Hearing Aids Research Articles

Neural-WDRC: A Deep Learning Wide Dynamic Range Compression Method Combined With Controllable Noise Reduction for Hearing Aids.

Wide dynamic range compression (WDRC) and noise reduction both play important roles in hearing aids. WDRC provides level-dependent amplification so that the level of sound produced by the hearing aid falls between the hearing threshold and the highest comfortable level of the listener, while noise reduction reduces ambient noise with the goal of improving intelligibility and listening comfort and reducing effort. In most current hearing aids, noise reduction and WDRC are implemented sequentially, but this may lead to distortion of the amplitude modulation patterns of both the speech and the noise. This paper describes a deep learning method, called Neural-WDRC, for implementing both noise reduction and WDRC, employing a two-stage low-complexity network. The network initially estimates the noise alone and the speech alone. Fast-acting compression is applied to the estimated speech and slow-acting compression to the estimated noise, but with a controllable residual noise level to help the user to perceive natural environmental sounds. Neural-WDRC is frame-based, and the output of the current frame is determined only by the current and preceding frames. Neural-WDRC was compared with conventional slow- and fast-acting compression and with signal-to-noise ratio (SNR)-aware compression using objective measures and listening tests based on normal-hearing participants listening to signals processed to simulate the effects of hearing loss and hearing-impaired participants. The objective measures demonstrated that Neural-WDRC effectively reduced negative interactions of speech and noise in highly non-stationary noise scenarios. The listening tests showed that Neural-WDRC was preferred over the other compression methods for speech in non-stationary noises.

Access to Hearing Healthcare and Barriers Among United States Veterans: A Survey-Based Study.

We investigated use of hearing care among US veterans and explore motivations, barriers, and adherence to hearing healthcare. Cross-sectional online survey. US Veterans. This cross-sectional, online survey-based study included 287 respondents who identified themselves as veterans on ResearchMatch (NIH-sponsored national registry of research volunteers). Questions regarding hearing loss, tinnitus, use of hearing care, and facilitators/barriers to hearing care were asked. Descriptive statistics were utilized for data analysis. In this cohort, the rate of self-reported hearing loss and tinnitus were 61.0% and 74.2%, respectively. Among these, 66.9% of those with hearing loss and 36.2% of those with tinnitus reported seeking hearing care. Most important motivators of seeking hearing care (average on 1-5 Likert scale) included personal importance of hearing (4.0; SD = 1.1), difficulty hearing others (3.6; SD = 1.1), and degree of hearing loss (3.3; SD = 1.1). Most common barriers included uncertainty regarding who to reach out to for hearing care (42.9%), inability to get time off work (34.3%), and nervousness about seeing a provider (28.6%). Common reasons to decline hearing aids reporting that hearing was not bad enough for hearing aids (72.2%) and included inability to afford hearing aid (55.6%). In this cohort, many US veterans sought care for hearing loss, though barriers still exist, including uncertainty regarding how to access appropriate care, being too far from a provider, and challenges with cost. Future studies should investigate methods to alleviate these internal and external barriers to hearing care and emphasize the importance of motivators for seeking care.

Use of Hearing Aids Embedded with Inertial Sensors and Artificial Intelligence to Identify Patients at Risk for Falling.

To compare fall risk scores of hearing aids embedded with inertial measurement units (IMU-HAs) and powered by artificial intelligence (AI) algorithms with scores by trained observers. Prospective, double-blinded, observational study of fall risk scores between trained observers and those of IMU-HAs. Tertiary referral center. Two hundred fifty participants aged 55-100 years who were at risk for falls. Fall risk was categorized using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test battery consisting of the 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests. Performance was scored using bilateral IMU-HAs and compared to scores by clinicians blinded to the hearing aid measures. Fall risk categorizations based on 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests obtained from IMU-HAs and clinicians. Interrater reliability was excellent across all clinicians. The 4-Stage Balance and TUG showed no statistically significant differences between clinician and HAs. However, the IMU-HAs failed to record a response in 12% of TUG trials. For the 30-Second Chair Stand test, there was a significant difference of nearly one stand count, which would have altered fall risk classification in 21% of participants. These results suggest that fall risk as determined by the STEADI tests was in most instances similar for IMU-HAs and trained observers; however, differences were observed in certain situations, suggesting improvements are needed in the algorithm to maximize accurate fall risk categorization.

