Ear & Hearing

Objectives: The purpose of this pilot study was to investigate (1) if the Speech Intelligibility Index (SII) could be used to identify ears that meet cochlear implant (CI) candidacy beyond the "60/60" referral guidelines and (2) investigate the relationship between SII from patients' own hearing aids (HAs) and SII from optimally fit clinic-stock HAs such that a patient's own HAs can act as a proxy for an optimally fit HA and thus as a referral metric. Design: Prospective study of 23 participants ([&ge;] 18 years) with bilateral moderate to profound sensorineural hearing loss who were CI candidates in at least one ear. SII-Clinic (SII-C) values were recorded with probe-microphone measures using a Verifit II device (NAL-N2 targets) with speech stimuli presented at 60 dB A during patient CI evaluation in either their own HAs or clinic-stock HAs. SII values from participants' own HAs were recorded as part of a larger research protocol, thus SII-Personal (SII-P), with probe-microphone measures using a Verifit I device (NAL-RP targets) with pink noise stimuli presented at 65 dB A. Participants that did not wear HAs did not have SII-P calculated. Data was collapsed across ears. Correlation analysis between SII and best-aided consonant-nucleus-consonant (CNC) was conducted. Benchmark SII values were extrapolated using a best-fit line and CI candidacy rates reflecting various aided CNC scores that could be applied across CI centers. Nested logistic regression models were used to determine if the SII-C could improve model fit beyond the revised ear-specific 60/60 referral guideline. The relationship between SII-C and SII-P was assessed with Wilcoxon signed-rank test and Spearman correlation. Results: Correlation between SII-C and aided CNC score was r = 0.82 (p < 0.001), and the correlation between SII-P and aided CNC was r = 0.46 (p = 0.014). Extrapolated benchmarks of SII were calculated based on different CNC candidacy cutoffs, and benchmarks were able to capture at least 83% of the ears that met CNC candidacy cutoffs. SII was also found to improve model fit with word recognition score (WRS) and pure tone average (PTA) for 60% CNC candidacy cutoff ({chi}2 = 9.7; p = 0.002) and increased discrimination (AUC = 0.89 to AUC = 0.99). There was no significant difference between SII-C and SII-P using the Wilcoxon signed-rank test (p = 0.559). Conclusions: A larger study is needed that includes more ears that do not qualify for a CI; however, the results of this study demonstrate that (1) SII has the potential to be used in conjunction with the 60/60 referral guideline for CI candidacy evaluations and (2) SII can be used as a marker of audibility across different devices, including patients' own HAs, making SII an accessible metric during HA fittings and fine tunings.

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 availability of hearing aids that can connect wirelessly to smartphone technologies via Bluetooth has grown exponentially in recent years. However, there is limited evidence assessing the benefits of user-adjustability afforded by these devices. This study aimed to assess the benefits of smartphone-connected hearing aids and an accompanying application (or app) in new and existing hearing aid users. In this single-centre, prospective, observational study, 44 adult hearing aid users (14 new and 30 existing) were recruited. Participants were fitted bilaterally with smartphone-connected hearing aids that could be adjusted by the user via an app. Self-reported outcome measures were collected at fitting and after seven-weeks of using the device in everyday life. For both new and existing hearing aid users, significant improvements in social participation, hearing-related fatigue, and hearing aid benefit and satisfaction were found. For existing hearing aid users, all outcomes were significantly better for the smartphone-connected hearing aids plus app in comparison to their existing hearing aids that did not connect to a smartphone, all with moderate-to-large clinical effect sizes (d> .6). User-controllability via the app was identified as the key benefit, and most participants (68%) reported that the app met their needs 'extremely' or 'very well'. These results suggest that, when used in conjunction with an app, smartphone-connected hearing aids can improve hearing outcomes due to greater user-controllability to improve listening. Thus, smartphone-connected hearing aids have the potential to facilitate patient-centred care, empowering the individual to successfully manage their hearing loss.

