This paper evaluates the current performance of hearing aids, based on research findings and my experiences with hearing aids. The type of acoustic coupling to the ear is important. The fitting can be "closed" (sealing the ear canal), but this can lead to the occlusion effect; the user's own voice sounds too loud or too boomy. Alternatively, the fitting can be open (the eartip has a vent). This alleviates the occlusion effect, but it introduces comb-filtering (heard as perceptual coloration) and leads to little or no gain at low frequencies. Also, the highest frequency at which useful gain can be achieved is often about 5kHz, which is lower than optimal. While acoustic feedback cancellation systems have improved markedly, they can still introduce artifacts and impair sound quality, especially for music. Hearing aids use multi-channel amplitude compression to compensate for the reduced dynamic range of hearing-impaired people, but they often fail to restore the audibility of soft sounds, especially at high frequencies, and the amount of compression is often limited (and less than indicated by the manufacturers' fitting software), leading to loudness discomfort (and sometimes reduced speech intelligibility) at high sound levels. Also, compression systems introduce cross-modulation, impairing sound quality. Most hearing aids incorporate directional processing and noise-reduction systems intended to improve the ability to understand speech in noisy situations. These systems can be effective with a closed fitting, but much of the benefit is lost with an open fitting because of leakage of background sounds through the vent.

Hearing loss (HL) is a prevalent condition that can substantially impact quality of life. Hearing aids can benefit people living with HL, yet many delay seeking treatment. This may be due to limited public awareness of HL and the stigma surrounding HL and hearing aids. The media can significantly shape public perceptions of HL and D/deafness, and there have been calls for improved media portrayals of HL and D/deafness. This study examined how British newspapers represent HL and D/deafness both visually and textually, and whether these representations reiterate and/or challenge stigma. This qualitative study used multimodal critical discourse analysis (MCDA) guided by stigma theory and the Visual Discourses of Disability framework. Public contributors living with HL or D/deafness were consulted. A Nexis database search retrieved 7,173 articles about HL or D/deafness from 2022-2023. A random sample, extracted from the 200 most relevant articles, was screened. Three key themes were identified: (1) representing social progress, including technological advancements and societal roles for people with HL or D/deaf people, (2) the lack of diverse narratives and perspectives, including the absence of older adults, and (3) the stigma and social barriers associated with living in a hearing-orientated world, including tensions regarding whether HL should be (in)visible. Combined, this suggests that the overall social progress narrative is challenged by continued stigmatisation and inadequate diversity. This research was a novel application of MCDA to representations of HL and D/deafness, which focused on British newspapers. Further efforts are needed to improve these representations, particularly representations of older adults. Future research should apply MCDA to representations of HL and D/deafness in other contexts. The findings have important implications for academics in discourse and disability studies, and for all those who communicate with the public about hearing loss, including researchers, clinicians, public health officials, charities, and the media.

Hearing loss is a risk factor of cognitive decline and dementia. We sought to investigate the effect of hearing aid (HA) use on cognition and dementia risk in older adults with hearing impairment. We emulated a target trial using data from Australian participants of the ASPirin in Reducing Events in the Elderly study. In the target trial, eligible participants were dementia-free, had moderate hearing impairment, and had no previous HA use. The treatment strategies were "use HAs" and "do not use HAs." Outcomes included overall cognition, dementia (DSM-IV criteria), and cognitive impairment (cognitive decline or dementia). The emulation used new HA prescription and frequency-of-use data measured by questionnaire, as well as cognition data from semiannual assessments over 7 years. Self-reported hearing problems were used as a proxy for moderate hearing impairment. Using the parametric g-formula, we estimated observational analogs of the intention-to-treat effect, using HA prescription to emulate allocation. Analyses for cognition outcomes were restricted to survivors. Multiple imputation was used for missing covariate and cognitive outcome data. We also emulated a second target trial with treatment strategies of (1) never, (2) rarely/sometimes, and (3) often/always use HAs. Across imputed data sets, a median of 2,777 eligible individuals were included, with a median of 664 receiving a new HA prescription. The mean age was 75 years, and 48% were female. The estimated 7-year mean overall cognition scores among survivors were similar under HA prescription and no HA prescription (mean difference 0.03 SDs; 95% CI -0.14 to 0.21). The estimated 7-year risk of dementia was 5.0% under HA prescription and 7.5% under no HA prescription (risk ratio [RR] 0.67; 95% CI 0.37-0.97), and that of cognitive impairment was 36.1% under HA prescription and 42.4% under no HA prescription (RR 0.85; 95% CI 0.70-1.00). The risks of dementia and cognitive impairment were inversely associated with the frequency of HA use. We found that HA use in older people with hearing impairment may reduce dementia risk, although differences in age-related cognitive change were insubstantial. We cannot rule out residual confounding as an explanation for our findings. Long-term randomized trials of HAs for dementia risk are justified. This study provides Class III evidence that the use of hearing aids did not change overall cognitive scores in people 70 years and older with moderate hearing impairment as compared to those who used hearing aids.