Ensemble responses of auditory midbrain neurons in the cat to speech stimuli at different signal-to-noise ratios

Originally reserved for those who are profoundly deaf, cochlear implantation is now common for people with partial hearing loss, particularly when combined with a hearing aid. This combined intervention enhances speech comprehension and sound quality when compared to electrical stimulation alone, particularly in noisy environments, but the physiological basis for the benefits is not well understood. Our long-term aim is to elucidate the underlying physiological mechanisms of this improvement, and as a first step in this process, we have investigated in normal hearing cats, the degree to which the patterns of neural activity evoked in the inferior colliculus (IC) by speech sounds in various levels of noise allows discrimination between those sounds. Neuronal responses were recorded simultaneously from 32 sites across the tonotopic axis of the IC in anaesthetised normal hearing cats (n=7). Speech sounds were presented at 20, 40 and 60dB SPL in quiet and with increasing levels of additive noise (signal-to-noise ratios (SNRs) –20, –15, –10, –5, 0, +5, +10, +15, +20dB). Neural discrimination was assessed using a Euclidean measure of distance between neural responses, resulting in a function reflecting speech sound differentiation across various SNRs. Responses of IC neurons reliably encoded the speech stimuli when presented in quiet, with optimal performance when an analysis bin-width of 5-10ms was used. Discrimination thresholds did not depend on stimulus level and were best for shorter analysis binwidths. This study sheds light on how the auditory midbrain represents speech sounds and provides baseline data with which responses to electro-acoustic speech sounds in partially deafened animals can be compared.

Educational Disparities in Age-related Hearing Loss and Hearing Aid Use across Age, Gender, and European Region.

Affecting one in five adults in Europe, hearing loss (HL) is linked to adverse health outcomes, including dementia. We aim to investigate educational inequalities in hearing health in Europe and how these inequalities change with age, gender, and region. Utilizing 2004-2020 data from the Harmonised Survey of Health, Ageing, and Retirement in Europe (SHARE), a representative sample of Europeans aged 50 and above, we analyse: 1) age-standardized prevalence of HL and hearing aid (HA) use among eligible individuals; 2) educational inequalities therein using the Relative Index of Inequality (RII) across age, gender, and European regions. The prevalence of self-reported HL increases with age, is greater among men, and is consistently higher among those with lower levels of education. At age 50-64, particularly in Southern and Eastern Europe, low-educated women experience more than three times the risk of HL compared to highly educated women. These inequalities diminish as women age. Northern Europe is a front-runner in meeting HA needs. Southern and Eastern Europe lag behind, with less than two in ten individuals eligible for HAs utilizing them. Substantial variations in the educational gradient of hearing health across age, gender, and European regions underscore the importance of targeting specific subpopulations in efforts to mitigate health inequalities. Of particular concern is the regional discrepancy between the prevalence of HL and the use of HAs. The example of Northern Europe suggests that there is unused potential to improve healthy ageing in Europe through enhanced access to HAs.

A qualitative study of the role of hearing aid use and physical fit accessories in a sample of older adults.

The purpose of the study was to qualitatively describe the experiences of hearing aid and physical fit accessories use during physical activity and exercise participation in a sample of older adults with hearing loss. A prospective qualitative research design was employed with the use of focus groups with older adult participants who were fitted with hearing aids and physical fit accessories. Twelve older adults with hearing loss (six experienced and six new hearing aid users, age range 64 - 88 years) were recruited in this study. The barriers to hearing at physical activity and exercise environments were related to reverberation, loud music, and instructor's location and position relative to exercise members, whereas facilitators were aided hearing, the instructor projecting their voice and demonstrating the moves. The most preferred physical fit accessories were the retention lock and the corded and cordless hearing aid sleeves. The least preferred accessories were the hearing aid-to-glasses connector and stick'n stay tape. Individual differences and needs were factored into different perspectives on hearing aid and physical fit accessory use, emphasising patient-centered approach when coaching and counselling on device use for physical activity and exercise.

Racial Differences in Discrepancies Between Subjective Ratings and Objective Assessments of Hearing Impairment.