Studies employing and evaluating hearing-aid self-adjustments frequently label the resulting settings as 'preferences' without questioning that label. There is a lack of inquiries into the rationale behind participants' choices or their approach to self-adjustment. We here employed a think-aloud protocol concurrent with individuals' self-adjustments to capture qualitative perspectives on these processes. Thirty-six adult hearing-aid users were asked to verbalise what they were thinking while adjusting to their preference three stimuli (music, speech or speech in noise) using three control interfaces (1 slider jointly controlling bass/treble, 2 sliders separately controlling bass and treble or 3 sliders controlling bass, mid and treble). Audio-video recordings were transcribed, annotated and analysed using inductive content coding and thematic analysis. Participants' approach and navigation of the self-adjustment process was best defined as a continuum between exploratory and anticipatory archetypes, with both types sometimes occurring at different stages within the same adjustment. The exploratory type initially assesses control functions, then selects the optimal setting from available options, and evaluates sound changes affectively in isolation or comparatively against prior settings. The anticipatory type begins by evaluating the sound, identifying issues, adjusting settings guided by past experiences, and evaluating adjustments against the identified issues. Additionally, the descriptors elicited during adjustments generally agreed with expert-based data. The resulting qualitative framework of self-adjustment helps explain both how hearing-aid users navigate the personalisation process and how self-adjustment can promote greater understanding of the options available and greater ownership in that process.

Introduction Deafness is the most common human sensory deficit. Cochlear implantation is the primary intervention for severe-to-profound deafness. Currently, over 7000 people have bilateral cochlear implants (CIs) in the United Kingdom (UK), most of whom are children. Patient feedback suggests that for children with bilateral CIs, everyday communication is challenging and tiring, with extra effort required to integrate information from two ears, especially in noise, and that current rehabilitation techniques are not engaging, or appropriate to their lifestyles. To address these issues, researchers developed the Both EARS (BEARS) training package comprised of three virtual reality games to improve sound localization and listening in noise. Objectives This protocol describes the design and methodology of a multi-center phase III randomized controlled trial (RCT) to evaluate whether use of the BEARS training package alongside usual care compared to only receiving usual care improves speech-in-noise perception, hearing experiences, vocabulary and quality of life and reduces listening effort in children and young people (aged 8 -16 years (inclusive) with bilateral CIs. Methods This RCT is currently underway in 16 clinical CI departments in National Health Service or university hospitals across the UK. The intervention involves 3 months of spatial-listening training delivered via the BEARS training package in addition to any routine rehabilitation. The control is usual care (routine rehabilitation clinical care pathway). The primary outcome is the difference between the intervention groups in speech-in-noise perception score at 3 months derived from the spatial speech in noise (SSiN-VA) test. Recruitment closes at the end of the day on 31st July 2026, and end of data collection is 31st October 2026. Data analyses will be reported by 31st March 2026. Significance This is the largest known trial of children and young people with bilateral CIs. It will generate high-quality evidence on speech-in-noise outcomes and inform training interventions to improve spatial listening. Trial registration ClinicalTrials.gov registration: NCT05808543; UKs clinical study registry (ISRCTN92454702)

