Background Vestibular involvement in CDH23-related nonsyndromic hearing loss remains incompletely understood, particularly prior to cochlear implantation. Aims/Objectives To evaluate vestibular function prior to cochlear implantation in patients with severe to profound non-syndromic hearing loss caused by CDH23 mutations. Material and Methods We retrospectively evaluated vestibular function in seven patients with severe to profound non-syndromic hearing loss caused by CDH23 mutations who were scheduled for cochlear implantation. Vestibular assessment included caloric testing, ACS-cVEMP, BCV-oVEMP, and damped rotation testing, depending on age. Results Six patients had homozygous missense mutations, and one had compound heterozygous mutations in CDH23. Caloric testing revealed unilateral reduced responses in two patients (28.6%). Damped rotation testing, performed in four pediatric patients, showed a unilateral reduced response in one patient (25%). ACS-cVEMP demonstrated a unilateral reduced response in one patient (14.3%) and an absent response in another (14.3%). BCV-oVEMP, conducted in three patients, revealed a unilateral absent response in one patient (33.3%). Overall, unilateral vestibular dysfunction was identified in four of seven patients (57.1%). Conclusions and Significance More than half of patients with CDH23-related non-syndromic deafness exhibited unilateral vestibular dysfunction prior to cochlear implantation, suggesting that preoperative vestibular assessment may be clinically relevant in this population.

Advancements in cochlear implant (CI) and hearing aid (HA) technology enabled the combining of acoustic and electric stimulation for bimodal hearing and electro-acoustic stimulation (EAS) among listeners with hearing loss. While some users experience benefits such as enhanced speech or music perception and improved localization, others face interference between CI and HA, potentially leading to HA discontinuation. Our study aims to explore the underlying causes of interference, map existing evidence, and identify potential research gaps. The insights gained on interference will help foresee and mitigate such scenarios, improving speech and music perception in bimodal and EAS users. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines, and it was registered on protocols.io (access online at dx.doi.org/10.17504/protocols.io.dm6gp37xdvzp/v2). Inclusion criteria were peer-reviewed articles written in English and published between 2000 and May 2024, and articles reported adverse performance outcomes with combined CI and HA use in adults or children compared to CI or HA alone. Relevant articles were searched using specific key words and Boolean operators across multiple databases. The final scoping review included 15 articles published across 13 scientific journals. These articles originated from nine countries and underwent narrative analysis to extract insights on interference in combined CI and HA use. The study offers valuable insights into the prevalence, causes, and assessment of interference in the combined use of CI and HA. Our review suggests that bimodal interference is individualized or listener-specific, with various factors affecting the utility of bimodal and EAS. Thus, a mixed-methods approach should be implemented in the future to gain a more comprehensive understanding of interference. Customized strategies can also be explored and applied to reduce interference through HA programming, CI mapping, counseling, and training to enhance the benefits for bimodal and EAS users.

Objective: To evaluate whether early cochlear implant (CI) use can significantly and positively change hearing and speech abilities during a child’s development.Methods: The present study included 42 children with bilateral CIs (8–36 months) and 40 age-matched children with normal hearing (NH) (6–48 months). Ages & Stages Questionnaires, Third Edition (ASQ-3); Categories of Auditory Performance (CAP); Speech Intelligibility Rate (SIR) were used.Results: Twelve months after receiving bilateral CIs, the hearing status of the infants (1–12 months) and toddlers (13–36 months) had improved significantly. Infants using CIs were comparable to those with NH in all ASQ-3 aspects (p > 0.05). For toddlers, there was a post-implantation improvement in the gross motor, problem solving, and personal social domains (p > 0.05). However, there were still gaps in the communication domain (p < 0.001). Multivariate analysis revealed that pre-implantation hearing aid usage duration, schooling, SIR score, communication, and caregiver education level significantly influenced post implantation outcomes.Conclusions: With CI use, infants and toddlers with congenital sensorineural hearing loss showed improvements in auditory perception, speech production, and developmental abilities. Infant implant recipients performed better in all areas of development than toddlers, comparable to with NH children. Hearing aid use, language rehabilitation training, caregivers’ education level, and communication method were all highly correlated with the overall development of the children.