Speech-evoked envelope following responses (EFRs) are a promising objective metric to assess aided access to speech. However, most studies have used unilateral stimulation and therefore do not reflect typical everyday listening, which is usually bilateral. The purpose of this study was to investigate: (i) the benefits of bilateral over unilateral stimulation in terms of increased EFR amplitudes, and (ii) the influence of clinically relevant interaural asymmetries, including relatively large interaural time and level differences (ITDs, ILDs) potentially caused by unilateral hearing aid fitting and asymmetry in hearing thresholds, respectively. In 42 adults with normal hearing, EFRs were elicited by male-spoken tokens /sashi/ or /sa/. The tokens enabled eliciting multiple EFRs, one at the fundamental frequency (f0) of voice (f0 EFRs; typically at ~80 to 100 Hz) by low, mid and high frequency phoneme bands, and one by the syllabic structure (slow-rate EFRs; <8 Hz). To evaluate the benefit of bilateral over unilateral stimulation, stimuli were presented bilaterally and unilaterally at 65, 50, 35, and 15 dB SPL. To evaluate the effect of ILDs, the stimulus in the right ear was held constant at 65 dB SPL whilst the stimulus in the left ear was lowered to create ILDs of 15, 30, and 50 dB. To evaluate the effect of ITD, the stimulus was delayed by 5.6 msec in the left relative to the right ear to simulate a left unilateral hearing aid fitting. EFRs were measured with a non-inverting electrode at the vertex and an inverting electrode at the nape. Between 35 and 65 dB SPL, bilateral f0 EFR amplitudes were 80 to 127% larger than their unilateral counterparts. Relatively smaller (20 to 46%) increases in amplitude were evident for the slow-rate EFRs. Detection rates improved mainly at lower levels, increasing by up to 50% and 15% in bilateral relative to unilateral conditions for f0 and slow-rate EFRs, respectively. The large 5.6-msec ITD attenuated f0 EFR amplitudes significantly, but had no significant effect on the slow-rate EFRs. ILD reduced f0 and slow-rate EFR amplitudes, but had no noticeable impact on detection rates. When stimuli were audible in both ears (ILD < 30 dB), the bilateral f0 and slow-rate EFR amplitudes were slightly smaller than the sum of their unilateral counterparts, suggesting the presence of binaural interactions. The ratio of the bilateral to the unilateral sum of response amplitudes was 88 to 93% and 62 to 73% for the f0 and slow-rate EFRs, respectively. The significant bilateral advantage in f0 and slow-rate EFR amplitudes, especially for stimuli closer to hearing thresholds, encourages the use of bilateral stimulation where appropriate. While a large 5.6 msec ITD-such as those introduced by a unilateral hearing aid-reduced f0 EFR amplitudes, slow-rate EFRs remained unaffected. Thus, unilateral hearing aid fittings in sound field might leverage slow-rate EFRs to prevent false negatives. Bilateral advantages were preserved despite ILDs, provided the better ear had sufficient audibility. This study provides the first evidence of observable binaural interactions in 80 to 100 Hz EFRs.