Objectives: Speech outcomes with cochlear implants (CIs) vary widely across patients and remain difficult to predict from pre-operative data. This study addressed three questions with clinical relevance: (RQ1) Can AI models predict individual CI speech outcomes, and if not, why? (RQ2) Can pre-operative data be used to identify patients at risk of poor outcomes? (RQ3) Do post-operative speech scores early after implantation contain prognostic information for later speech outcomes? Design: A retrospective analysis was performed using data from a single centre contributing to the Swiss National Cochlear Implant Database (N = 771 patients; 473 adults after exclusion of single-sided deafness). For RQ1, pre-operative data and seven prediction methods, from standard linear regression to recent machine-learning models, were used to predict post-operative word recognition scores. Prediction models were assessed on held-out data and on data from patients implanted later than the cohort used for model training. For RQ2, the best-performing model under RQ1 was used to predict patients with a poor outcome after implantation (word-recognition score below 40%), and pre-operative variables were grouped by clinical type to identify sources of information for risk prediction. For RQ3, the prognostic value of early post-operative speech measurement was assessed by adding six-month post-operative word scores to the pre-operative data and a clustering analysis was performed to identify distinct trajectories post implantation. Results: Cross-validated R2 for individual CI speech score prediction was small across all algorithms (best model with full feature set: R2 = 0.22) and conformal prediction intervals spanned +/- 41 percentage points, covering nearly the whole range of possible scores. Speech score distributions of patient groups defined by audiometric, aided-field and pre-operative speech variables converged after implantation (mean distance between group distributions decreased from 21.5 to 6.0 percentage points), while distributions of groups defined by developmental and communicative variables diverged. Pre-operative speech scores were much better predicted from pre-operative variables (R2 = 0.48 based on audiometric data only). For risk prediction, the best-performing model identified poor outcome with AUC = 0.71. Self-rated articulation was the dominant pre-operative predictor. Audiometric, aided-field, and pre-operative speech data on which other prediction models have relied classified poor outcome at chance (AUC = 0.53), whereas developmental and communicative variables performed better (AUC = 0.65). Adding the six-month post-operative word score to the pre-operative data substantially raised R2 for long-term outcome from 0.03 to 0.48. Four trajectory types (Early Responders, Late Responders, Non-Responders, and Decliners) emerged from the clustering analysis but were not predictable from pre-operative data. Conclusions: The limited prediction performance for CI speech outcomes appears to be a property of the pre-operative data rather than of the prediction methods applied to them. However, pre-operative data can partially identify patients at risk of poor outcome. Importantly, speech data obtained within six months after implantation significantly improves outcome prediction at later time points. Longitudinal assessments post implantation therefore have potential for clinical intervention to improve long-term CI outcome. These findings support a two-stage framework for clinical translation: data-based risk counselling before surgery and post-operative monitoring for selective intervention after surgery.

Objective: Impaired understanding of noisy or degraded speech is a central feature of listening difficulties (LiD), but the possible causes of these symptoms are wide-ranging. Accordingly, recent research underscores the need to study these deficits using a test battery approach. Event-related potentials are useful objective metrics for studying LiD, but probing function across the speech processing hierarchy using traditional protocols is sequential and unrealistic in clinical settings. The novel chirped speech (Cheech) method combines natural speech with acoustic chirps to overcome these limitations. This study examines its utility for profiling childhood LiD. Methods: Twenty-eight children (15 typically developing, 13 with LiD), aged 8-17 years old, listened to a 17-minute Cheech story and detected a target word within the story via button press while EEG data were collected from 53 scalp sites. Results: Cheech successfully evoked responses from the auditory brainstem response through to the brain's language centers, as reflected by the N400 effect. Unlike TD children, those with LiD demonstrated N400 effects with atypical distributions that favored frontal rather than the typical parietal sites. A trend towards a delayed and reduced amplitude Wave V was also observed. Conclusions: Hierarchical examination of speech processing using Cheech primarily implicates altered language processing as a contributing factor to LiD, with the frontal topography of the N400 effect for those with LiD potentially suggesting a greater reliance on deliberate memory retrieval during the speech perception task. Significance: LiD could arise due to auditory and/or cognitive factors. The present results demonstrate the feasibility of objective, parallel measurement across this hierarchy and point to impaired language processing as a possible mechanism.

