Motor skill acquisition is crucial for physical, cognitive, and social development, especially among students with hearing impairments who rely heavily on visual and kinesthetic cues. This study examined the comparative effects of autocratic, democratic, and laissez-faire coaching styles on motor skill acquisition in hearing-impaired male students enrolled in the Diploma in Special Education at Government Degree College of Special Education, Dera Ghazi Khan. A quasi-experimental pre-test & post-test design was employed with 30 purposively selected participants, divided equally into three coaching groups. A standardized motor skill test battery measured performance accuracy, coordination, and technique before and after a 6-week intervention.Descriptive statistics indicated that all groups improved significantly (p < 0.001), with the democratic group achieving the highest gain (Mean = 25.60), followed by autocratic (Mean = 15.30) and laissez-faire (Mean = 9.20). One-way ANOVA confirmed significant differences in post-test scores among the groups (F = 45.62, p < 0.001). Post-hoc Tukey HSD tests revealed that democratic coaching outperformed both autocratic and laissez-faire styles, while autocratic was more effective than laissez-faire.The findings suggest that democratic coaching, which combines structured guidance with active learner participation, is most effective for enhancing motor skills in hearing-impaired students. Autocratic coaching supports immediate skill improvement but limits autonomy, whereas laissez-faire provides minimal gains. These results highlight the importance of inclusive and participatory teaching strategies. Future research should explore larger samples, long-term retention, hybrid coaching approaches, broader age ranges, and motivational outcomes to optimize adapted physical education.

The antiphasic digit-in-noise test has demonstrated the advantages of antiphasic presentation in hearing screening. Inspired by this, this study explores whether incorporating antiphasic stimuli in the Chinese zodiac-in-noise (ZIN) test can enhance its sensitivity to detect hearing loss. Furthermore, this study investigates the relation between the binaural intelligibility level difference (BILD), calculated as the difference between antiphasic and diotic results, and hearing thresholds, and evaluates the potential of BILD as an indicator for hearing loss. Normative data for the antiphasic ZIN test were established based on data from 117 normal-hearing listeners. Subsequently, the performance of the antiphasic ZIN test was evaluated in 195 listeners with varying degrees and types of hearing loss. Participants were classified into four groups based on their audiograms: normal hearing (n = 115), symmetric hearing loss (n = 37), asymmetric hearing loss (n = 14), and unilateral hearing loss (n = 29). BILD was further analyzed to assess its relation with high- and low-frequency hearing thresholds. The antiphasic ZIN test has a cutoff value of -13.7 dB and a reference speech reception threshold of -19.0 ± 3.2 dB. The measurement error, as estimated from the test-retest reliability, was 1.2 dB. Partial correlation analysis controlling for age revealed comparable associations of hearing thresholds across ears with BILD (ρpoorer-antiphasic = 0.65, 95% confidence interval [CI]: 0.54 to 0.74 versus ρpoorer-diotic = 0.43, 95% CI: 0.29 to 0.55). Compared with the diotic ZIN test, the antiphasic ZIN demonstrates higher sensitivity (0.88, 95% CI: 0.78 to 0.93 versus 0.49, 95% CI: 0.38 to 0.60) in detecting hearing loss of >25 dB HL in the poorer ear, with comparable specificity (0.86, 95% CI: 0.79 to 0.91 versus 0.97, 95% CI: 0.93 to 0.99). Compared with high-frequency hearing loss, BILD showed a stronger association with low-frequency hearing loss, with a more pronounced decrease as hearing impairment in the poorer ear worsened. The antiphasic ZIN test demonstrates higher screening sensitivity compared with the diotic ZIN, particularly in detecting asymmetric and unilateral hearing loss. BILD is more sensitive to low-frequency hearing impairments and shows substantial promise as an indicator for hearing loss.

Many aquatic animals have a well-developed sense of hearing as sound is important for communication underwater. However, this trait leaves them susceptible to injury, and physiological and behavioral impacts from exposure to intense or persistent anthropogenic sounds. We provide an overview of the current state of knowledge on the physiological effects of five main sources of anthropogenic sound: marine traffic, seismic exploration, pile driving, other industrial activity and sonar. Our understanding of impacts varies greatly by sound type and taxon, although the studied species do not represent the full taxonomic diversity. Exposure to ship sounds has been best studied in fish and it generally leads to responses along the stress response cascade, while few studies have been conducted on its physiological effect on invertebrates or marine mammals. Effects of exposure to seismic sound show mixed impact across taxa. Pile driving sounds have been shown in captive studies to result in hearing impairment in marine mammals and can cause injury to fishes. Lethal impacts have been documented from naval sonar on marine mammal species. Currently, physiological impacts from other industrial sound sources are poorly documented across taxa. Overall, given the limited number of species examined in sound impact experiments, it is crucial to establish categorizing principles and guidelines and modeled response pathways to improve management strategies, especially as new sound threats continue to emerge in our changing world.