An Adult Cochlear Implant Aural Rehabilitation Special Interest Group was formed in 2023. Members represent interdisciplinary collaborators, including audiologists, speech-language pathologists, surgeons, nonclinical administrators, manufacturer/industry representatives, and researchers. Current perspectives of adult cochlear implant (CI) recipients regarding aural rehabilitation (AR) remain unknown and understudied. The aim of this study is to survey adult CI recipients to determine their perspectives on the AR process. A web-based national survey was sent to adult CI recipients through multiple channels. The survey asked recipients about their demographics, state of residence, hearing loss history, and device configuration. Questions probed recipients' experiences of learning about AR options, services used, definitions of AR, and perceived value of services received. Questions were also asked about barriers to AR services, preoperative counseling, and satisfaction with their decision to pursue a CI. A total of 115 CI recipients responded to the survey. Results revealed a relative lack of information provided to many CI recipients regarding AR services. Many CI recipients reported wishing they had received additional resources in the areas of music training and equipment troubleshooting. Most participants reported that both one-on-one clinician-guided AR and independent listening practice were effective methods of AR. Findings shed light on current gaps in providing the most effective AR services, which will need to be addressed to optimize hearing health care and outcomes for adult CI recipients. Future work should include outreach to a broader representation of CI users to expand our understanding of AR resources, education, and limitations.

BackgroundMumps, a viral infection from the Paramyxoviridae family, is a rare but significant cause of sensorineural hearing loss (SNHL), especially in children. While typically unilateral, mumps-induced SNHL can result in profound single-sided deafness, for which cochlear implantation may be considered when hearing aids are ineffective. This study aimed to evaluate outcomes of cochlear implantation in patients with single-sided deafness caused by mumps.Material/MethodsThis retrospective study included 14 patients (10 women, 4 men; mean age 39.4) with single-sided deafness caused by mumps. Inclusion criteria included a hearing threshold ≥90 dB and no benefit from hearing aids. Audiometric evaluations and speech discrimination tests were conducted preoperatively and 12 months postoperatively. Surgical procedures followed the 6-step Skarżyński method with a round window approach.ResultsImplants were successfully placed in all patients, with full electrode insertion achieved in 92.9% of cases. The mean time from hearing loss to implantation was 28.1 years. Postoperative speech discrimination improved significantly: from 0–10% preoperatively to 48.9% word-recognition score without and 66.8% word-recognition score with an active processor. Hearing preservation was achieved in 11 out of 12 evaluable patients, with partial preservation in 58% and minimal in 33%.ConclusionsCochlear implantation in patients with mumps-induced single-sided deafness provides substantial auditory benefits, particularly in speech perception. Favorable surgical outcomes were achieved even in cases with cochlear ossification. Given the scarcity of evidence specific to this etiology, the present findings underscore the effectiveness of cochlear implantation and warrant further validation through large-scale, prospective investigations.

Objective To compare replacement hearing aids (HA) with a cochlear implant (CI) and a HA in the bimodal solution using the Signal to Noise Ratio (SNR) at 70% correct Speech Reception Threshold (SRT70) measured with the Hearing in Noise Test (HINT), Word Recognition Scores (WRS) in quiet and noise and patient reported outcome using Speech Spatial and Quality (SSQ-12) questionnaire. Design/Study Sample Prospective randomised controlled trial between bimodal use and continuous HA use for additional three months. Study Sample Sixty-three CI candidates (mean age: 63.4, range: 23–83 years) with asymmetric hearing loss (AHL) fulfilling CI candidacy criteria on one ear. Results No difference was found between the original and new replacement HAs after one month. However, comparing the bimodal solution with new replacement HAs mean SRT70 improved by −10.26 dB SNR (95%CI:−15.38;−5.13), WRS in quiet by 18.56% (95%CI:9.48;27.64), WRS in noise by 18.18% (95%CI:8.84;27.53), and SSQ12 total scores improved by 2.67 scale points (95%CI:1.81;3.53). Conclusion Extended use of HAs offers no additional benefit; CI surgery can proceed once one month of acclimatisation is achieved as the addition of a CI outperforms new replacement HAs in CI candidates with AHL.