Cochlear implant (CI) candidates with residual low frequency hearing increasingly receive hearing preserving electrode arrays to enable electric acoustic stimulation (EAS). However, assessing very low frequency hearing in newborns and young children remains difficult. Previous work has shown that acoustic stimulation can mask electrically evoked auditory percepts when stimulation sites are spatially separated. Whether such masking also occurs when electric stimulation is delivered near the round window (RW), prior to cochlear insertion, remains unclear. This study investigated ipsilateral acoustic masking of electric stimulation delivered at apical, basal, and near RW sites in 12 EAS users with residual low frequency hearing implanted with short or partially inserted electrode arrays. Using a psychophysical paradigm, threshold elevations of electric pulse trains were measured during simultaneous acoustic stimulation. Electric stimulation was applied at extra cochlear RW locations and intra cochlear basal and apical electrodes, while stimulation parameters were systematically varied. Electric stimulation near the RW reliably evoked auditory percepts without side effects, though optimal stimulation parameters and masking strength varied across participants. Strong acoustic masking was consistently observed for apical stimulation, whereas weaker but measurable masking occurred for basal and RW stimulation. A cochlear lumped parameter model indicated that approximately 5% of current delivered at the RW can reach apical regions, explaining the observed masking by low frequency acoustic tones. Masking strength correlated with residual hearing for apical stimulation only. These findings indicate that acoustic masking of apical electric stimulation, which correlated with residual hearing, holds potential as a diagnostic tool for assessing low frequency hearing post operatively. The detection of masking during both RW and basal stimulation represents a promising result, indicating that these stimulation paradigms can produce quantifiable effects. Given the considerable variability observed among participants, further investigation is required to establish the extent to which masking measures reflect residual hearing or hearing loss. Nonetheless, these results provide novel insight into auditory perception and side effects associated with basal and extra cochlear electric stimulation, informing future efforts to optimize this approach for low-frequency hearing assessment.

BackgroundHearing aids and cochlear implants (CIs) are the primary interventions for sensorineural hearing loss, restoring auditory function through amplification and intracochlear electrical stimulation, respectively. For those with residual low-frequency hearing, the combined electric-acoustic stimulation (EAS) has demonstrated superior speech perception, particularly in noisy environments, compared to either modality. However, CI surgery carries inherent risks, including postoperative hearing loss, which undermines EAS benefits and limits future rehabilitation options. To overcome these limitations, we propose a non-invasive alternative: extracochlear electric and acoustic stimulation (EEAS), delivering electrical stimulation via transcutaneous electrodes without surgery. Here, we present a first systematic investigation of non-invasive extracochlear electrical stimulation using ear canal electrode montages, evaluating its feasibility, perceptual effects, and key parameters across diverse hearing statuses. MethodsWe conducted a controlled, within-subject study with 15 participants: 5 with normal hearing (NH), 5 with high-frequency hearing loss (HI), and 5 with severe-to-profound deafness (PL). We used charge-balanced sinusoidal stimuli (125-4000 Hz) applied via an ear canal electrode and four return electrode montages, including contralateral ear canal, contralateral mastoid, ipsilateral mastoid, and forehead electrodes. Participants rated auditory sensations, including loudness, sound quality, and lateralization, as well as side effects on separate 0-10 scales, with current intensity increased up to 2 mA/cm{superscript 2}. Thresholds and perceptual responses were analyzed across frequencies, electrode configurations, and hearing groups. ResultsReliable auditory percepts were elicited across all groups. NH participants reported pure-tone sensations, whereas HI and PL participants perceived broadband, noise-like sounds. Loudness decreased with increasing frequency, particularly for HI and PL, with minimal responses in the high-frequency range. The current threshold increased with stimulation frequency, whereas the threshold expressed as charge per phase remained constant, suggesting that charge per phase primarily determines neural activation, whereas current amplitude is more closely associated with the intensity of auditory and side effect perception. Contralateral montages produced significantly higher loudness ratings than ipsilateral or forehead configurations. The forehead montage was poorly tolerated, leading to early termination due to discomforting side effects. Sound lateralization was predominantly central or bilateral with contralateral setups, while ipsilateral and forehead configurations yielded ipsilateral perceptions. ConclusionsNon-invasive extracochlear electrical stimulation via ear canal electrodes is feasible and perceptually effective across a spectrum of hearing statuses. Perceptive outcomes are strongly influenced by electrode montage and residual hearing, with evidence of electrophonic excitation in NH individuals and electroneural activation in HI and PL participants. Contralateral mastoid electrode configurations offer the optimal balance of perceptual strength, tolerability, and spatial localization. These findings establish a critical foundation for the development of EEAS devices, demonstrating that non-invasive electrical stimulation can generate meaningful auditory percepts, paving the way for safe, accessible, and integrated hearing rehabilitation solutions. This work informs future EEAS developments and advances the path toward clinically viable, non-invasive cochlear stimulation.

