Background/Objectives: Recurrent acute otitis media (AOM) in children is known to cause cumulative cochlear and vestibular injury. Whether a single fulminant episode severe enough to require surgical intervention produces an analogous long-term audiovestibular signature, and whether infection severity contributes to outcome independently of cumulative episode count, is unclear. The present study addressed this gap. Methods: In this single-centre retrospective cohort study, 65 paediatric patients who had undergone surgical treatment for acute mastoiditis-the fulminant form of AOM-between July 2001 and March 2021 were assessed a median of 11.5 years after surgery. Of these, 35 had undergone mastoidectomy with tympanostomy and 30 had undergone tympanostomy alone because their episode had not been severe enough to require mastoidectomy. Thirty-two age-matched healthy volunteers (one ear each) formed the control group, yielding 97 ears in three groups (Group TM, 35 ears; Group T, 30 ears; Group C, 32 ears). Extended high-frequency pure-tone audiometry (125-20 kHz), distortion-product otoacoustic emissions (DPOAEs), single-frequency and wideband tympanometry, ipsilateral acoustic reflex thresholds, and lateral-canal vestibulo-ocular reflex gain were measured. Results: Both operated groups showed significantly elevated audiometric thresholds in the high- and extended high-frequency ranges compared with controls (HTA: χ2 = 24.25, p < 0.001), with corresponding reductions in DPOAE amplitudes (HTA: χ2 = 25.04, p < 0.001). Group TM did not differ significantly from Group T at any frequency band, indicating a negligible additional contribution of mastoidectomy itself. Acoustic reflex thresholds were elevated in Group TM. Vestibulo-ocular reflex gain was within reference ranges in all groups. Conclusions: A single fulminant episode of acute middle-ear infection in childhood-whether severe enough to require mastoidectomy or treated by tympanostomy alone-was associated, more than a decade later, with significantly elevated audiometric thresholds closely resembling those reported after multiple recurrent infections, supporting an effect of infection severity independent of cumulative episode count. Long-term audiological follow-up with extended high-frequency audiometry and otoacoustic emission testing is warranted, irrespective of whether mastoidectomy was required.

Purpose: This study aimed to map publication trends, topical focus, study designs, and institutional concentration in otology research in Saudi Arabia from 1978 to 2024 to deduce any topical, regional, institutional, or funding disparities in the field of otology in the country. Methods: We conducted a scoping review of studies on human ear diseases in Saudi Arabia, searching PubMed and the Cochrane Library from inception to 31 December 2024. Bibliometric characteristics were charted, topics were mapped to ICD-11 chapters, and temporal trends were modelled using negative binomial regression with a single data-driven breakpoint. Results: Of 2227 records identified, 510 studies were included. Annual output increased by 9.28% (95% CI 7.05-11.55). An inflection occurred around 2017, with slower growth before 2017 (7.2%/year, 95% CI 5.3-9.1) and faster growth from 2018 onward (23.9%/year, 95% CI 18.6-29.4). The institutional affiliation of first authors was concentrated in a small number of organizations, led by King Saud University. Observational studies predominated (441/510), whereas experimental studies were limited (16/510). ICD-11 mapping showed the greatest concentration in "Ear and mastoid" (189/510, 37.1%) and "Factors influencing health status or contact with health services" (179/510, 35.1%) chapters. Funding was reported in 75 studies. Conclusions: PubMed- and Cochrane-indexed otology and hearing health research output in Saudi Arabia has grown substantially, particularly since 2017, but remains concentrated by institution, region, study design, and topic. The dominance of cochlear implant and hearing impairment research, together with limited multicenter, experimental, vestibular, tinnitus, and rehabilitation-focused studies, identifies priorities for future audiology and neurotology research planning.

Introduction: Teprotumumab (Tepezza®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols.

Sensorineural hearing loss (SNHL) is a chronic condition with no established pharmacological treatment. Recent advances in drug-based therapies offer promising opportunities to prevent or treat SNHL. This scoping review summarizes the current landscape of pharmacotherapeutics for SNHL. This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A literature search of PubMed, Google Scholar, Embase, Scopus, and Web of Science was conducted in 2024 using keywords related to SNHL and pharmacotherapeutics. A review protocol was preregistered on the Open Science Framework. A systematic search of five electronic databases identified published studies from 2004 to 2024 on pharmacological treatments for SNHL in human participants, as well as ongoing clinical trials. Interventions were categorized by mechanism of action: antioxidant therapy, steroid-based combination therapy, hematologic-based therapy, pathway modulator therapy, regenerative therapy, and gene therapy. A narrative synthesis approach was used to map key trends across treatment types, study designs, and outcomes. Sixty-six records met the inclusion criteria, including 48 published studies and 18 ongoing or recently completed clinical trial records. Antioxidants, corticosteroids, hematologic agents, and pathway modulators have demonstrated potential in preventing or treating SNHL caused by cisplatin, aminoglycosides, noise-induced ototoxicity, and intraoperative cochlear implantation trauma. Emerging regenerative and gene therapies show promise as future pharmacologic treatment options. Pharmacologic therapies for SNHL are promising but remain constrained by small sample sizes, heterogeneous study designs, and drug delivery challenges across the blood-labyrinth barrier. Future research should prioritize multicenter randomized trials, optimized delivery strategies, and integration of precision medicine approaches.

