Hearing Aids Research Articles

Esteem® Active Middle Ear Implant versus Conventional Hearing Aids: Long-Term Performance

Introduction: The totally implantable active middle ear implant Esteem® may be considered an effective alternative to conventional hearing aids (cHAs) to manage moderate-to-severe forms of sensorineural hearing loss. This study aimed to provide long-term comparative data of Esteem performances with those achieved by cHA. Methods: From a total of 46 subjects who received unilateral application of Esteem®, and were followed up over the years, ten underwent an audiological assessment that compared the outcomes with those achieved in the contralateral ear by a cHA, considering the initially symmetric auditory thresholds in both ears. Other than pure tone audiometry and speech audiometry in quiet, the assessment was performed by using the adaptive speech in noise, i.e., Matrix test. Results: The mean speech intelligibility in quiet shows in the unaided situation a recognition of 50.7% at 71 dBHL, 71% at 69 dBHL with only contralateral cHA, 92% at 66 dBHL with only Esteem device and 94% at 61 dBHL with Esteem® device and contralateral cHA. The mean speech intelligibility in noise shows in the unaided situation a recognition of 36% at 71 dBHL, 56% at 69 dBHL with only contralateral cHA, 79% at 66 dBHL with only Esteem® device and 84% at 61 dBHL with Esteem® device and contralateral cHA. At Matrix test in the unaided condition, 4 patients reached 50% of intelligibility and the 50% threshold was obtained with a mean sound/noise ratio of +10 dBHL. In the contralaterally aided condition, 10 patients reached a 50% threshold in a condition of mean S/N ratio of +10.6 dBHL. In the Esteem® only and Esteem® plus cHA condition, all patients reached the 50% threshold with a mean S/N ratio of +3.4 dBHL with the Esteem® device and +0.92 dBHL with Esteem® plus a contralateral cHA, with a statistically nonsignificant difference. The mean deviation from the reference value (7.1 dB in the normal hearing population) was 17.1 dBHL, in unaided situation; this condition did not change with only the contralateral cHA (17.6 dBHL), whilst a significant improvement could be identified with only Esteem® device, where the mean deviation was 10.5 dBHL, and mostly with Esteem® device associated with the contralateral cHA, with a value of 8.02 dBHL. Conclusions: The adaptive speech audiometry in noise (Matrix Test) showed that binaural stimulation provides greater benefits in the speech recognition in noise test in comparison to monaural stimulation, especially when this is carried out only by the cHA. However, the Esteem® device allowed to obtain audiological benefits that are significantly superior to those offered by cHAs, especially in cases where the hearing loss is severe and, in some cases, profound, achieving performances almost comparable to those of a cochlear implant.

Assessment of a Hearing Aid Training Program for Health Care Workers

Purpose: The purpose of the present study was to develop and evaluate an in-person hearing aid training program designed for health care workers and personal care aides (PCAs) who care for older adults. Method: Participants were 18 health care workers and PCAs whose clients were older adults. This was a randomized controlled study in which half of the participants were assigned to the experimental group ( n = 9) and the other half to a control group ( n = 9). The experimental group was administered a hearing aid training program that was developed in this study for health care workers and PCAs. Participants in the control group were trained on a task similar in complexity and administration time to the hearing aid training program. The Practical Hearing Aid Skills Test–Revised Version 2 (PHAST-Rv2) was administered before and immediately after training. A 2 × 2 mixed analysis of variance (ANOVA) was used to compare the pre- and post-training scores between and within the experimental and control groups. Descriptive statistics were used to examine the differences between pre- and post-training scores on each of the administered PHAST-Rv2 tasks. In addition, participants were asked about their experience helping clients with their hearing aids. Results: Mean pre- and post-training PHAST-Rv2 scores for the experimental group were 59.50% and 95.84%, respectively, and 57.66% and 59.96%, respectively, for the control group. Results from a 2 × 2 mixed ANOVA with time point (pre- and post-training) as the within-subject variable and group (experimental and control) as the between-subject variable demonstrated that hearing aid training significantly improved PHAST-Rv2 scores for the experimental group. Post-training, the tasks that the experimental group improved on the most were brushing the microphone port, cleaning the dome, placing the hearing aids in the charger, and inserting the hearing aid into the model ear. No demographic variables were significantly correlated with the participants' improvement on the PHAST-Rv2 post-training score. Conclusion: A hearing aid training program designed specifically for health care workers was shown to be an efficient and effective way to improve how well health care workers can care for and operate a hearing aid.