Speech enhancement aims to improve speech quality and intelligibility in noisy environments and is important in applications such as hearing aids, mobile communications and automatic speech recognition (ASR). This paper shows a structured review of speech enhancement techniques, classified depending on the channel configuration and signal processing framework. Both traditional and modern approaches are discussed, including classical signal processing methods, machine learning techniques, and recent deep learning-based models. Furthermore, common noise types, widely used speech datasets, and standard evaluation metrics for evaluating speech quality and intelligibility are reviewed. Key challenges such as non-stationary noise, data limitations, reverberation, and generalization to unseen noise conditions are highlighted. This review presents the advancements in speech enhancement and discusses the challenges and trends of this field. Valuable insights are provided for researchers, engineers, and practitioners in the area. The findings aid in the selection of suitable techniques for improved speech quality and intelligibility, and we concluded that the trend in speech enhancement has shifted from standard algorithms to deep learning methods that can efficiently learn information regarding speech signals.

Abstract The purpose of the current study is to characterize hearing aid streaming in a group of adolescent hearing aid users. Streaming via Bluetooth technology has been broadly adopted in devices such as hearing aids, for both children and adults; however, most research on the applications and benefits of streaming has only been conducted with adults who are deaf or hard of hearing (DHH). We have a limited knowledge base on how streaming impacts hearing aid use during adolescence or how adolescents who are DHH use streaming with their hearing aids. The results of this prospective research study indicate that adolescents with streaming used their hearing aids more often than peers without streaming, averaging over two additional hours of daily use. Streaming music and videos were the most common situations in which adolescents reported using connectivity, while tracking hearing aid use and using a phone app to troubleshoot hearing aid problems were the least common. While adolescents experienced some technical challenges with streaming, such as connectivity issues, reduced battery life, and compatibility with a limited number of devices, their overall perception of streaming through their hearing aids was extremely positive.

There is extensive research on sound localization performance of blind individuals in laboratory settings. However, less is known about their spatial hearing experiences in more complex everyday environments. This study aims to assess the perceived sound localization abilities in blind individuals in common everyday tasks, which is a critical determinant of confidence and engagement in such tasks (e.g., independent travel). Fifty-eight adults with total or near-total blindness, including 28 with self-reported normal hearing and 30 with self-reported hard of hearing participated in this study. They completed the Dual Sensory Spatial Localization Questionnaire (DS-SLQ), a recently developed instrument that evaluates perceived difficulty in everyday localization tasks using vision and hearing. Properties of the DS-SLQ for blind individuals, including whether its items measure a single attribute (i.e., unidimensionality) and whether item difficulties match blind individuals' perceived abilities (i.e., targeting), were validated using Rasch analysis. Multivariable regression models and correlation analysis evaluated the impacts of the onset of blindness, residual vision, hearing status, onset of hearing loss, use of hearing aids, and echolocation skills on perceived sound localization abilities. The DS-SLQ showed excellent targeting and good unidimentionality for blind individuals. Individuals with later onset of blindness reported significantly lower perceived sound localization abilities. The presence of hearing loss, particularly early onset, was associated with further reductions in perceived sound localization ability. Those who reported higher echolocation skills also reported better perceived sound localization abilities, regardless of their hearing status. Residual vision and use of hearing aids were not associated with perceived sound localization abilities. Beyond frequently studied vision factors, hearing loss and its onset further affect perceived sound localization abilities and the likelihood of an individual being an echolocator. It is critical to consider hearing status in the rehabilitation of blind individuals for maintaining and enhancing spatial localization skills.