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.

The population distribution of age-related functional impairments (ARFIs) and their associations with mortality and life expectancy (LE) among Chinese adults remain poorly understood. We included 12,906 participants (mean age: 62.6 years) from the China Health and Retirement Longitudinal Study. Visual impairment, hearing impairment, cognitive impairment, sleep disorder, depressive symptoms, and disability in activities of daily living (ADL) were assessed. Cox proportional hazards models were used to estimate the associations of ARFIs with all-cause mortality. Life expectancy at age 50 was estimated by the presence and number of key ARFIs. The six ARFIs exhibit distinct distributions by ages and provinces across China. During the 9-year follow-up, ADL disability, cognitive impairment, and depressive symptoms are independently associated with 64% (95% confidence interval [CI]: 48%-80%), 41% (21%-64%), and 20% (8%-33%) higher risks of mortality, corresponding to LE losses of 4.45, 3.08, and 1.59 years at the age of50years. A greater number of key ARFIs is associated with higher mortality riskin a dose-response manner (hazard ratios [95% CI] vs. none: 1.23 [1.11-1.36] for one, 1.42 [1.26-1.61] for two, and 1.86 [1.47-2.36] for three) and greater LE loss (1.63 [1.35-1.90] years for one, 3.37 [3.02-3.71] for two, and 4.96 [4.22-5.71] for three, with three ARFIsaccounting for 17% of total LE). The study highlights the important roles of co-existing ARFIs in mortality and LE loss. Integrated prevention strategies and management systems for multiple functional impairments are warranted in the context of rapid population aging.

Background. Diagnosis of mild forms of mucopolysaccharidosis (MPS) causes significant difficulties, and its untimely recognition delays pathogenetic therapy initiation. Case description . Girl Ya., was consulted by neurologist at the age of 6 months due to delayed motor development. Umbilical hernia was diagnosed at the age of 1 year, appearance of fine motor disorders, adenoid hypertrophy and hearing impairment were noted at the age of 3 years, elbow and knee stiffness, gait disturbance, fatigue, exertional dyspnea, and corneal opacity — at 4 years, myelopathy of cervical spinal cord with flail hands paraparesis, external hydrocephalus, flexion elbow contractures, varus feet deformity, and bilateral tubotitis were diagnosed in the hospital at the age of 5. She was examined by a geneticist for а first at the age of 8, disease from the MPS group was suspected. Decreasein arylsulfatase B activity (1.8 nM/mg/h) (reference values 42.8–129.8 nM/mg/h) and dermatan sulfate excretion were revealed, thus, MPS, type VI was suspected. Full sequencing of the ARSB gene was performed, no pathogenic or probably pathogenic variants were revealed. Arylsulfatase activity was within the reference values during the next analysis, however dramatic decrease in a-L-iduronidase activity was detected — up to 0.001 μM/L/h (reference values 1–25 μM/L/h). Pathogenic variant c.208C> T (p.Gln70*) was revealed in exon 2 of the IDUA gene, as well as variant of unknown clinical value c.1505G> C (p.Arg502Pro) in exon 10, both in a heterozygous state. The patient was diagnosed with mucopolysaccharidosis, type I (Scheie syndrome). Pathogenetic (enzyme replacement) therapy was initiated, its results were followed-up until the age of 17 years old. Conclusion . Early diagnosis of MPS is crucial for timely pathogenetic treatment initiation, as it can significantly improve the prognosis for mild forms of the disease.