Purpose: Conventional clinical acoustic analysis systems are confined to specialized clinical environments, which limits scalable and remote voice monitoring. This study aimed to validate LIS-N, a web-based prototype of a novel mobile application that uses the open-source Praat-Parselmouth library for acoustic feature extraction, against the Computerized Speech Lab (CSL), the clinical reference standard, to assess its potential for telehealth and longitudinal voice assessment before integration into clinical or research workflows. Method: Twenty adult volunteers without voice complaints or diagnosed dysphonia completed three voice tasks across three consecutive days at a tertiary academic voice center in quiet isolated rooms. All participants completed the full protocol across three consecutive days. Voice tasks included Rainbow Passage reading, sustained vowel /i/, and maximum phonation time /a/. Audio was captured concurrently using CSL and the LIS-N prototype, which uses Praat-Parselmouth for acoustic feature extraction. To isolate the contributions of recording hardware and analysis software, four cross-system conditions were also examined. Agreement was assessed using Pearson correlation and Bland-Altman analyses. Session-to-session trajectory correlations were computed to evaluate temporal consistency across systems. Results: Fundamental frequency and Pitch Mean demonstrated excellent agreement across all tasks and conditions (r > 0.98), with robustness to hardware and software differences. Pitch Minimum and Pitch Maximum showed strong agreement during sustained vowel tasks. Energy-based features showed moderate agreement, with variability driven primarily by microphone differences, and same-microphone conditions yielded substantially stronger energy agreement. Perturbation measures including jitter, shimmer and CPP showed consistently poor cross-platform agreement, consistent with prior literature. Conclusion: This study provides proof of concept for the viability of open-source acoustic frameworks as accessible alternatives to proprietary clinical systems, while also identifying limitations. Both systems should be interpreted separately, as each remains reliable within its own framework. The LIS-N prototype demonstrated strong agreement for frequency-based voice measures and consistent longitudinal monitoring, supporting adoption of open-source acoustic tools in telehealth and remote voice monitoring.

Children and adolescents with hearing loss frequently encounter reduced auditory access and delayed language development, factors that may influence the maturation of executive functions. This study examined developmental differences in planning, a core executive function, in 98 children and adolescents with hearing loss or normal hearing aged 7 to18 years using the Tower of London task. Compared to normal hearing peers, participants with hearing loss made more unnecessary moves and rule violations and initiated problem-solving more rapidly, suggesting reduced preplanning efficiency and increased impulsivity. These group differences were most pronounced in adolescents, who showed faster initiation and greater movement inefficiency than age-matched normal hearing participants. Within the hearing loss group, adolescents displayed higher accuracy and longer initiation times than children, reflecting developmental improvements despite persistent gaps relative to hearing peers. Language development age did not alter the main effects. Findings indicate that reduced early auditory and language access may contribute to differences in planning development, highlighting the need for targeted executive functions support in educational and clinical settings for youth with hearing loss.

Difficulties understanding speech in noise remain a common complaint even among listeners with normal hearing sensitivity, highlighting the need for objective, more effective measures of real-world listening. The goal of this study was to validate the use of a novel, chirped-speech (Cheech) stimulus - continuous, naturally-spoken speech fused with chirps designed to elicit robust auditory evoked potentials - to characterize relationships between speech recognition, listening effort, and auditory neural encoding. Twenty-five normal-hearing adults completed a sentence-recognition task using both original (unmodified) and Cheech-modified AzBio sentence lists in quiet, +3 dB, and -3 dB signal-to-noise ratio (SNR) conditions while neural responses from the brainstem through cortex were recorded simultaneously. Speech recognition remained near ceiling in quiet but declined with decreasing SNR for both original and Cheech stimuli. Compared with clean speech, Cheech-modified speech showed slightly poorer recognition performance as SNR decreased and somewhat higher perceived effort overall. Yet, Cheech was highly effective at evoking auditory responses from the brainstem (auditory brainstem response, ABR) through the cortex (including middle- and late-latency responses, MLR and LLR) even with <5 minutes listening time per condition. Neural responses showed reduced amplitudes and prolonged latencies as SNR decreased. In general, ABR latencies and wave I amplitudes were associated with speech-in-noise recognition performance, whereas cortical responses (MLR Na, Nb, and LLR P1) were associated with subjective workload. These findings show that Cheech-modified speech preserves intelligibility while yielding robust, multilevel neural recordings during sentence perception, offering a promising approach to examine hierarchical auditory processing under ecologically relevant speech-in-noise conditions.