Adult cochlear implant (CI) users display enormous variability in both speech recognition (SR) and quality of life (QOL) outcomes. Traditional demographic and audiologic factors together explain <40% of outcome variability. Moreover, SR and QOL are only weakly correlated. This study used a supervised machine-learning approach to develop patient profiles to explain both SR and QOL outcomes in CI users. Prospective cohort study. Single-institution, tertiary care center. Forty-nine experienced adult CI users. Supervised machine learning to identify patient profiles discriminating outcome groups. SR was measured using the Perceptually Robust English Sentence Test Open-Set (PRESTO). QOL was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ). Participants were median-split based on PRESTO and NCIQ scores, resulting in 4 outcome groups: High-SR/High-QOL, Low-SR/Low-QOL, High-SR/Low-QOL, and Low-SR/High-QOL. Demographic, auditory, and cognitive-linguistic assessments were collected to define profiles for the 4 outcome groups. The 4 outcome groups demonstrated different factor profiles. Notably, the factors that most strongly distinguished the groups included duration of hearing loss, age at onset of hearing loss, speed of phonological and lexical processing, working memory, and nonverbal reasoning. A battery of assessments can help characterize the profiles of CI users who experience favorable SR and QOL outcomes versus those who do not. This type of profiling analysis provides a potential tool for identifying individuals who are at high risk for experiencing poor SR and/or QOL outcomes, and those who may benefit from more specific counseling or rehabilitation.

Objective Speech understanding outcomes after cochlear implantation (CI) exhibit considerable variability. Speech understanding is a bi-modal and bi-directional process, involving also visual and cognitive functions. Therefore, follow-up for CI candidates should consider a broader range of factors beyond auditory factors. The current study aimed to evaluate the auditory, visual, and cognitive abilities of adults with a severe-to-profound hearing loss before and after implantation. Design and Study sample Twenty-six CI-candidates were assessed before implantation, and at three, six, and twelve months post-implantation. The auditory abilities were evaluated using pure-tone audiometry, speech audiometry in quiet and in noise. For assessing the (audio-)visual speech processing abilities the Test for (Audio-) Visual Speech Perception (TAUVIS) was used. The cognitive tests included the Letter-number sequencing task, the Letter Detection Test, and an auditory Stroop test. Linear Mixed Models were used to investigate the effect of test moment statistically. Results Findings show improvement in auditory, visual, and cognitive abilities post-implantation, with the most significant gains observed at three months post-implantation. Conclusions This study underscores the importance of evaluating CI outcomes comprehensively, considering auditory, visual, and cognitive abilities involved in speech understanding. These results could provide useful information for the counselling and rehabilitation before and after implantation.

An increasing number of children and adultswho are deaf are receiving cochlear implants in both ears (bilateral CIs or BiCIs), promoting the possibility of access to binaural cues. However, their effectiveness remains limited, as they do not adequately restore key acoustic cues for sound localization, particularly interaural time differences (ITDs) at low frequencies. The cochlea, the auditory sensory organ, typically transmits information for encoding ITDs more effectively at the apical region, which is specifically "tuned" to low frequencies. However, sensitivity to electrically-stimulated ITDs does not necessarily follow the non-implanted anatomy. We hypothesized that effective restoration of robust ITD perception through electrical stimulation with BiCIs depends on targeting cochlear locations that transmit information most effectively. We created a personalized sound-coding strategy that delivered ITDs to each participant's single "best" cochlear location. We then evaluated the spatial hearing of 14 BiCI listeners using this "Best" strategy and compared it with three control strategies. Here, we show an improvement in perception of ITDs with a tone stimulus with the "Best" strategy. However, this benefit does not seem to translate to speech stimuli. This suggests that restoration of ITD sensitivity requires targeting more than one good cochlear location for redundancy when it comes to more complex sounds such as speech.

ABSTRACT Objectives To evaluate the clinical impact of anatomy‐based fitting (ABF) in cochlear implants for patients with asymmetric hearing loss. Study Design Prospective cohort study. Setting Tertiary referral center specializing in hearing disorders. Methods Fifteen adult patients with asymmetric severe‐to‐profound sensorineural hearing loss or anacusis in the implanted ear, and residual low‐frequency hearing (≤ 65 dB HL at 125–500 Hz) in the better ear, were enrolled. All underwent cochlear implantation with bimodal rehabilitation (cochlear implant + hearing aid) and completed a 12‐month follow‐up. Cochlear duct length was measured preoperatively using OTOPLAN software to select the appropriate electrode array. Postoperative CT scans were analyzed with OTOPLAN to verify electrode positioning and generate the ABF map. Speech intelligibility in noise was assessed using the Italian Matrix sentence test in three listening conditions, comparing outcomes between the ABF and the default MAESTRO fitting maps. Results No statistically significant differences were found in speech perception scores between ABF and MAESTRO maps across test conditions. However, 86.7% of patients (13/15) preferred the ABF map for daily use, citing improved sound quality and listening comfort. Conclusion ABF, which aligns electrical stimulation with the patient's cochlear tonotopy by individualizing electrode selection and programming, may enhance the subjective auditory experience. While objective speech outcomes were comparable, patient preference strongly favored ABF, supporting its clinical relevance for optimizing cochlear implant performance in bimodal users.