To better understand racial/ethnic disparities in hearing aid use, we examined racial differences in discrepancies between subjective hearing ratings and objective hearing tests as a potential source of this disparity. A cross-sectional assessment was conducted using the data from the Health and Retirement Study (HRS). Our analytic sample included 2,568 participants aged 50 and older: 1,814 non-Hispanic White Americans and 754 non-Hispanic Black Americans. Discordant groups were identified based on self-ratings of hearing abilities (positive versus negative) and objective hearing test results (normal versus hearing loss). Analysis of HRS data revealed that approximately 73% of participants with objectively measured hearing loss reported positive hearing ratings. False positive hearing rates were found to be 80% among Black older adults and 70% among their White counterparts. Odds for false positive hearing ratings were significantly greater for Black older adults, men, those with less than a high school education, more health conditions and depressive symptoms, and current smoking. Racial differences were maintained after adjustment for these covariates. While cost of hearing aids has been a predominant explanation of low hearing aid use in Black Americans, false positive perceptions of hearing abilities may also play a significant role as a psychosocial mechanism. Future studies examining racial/ethnic differences in possible psychosocial mechanisms for discrepancies between objective and subjective hearing could guide the development and evaluation of culturally appropriate educational interventions.

Hearing care in low-resourced and humanitarian settings: findings from a pilot study in South Sudan.

This longitudinal experimental study aimed to profile audiometric hearing loss, explore the feasibility and efficacy of low-cost hearing devices, and examine their social and emotional impact on participants in South Sudan, a low-resource humanitarian setting. We performed pure tone hearing screenings on adults with self-reported hearing disability, randomly providing eligible participants with one of two inexpensive devices-Asana Pro 800, a non-customizable hearing device fit unilaterally, or the Super Ear SE9000, a hand-held amplifier with headphones given one per individual. Between October 2022 and January 2023, 142 adults underwent hearing screening at the Juba Teaching Hospital ENT clinic, of whom 19 eligible individuals were provided with hearing devices. Eighteen participants completed the full follow-up period. Significant auditory and functional improvements were observed among device users over the study period, alongside self-reported enhanced quality of life. Qualitative data showed improvement in daily activity performance. The provision of low-cost hearing devices appears plausible and impactful. Hearing loss poses a significant health issue with complex genetic, environmental, and disease-related causes. Our collaboration initiated accessible, affordable hearing solutions to serve as a framework for hearing healthcare in resource-deprived settings. Further investigation is warranted for scaling this model.

Evaluating a Hearing Loop Implementation for Live Orchestral Music.

Live music creates a sense of connectedness in older adults, which can help alleviate the social isolation frequently associated with hearing loss and aging. However, most hearing-aid (HA) users are dissatisfied with the sound quality of live music and rate sound quality as important to them. Assistive listening systems are frequently independent of a user's HAs and fall short in tailoring to each individual's hearing loss. The present study thus tested whether the use of a hearing loop would improve sound quality during an orchestral concert. Participants with symmetrical moderate-to-severe hearing loss were assigned to use Sonova-provided HAs with a telecoil (n = 20) or their own HAs (n = 8) without a telecoil during a performance by the Hamilton Philharmonic Orchestra. We changed loop input to use one of three feeds every 5 minutes: a mix of microphones from the hall's standard assistive feed on the first balcony (house condition), a mix of microphones located on the stage (stage condition), or no input to the loop (no feed). After each 5-minute interval, we collected sound quality and naturalness ratings for the previous 5 minutes. Sound quality and naturalness ratings were highly related (rRM = 0.81), though each provided unique insight. Repeated measures analysis of variance found significant differences among the loop feed conditions for sound quality and naturalness, with the no feed condition significantly outperforming the house condition on sound quality [t(18) = -3.73, adj. p = 0.005] and naturalness [t(18) = -4.15, adj. p = 0.002]. Mixed effects models allowed us to retain the richness of a repeated observation dataset and provided point estimates of the overall quality and naturalness among conditions; however, assumption violations of normality and homoskedasticity prevented further interpretation. Though HA-integrated assistive listening systems are a promising option for improving live music for people with hearing loss, a hearing loop does not seem to be crucial for orchestral music. Future directions include improving lyric understanding for music with vocals and customizing user experience via Bluetooth Low Energy Audio systems.