Atypical sensory processing is common in attention-deficit/hyperactivity disorder (ADHD), yet decreased sound tolerance has received little attention, and it remains unclear whether it reflects actual auditory sensitivity or a vulnerability to attentional breakdown under acoustic load. The only prior study provided a single overall estimate, unable to separate sensory symptoms such as avoidance and distress from attentional and fatigue-related difficulties under noisy or demanding conditions. Here, we examined whether parent-reported auditory difficulties in children with ADHD are uniform or concentrated within specific symptom domains, and whether they vary with clinical presentation or medication. A total of 226 children (ages 6-12; 162 with ADHD, 64 typically developing controls) were assessed using the parent-report adaptation of the Khalfa Hyperacusis Questionnaire (Turkish version). The ADHD cohort was stratified by medication status and clinical presentation, and total, subscale, and item-level scores were compared across groups. Our findings show that children with ADHD scored higher than controls on the total and hyperacusis-effects subscale, but not on the coping subscale. Only four of the eleven items distinguished the groups, all reflecting concentration in noise or its decline under fatigue; no item reflecting sound avoidance, sensitivity, or distress differed between groups. This pattern was independent of clinical presentation, medication, and age; it persisted after adjustment for parental education. These results suggest that elevated auditory difficulties in ADHD are better explained by attention- and fatigue-related vulnerability than by heightened auditory sensitivity and may warrant environmental rather than audiological interventions.

Introduction We are currently working on the BEARS (Both Ears) virtual reality (VR) Randomised Controlled Trial. We are recruiting 272 deaf children and young people who use bilateral (both ears) cochlear implants (CI) to examine if using the BEARS VR games helps their hearing in background noise and ultimately their quality of life. Clinical trial participants should be representative of the population with the health condition, although this is rarely achieved in practice as people from ethnic minorities or those from more deprived areas may face barriers to participation. Study Design Mixed methods design Objectives Use a literature review and collection of data from cochlear implant centres to establish the sociodemographic characteristics of deaf children aged 8 to 16 years with bilateral cochlear implants in the United Kingdom (UK). a. Establish the sociodemographic characteristics of the families recruited to the BEARS clinical trial in the first six months, and compare with the age-matched population of deaf children with bilateral cochlear implants in the UK. b. Analyse the BEARS clinical trial pre-screening diversity data. c. Implement an established recruitment intervention method in a workshop to explore and optimise recruitment number and diversity. d. Compare the final six months of recruitment data diversity with the initial six months. Use interviews and focus groups to collect qualitative data from children and their families who chose not to take part in BEARS, clinicians, and family representatives (e.g. teachers) to explore barriers and facilitators to families taking part in BEARS. Amend the BEARS scale-up plan based on new learning. Methods Literature and scoping reviews, quantitative analysis of BEARS recruitment data, in-depth interviews, paired interviews, focus groups Sample size Qualitative sample: 10-15 children aged 8-16 with bilateral CI, 10-15 parents/carers of children with bilateral CI, 10-12 clinicians and 10-12 family representatives. Significance This work will evaluate how diverse the BEARS clinical trial recruitment is and whether it is representative of the UK population of children with bilateral cochlear implants. We will investigate recruitment barriers and implement measures to try to improve recruitment diversity.

