longitudinal, multi-session training protocols are likely essential prerequisites for achieving beneficial neurofeedback effects in closed-loop auditory attention systems.

PurposeMild therapeutic hypothermia (MTH) preserves cochlear function in animal models and is now entering early-phase human trials for hearing preservation. However, the extent to which the human cochlea can actually be cooled, and the mechanisms underlying MTH, remain unclear, in part because blood perfusion is expected to oppose localized cooling. In this study we evaluated the impact of blood flow on human cochlear temperature exposed to the MTH device using a combined experimental and computational approach. MethodsTemperature measurements were obtained from a human cadaver skull exposed to a commercial MTH device. These data were used to validate a three-dimensional bioheat transfer model incorporating realistic skull anatomy. The validated model was subsequently extended to include physiological blood perfusion in the internal carotid artery; a major heat source located near the cochlea. Finally, the in silico model was further expanded to incorporate the surrounding skin and brain tissues. ResultsIncorporating blood flow in internal carotid artery substantially altered predicted cochlear temperature distributions, highlighting the importance of localized vascular heat transport in the human cochlea during MTH. Although cochlear cooling was attenuated in the presence of perfusion, the therapeutic effects of MTH may not depend solely on the magnitude of local intracochlear temperature reduction. Additional mechanisms, such as reduced facial surface temperature, may also contribute to its efficacy. ConclusionThe validated in silico model provides a physiologically realistic framework for evaluating human cochlear thermal responses, investigating MTH mechanisms, and optimizing temperature-based strategies for hearing preservation.

Understanding speech in noisy environments (SPIN) is an important everyday ability, and engaging in musical activities has been proposed as a factor that may support this ability. However, the cognitive mechanisms underlying a potential musical advantage in SPIN perception remain unclear. Here we investigated whether musical sophistication is associated with better SPIN perception in a large population-based sample, and whether this relationship is mediated by auditory working memory (AWM), verbal working memory (VWM), or non-verbal intelligence. We recruited 203 participants and measured SPIN perception at both word and sentence levels. Musical sophistication was assessed using the Goldsmiths Musical Sophistication Index (Gold-MSI). AWM was measured using delayed matching of tone frequency or the modulation rate of amplitude modulated white noise, VWM was based on backward digit span task, and non-verbal intelligence used matrix reasoning. Mediation analyses revealed that AWM fully mediated the relationship between musical sophistication and SPIN perception, whereas VWM showed no mediation effect. Non-verbal intelligence showed a partial mediating effect. Additional control analyses using structural equation modelling revealed that the indirect effect through AWM remained significant after accounting for age, hearing thresholds, and non-verbal intelligence. Together, these findings suggest that individuals with greater musical sophistication demonstrate better daily life listening abilities, and that superior auditory working memory may be the key cognitive mechanism underlying this advantage.

Aging and noise over-exposure lead to complex mixtures of cochlear degradation that impair the structure and function of outer hair cells, inner hair cells (IHCs), and the cochlear nerve. However, IHC damage and cochlear synaptopathy (CS) remain pathologies "hidden" from the audiogram. This study aimed to identify and differentiate the physiological signatures of these two distinct pathologies using promising non-invasive assays: Envelope Following Responses (EFRs), Auditory Brainstem Response (ABRs), Wideband middle-ear reflexes (WB-MEMRs), and Distortion Product Otoacoustic Emissions (DPOAEs). We utilized chinchilla models of carboplatin-induced (CA) IHC damage (N = 4) and temporary threshold shift (TTS) noise-induced CS (N = 4) to compare the physiological signatures of each pathology. While both groups showed unchanged ABR thresholds two weeks after exposure, EFRs, ABR Wave V/I ratios, and MEMRs showed distinct effects of exposure. Despite non-elevated ABR-derived audiometric thresholds after exposure, both CA and TTS exposure resulted in severe in EFR "peakiness", particularly for sharp, short-duty-cycle stimuli and significant elevations in ABR Wave V/I ratios. However, these findings were less-pronounced in the TTS-exposed animals. WB-MEMR amplitudes were decreased with elevated thresholds in both groups; this effect was more pronounced in the TTS group. Opposite trends in DPOAE amplitudes indicated that while both IHC damage and CS result in similar suprathreshold temporal coding deficits, effects on outer-hair-cell integrity and auditory efferent physiology may differ between the two pathologies. Future work and novel diagnostics should aim to distinguish these specific cochlear pathologies in clinical populations, or at the very least consider their overlap. HighlightsO_LIA multi-metric diagnostic approach was used with chinchilla models of inner-hair-cell (IHC) damage and cochlear synaptopathy (CS). C_LIO_LIIHC damage and synaptopathy both cause suprathreshold deficits "hidden" from the audiogram. C_LIO_LIIHC damage results in more severe temporal envelope coding degradation than does synaptopathy. C_LIO_LIA combination of EFR "peakiness", ABR Wave V/I ratio, and Wideband Middle Ear Muscle Reflex (WB-MEMR) appear to be useful measures for profiling IHC damage and CS. C_LI