Tinnitus is a prevalent auditory condition associated with significant psychological burden and limited treatment efficacy. While physical activity confers broad health benefits, its relationship with tinnitus remains understudied. This study examined associations between domain-specific physical activity and tinnitus in a nationally representative sample of U.S. adults. Data from NHANES 2015-2018 were analyzed. The final analytic sample comprised 4301 adults aged 20 years and older. Tinnitus was assessed via the NHANES audiometry questionnaire. Physical activity was categorized as low, moderate, and high (MET-min/week) separately for work-related (WORK) and non-work-related (NW) domains. Survey-weighted multivariable logistic regression models, adjusted for age, sex, race, BMI, poverty-income ratio, sedentary time, smoking, education, noise exposure, hypertension, diabetes, and depressive symptoms, were used to examine associations. Linear trends across ordered physical activity categories were evaluated using ordinal trend analyses. The weighted prevalence of tinnitus was 17.3%. High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475), while high WORK PA was associated with significantly higher odds (OR = 1.30, 95% CI: 1.06-1.60, p = 0.018). Trend analyses confirmed opposing linear trends across ordered categories: inverse for NW PA (OR = 0.83 per category, p-trend = 0.0406) and positive for WORK PA (OR = 1.14 per category, p-trend = 0.017). Noise exposure and depressive symptoms were independently associated with tinnitus across both models. These findings suggest a domain-specific paradox: NW PA was associated with lower odds of tinnitus, whereas WORK PA was associated with higher odds. These results highlight the importance of domain-specific assessment and identify recreational activity as a potential modifiable factor warranting further investigation. Given the cross-sectional design, these associations should not be interpreted as causal.

Background/Objectives: Auditory neuropathy spectrum disorder (ANSD) is a well-established hearing disorder in the pediatric population and is estimated to account for at least 10% of children with sensorineural hearing loss. Compared to auditory function, vestibular function in children with ANSD has not been well described in the past. The purpose of this study is to examine vestibular testing results in children with ANSD and to better characterize vestibular dysfunction in these children. Methods: A retrospective review of vestibular laboratory testing results was conducted in pediatric patients diagnosed with ANSD. Vestibular evaluation included vestibular evoked myogenic potential (VEMP), rotary chair test, video head impulse test (vHIT), and videonystagmography (VNG). Results: A total of 30 pediatric patients with ANSD were identified, including 18 boys and 12 girls, with a mean age of 4.5 years. Bilateral ANSD was found in 24 cases, while 6 cases were unilateral. Etiologies of ANSD included a history of hyperbilirubinemia in infancy, cochlear nerve dysplasia, genetic-related conditions, etc. Vestibular dysfunction was found in 12 cases, as indicated by at least one abnormal outcome in VEMP, vHIT, or rotary chair testing. Nineteen children were cochlear implant candidates and eventually underwent unilateral or bilateral implantation. Conclusions: Vestibular dysfunction is significant in pediatric patients with ANSD, and vestibular outcomes appear to be related to underlying etiologies. Formal vestibular evaluation is necessary to identify such vestibular losses, and these findings will be helpful to guide clinical management and rehabilitation strategies for these children.