Abstract Introduction Hearing aids often appear broken and whether due to the battery or earwax simple fixes can allow patients to hear. This project aimed to improve hearing impaired patients’ experience and healthcare by providing support for hearing aids across Elderly Medicine wards in a large teaching hospital in Leeds. Method A survey evaluated the proportion of patients with non-functional hearing aids, with qualitative questions to evaluate the impact. The first intervention was a toolkit showing how to check if a hearing aid worked, how to fix common issues, to go alongside spare batteries with a QR code link for further information. As a second intervention, teaching sessions were arranged for ward staff to improve knowledge and encourage staff to fix issues. Results 101, 100 and 102 inpatients were surveyed for the baseline data collection, 1st re-audit and 2nd reaudit respectively. 1 in 4 patients had hearing aids with them and the primary outcome measure of ‘Are both hearing aids working’ improved from 56% to 70% to 87% after each intervention. The most common issue found was a flat battery and the prevalence reduced from 5 to 2 to 1. When asked what difference a working hearing aid makes: ‘It makes all the difference, I wouldn’t manage, I don’t want to miss anything,’ with one relative stating ‘I think it’s hugely important, people may just think she’s confused if she can’t hear what you’re saying, when she’s as sharp as a tack in there.’ Conclusion There was a clear improvement in the proportion of working hearing aids after each intervention and feedback from patients reinforced how impactful having a working hearing aid is. This has shown that providing hearing aid support is a practical and meaningful way of improving patient care that can be easily implemented elsewhere.

Objectives To identify in a clinical hearing loss population (i) how, and to what extent, hearing-specific empowerment is associated with demographics (e.g. age, gender, employment), hearing factors, social isolation and loneliness, emotional and mental health, and cognition, and (ii) the impact of hearing aids on hearing-specific empowerment. Design A prospective, cross-sectional study collected data via an online survey (RedCAP). Multiple regression analyses used the 15-item Empowerment Audiology Questionnaire (EmpAQ-15) as the dependent variable. Study sample Adults (n = 693) who attended four audiology clinics or were invited from a research database. Results Across the whole sample, hearing aid use, social satisfaction, emotional and cognitive measures were most highly correlated with the EmpAQ-15. Similar results were seen for a subset of hearing aid users (n = 472), with additional effects seen for both hearing aid use and residual hearing disability. There was no relationship between EmpAQ-15 and measures of mental health, social isolation or loneliness, nor demographic variables. Conclusions Hearing-specific empowerment in adults with hearing loss is predicted by social, emotional, and cognitive measures. Those who wore hearing aids were more empowered than those who did not. Measuring hearing-specific empowerment has potential to provide a holistic patient-centred approach to assessing adults attending audiology clinics.

This study aimed to adapt the Social Participation Restrictions Questionnaire (SPaRQ) into Turkish (SPaRQ-T) and assess its validity and reliability for evaluating participation restrictions in adults with hearing loss. A cross-sectional, multicenter study was conducted with 278 individuals with hearing loss who had used hearing aids for at least one year. The adaptation process followed international guidelines, including back-translation and expert evaluation. Rasch analysis, test-retest reliability, and concurrent validity assessments were performed.The SPaRQ-T demonstrated strong internal consistency (Cronbach's α = 0.926 for Social Behaviors and 0.871 for Social Perceptions) and test-retest reliability (ICC = 0.928 and 0.773, respectively). Rasch analysis confirmed the unidimensionality of both subscales and supported good model fit. The SPaRQ-T is a reliable and valid instrument for assessing social participation restrictions in Turkish-speaking adults with hearing loss. It provides a comprehensive evaluation of the social and emotional dimensions of participation and can be used in clinical and research settings.

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.