The aim of this study was to evaluate the feasibility of a 3D exoscope system (VITOM 3D, Karl Storz, Tuttlingen, Germany) in comparison with conventional surgical microscopes (SM, hereafter referred to as ‘microscope’) in ear surgery. This paper represents the second part of a two-part publication series. A total of 62 patients were included in the study, with 31 cases assigned to the exoscope group (E+) and 31 to the conventional microscope group (E–). Surgical procedures comprised cochlear implantation (nE+ = 10, nE– = 10), reconstructive middle ear surgery for chronic otitis media with cholesteatoma (COMwC; nE+ = 11, nE– = 11), and without cholesteatoma (COMsC; nE+ = 10, nE– = 10). While the first part of the study focused on objective perioperative parameters, the present part specifically evaluates subjective outcomes as reported by the operating surgeons. These include technical aspects (perceived image quality assessed through a detailed questionnaire), surgical aspects (handling characteristics, mental and physical workload evaluated using the NASA-TLX questionnaire and ergonomic factors assessed using a questionnaire to assess localized musculoskeletal discomfort (LMD)), as well as overall satisfaction. All assessments were completed immediately after each procedure using standardized questionnaires. Additionally, a cluster analysis was performed to identify potential differences between the subgroups. The microscope received significantly better scores regarding image quality. The exoscope achieved comparable ratings for body posture and ergonomic comfort, while handling was rated slightly inferior. NASA-TLX assessments revealed no significant differences in mental or physical workload between the systems. LMD scores indicated overall low musculoskeletal strain, with only the upper back showing slightly higher discomfort in the exoscope group. Cluster analysis demonstrated heterogeneous subgroup patterns without a consistent trend, although cochlear implantation procedures were most frequently associated with less favorable subjective ratings in the exoscope group. Direct comparison of both visualization systems confirmed a slight but significant advantage of the surgical microscope in terms of system operation, visual display, and handling, while ergonomics showed no significant difference Under the conditions evaluated in this study, the investigated exoscope system did not achieve equivalence to a standard microscope across all assessed domains. In particular, limitations in optical performance and handling currently preclude its use as a full substitute for the microscope in routine ear surgery. The present findings apply to the specific system generation evaluated and the study conditions employed. Ongoing technological advancements and further refinement of exoscope systems may enable future generations to achieve equivalence with microscopes and serve as viable alternatives in routine clinical practice Our study involves a clinical trial registered at the ethics committee of the Carl Gustav Carus Faculty of Medicine at the Technische Universität Dresden, with the registration number EK 393102018. This registration reflects our commitment to transparency and adherence to international standards for clinical research.

It is unknown how electrode array position in the cochlea influences long-term hearing preservation for cochlear implant (CI) recipients with preserved low-frequency hearing after surgery. The aim of this study was to evaluate the influence of electrode insertion depth relative to regions of post-operative acoustic hearing and hearing preservation ≥ 1 year after CI activation. A retrospective review of adult CI recipients of a straight electrode array from 2017 to 2022 with functional acoustic hearing preservation (≤ 80 dB HL at 250 Hz) at device activation was performed. Proximity was quantified as the angular insertion depth (AID) of the most apical contact relative to the region of preserved functional acoustic hearing. Positive values indicate placement within the functional acoustic region; negative values indicate placement basal to the functional acoustic region. Low-frequency pure tone average (LFPTA) was queried from the preoperative, device activation, and annual post-activation visits. Stepwise regression analyzed whether proximity, AID, age, biological sex, and pre-operative LFPTA were significant predictors for change in unaided hearing thresholds. One hundred and six CI recipients met inclusion criteria. AID ranged from 330° to 717° (mean 513°, SD 79°). Proximity values ranged from -183° to 442° (mean 35°, SD 110°). None of the reviewed independent variables, including proximity, significantly predicted unaided hearing threshold shifts at the 1-year or the ≥ 3-year visits (p ≥ 0.128). Deeper insertion depths and electrode array placement within the functional acoustic hearing region did not predispose CI recipients to delayed loss of residual hearing.