The Problem of the Sexy Cyborg: The Ethics of Cyborg Imagery

In this article, I discuss two popular tropes about the cyborg in speculative fiction visual media: apotheosis — the pinnacle of human form and function; and grotesquerie — the violation of that perfection through fascinating horror. I look at these tropes in service of discussing the effects of such images and cultural understandings on actual cyborgs. The everyday or common cyborgs that are disabled people; the ones with prosthetics, who use wheelchairs, hearing aids, beta blockers, and Ritalin, who have artificial valves, knees, and pacemakers. I argue that the imagery of perfection and horror that surround cyborgs in media reinforce problematic tropes about disabled people, specifically the tropes of the super crip, pity, and bitter cripple narratives, and the ugly is evil trope where physical disfigurements and disabilities are often shorthand for moral failing. I connect these tropes to longstanding beliefs that were foundational to the eugenics movement of the 19th and 20th centuries, and that still cause resistance to robust social services for disabled people.

PTSD Is Associated with Self-Perceived Hearing Handicap: An Evaluation of Comorbidities in Veterans Without Measured Hearing Loss.

Cases of self-reported hearing difficulty despite no traditionally measured hearing loss (pure tone audiometric thresholds ≤ 25 dB HL from 250 Hz through 8000 Hz) have risen with the return of Veterans from recent conflicts in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Auditory outcomes improved despite low compliance among those receiving treatment. Medical chart data appeared more comprehensive for Veterans with, rather than without, auditory complaints. One possibility is that self-reported hearing problems are associated with a subset of these comorbidities, the treatment of which improved auditory outcomes. This study examined the relationships between Veterans' self-reported auditory problems and other diagnosed medical conditions. A retrospective chart review was used. Participants were 286 Veterans, aged 21 to 52 years with pure-tone audiometric thresholds ≤ 25 dB HL at all measured frequencies in both ears. Veterans were dichotomized into a group with either self-reported hearing complaints (n = 143) or an age-matched control group with no auditory complaints (n = 143). A query of the Computerized Patient Record System was performed with the date range restricted to 2009 to 2018. Metrics of self-perceived hearing handicap, auditory processing disorder testing, and hearing aid use were collected. All diagnoses and related symptoms were recorded. A best subsets regression with principled model selection was performed to investigate the role of these comorbidities on self-perceived hearing loss. The self-report group had 16 comorbidities that were classified as prevalent, having occurred in ≥33.3% of the group, compared with the age-matched control group, which had 2 comorbidities. The number of diagnosed medical conditions was associated with self-perceived hearing impairment. Specifically, posttraumatic stress disorder (PTSD) and related symptom clusters constituted the largest group of comorbidities that were significantly associated with self-reported hearing problems. The significant association between PTSD and self-perceived hearing impairment warrants investigations on whether treatment of PTSD would reduce perceived hearing handicap severity. Further, PTSD assessments could be useful for audiologists to identify potential candidates for auditory complaints without measured hearing loss.

Sound therapy in the treotment of tinnitus

Tinnitus is currently a serious problem of rhinolaryngology, leads to a significant decrease in the quality of human life, limits his ability to household, social and professional activities. It has a high prevalence and occurs in 10-15% of the adult population, while in 1-3% of cases a severe form of the disease is observed. There are more than 60 treatments for ear noise in the world. These include drug therapy; physiotherapeutic effects that allow stimulating various parts of the auditory pathway from the hair cells of the cochlea, the nuclei of the brain stem, the medulla oblongata, the temporal gyri of the cerebral cortex; sound therapy, as well as the use of technical means audio maskers, hearing aids, implants. The aim of this review is to highlight the current state of the issue, to analyze the sound-activating methods of rehabilitation of patients with tinnitus proposed in world practice. Such a variety of techniques is due to the polyethological nature of the factors causing tinnitus and the empirical approach to treatment. A significant arsenal of medications and surgical interventions used to treat pathological auditory sensations often turns out to be far from universal and often ineffective. It should be noted that with an increase in the prescription of subjective tinnitus, the effectiveness of drug therapy decreases and, in turn, the importance of rehabilitation therapies increases. Most modern methods of treating this pathology are based on the principles of neuroplasticity the ability of the central nervous system to structurally and functionally reorganize. Recently, much attention has been paid to non-drug treatment methods, including the method of reeducation (sound therapy).

A Novel RNS Hardware Architecture of FRM Filter Banks for Digital Hearing Aids

This paper presents a novel hardware architecture for Frequency Response Masking (FRM) Filter Bank based on Residue Number System (RNS) arithmetic for Digital Hearing Aids (DHA). FRM is a computationally efficient approach for filter bank design that separates different frequencies based on the Audiograms of a patient. However, filter banks are critical power-hungry elements that require high computational resources. Therefore, the proposed architecture aims to provide an efficient implementation of FRM filter banks, which can improve the value and affordability of DHAs. The proposed architecture employs FIR filters in direct form, linear phase, and poly phase using RNS arithmetic. This approach enables the performance of arithmetic operations in parallel and independently. The concepts are further extended for the efficient implementation of FRM filter bank. The results of the proposed architecture show that direct implementation reduces the delay when the number of taps increases in the FIR filter. However, to reduce computational resources and optimize the area requirement, a Folded RNS architecture is also proposed. The Folded RNS architecture offers hardware savings of 23–27% for a 40-tap FIR filter and 29–31% for a 60-tap FIR filter. Additionally, it improves speed by 13–15% for a 40-tap FIR filter and 16–19% for a 60-tap folded RNS FIR filter. The implementation of FRM filter bank using the folded FIR filter shows the same trend in hardware saving and speed improvement as in the case of FIR filters. These results demonstrate that the proposed hardware architecture has the potential to improve the efficiency and affordability of DHAs while enhancing the listening comfort, which can enhance the quality of life for patients with hearing impairments.