Hearing impairment, one of the most prevalent sensory disorders, remains a major risk factor for dementia in the aging population. Although interventions such as hearing aids and cochlear implants provide partial benefit, they do not address the underlying pathology of sensorineural hearing loss. Inner ear gene therapy has attracted significant attention as a promising approach; however, its clinical translation requires minimally invasive and controllable methods for gene activation. We previously developed a photoactivatable Cre recombinase (PA-Cre) system for spatiotemporal regulation of gene expression. In this study, we evaluated the feasibility of irradiating the external auditory canal (EAC) and tympanic membrane (TM) as minimally invasive approaches for activating cochlear gene expression. Tyrosine-mutant AAV9/3 vectors (AAV.GTX) encoding PA-Cre and a Cre-dependent reporter (sfGFP-to-tdTomato) were injected via the round window membrane in 9-week-old C57BL/6J mice. Seven days later, light irradiation was applied using three approaches: (1) Direct cochlear irradiation via postauricular access, (2) TM irradiation with a fiber-optic probe, and (3) noninvasive EAC irradiation through the intact TM. Recombination efficiency in inner hair cells (IHCs) was quantified using whole-mount immunohistochemistry. AAV.GTX efficiently transduced IHCs and drove robust sfGFP expression. In the absence of light, tdTomato expression remained minimal (<5%), indicating low basal Cre leak activity. Direct cochlear irradiation produced strong recombination (conversion rate: 88.4 ± 1.5%), confirming the functionality of PA-Cre in the mouse inner ear. TM and EAC irradiation yielded high conversion efficiencies (95.8 ± 1.7% and 97.6 ± 1.2%, respectively), comparable to direct irradiation, while preserving cochlear integrity. These findings indicate that PA-Cre functions effectively in the mouse cochlea with minimal leak activity and that TM and EAC irradiation enable robust, minimally invasive gene activation. This strategy highlights the light-mediated, noninvasive modulation of cochlear gene expression, informing future translational development.

The singing pitch accuracy of children with hearing loss (HL) is typically poor, which may discourage them from singing. Improving this skill is important because it can further impact their cognitive and language development and overall well-being. In children with normal hearing (NH), improving singing pitch accuracy is associated with more musical activities and better language skills. We hypothesized that the singing pitch accuracy of children with HL (1) would be poorer than that of children with NH, (2) would improve more during the music intervention period than during the period without music intervention, (3) would be higher in children who participate in more informal musical activities and (4) would be higher in children who have better semantic verbal fluency performance. The participants were 18 children with HL (age range: 3 to 6 years 10 months; 7 with bilateral cochlear implants, 7 with bilateral hearing aids, 4 with bimodal devices) and 20 children with NH (age range: 2 years 10 months to 6 years 10 months). Children with HL participated in remote or in-person music intervention for 10 weeks. A crossover study design was used, with waiting periods before and after the intervention. Three rounds of measurements were made for each child with HL, before and after each period (at T1, T2, and T3). Children with NH did not participate in the music intervention, and their singing pitch accuracy was measured at a single time point. Children sang the song "Twinkle Twinkle Little Star." A measure of mean note deviation assessed the accuracy of each individually sung note, while a measure of mean interval deviation assessed the accuracy of the relative pitch between two consecutively sung notes (e.g., C4 - F4 = 4th), both averaged across the sung sequence. The average of the "mean note" and "mean interval deviation" was used as a dependent variable in a Linear Mixed Model (LMM). For the semantic verbal fluency task, children listed as many animals as they could in one minute, and the number of correct animal words was calculated. Informal music participation was calculated from a parent-completed questionnaire. The mean of the frequency of these activities/number of correct animal words across T1, T2, and T3 was used in LMM. The singing pitch accuracy of the children with bilateral HL group at baseline (T1) was similar to that of children with NH, and there were no significant effects of intervention versus waiting period on mean note/interval deviation. The LMM showed that (i) the more children with HL participated in informal music activities, the better their singing pitch accuracy (main effect, p = 0.009), and (ii) the better they were at the semantic verbal fluency task, the better their singing pitch accuracy (main effect, p = 0.014). Although a 10-week music intervention did not improve singing pitch accuracy in this study of children with HL, these novel results showed that participation in informal music activities, along with language skills, is an important contributing factor to how accurately children with HL can sing in tune.