Several types of cues contribute to speech recognition in multi-talker environments. In this study, we investigated how talker head-orientation related (THOR) cues and extended high- frequency (EHF; >8kHz) cues affect speech-in-speech recognition for both female and male speech. We examined the THOR benefit associated with a non-facing masker talker head orientation (relative to a facing orientation) as a function of masker talker facing angle. The target talker always faced the listener, whereas co-located maskers were tested with eight different masker head angles, ranging from 0{degrees} (facing the listener) to facing 180{degrees} away. Two filtering conditions were tested: full- band and low-pass filtered at 8 kHz. A THOR benefit was observed at masker head angles greater than 45{degrees}, increasing from 2 dB to 8 dB between angles of 67.5{degrees} and 180{degrees}. This benefit was reduced for low-pass filtered speech. Access to EHF cues improved performance, but only for masker head angles >22.5{degrees}. There was no significant relationship between 16-kHz pure-tone thresholds and performance for young, normal-hearing listeners with good EHF hearing. These findings indicate that listeners benefit from non-facing masker talker head orientations >45{degrees} when the target talker is facing the listener, with greater benefit for larger head angles.

Hearing aid users commonly report listening-related fatigue, which may contribute to disengagement from demanding listening situations and negative psychosocial outcomes. Hearing rehabilitation currently lacks strategies to mitigate listening fatigue, partly because fatigue build-up and its consequences are difficult to measure beyond self-report. This study investigated whether value-based listening decisions and associated frontal cortical activity are modulated by fatigue. Thirty hearing aid users completed a one-hour listening paradigm while cortical hemodynamic activity was measured using functional near-infrared spectroscopy (fNIRS). On each trial, participants decided whether to engage in listening or rest based on an offer defined by expected task difficulty and reward, and rated their momentary fatigue. Fatigue ratings increased over time, and unsuccessful listening trials were associated with larger subsequent increases in fatigue, suggesting that performance contributed to changes in self-reported fatigue. Listen-versus-rest decisions followed the expected effort-reward trade-off, with participants more likely to accept offers that provided higher rewards and lower listening demands. Over the course of the experiment, participants became less likely to accept listening offers; however, neither time on task nor subjective fatigue altered the weighting of reward and difficulty. In contrast, frontal cortical activation during evaluation of accepted offers increased over time for high-difficulty offers with low or medium rewards. Follow-up analyses indicated that frontal oxygenation and listening decisions were more strongly associated with time on task than with subjective fatigue ratings. Together, these findings suggest that behavioral and neural measures obtained before listening capture fatigue-related processes beyond self-report, providing a basis for identifying and potentially addressing fatigue in hearing rehabilitation.

Speech perception ability in a cocktail party environment is highly variable, even for people with clinically healthy hearing. The mechanisms of these differences are poorly understood. A possible reason for these differences could be due to the neural mechanisms of auditory attention. This investigation aims to quantify how well a person is able to neurally entrain to a continuous narrative using a temporal response function (TRF), then evaluate if that TRF measure is correlated with an individual's performance on a selective attention and narrative comprehension task. This was accomplished using a cohort of twenty-five young and healthy listeners who completed speech-in-noise (SIN) perception tasks while their neural activity was recorded with EEG. This EEG data and regressors (speech envelope and gammatone spectrogram) of an auditory stimulus was used to train TRF models. TRF cross validation correlation coefficients were then used in multiple regression models to predict a participant's SIN performance. Task performance had a significant positive relationship with the neural entrainment to an attended stimulus and a negative relationship with the neural entrainment to an unattended stimulus. This was observed with both the selective attention and narrative comprehension measures. The difference of the attended and unattended correlation coefficients were also significantly related to increased task performance. These measures could be a potential biomarker to predict an individual's speech perception in a noisy environment.