ObjectivesTo address the gap between artificial intelligence (AI) model development and clinical implementation by developing a machine-learning model to predict cochlear implant (CI) eligibility based on routine hearing tests, while illustrating 3 practical lessons: reformulation for clinical utility, selection of problem-specific metrics, and handling input data variability.Materials and MethodsData were extracted from adult patients who underwent behavioral audiometric and subsequent CI candidacy testing (Arizona Biomedical and Consonant-Nucleus-Consonant tests) at Mayo Clinic between 2011 and 2023. Regression models were initially developed to predict AzBio and CNC scores using features from routine audiograms. Models were then reformulated into binary classification tasks using clinical thresholds (AzBio ≤60%; CNC <50%) and reported sensitivity and positive predictive value (PPV). Input data variability was assessed by analyzing test-retest differences in isophonemes scores.ResultsBinary classification models achieved sensitivity of 90.4% with PPV 80.2% at CNC 50/AzBio 60, outperforming referral heuristics (60/60 and 75/40). Applying the models to 50 700 historical audiograms identified 525 patients at PPV 90% (sensitivity 58%), 396 at PPV 94% (sensitivity 44%), and 1582 at PPV 71% (sensitivity 94%). Variability analyses indicated that attainable precision is bounded by noise in key predictors.ConclusionThis study demonstrates how AI models can be translated into clinically actionable tools by reformulating regression outputs, selecting metrics aligned with clinical priorities, and addressing data variability. These strategies provide a scalable framework for implementing AI in health care and improving decision-making in diverse clinical contexts.

ABSTRACT Objectives To understand the sociodemographic, audiologic, and performance variables that influence participant attrition in long‐term, repeated‐measures clinical research. Methods A retrospective review was completed for adult cochlear implant (CI) recipients who enrolled in an ongoing, repeated‐measures clinical research study investigating outcomes between two mapping procedures. The sample was stratified into those who completed the 12‐month study and those who withdrew prior to the study endpoint. The groups were compared for sociodemographic variables (age at consent, race, ethnicity, biological sex, drive time to the clinic, socioeconomic position, and rurality), cognition, and audiologic variables (device type, ipsilateral and contralateral hearing, device wear‐time, and tonotopic mismatch). Early performance on CNC word recognition was analyzed between groups. Results Of the 118 research participants, the attrition rate for the sample was 21%. Sociodemographic variables were at parity between the completed and withdrawal groups. Of the reviewed audiologic variables, the withdrawal group had poorer low‐frequency acoustic hearing thresholds, was less likely to be electric‐acoustic stimulation users than CI alone users (likely due to unaided thresholds), and had greater tonotopic mismatch. Early CNC word recognition was significantly different between the two groups, with the completed group having better early performance than the withdrawal group. Conclusion The present findings serve as a reminder of the need for reflection on clinical research study attrition patterns and a call for intentionally designed study inclusion criteria and procedures to support enrollment and retention of a representative sample. Level of Evidence 3.

To assess the S-value in pediatric cochlear implant (CI) patients using high-resolution CT images and examine its correlation with main cochlear parameters and angular insertion depth (AID). A retrospective review of preoperative CT images from pediatric CI recipients with normal cochlear anatomy was conducted at a referral hearing implant center. Cases involving congenital or acquired inner-ear abnormalities were excluded. Two independent reviewers with equivalent expertise used OTOPLAN to measure the main cochlear parameters, and the interrater reliability study revealed good agreement. S-values (the straight section of the cochlear basal turn) were measured and examined, and their correlation to electrode insertion angles and cochlear parameters (A- and B-values) was evaluated. The average cochlear duct length (CDL) of the included patients was 36.14 ± 0.26 mm, with an average S-value of 7.06 ± 0.40 mm, insertion angle of 598.20° ± 48.72°, and cochlear coverage of 77.49% ± 0.57. A statistically significant relationship was found between A- and the S-values (r = 0.65, p = 0.004). However, the B-value showed a moderate, non-significant correlation with the S-value (r = 0.43). Furthermore, a consistent negative, but not statistically significant, association was found between the S-value and the angular insertion depths of all electrode contacts(r = -0.28 to - 0.30). The S-value is a dependable anatomical parameter that correlates positively with the A-value. The evaluated lateral-wall array showed consistent insertion depths among patients with similar CDL, even when S-values differed. Further studies are needed to investigate the impact of greater variability in S-values on clinical outcomes and electrode-array position among CI users.