Hearing aids, which are primarily designed to improve the intelligibility of speech, can negatively affect the perception and enjoyment of music. This large-scale survey study, conducted between 2016 and 2018, explored hearing aid use and preference behavior in both recorded and live music listening settings, aiming to understand the challenges and strategies used by listeners to improve their experiences, and how these may be affected by level of hearing loss (HL). One thousand five hundred and seven hearing aid users (mean age = 60 years) completed an online survey about their music listening behavior and use of hearing aids. Results showed that whilst hearing aids support engagement in music listening, they also present many issues and overall helpfulness is mixed. The most commonly reported issue was distortion and poor sound quality, particularly in loud or live contexts. The most frequently reported strategy for reducing distortion was to remove hearing aids altogether. Only a third of the sample reported using a music program and effectiveness was mixed, suggesting that manufacturer music programs do not currently provide significant benefits for music listening, and further research into the use, uptake and efficacy of music programs is needed. We call for further research into signal processing strategies for music especially for high sound levels such as live music or concert settings. The positive impact of mindsets supporting proactive behaviors, perseverance, adaptation, and experimentation with different technologies, genres, and listening environments was highlighted, strengthening the evidence base for audiologists to provide music listening guidance in the clinic.

Over-the-counter (OTC) hearing aids have become increasingly accessible, yet limited information exists regarding their online listings and marketing practices. This study evaluated cost, satisfaction ratings, review, volume, readability of product descriptions, and Food and Drug Administration (FDA) clearance status of OTC hearing aid listings on Amazon.com. This cross-sectional, descriptive study analyzed 138 Amazon OTC hearing aid listings. Listing characteristics were extracted, and FDA clearance or registration was verified. Analyses included descriptive data on listing characteristics and nonparametric analysis of key variables: price, FDA-clearance status, device type, and form factor. Readability indices were used to assess the accessibility of product descriptions. Of the 138 listings analyzed, 92 listings (66.7%) identified their product as "OTC hearing aids," while only 37 (26.8%) were verified as FDA-cleared or registered. FDA-cleared/registered devices cost significantly more than non-FDA-cleared devices. Behind-the-ear (BTE) devices had a significantly higher number of reviews compared with in-the-ear (ITE) devices. The readability of product descriptions was advanced, ranging from 11th-grade to college graduate levels. In addition, 52 listings (37.7%) lacked specific marketing for mild-to-moderate hearing loss, and 13 (9.4%) were marketed to those with hearing loss beyond mild-to-moderate. Amazon listings for OTC hearing aids reveal significant inconsistencies in marketing and labeling, including misleading FDA clearance claims and inadequate accessibility of product information. Advanced readability levels and marketing for hearing loss degrees beyond mild-to-moderate further impede consumers' ability to make informed purchasing decisions. These findings highlight the urgent need for stricter regulatory oversight and improved dissemination of accurate, accessible consumer information.

Hearing aids for otitis media with effusion in children: practicality and cost.

Music is a complex auditory stimulus characterized by spectral and temporal elements that is a fundamental part of the human experience across cultures. Music perception and enjoyment are distinct yet related experiences of music that can be assessed using a variety of standardized survey instruments, qualitative interviews, and neuroimaging studies. Hearing loss significantly diminishes music perception and enjoyment, and current hearing devices can only partially restore these qualities. In cochlear implant users especially, technological limitations of devices uniquely compromise their experience of music, but the wide variability in individual outcomes suggests that multiple listener and device-related factors contribute to music perception and enjoyment. Ongoing research into music modification, device programming, and music-based training aim to improve music outcomes in people using hearing devices.

Background Non-implantable bone conduction (BC) hearing systems are well-established for individuals with conductive or mixed hearing loss. Objective To evaluate the audiological performance of two wearing options—an adhesive adapter and headband—worn unilaterally and bilaterally using the same non-implantable BC hearing device Contact Forte (BHM Inc., Grafenschachen, Austria). Material and Methods Fifteen normal hearing adults with simulated bilateral conductive hearing losses participated in the study. Speech understanding in quiet and in noise were measured unaided and with BC devices worn unilaterally, bilaterally, with adhesive adapters, and mounted on headbands. Sound quality was rated using a questionnaire. Results At 50 dB SPL word recognition scores in quiet improved, on average, by 58% (unilateral), and 69% (bilateral) with adhesive adapters and by 65% and 74% with headbands. At 65 dB mean scores were above 95% in all aided conditions. In noise, speech presented speech reception thresholds decreased by 2.3–3.6 dB. With two devices, an additional benefit of 4.4 dB SNR (p<.001) was observed for speech from the side of the second device. Participants favored the bilateral configurations. Conclusion and significance Both wearing options showed comparable improvements in speech understanding. Bilateral fittings led to better speech understanding for one configuration and were favored subjectively.