Management of Prenatal Expanded Genetic Carrier Screening Results for Autosomal Recessive Sensorineural Hearing Loss

AbstractObjectiveExpanded carrier screening (ECS) identified couples at‐risk to have a baby with an autosomal recessive genetic condition. Several genes implicated in sensorineural hearing loss (SNHL) are included in prenatal or preconception genetics ECS testing. Early identification of SNHL risk may enable prognostication of hearing loss, early educational intervention, and minimization of unnecessary diagnostic testing. We sought to describe cases where ECS enabled early SNHL‐risk identification.Study DesignRetrospective chart review.SettingMaternal‐Fetal Care Center and Otolaryngology department at an academic tertiary hospital.MethodsMedical records of parent‐infant dyads with positive ECS results for variants in autosomal recessive SNHL genes were reviewed. Data regarding genetic diagnostic testing, newborn hearing screening, time to HL diagnosis, audiological evaluation, and clinical consultations were compiled.ResultsFifteen pregnant with positive ECS results for SNHL were referred for consultation with a pediatric otolaryngologist and genetic counselor. Generally, these couples were highly educated and adequately insured. 14 had pathogenic variants for GJB2 and 1 for USH2A. Four couples pursued prenatal genetic diagnosis via amniocentesis; 11 couples deferred genetic testing to the postnatal period or waited for initial hearing evaluation. Six babies inherited biallelic GJB2 mutations. Four were found to have SNHL on ABR by age 5 weeks and received follow‐up management, 1 had a normal hearing evaluation despite being gene‐positive, and 1 was lost to follow‐up before hearing evaluation.ConclusionsCarrier screening and confirmatory prenatal or neonatal genetic testing provided considerable lead time for early audiometric testing and appropriate intervention services including hearing aid fitting.

The Effect of Different Adaptation Formulas on Mid-Latency Auditory Evoked Potentials in Adults with Hearing Aids

Introduction: We were conducting this study to evaluate the effects of different hearing aid adaptation formulas on middle latency responses (MLR) in adult hearing aid users. Methods: The study included 72 participants: those with moderate hearing loss using hearing aids with two different formulas for the last year, those with moderate hearing loss not using hearing aids, and those without hearing loss. Sixteen participants using NAL-NL1 and NAL-RP formulas were Group 1; twenty using NAL-NL2 and DSL formulas were Group 2; fifteen with hearing loss not using devices were Group 3; and twenty-one without hearing loss were Group 4. We obtained and compared MLR responses, including Na latency, Pa latency, and Na-Pa amplitude. Results: Group 1 mean Na-Pa amplitude value was found to be higher than Group 2 (p = 0.001). No significant difference was observed between Group 1 and Group 2 in terms of Na latency and Pa latency values (p = 0.001; p = 0.035). It was observed that the mean Na-Pa amplitude values in Group 1 and Group 2 were higher than Group 3 (p = 0.001), but this elevation reached the level of statistical significance only in Group 1. No difference was observed between Group 1, Group 2, and Group 3 in terms of Na latency and Pa latency values (p = 0.001; p = 0.035). Compared with those without hearing loss (Group 4), participants with hearing loss (Group 1, Group 2, and Group 3) had longer Na latency and Pa latency values (p = 0.001; p = 0.035), and Na-Pa amplitudes were lower (p = 0.001). The effect of current (tested) hearing aid usage time on Na latency, Pa latency, and Na-Pa amplitude values of Group 1 and Group 2 was not observed. In all groups, there was a positive correlation between audiometric airway/bone conduction pure tone averages and speech acquisition threshold values, Na latency and Pa latency values, and a negative correlation between Na-Pa amplitude values. In all groups, there was a negative correlation between speech discrimination scores and Na and Pa latency values, as well as a positive correlation between Na and Pa amplitude values. There was a positive correlation between age and Pa latency values in all groups, as well as a negative correlation between Na and Pa amplitude values. Conclusion: Middle latency responses are affected by the presence of hearing loss, the use of hearing aids, and different hearing aid adaptation formulas. MLR measurements with a hearing aid can be used as an objective test to evaluate the benefit of hearing aid use.