Medicare annual wellness visits (AWVs) are vital for older adults' preventive care, which was transitioned to telehealth modalities during COVID-19. This study examined primary care providers' perceptions of telehealth-delivered AWVs and explored the factors influencing telehealth implementation using the Practical Robust Implementation and Sustainability Model (PRISM). Twenty-five primary care providers from eight clinics within an integrated health system in the Midwestern United States were interviewed. Eligibility required having conducted at least one telehealth AWV for patients aged 65 or older between March 2023 and October 2023. Semi-structured interviews lasting 30-45 min were conducted using purposeful sampling. Topics aligned with PRISM domains were addressed: program (telehealth utilization), recipient (organizational characteristics), external environment, and implementation infrastructure. Data were analyzed using NVivo software, using inductive and deductive thematic coding. Providers described telehealth AWV as flexible, convenient, and efficient. Benefits included shorter visit durations and the ability to observe patients' home environments. Challenges included difficulty conducting cognitive and mobility assessments, limitations in physical exams, and managing patients with hearing or visual impairments without caregiver support. Most providers did not perceive language as a major barrier, particularly for Spanish-speaking patients (Program domain). Providers noted that limited internet, device access, and lack of community technology support, especially in underserved areas, hindered telehealth use. They also emphasized the importance of maintaining reimbursement parity between telehealth and in-person visits (External Environment). Providers reported minimal formal training and inconsistent access to telehealth-equipped rooms, though support from colleagues and workflow adaptations helped address these limitations (Implementation Infrastructure). Staff support, particularly through pre-visit coordination, technical troubleshooting, and patient preparation, was crucial in implementing telehealth (Recipient). This study provided valuable insights into the implementation of telehealth AWVs and underscored the importance of organizational support for sustainable telehealth practices in primary care settings.

This study investigates the relationship between hearing loss and cognitive decline in elderly people living in care facilities in the greater Hanover area. Hearing loss was assessed using pure-tone and speech audiograms, while cognitive decline was assessed using the mini-mental status test (MMST) and the clock-drawing test. Afollow-up examination was carried out on 38participants after 1year. The data suggest atendency toward residents with poorer hearing exhibiting afaster rate of cognitive decline. These results emphasize the importance of treating hearing impairment in elderly care to mitigate cognitive decline and the progression of possible dementia.

Sensory impairments in older adulthood are associated with interpersonal struggles, including communication difficulties and lower relationship satisfaction. Using a sample of 139 older Danish couples (aged 60 years and older), we examined the dyadic associations between sensory impairment (hearing and/or vision), communication satisfaction (with self-presence, own emotional experience, partner's responsiveness, partner's contribution), and relationship satisfaction. Actor-partner-interdependence-modeling showed that husband's greater hearing impairment was associated with wife's lower emotional experience and presence during communication. Conversely, wife's greater vision impairment was associated with husband's lower emotional experience, and lower perceptions of wife's responsiveness and contribution during communications. Moreover, husband's lower satisfaction with wife's responsiveness and contribution during communication was associated with lower relationship satisfaction. For wives, lower satisfaction with their emotional experience and their partner's responsiveness was associated with lower relationship satisfaction. Results contribute to a limited literature that seeks to understand sensory impairment among older adults from a dyadic perspective.

Background: Hearing Loss is a common public health issue among middle aged and elderly individuals, with significant effects on communication, social functioning and quality of life.Hearing loss in elderly patients is one of the commonest health issue now a days in Bangladesh. Noise pollution, Ototoxicity, Genetic predisposition, Metabolic disorders, Otological diseases etc. are contributing more or less for this major health issue. In this study we have tried to analyze the clinical presentation, audiological characteristics and etiological profile of hearing loss in patients presenting after the age of 40. Material and methods: This is a prospective cross- sectional study was conducted at Medical Centre Hospital, Chattogram from January 2023 to July 2024. 150 consecutive patients aged >40 years presenting with a chief complaint of hearing loss underwent detailed history-taking, otoscopic examination, and pure-tone audiometry. HRCT of temporal bone and MRI of brain were done in selected cases to establish the diagnosis of Idiopathic hearing loss. Data on presentation, type, degree, and configuration of hearing loss were analyzed. Data were analyzed using SPSS version 26. Descriptive statistics were presented as means ± standard deviation for ‘continuous variables’ and as numbers and percentages for ‘categorical variables’ Results: The mean age of presentation was 62.4 ± 11.8 years. The most common presenting symptom was difficulty in hearing speech in noise (86.7%) followed by tinnitus (68%) and requiring increased television volume (61.3%). The most frequent type of hearing loss was sensorineural (72%) followed by mixed (18.7%) and conductive (9.3%). Bilateral symmetrical hearing loss was present in 78% of cases. Presbycusis was the leading etiological diagnosis (44.7%) followed by noise-induced hearing loss (20.7%) and chronic otitis media (12.7%). A significant portion of patients (59.3%) never sought medical advice prior to testing. Conclusion: Hearing loss in adults over 40 is predominantly sensorineural, bilateral, and characterized by high-frequency loss. Difficulty understanding speech in noisy environments is the most debilitating symptom. There is a significant gap between the perception and reality of hearing impairment, underscoring the need for proactive screening and counseling in this age group. JCMCTA 2025 ; 36 (2) : 31-34