Objective: To evaluate the efficacy, engagement, and usability of Tune Out, an unguided, self-paced online tinnitus management program, for reducing tinnitus severity in adults with tinnitus. Design: A two-arm, parallel-group randomised controlled trial was conducted with Australian adults reporting diagnosed or self-reported tinnitus. Participants were randomised to immediate access to Tune Out or a waitlist control group. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. The primary outcome was tinnitus severity measured using the Tinnitus Functional Index (TFI). Secondary outcomes included tinnitus handicap, psychological symptoms, program engagement, self-efficacy, and usability. Results: Eighty-eight participants were randomised: 43 to the intervention group and 45 to the waitlist control group. The primary outcome analysis included 63 participants at 12 weeks. A significant Group x Time interaction was observed for TFI total score, indicating greater reductions in tinnitus severity over time in the intervention group compared with waitlist control, F(2, 102.57) = 5.95, p = .004, partial 2= .104. Significant effects were also observed for tinnitus handicap, F(2, 106.76) = 4.12, p = .019, partial 2 = .072. Effects on psychological symptoms were less consistent, although anxiety showed a significant Group x Time interaction, F(2, 116.85) = 3.63, p = .030, partial 2 = .059. At 12 weeks, 23.1% of intervention participants achieved a clinically meaningful reduction in tinnitus severity compared with 5.4% of controls. Program use was highly variable, with a median use of 1.10 hours, and 25.6% of intervention participants recording no use. Usability ratings were favourable among respondents, with a mean System Usability Scale score of 73.13. Conclusions: Tune Out demonstrated preliminary efficacy for reducing tinnitus severity and tinnitus handicap compared with waitlist control. Effects on broader psychological symptoms were less consistent. Although usability was rated positively, low and variable engagement highlights the need for strategies to support uptake and sustained use in unguided digital tinnitus interventions.

With the emergence of electroencephalography (EEG) as a tool in the cognitive domain, new demands are being placed on the technology to keep up with functional applications, especially in the context of at-home neural monitoring. New use cases have fostered development of wearable EEG (wEEG) devices: portable, low-cost headsets used for EEG monitoring. This evolution of technology and application has not been accompanied by development in technology evaluation, often relying on function-agnostic markers to assess devices for efficacy in this new space. With current methods limited in scope, this study designed, tested and evaluated a novel functionally-focused comparative protocol for wEEG devices. Eight participants undertook a protocol for the evaluation of four established wEEG devices, assessing cognitive resolution and general usability. Compared to a well-established traditional analysis method (eyes open/eyes closed protocol), the novel design proposed here enabled the same analysis of headset resolution, while also providing additional context into user preferences and opening downstream possibilities for specific cognitive insights. Future research could enable the development of this protocol into a standardised method to ensure the performance of wEEG technology can satisfy emerging clinical needs.

This study examined the extent to which goodness of pronunciation (GoP) scores and phonological posterior probabilities capture perceptual ratings of speech severity in individuals with motor speech disorders (MSD). Speech recordings of the word catastrophe were obtained from 489 participants, including 333 neurologically typical controls and 156 individuals with MSD. GoP scores were derived using traditional acoustic features and self-supervised speech representations, including WavLM and XLS-R, across multiple modeling approaches, while phonological posterior probabilities were extracted using Phonet. Model performance was evaluated using Kendall's rank correlations, regression, and receiver operating characteristic analyses against speech-language pathologists' perceptual ratings of sound distortion and intelligibility. Both GoP and phonological posterior probabilities were significantly associated with perceptual ratings. Self-supervised speech representations substantially outperformed traditional acoustic features, with WavLM-based GoP using k-nearest neighbors achieving the strongest performance. Across correlation, regression, and classification analyses, GoP consistently outperformed phonological posterior probabilities for both sound distortion and intelligibility. Age and gender had minimal influence on model-derived measures or their relationships with perceptual ratings. These findings demonstrate the value of self-supervised GoP as an objective measure of speech impairment while highlighting the complementary role of phonological posterior probabilities in characterizing articulatory aspects of motor speech disorders.

Since young adults hear sounds up to 20 kHz, the loss of extended high-frequency hearing (EHF; above 8 kHz) is a hallmark of age-related hearing loss, often progressing from early lifetime. However, this deficit frequently goes undetected because routine clinical hearing tests and most hearing aids are currently limited mostly up to 8 kHz. EHF hearing has been linked to deficits in speech perception in noise and to self-reported hearing. However, it remains elusive how EHF hearing influences speech intelligibility. Here we recorded neuromagnetic brain responses using magnetoencephalography (MEG) within a frequency-tagging speech paradigm designed to probe hierarchical levels of attention and memory-dependent speech processing and recognition. Auditory evoked cortical magnetic field (AEF) responses were significantly reduced in both left and right brain hemispheres in individuals with impaired EHF hearing compared to those subjects with rather preserved EHF hearing. A gradual reinforcement of left-hemispheric AEF seen over age was not observed in young adults (19-29 y) with preserved EHF hearing. This was linked to stronger auditory brainstem responses (ABR), reflecting better neural synchronized auditory responses at stimulus onset. The reinforced left hemispheric dominance in young adults with impaired EHF hearing, in contrast, was linked to lower ABRs. Our findings suggest that sound energy above 8 kHz contributes through its impact on stimulus-onset synchrony to phase locking of oscillations in the auditory cortex to intelligible speech. Together, the results highlight the need to reconsider the neglect of EHF hearing in both audiological assessment and hearing aid design. SignificanceWe show here that deficits in extended high-frequency (EHF) hearing, up to now neglected in routine clinical audiometry and hearing aid technology, lead to reduced cortical evoked auditory field (AEF) response amplitudes to attended and unattended speech, even at a young age. A gradual increase in reinforced left-hemispheric AEF responses during attended speech does not occur in young people with good EHF hearing; this is linked to better synchronization of neural responses at the onset of sound. This suggests a crucial role of sounds containing energy above 8kHz in minimizing the need for cognitive resources during active listening. Collectively, our results challenge current clinical practices and underscore the need to incorporate EHF hearing into audiological assessment and hearing aid design.