Hybrid cochlear implant:a scoping review

Cochlear implants (CIs) restore the perception of sound for individuals with severe to profound hearing loss by employing electrical stimulation to directly activate the remaining auditory neurons. Post-implantation ipsilateral hearing loss has been observed in every patient series involving hearing preservation cochlear implantation. Patients with residual hearing in the low-pitched area of the cochlea but severe to profound hearing loss in the middle and high-frequency range can be inserted with a shorter electrode array which preserves the residual hearing. The Hybrid CI, also referred to as electro-acoustic stimulation (EAS), is a type of cochlear implant designed to preserve residual acoustic hearing. It allows for the simultaneous use of a cochlear implant and a hearing aid in the same ear. Expanding electrical speech processing to individuals with more remaining acoustic hearing using a less invasive and shorter cochlear implant marks a significant milestone in cochlear implant technology. In Hybrid CI, the integration of electrical and acoustic hearing often leads to notable improvements in word recognition for the majority of cases. There is a distinct advantage of combining acoustic and electric hearing over relying solely on electrical stimulation, particularly in understanding speech in noisy environments and appreciating music. In general, patients who undergo Hybrid CI express high levels of satisfaction with their outcomes. This review's goal is to discuss Hybrid CI with its history, principles, design, candidacy, advantages, and limitations.

Effects of Interaural Latency and Frequency Mismatch on Speech Recognition for Bimodal Cochlear Implant Users.

Bimodal cochlear implant (CI) users vary in speech recognition outcomes. This variability may be influenced partly by the CI and contralateral hearing aid (HA) programming procedures, which can result in mismatches in latency and frequency. We assessed the performance of bimodal listeners when latency mismatches were corrected and analyzed how frequency mismatches influenced outcomes. Twelve adults with at least 1 year of bimodal use were evaluated in latency mismatched versus matched conditions. Masked sentence recognition was assessed in a 10-talker masker for three spatial configurations: target from the front and the masker either co-located, 90° toward the CI-ear, or 90° toward the HA-ear. Frequency mismatch for the most apical electrode (E1) was determined from postoperative imaging and the filter frequency assignment of their familiar CI map. Participants had significantly better performance when latency mismatches were small or matched between the devices, with an approximately 10% improvement in the configuration with the masker toward the HA-ear. Significantly, poorer performance was observed with larger magnitudes of frequency mismatch, with a 2% drop in performance for every one semitone deviation increase in mismatch. The interaction between latency and frequency mismatch was nonsignificant, suggesting that the benefit of latency matching was approximately additive across the range of frequency mismatches. Detrimental effects of interaural mismatches in latency and frequency were observed, even after long-term device use. These preliminary results suggest that bimodal CI users might benefit from individualized fitting procedures that match latency across devices and minimize frequency mismatch for the CI. 3 Laryngoscope, 2025.

P-27 H SYNDROME: CASE REPORT

Abstract Introduction H Syndrome is an autosomal recessive disorder characterized by cutaneous hyperpigmentation, hypertrichosis, and induration with numerous systemic manifestations. The syndrome is caused by mutations in SLC29A3, a gene located on chromosome 10q23, which encodes the human equilibrative transporter 3 (hENT3). H syndrome is a rare autoinflammatory syndrome with pleiotropic manifestations that affect multiple organ systems. We are presenting first possible case of H syndrome reported in Iraq up to our knowledge. Clinical Case A 14 year old Iraqi boy presented with abnormal lower limb hyperpigmentation, and symmetrical, indurated plaques with marked hypertrichosis over medial aspect of thighs and legs. The skin hyperpigmentation was not itchy and did not involve the feet and knees. This hyperpigmentation had been present for several months. The patient was known to have type 1 diabetes mellitus (DM) since 5 years of age and was treated with insulin with fair control, although without features of advanced microvascular diabetic complications. The patient had deafness and he was wearing a hearing aid device recently. Laboratory analysis showed normal kidney and liver function and normal blood counts but with subclinical hypothyroidism and surprisingly positive serology for celiac disease and this feature was not reported in the few documented cases in the literature. Conclusion This rare syndrome of skin hyperpigmentation, diabetes and deafness may represent the first reported case of H syndrome in Iraq and occurrence of celiac disease is another manifestation that could be part of this syndrome.Figure 1:Hyperpigmentation