Cornelia de Lange syndrome (CdLS) is a rare congenital multisystem syndrome characterized by a distinctive craniofacial appearance, developmental delay, intellectual disability, limb abnormalities, and hypertrichosis. Hearing loss is one of the common manifestations in CdLS. This study presents a 6-year-old child with CdLS, who exhibited developmental delay, intellectual disability, and displayed autistic features, and experienced challenges during right cochlear implant (CI) surgery at the age of 5 due to inner ear abnormality. After the CI, the sound field hearing test showed minimal response levels of 60-70 dB HL at post-CI 12 months. He obtained scores of 2%, 14%, 16%, and 27% on the PEACH rating scale at pre-CI, post-CI 3 months, post-CI 6 months, and post-CI 12 months, respectively. Nevertheless, for CdLS patients with severe-to-profound hearing loss, CI can offer potential improvements in auditory skills and social connections, even though the benefits may be limited. It remains a viable solution.

Vestibular function is a key component of balance and motor control, together with hearing for spatial orientation. Vestibular impairment is often present in case of childhood deafness, which is frequently resolved with cochlear implant (CI). With this study, we aimed to explore (1) the relation between balance, physical activity and vestibular function in teenagers and young adults since infancy (TAYACI), (2) the influence on balance with CI on vs. off, and (3) balance tests’ possibility to screen vestibular impairment in paediatric standard care. 41 TAYACI, aged 12–22, and 20 normal hearing (NH) peers participated. Vestibular function was assessed with Video Head Impulse Test (vHIT). Balance was tested with the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) balance subtest, Kids Balance Evaluation Systems Test (Kids-BESTest) sections Sensory Orientation and Reactive Postural Responses, and a test of walking 10 m with head turns (10mW). Self-reported questionnaires were used to report experience of balance and physical activity. vHIT ascertained vestibular impairment in 49% of TAYACI; balance was inferior in TAYACI compared to NH with lower scores on BOT2 subtest: mean (sd) 8.3 (4.0) vs. 15.1 (4.0) (p < 0.001), and on Kids-BESTest section Sensory Orientation: median (min, max) 13 (13–15) vs. 15 (15–15) (p < 0.001). Screening properties for vestibular impairment were found for BOT-2 balance subtest (AUC = 0.947; best score cut off: 9/25 – sensitivity: 100%, specificity: 89.7%), and singular items, especially BOT9 (standing on one leg on a balance beam with eyes closed) (AUC = 0.92, best cut off: 2.8/10 seconds – sensitivity:100% specificity:74%). None of the tests could distinguish between subjects with bilateral vestibular impairment or unilateral vestibular impairment, nor between TAYACI and NH with normal vestibular function. The CI activity (on/off) did not affect balance tests. 40% of TAYACI reported inferior balance than NH peers, but they were equally physically active. vestibular impairment is prevalent in TAYACI and represents an important determinant for balance skills. Standing on one leg on a balance beam with eyes closed is an accessible test to screen for vestibular impairment in children. Physical activity was comparable between TAYACI and NH peers. NCT 07079488.