Objective: This study investigated whether plosive consonants carry a perceptual loudness weighting that significantly exceeds that of non-plosive consonants when judged by hearing-impaired listeners. Design: A prospective loudness matching experiment utilizing the method of adjustment. Study Sample: 19 consenting native English speakers (Mean age: 61.4, SD: 16.4) with bilateral mild to moderate high-frequency sensorineural hearing loss, indicative of presbycusis. Stimuli: 13 vowel-consonant-vowel (VCV) nonsense syllables, exclusively utilizing the flanking vowel /u/. Results: Descriptive analysis revealed a strong time-order effect influencing loudness judgments for 7 of the 13 VCV test stimuli. Statistical testing showed no significant didference (P = 0.94) between the relative amplitudes corresponding to the point of equal loudness for plosive-containing versus non-plosive-containing VCV stimuli. However, 6 individual VCV stimuli, containing consonants from 4 separate manners of articulation, produced significant loudness matching data (P < 0.01). Conclusions: The results falsify the hypothesis that plosives, analyzed collectively as a class, possess a heavier perceptual loudness weighting than non-plosive consonants. While 6 individual VCV stimuli indicated potential individual consonantal loudness weightings, these findings must be interpreted cautiously due to the restriction to a single vowel context and the presence of procedural time-order biases.

Introduction Hearing loss (HL) affects over 1{middle dot}5 billion people globally and India shares a disproportionately high burden including Disabling Hearing Loss (DHL). HL affects an Individual socio-economically, but there are limited studies on the broader societal economic consequences of HL in India.Methods Using Cost-of-Illness (COI) approach, we studied the societal economic burden of HL in India. This study uses epidemiological and macroeconomic data and modelling to estimate the loss of Gross National Income (GNI) due to HL and DHL across three economic pathways. Uncertainty is evaluated using deterministic and Probabilistic Sensitivity Analyses (PSA).Results The model estimates that there are in India, 289 million and 85{middle dot}9 million people with HL and DHL respectively. Direct Loss of GNI and Indirect Loss of GNI (Caregiver burden) are estimated as INR 4,648{middle dot}4 billion (USD 55{middle dot}6 billion) and INR 3,268 billion (USD 39 billion) respectively. The Loss of GNI due to Low Education amongst those with HL is estimated as INR 1,041{middle dot}9 billion (USD 12{middle dot}45 billion).Discussion Economic burden of HL is presented across three pathways with Direct Loss of GNI due to DHL being the greatest. It also presents age stratified caregiver economic burden. The findings of the study help in estimating similar cost pathways, advocacy, and policy decisions towards reducing HL prevalence in India and LMICs. This study also highlights the need for India specific estimations related to the HL attributable low education, state-wise disaggregates, and prevalence studies. Funding This study has not received any funding.

The inflammatory foreign body response that follows cochlear implantation produces intracochlear fibrosis, neo-ossification, and elevated electrode impedances that can compromise implant performance. Dexamethasone-eluting cochlear implants reduce this response, but the durability of their anti-inflammatory effect over long implantation intervals has not been established. Using a murine model of chronic cochlear implantation in CX3CR1+/eGFP Thy1+/eYFP dual-reporter mice, we compared dexamethasone-eluting and standard mouse cochlear implants at 224 and 336 days post-implantation. Density of CX3CR1+ macrophages, MHCII+CX3CR1+ antigen-presenting macrophages, -SMA+ fibrosis, and neo-ossification were quantified in the scala tympani, Rosenthal canal, and lateral wall of the basal turn. Standard implants produced persistent macrophage and antigen-presenting macrophage infiltration, accompanied by an -SMA+ fibrotic response and neo-ossification. Dexamethasone-eluting implants suppressed macrophage infiltration in all three regions out to 336 days and reduced fibrosis at 224 days. In the subset of cochleae with electrode array translocation, dexamethasone-eluting implants attenuated macrophage infiltration and confined the fibrotic and osseous response to the site of translocation, whereas standard implants produced a widespread response. A reduction in immune cell density was also observed in the contralateral, unimplanted cochleae of animals implanted with dexamethasone-eluting implants, suggesting a wider component to the drug's effect. Dexamethasone-eluting cochlear implants therefore provide sustained, long-term suppression of the cochlear foreign body response in mice, supporting their continued translation toward clinical application. This effect was associated with continued low-level dexamethasone elution out to 336 days post-implantation; further work is needed to assess the durability of this effect at the conclusion of drug elution.