Effect of Supplemental Language Therapy on Cortical Neuroplasticity and Language Outcomes in Children with Hearing Loss

Background/Objectives: The cortical auditory evoked potential P1 response is a biomarker of cortical auditory maturation for tracking longitudinal cortical maturation in children with hearing loss after treatment with hearing aids and/or cochlear implants. In conjunction with hearing treatments, children with hearing loss commonly receive language therapy services. However, the effect of language therapy on cortical maturation in hearing loss is less well studied. Methods: This study explored auditory cortical maturation changes, using the P1 response, with coinciding language changes, utilizing the Preschool Language Scales test, following approximately six months of supplemental listening and spoken language therapy services in 39 children with hearing aids or cochlear implants. Results: Following supplemental language therapy, P1 latencies significantly decreased in all children, at a rate found to be significantly faster than expected for typical maturation. Language scores also significantly improved beyond expected maturation effects and were correlated with P1 latencies following supplemental therapy. Overall, with approximately six months of therapy, the children in this study made significantly greater gains of 9 to 10 months in total language and expressive communication. A subgroup analysis revealed that children with cochlear implants showed significantly lower language scores than their chronological age following supplemental therapy, while children with hearing aids obtained language scores that were not significantly different to their chronological age at follow-up. Conclusions: Overall, the results from this study showed that supplemental language therapy resulted in more typical auditory cortical maturation and improved language abilities and that the P1 CAEP response can objectively track neuroplastic changes in children as a function of language therapy provided in conjunction with hearing aids and CIs.

The Benefits of Hearing Aids for Adults: A Systematic Umbrella Review.

This umbrella review aims to summarize the major benefits of hearing aid usage in adults by synthesizing findings from published review articles. A comprehensive search of databases, including MEDLINE, EMBASE, PsycINFO, and Google Scholar, was conducted. The search was limited to English-language review articles published between 1990 and 2023, focusing on hearing aid outcomes in at least 5 adults (aged ≥18 years). Two researchers independently screened titles, abstracts, and full-text articles, and conducted a quality assessment using the Joanna Briggs Checklist for Systematic Reviews and Research Syntheses. A third researcher was involved in discussions with the 2 researchers to resolve conflicts during the screening and quality assessment stages. Eleven articles were included in this review. There were three systematic reviews with meta-analysis and eight systematic reviews without meta-analysis. The quality assessment indicated that articles scored between 6 and 11 out of a total of 11 criteria. Three articles met all quality criteria. Study participants tended to be middle-aged (≥40 years) or older adults (≥65 years). Participant gender was less clear as this was not consistently reported but appeared to favor men. This umbrella review found that speech perception, communication function, hearing handicap, and self-assessed hearing aid benefit were consistently positively associated with hearing aid use in the analysis of included studies. Hearing handicap was the most frequently reported outcome with evidence from four different studies supporting its mitigation with hearing aid use. There was insufficient evidence in terms of benefit on balance, cognitive function, depression, tinnitus, loneliness, and social isolation. There was conflicting evidence on the impact of hearing aid use on quality of life. Among eligible studies, there were no reports of negative impacts of hearing aid use. There are a number of potential benefits associated with hearing aid use. However, this review found that there was a clear lack of high-quality evidence and limited use of robust study design to support the benefits of hearing aids on other outcomes such as quality of life and cognition. Inconsistent use and interpretation of various outcome measures makes it difficult to produce homogenous data which is needed to make more conclusive statements about the benefits of hearing aids.

Factors Associated With Social-Pragmatic Understanding in Deaf and Hard of Hearing and Typically Hearing 6-Year-Old Children.