Neurocognitive factors contribute to heterogeneity in cochlear implant (CI) success. This study addresses three gaps: (1) whether long, low-redundancy sentences in quiet vs. short, high-redundancy sentences in noise recruit different cognitive involvement; (2) the methodological conflation of processing speed with inhibition-concentration; (3) the scarcity of tone language evidence in understanding the cognitive-speech relationship. Twenty-five postlingually deafened Mandarin CI users completed long-sentence recognition in quiet (Mandarin Chinese Adaptation of AzBio Sentence, CMnBio) and short-sentence recognition in four-talker babble noise (the BKB Sentences in Noise, BKB-SIN). Auditory input quality was assessed using the Spectral-Temporally Modulated Ripple Test (SMRT). The Shape Trail Test, a pencil-and-line task, was used to assess processing speed (STT-A/B), and inhibition-concentration (STT-B). Because STT-B reflects both processing speed and inhibition-concentration, the latter was isolated using STT-B.A (the residual of STT-B on STT-A). Independent contributions to recognition were assessed with hierarchical regression analyses. SMRT, STT-A, and STT-B showed correlations with both sentence outcomes, whereas STT-B.A correlated solely with BKB-SIN. In regression models controlling for SMRT, STT-A explained significant variance in CMnBio (β = -0.507, p = 0.001) and BKB-SIN (β = -0.371, p = 0.012). STT-B.A contributed only to BKB-SIN (β = -0.318, p = 0.014). Information processing speed shows a general association with sentence recognition in both quiet and noise, whereas inhibition-concentration shows a noise-specific association in Mandarin CI users. This study highlights the importance of methodological distinction separating these two cognitive functions and extends cognition-speech links to tonal languages.

Abstract Background Cochlear implant (CI) is a neuroprosthetic device that enables individuals with severe to profound hearing loss to hear and communicate. Selection of an appropriate CI manufacturer from amongst the three major global CI manufacturers, namely Advanced Bionics, Cochlear Corporation and MED-EL, can be a daunting and high-stakes decision for CI candidates. On this background, the present questionnaire-based, retrospective survey aimed to better understand the parental decision-making process regarding selection of CI manufacturer for their child. It examined the sources of information utilised by parents and the relative importance of the influencing factors in their decision-making. Results The survey incorporated 57 participants in all. It included parents of children who underwent cochlear implantation between January 2022 and January 2025, at the CI centre of a tertiary care hospital in Western India. Parents of children with cochlear deformity and those with cochlear implantation performed under government schemes were excluded from the study. The majority of the parents (68.42%) cited their auditory habilitationist as the most popular source of information when selecting a CI brand. Regardless of the CI manufacture chosen, parents ranked technology as the most important deciding factor while choosing the device. Conclusions Auditory habilitationist, audiologist and ENT Surgeon were the key sources of information for parents selecting CI manufacturer for their child. The majority of the parents prioritised technology and device construction during the selection process. Results of this study highlight the crucial role played by healthcare professionals in providing accurate, comprehensive and technology-focused guidance to support informed parental decision-making when selecting CI manufacturer.

Background: Cochlear implantation represents the paramount intervention for severe-to-profound sensorineural hearing loss. However, device efficacy is fundamentally constrained by retrograde degeneration of spiral ganglion neurons and post-insertional intracochlear fibrosis. This study aimed to quantitatively evaluate the synergistic efficacy of integrating stem cell therapies with cochlear implants to preserve neural architecture and enhance auditory functional outcomes. Methods: A systematic review and meta-analysis were executed following PRISMA guidelines. Comprehensive searches of electronic databases utilized specific Medical Subject Headings targeting biohybrid electrodes, mesenchymal stem cells, and spiral ganglion survival. Inclusion criteria strictly selected controlled in vivo preclinical models and human clinical trials evaluating concurrent stem cell application with implantation. Risk of bias was assessed utilizing SYRCLE and ROBINS-I tools. Random-effects models synthesized Standardized Mean Differences for neural preservation, with subgroup analyses evaluating delivery modalities. Results: Eight pivotal studies met stringent inclusion criteria. Meta-analysis demonstrated a highly significant preservation of spiral ganglion density in stem cell-integrated cohorts compared to implant-alone controls (Pooled Standardized Mean Difference = 2.45; 95% Confidence Interval: 1.54–3.36; p &lt; 0.001). Subgroup analysis revealed that electrode coating yielded superior neuroprotection compared to bolus injections. Electrophysiological data demonstrated significantly lowered Electrically Evoked Auditory Brainstem Response thresholds. Clinical cohorts exhibited stable impedances and rapid improvements in speech perception. Conclusion: Stem cell-integrated cochlear implants orchestrate a potent bio-electronic synergy, modulating neuroinflammation and mitigating neural degeneration primarily through paracrine neurotrophic signaling. This bio-electronic integration represents a transformative paradigm in auditory rehabilitation, maximizing the fidelity of neural stimulation and optimizing clinical outcomes.