Association of Brain Atrophy with Subjective and Objective Hearing Assessments in Older Adults.

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.

To design and evaluate an animated educational application to improve oral health among children with hearing impairment. A feasibility pilot pre-post study was conducted over 2 months with 26 children with hearing impairment. The intervention consisted of application-based animations and questionnaires, developed through focus group input. Knowledge changes in children were assessed using a visual questionnaire, while behavioral changes and application satisfaction were evaluated via online questionnaires completed by mothers, both before and after the intervention. Significant improvements were observed in children's overall oral health knowledge and behavior following the intervention (p < 0.05). While individual items were not statistically analyzed, descriptive data indicated positive trends. Children showed increased awareness of healthy food choices, proper brushing and flossing techniques, and the importance of regular dental visits. Mothers reported behavioral changes, including more frequent toothbrushing and flossing, reduced sugary snack consumption, and increased intake of fruits and milk. High satisfaction among mothers reflected strong acceptability and usability of the intervention. This pilot study demonstrates the feasibility and acceptability of using animation-based applications to promote oral health among children with hearing impairments.

Communication challenges are exacerbated by noise, particularly for individuals with hearing impairment who may also have ear occlusion from hearing protection devices in occupational settings. These combined effects on speech production are understudied, despite auditory feedback being crucial for speech motor control and thus effective communication. This paper introduces Hearing-Integrated Bilingual Speech Corpus, a comprehensive database for examining speech production across varying levels of noise, ear occlusion, and hearing thresholds. We recruited 49 participants [19 with at least one frequency at ≥ 20 dB hearing level (dBHL)] who completed sentence reading, sustained vowel production, and picture description tasks. We demonstrate the database's utility by analyzing speech level responses in the sentence-reading task. We investigated all three factors categorically and additionally modeled hearing impairment as a continuous variable using pure-tone average (PTA). Key results showed that ear occlusion led to increased speech level, but the relationship exhibited non-linearity. Additionally, preliminary findings revealed that participants with PTA > 15 dBHL spoke louder overall, and a categorical shift occurs around PTA = 15 dBHL, where individuals with greater hearing impairment became less reactive to noise under high occlusion conditions. The considerable individual variability challenges categorical groupings of all investigated variables and highlights the need for individualized modeling approaches.

Objectives To examine how sensory impairments are associated with loneliness and quality of life (QoL) over time, and to assess the mediating roles of depressive symptoms and activity participation. Method A longitudinal study including 83,459 participants who took part in at least two waves of the Survey of Health, Ageing and Retirement in Europe (2011–2022). Mixed-effects linear regression models were used, adjusting for socio-demographic and health-related factors. Results Sensory impairments were associated with increased loneliness and reduced QoL. For vision impairment (VI), loneliness increased (coef. = 0.13, 95% CI: 0.11; 0.15) and QoL decreased (coef. = −1.01, 95% CI: −1.10; −0.92). Hearing impairment (HI) showed similar patterns (loneliness: 0.11, 95% CI: 0.08; 0.14; QoL: −0.76, 95% CI: −0.88; −0.64), while dual sensory impairment (DSI) showed the strongest associations (loneliness: 0.30, 95% CI: 0.26; 0.33; QoL: −2.18, 95% CI: −2.32; −2.04). Depressive symptoms were the most prominent mediator, while activity participation mediated only the associations with VI and DSI. Associations were strongest for HI and loneliness, and DSI and QoL, in women. Loneliness associations were most pronounced in Northern and Western Europe. Conclusion Addressing depressive symptoms may be key to mitigating loneliness and reduced QoL in older adults with sensory impairments.