Children develop social-pragmatic understanding with the help of sensory, cognitive, and linguistic functions by interacting with other people. This study aimed to explore (a) associations between auditory, demographic, cognitive, and linguistic factors and social-pragmatic understanding in children who use bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) and in typically hearing (TH) children and (b) the effect of the group (BiHA, BiCI, TH) on social-pragmatic understanding when the effects of demographic, cognitive, and linguistic factors are controlled for. The Pragma test was used to assess social-pragmatic understanding in 119 six-year-old children: 25 children who use BiHAs, 29 who use BiCIs, and 65 TH children. The Pragma test is a standardized test that requires answering socially and contextually demanding questions with varying focuses and thus enables a comprehensive assessment of social-pragmatic understanding. Associations between auditory, demographic, cognitive, and linguistic factors and the Pragma test performance were analyzed. Between-groups differences in the Pragma test performance were analyzed while statistically controlling for the effects of factors that were associated with the Pragma test scores. The BiHA users who had better unaided pure-tone average hearing thresholds had better social-pragmatic understanding. A higher level of maternal education and nonverbal intelligence were associated with a better social-pragmatic understanding in the BiHA and BiCI groups. Linguistic abilities correlated strongly with social-pragmatic understanding in all groups. The deaf and hard of hearing (DHH) groups differed from the TH children in social-pragmatic understanding even after the effects of maternal education, nonverbal intelligence, and linguistic skills were controlled for. Despite early diagnosis of hearing loss and intervention, many DHH children are still at risk for social-pragmatic difficulties. Several factors may associate with social-pragmatic understanding in DHH children, which highlights the importance of a wide-ranging, multidisciplinary assessment, and the planning of focused, assessment-based interventions.

Early deficits in speech perception in carriers of the p.Pro51Ser variant in the COCH gene: a prospective longitudinal evaluation of speech perception in quiet and noise.

The primary concern among adults with regard to their hearing is the difficulty in comprehending speech, particularly in noisy environments. The constant need to listen attentively leads to heightened frustration, fatigue and decreased concentration. According to research, high-frequency hearing loss could have negative implications on speech perception and make it even harder to communicate. In this study, the focus is on patients with DFNA9 as it is one of the most common forms of non-syndromic high-frequency hearing loss. These patients carry the p.Pro51Ser variant in the COCH gene, which leads to progressive decline of hearing and vestibular function. Despite various cross-sectional studies on the natural progression of hearing levels, speech perception in silence and noisy surroundings is largely unexplored in this group of patients. Method. For the longitudinal analysis of speech perception, 101 heterozygous carriers were enrolled. In addition, a control group composed of individuals with normal hearing, who matched the patients with DFNA9 in terms of age and sex, was recruited. All patients underwent pure-tone audiometry, speech perception in quiet (SPIQ), and in noise (SPIN).The SPIQ outcomes reveal a mean SRT of 28.18 dB SPL for male carriers and 29.29 dB SPL for female carriers in the youngest age group (18-29 years). With increasing age, a steep decrease was noticed, and no speech discrimination ability in quiet remained for carriers in their seventh decade. Differences between carriers and control participants seem evident in the third decade of life and become more pronounced in the decades that follow. The SPIN displayed a similar trend, varying from -5 dB SNR in the youngest age group, to no speech-in-noise thresholds in patients above the age of 60 years. In contrast, the matched group exhibited a SRT range from -5.5 to -3.25 dB SNR for males, and from -6.23 to -4.58 dB SNR for females from the second/third to the seventh decade. This stands in contrast to the DFNA9 population, where male carriers reach values of -5.18 dB SNR and female carriers reach -3.12 dB SNR as early as in the fourth decade. This study indicates poor performance on speech understanding in quiet and noise in DFNA9 patients in comparison with the group with normal hearing, even at a young age. Therefore, future research should not only investigate pure-tone audiometry, but also speech perception. Moreover, reimbursing hearing aids based on speech-in-noise testing could prove to be more advantageous than based on pure-tone audiometry.

Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States.

Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes. To investigate the associations between self-recognition of hearing loss and hospitalization outcomes. This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study. The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss. Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss. In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.

EXPRESS: The Time Course of Cognitive Effort During Disrupted Speech.