Hearing aids are the standard intervention for age‑related hearing loss; however, abandonment rates remain high, exposing individuals to the adverse consequences of untreated hearing loss. While prior studies have examined the effects of attitudes on hearing‑aid abandonment, evidence on how attitudes change over time and the factors associated with those changes is limited. Moreover, the impact of attitudinal change on abandonment remains unexplored. Our primary objective was to determine whether changes in attitudes toward hearing loss and hearing aids are associated with social (education level and social support) and clinical/individual factors (hearing self-perception and perceived social pressure). A secondary objective was to determine whether changes in attitudes predict hearing‑aid abandonment. We conducted a prospective longitudinal study of older adults fitted with hearing aids at a public hospital within Chile's public health system. Thirty‑one hearing‑aid users (both sexes) were reassessed 6 years after baseline. Hearing‑aid abandonment was determined by self‑report using a single item from the International Outcome Inventory for Hearing Aids (IOI‑HA). Attitudes toward hearing loss and hearing aids were measured at baseline and follow‑up using the Spanish version of the Attitudes towards Loss of Hearing Questionnaire (S‑ALHQ). Univariable and multivariable linear regression models were fitted to estimate predictors of change in these attitudes. The median S‑ALHQ score increased from 2.34 (25th-75th percentile: 2.05-2.50) at baseline to 2.45 (25th-75th percentile: 2.14-2.86) at follow-up. Multivariate analysis showed that a closer social network (i.e. social support) at baseline significantly predicted changes in attitudes toward hearing loss and hearing aids. Shifting toward negative attitudes was significantly associated with a higher risk of abandoning hearing aids (RR = 2.11; 95% CI, 1.32-3.35; p = 0.002). Additionally, a higher income level was associated with a decreased risk of abandonment (RR = 0.39; 95% CI, 0.21-0.73; p = 0.003). Baseline social support was a significant predictor of changes in attitudes. Moreover, shifts towards more negative attitudes could predict device abandonment. Addressing the variables associated with shifts toward negative attitudes about hearing loss and hearing aids, especially those related to coping strategies, could reduce the number of older adults who abandon their hearing aids.

This study aimed to examine auditory outcomes in young children implanted with active bone conduction implants. Prospective cohort study. A single tertiary referral academic center. Fourteen patients younger than 5 years of age who were implant with a piezoelectric active transcutaneous bone conduction implant (OSI) with a follow-up of at least 1 year. Demographics, surgical techniques, duration of surgery, hospital stay, auditory outcomes, postoperative complications, and device use were collected. After OSI surgery, patients were followed up for 1 week post-surgery, with devices switched on at 3 weeks postoperatively. Surgery and audiology follow-up occurred at 1, 3, 6 months, and 1 year. Perioperative course, surgical complications, aided audiograms, and speech discrimination scores were obtained 6 months and 1 year after implantation. Fourteen children received 18 implants (4 patients received bilateral simultaneous implants). The median implantation age in this study was 4.07 years (IQR=0.875). The indication for implantation was congenital conductive hearing loss (cCHL) due to external auditory canal atresia in 15/18 ears, and congenital single-sided deafness (SSD) in 3/18 ears. No patients experienced serious intraoperative or postoperative complications. For patients with cCHL, there was a significant postoperative improvement in hearing, marked by a median pure-tone average gain of 45 dB. All 14 patients regularly used their sound processors, with a median utility time of 10.6 h/day. There was no decline in the auditory performance in any ear throughout the median follow-up period of 2.36 years. Active transcutaneous piezoelectric bone conduction implants are a safe option for young children and provided significant and stable improvements in auditory function.