To evaluate the efficacy and safety of teprotumumab for the treatment of thyroid eye disease in geriatric patients. This was a multicenter cohort study of patients aged 75 and older, treated between February 2020 and September 2023 across 10 tertiary institutions. Patients were included if they had moderate-to-severe thyroid eye disease and at least 1 infusion of teprotumumab. Efficacy outcome measures included improvement in clinical activity score, proptosis, and Gorman diplopia score. Safety outcome measures included teprotumumab-related adverse event (TAE) incidence, onset, and severity. Fifty patients (40 females, 10 males), average age of 79.2 years, were evaluated. Patients received an average of 6.9 infusions, with 34.0% (17/50) discontinuing treatment due to TAEs. Mean baseline clinical activity score was 4.0 ± 1.6, with a mean reduction of 4.0 ± 1.1. Proptosis improved by ≥2 mm in 86.0% (43/50) of patients, with a mean reduction of 4.24 mm. Of patients with baseline diplopia, 42.9% (18/42) experienced an improvement in Gorman diplopia score. Proptosis regression occurred in 62.5% (15/24) of patients at 2.5 years, and 27.9% (12/43) experienced thyroid eye disease reactivation on average 49.8 weeks posttreatment completion. TAEs were reported by 78.0% (39/50) of patients, with 30% (15/46) experiencing moderate TAEs and 14% (7/50) severe TAEs. The most common TAEs were muscle cramps (42.0%, 21/50), hearing impairment (38.0%, 19/46), and hyperglycemia (36.0%, 18/46). Teprotumumab is effective in reducing clinical activity score and proptosis in geriatric thyroid eye disease patients with short-term follow-up; however, high rates of adverse events, reactivation, and proptosis regression over time warrant extreme caution and selective use in this population.

Impact of dual sensory impairment on dementia: A systematic review and meta-analysis.

To explore prescribers' awareness of medicine-related challenges of older people (≥65 years) with sensory impairment (hearing, visual or dual impaired) and identify the influences on prescribing behaviours for these patient populations. Semistructured interviews were completed online. Primary care-based prescribers in the UK. Independent prescribers working in primary care. Participants were recruited through professional networks and organisations, social media and using snowballing. Purposive sampling was used to ensure variation in roles, practice/organisational settings and geographical location. 15 prescribers participated, including general practitioners (n=6), pharmacists (n=5), nurses (n=3) and one optometrist. Many demonstrated limited awareness of sensory impairment and suggested that outdated patient records contribute to it being easy to overlook. Prescribers underestimated sensory impairment prevalence, with one predicting that only a small proportion of older patients had hearing loss. Formal training on prescribing for older people with sensory impairment was minimal, and most relied on experiential learning. Prescribers employed strategies to support safe prescribing, such as simplifying regimens and selecting lower-risk medications. The prescribers also reported a lack of evidence-based guidelines or resources tailored to these patient populations. Prescribers currently receive minimal training to support their prescribing practices for older people with sensory impairment. Given the increasing prevalence of age-related sensory impairment, evidence-based resources and training are needed to support prescribing for these patient populations.

Objective:To investigate the characteristics and clinical utility of vestibular evoked myogenic potentials （VEMPs） in patients with auditory neuropathy （AN）, and to provide evidence for diagnosis, disease assessment, and treatment of AN. Methods:A total of 86 patients with AN diagnosed according to strict clinical and audiological criteria were included as the case group, and 90 healthy subjects matched for age and gender were selected as the control group. Cervical vestibular evoked myogenic potentials（cVEMP） and ocular vestibular evoked myogenic potentials（oVEMP） were detected in both groups. Parameters such as the elicitation rates, amplitudes, and latencies of VEMPs were compared and analyzed between the two groups. The correlations between VEMP indices and audiological indices such as pure-tone audiometry（PTA） thresholds and speech recognition rates were also explored. Results:The elicitation rates and amplitudes of both cVEMP and oVEMP in the case group were significantly lower than those in the control group, while the latencies and asymmetry ratios（AR） were significantly higher. Additionally, the amplitudes of VEMPs were negatively correlated with the degree of hearing impairment and positively correlated with the speech recognition rate. There were significant differences in VEMP indices at different disease stages. Conclusion:To investigate the characteristics and clinical utility of vestibular evoked myogenic potentials （VEMPs） in patients with AN, and to provide evidence for diagnosis, disease assessment, and treatment of AN.

Effect of hearing impairment on fatigue and annoyance caused by task-irrelevant speech: A working day simulation in an open-plan office