Listeners often find themselves in scenarios where speech is disrupted, misperceived, or otherwise difficult to recognize. In these situations, many individuals report exerting additional effort to understand speech, even when repairing speech may be difficult or impossible. This investigation aimed to characterize cognitive effort across time during both sentence listening and a post-sentence retention interval by observing the pupillary response of participants with normal to borderline normal hearing in response to two interrupted speech conditions: sentences interrupted by gaps of silence or bursts of noise. The pupillary response serves as a measure of the cumulative resources devoted to task completion. Both interruption conditions resulted in significantly greater levels of pupil dilation compared to the uninterrupted speech condition. Just prior the end of a sentence, trials periodically interrupted by bursts of noise elicited greater pupil dilation compared to the silent interrupted condition. Compared to the uninterrupted condition, both interruption conditions resulted in increased dilation after sentence end but before repetition, possibly reflecting sustained processing demands. Understanding pupil dilation as a marker of cognitive effort is important for clinicians and researchers when assessing the additional effort exerted by listeners with hearing loss who may use cochlear implants or hearing aids. Even when successful perceptual repair is unlikely, listeners may continue to exert increased effort when processing misperceived speech, which could cause them to miss upcoming speech or may contribute to heightened listening fatigue.

Does amplitude compression help or hinder attentional neural speech tracking?

Amplitude compression is an indispensable feature of contemporary audio production and especially relevant in modern hearing aids. The cortical fate of amplitude-compressed speech signals is not well-studied, however, and may yield undesired side effects: We hypothesize that compressing the amplitude envelope of continuous speech reduces neural tracking. Yet, leveraging such a 'compression side effect' on unwanted, distracting sounds could potentially support attentive listening if effectively reducing their neural tracking. In this study, we examined 24 young normal-hearing (NH) individuals, 19 older hearing-impaired (HI) individuals, and 12 older normal-hearing individuals. Participants were instructed to focus on one of two competing talkers while ignoring the other. Envelope compression (1:8 ratio, loudness-matched) was applied to one or both streams containing short speech repeats. Electroencephalography (EEG) allowed us to quantify the cortical response function and degree of speech tracking. With compression applied to the attended target stream, HI participants showed reduced behavioural accuracy, and compressed speech yielded generally lowered metrics of neural tracking. Importantly, we found that compressing the ignored stream resulted in a stronger neural representation of the uncompressed target speech. Our results imply that intelligent compression algorithms, with variable compression ratios applied to separated sources, could help individuals with hearing loss suppress distraction in complex multi-talker environments.Significant statement Amplitude compression, integral in contemporary audio production and hearing aids, poses an underexplored cortical challenge. Compressing the amplitude envelope of continuous speech is hypothesized to diminish neural tracking. Yet, capitalizing on this 'compression side effect' for distracting sounds might enhance attentive listening. Studying normal-hearing (NH), older hearing-impaired (HI), and older normal hearing individuals in dual-talker scenarios, we applied envelope compression to speech streams. Both NH and HI participants showed diminished neural tracking with compression on the speech streams. Despite weaker tracking of a compressed distractor, HI individuals exhibited stronger neural representation of the concurrent target. This suggests that adaptive compression algorithms, employing variable ratios for distinct sources, could aid individuals with hearing loss in suppressing distractions in complex multi-talker environments.

The Impact of Financial Coverage on Hearing Aid Utilization Rates Within the Military Health System.

To investigate hearing aid utilization rates among populations with varying hearing aid insurance benefits. A retrospective cohort study was performed. A total of 377 patients were included in the study after being identified through consecutive, hearing loss-related otology clinic visits. With respect to hearing aid benefits, patients were separated into full, partial, and no coverage populations. Chart reviews identified if a patient underwent hearing aid evaluation and fitting. Audiometric data were collected. Chi-square tests of independence and two-sided Z-tests were used for statistical analysis. ANOVA single-factor analysis testing was used to analyze pure tone averages (PTA) and word recognition scores (WRS) data. The 377 patients who met criteria included: full insurance coverage (n = 210, mean age = 45 years), partial coverage (n = 82, mean age = 65 years), and no coverage (n = 85, mean age = 54 years). The full- and partial-coverage populations each had significantly higher hearing aid utilization rates (78% and 79%, respectively) than the no-coverage population (49%, p < 0.001). No statistical difference in mean PTA or WRS was noted among the three coverage categories. Patients with at least partial financial coverage are more likely to acquire hearing aids than those without despite similar degrees of hearing loss. This implies that the out-of-pocket cost of hearing aids is a primary impediment to hearing aid adoption and provides a useful road map for public and private insurers considering hearing aid coverage. Level III (retrospective cohort study) Laryngoscope, 2025.