Background: Hearing loss is highly prevalent among older adults and represents a growing public health burden. Increasing attention has been given to the associations between hearing loss, cognitive decline, and dementia risk. Cochlear implantation is an established intervention for adults with severe-to-profound sensorineural hearing loss who obtain limited benefit from conventional amplification, but its potential cognitive effects remain debated. Objective: This narrative review summarizes current evidence on cognitive outcomes after cochlear implantation in adults and older adults, with particular attention to cognitive domains, long-term trajectories, methodological limitations, and clinical implications. Main findings: Available evidence suggests that cochlear implantation may be associated with improvement or stabilization of selected cognitive domains, particularly attention, executive function, working memory, and memory. However, findings are heterogeneous across studies, cognitive tools, and follow-up durations. Prospective longitudinal studies using hearing-adapted or visually presented cognitive batteries support the possibility of postoperative cognitive benefit, but the magnitude and durability of this effect vary between individuals and domains. Long-term studies suggest that cognitive improvement may be strongest during the first postoperative years and may later stabilize or attenuate, whereas auditory and quality-of-life benefits appear more consistently sustained. Conclusions: Cochlear implantation should be regarded as an established hearing rehabilitation strategy with robust benefits for auditory performance and quality of life, and as a potentially cognition-supportive intervention in selected older adults with severe-to-profound hearing loss. Current evidence does not yet prove that cochlear implantation prevents dementia. Future studies should use standardized hearing-adapted cognitive protocols, longer follow-up, adequate comparison groups, and clinically meaningful cognitive endpoints.

Background/Objectives: The present study aimed to verify the importance of different components of aural rehabilitation and evaluate their relevance and acceptability among the Kannada-speaking population in India. This evaluation is intended to inform the development of a tailored aural rehabilitation module for this population. Methods: A thorough literature review was conducted to gain insights into the components of aural rehabilitation in the Western context. The insights gathered from this review served as foundational information for a focus group discussion. The focus group discussion consisted of 15 participants, including audiologists, adults with hearing loss, and their significant others. The data were transcribed and analyzed using inductive thematic analysis. Results: The audiologists in our study confirmed that the components of aural rehabilitation presented in the literature are essential, including sensory management, informational counseling, perceptual training, and personal adjustment counseling. Perspectives of significant others are the highlight of this study as they are less explored in the context of aural rehabilitation in India. Other themes identified from the FGDs included the involvement of family, the impact of hearing loss, awareness of various management options, and challenges/barriers related to aural rehabilitation. Furthermore, most of the adults with hearing loss and their significant others primarily viewed hearing aids as the sole solution. Conclusions: This study highlights the importance of a comprehensive aural rehabilitation program for adults with hearing loss and their significant others in the Kannada speaking population. It emphasizes the importance of informational counseling, communication strategies, and psychosocial support. Involving significant others might foster understanding and support, aiding in the acceptance of hearing loss and its rehabilitation, ultimately improving everyday communication and addressing functional challenges.

Background/Objectives: Hearing loss is a leading cause of disability worldwide, with speech perception representing a key functional outcome of auditory rehabilitation. While hearing aids improve audibility, outcomes vary substantially across clinical subgroups. This study aimed to compare speech perception outcomes after hearing aid fitting in adults with conductive and sensorineural hearing loss and to identify determinants of variability in rehabilitation outcomes. Methods: This prospective longitudinal observational study included 250 adults with clinically confirmed bilateral conductive or sensorineural hearing loss who underwent standardized audiological assessment, bilateral hearing-aid fitting, immediate post-fitting evaluation, and 3-month follow-up in Kazakhstan between January 2023 and December 2024. Participants were classified as having conductive (n = 100) or sensorineural hearing loss (n = 150) based on audiometric criteria. Speech perception was assessed using a Kazakh-language open-set speech audiometry test. Multivariable linear regression models were used to estimate differences in 3-month aided speech perception after adjustment for the corresponding immediate post-fitting aided score and prespecified demographic, clinical, and audiometric covariates. Linear mixed-effects models were used separately to assess change in aided speech perception from immediate post-fitting to 3 months and to test whether this change differed by hearing-loss type. Propensity score matching was performed as a secondary sensitivity analysis. Results: Patients with conductive hearing loss demonstrated consistently higher speech perception scores than those with sensorineural hearing loss across all conditions. At 3 months, adjusted analyses showed no significant difference between groups for aided speech perception in quiet at 60 dB SPL, whereas sensorineural hearing loss remained associated with lower aided speech perception in noise at 60 dB SPL with SNR +3 dB (β = -1.73; 95% CI: -3.10 to -0.36; p = 0.014). In mixed-effects models assessing repeated aided scores from immediate post-fitting to 3 months, sensorineural hearing loss was associated with lower overall aided speech perception in both quiet and noise conditions. A modest improvement over time was observed only for speech perception in noise, and the group-by-time interaction was not statistically significant. Increasing age, higher tonal thresholds, advanced hearing loss stage, and living alone were independently associated with poorer outcomes. Conclusions: Aided speech perception scores were high after hearing-aid fitting in both conductive and sensorineural hearing loss; however, patients with sensorineural hearing loss showed persistently poorer outcomes, particularly in noise. These findings highlight the importance of incorporating speech-in-noise assessment and addressing clinical and social determinants to support hearing rehabilitation.

Additional Affiliation [...].