Speech Enhancement Algorithm Based on Microphone Array and Lightweight CRN for Hearing Aid

To address the performance and computational complexity issues in speech enhancement for hearing aids, a speech enhancement algorithm based on a microphone array and a lightweight two-stage convolutional recurrent network (CRN) is proposed. The algorithm consists of two main modules: a beamforming module and a post-filtering module. The beamforming module utilizes directional features and a complex time-frequency long short-term memory (CFT-LSTM) network to extract local representations and perform spatial filtering. The post-filtering module uses analogous encoding and two symmetric decoding structures, with stacked CFT-LSTM blocks in between. It further reduces residual noise and improves filtering performance by passing spatial information through an inter-channel masking module. Experimental results show that this algorithm outperforms existing methods on the generated hearing aid dataset and the CHIME-3 dataset, with fewer parameters and lower model complexity, making it suitable for hearing aid scenarios with limited computational resources.

Analysis of TRIOBP gene in non-syndromic deafness: A case report

Rationale: Through family investigation, the genetic map was drawn and audiological characteristics were analyzed. High-throughput sequencing was used to screen the deafness genes of the proband. Sanger sequencing was used to verify the suspected pathogenic sites in the family. Patient concerns: Identify the causes of hearing loss and treatment options. Diagnoses: Bilateral moderate to severe sensorineural deafness. Interventions: After completing the examination, the patient was recommended to wear a hearing aid or do a cochlear implant, but the patient was not treated for personal reasons. Outcomes: All 8 patients in this family were nonsyndromic deafness. The proband had a compound heterozygous mutation of c.A4484T/c.A4510G in the TRIOBP gene, and the patient II-6 had a heterozygous mutation of c.A4484T in the TRIOBP gene. A complex heterozygous mutation of TRIOBP gene c.A4510G/c.G59T was found in II-7, but no reports of pathogenicity of these mutations were found in relevant literatures and databases. In addition, patients II-6, III-4, and III-6 had heterozygous mutations of CHD7 gene c.T2615C and C.3202-5T >C, and patients II-6 and III-4 also had heterozygous mutations of CHD23 gene c.G5312A and c.C6250T. Lessons: In this study, a new locus of the TRIOBP gene was found, which enriched the gene mutant spectrum and clarified the pathogenic gene of the proband. However, the etiology of deafness in other members of the family needs to be further analyzed.

Sounds of Nature and Hearing Loss: A Call to Action.

The ability to monitor surrounding natural sounds and scenes is important for performing many activities in daily life and for overall well-being. Yet, unlike speech, perception of natural sounds and scenes is relatively understudied in relation to hearing loss, despite the documented restorative health effects. We present data from first-time hearing aid users describing "rediscovered" natural sounds they could now perceive with clarity. These data suggest that hearing loss not only diminishes recognition of natural sounds, but also limits people's awareness of the richness of their environment, thus limiting their connection to it. Little is presently known about the extent hearing aids can restore the perception of abundance, clarity, or intensity of natural sounds. Our call to action outlines specific steps to improve the experience of natural sounds and scenes for people with hearing loss-an overlooked aspect of their quality of life.

Novel bias-reduced coherence measure for EEG-based speech tracking in listeners with hearing impairment

In the literature, auditory attention is explored through neural speech tracking, primarily entailing modeling and analyzing electroencephalography (EEG) responses to natural speech via linear filtering. Our study takes a novel approach, introducing an enhanced coherence estimation technique to assess the strength of neural speech tracking. This enables effective discrimination between attended and ignored speech. To mitigate the impact of colored noise in EEG, we address two biases–overall coherence-level bias and spectral peak-shifting bias. In a listening study involving 32 participants with hearing impairment, tasked with attending to competing talkers in background noise, our coherence-based method effectively discerns EEG representations of attended and ignored speech. We comprehensively analyze frequency bands, individual frequencies, and EEG channels. Frequency bands of importance are shown to be delta, theta and alpha, and the important EEG channels are the central. Lastly, we showcase coherence differences across different noise reduction settings implemented in hearing aids (HAs), underscoring our method's potential to objectively assess auditory attention and enhance HA efficacy.

No hearing aids needed: bats’ ears stay keen well into old age

No hearing aids needed: bats’ ears stay keen well into old age

An Unobtrusive and Lightweight Ear-worn System for Continuous Epileptic Seizure Detection

Epilepsy is one of the most common neurological diseases globally (around 50M people globally). Fortunately, up to 70% of people with epilepsy could live seizure-free if properly diagnosed and treated, and a reliable technique to monitor the onset of seizures could improve the quality of life of patients who are constantly facing the fear of random seizure attacks. The current gold standard, video-EEG (v-EEG), involves attaching over 20 electrodes to the scalp, is costly, requires hospitalization, trained professionals, and is uncomfortable for patients. To address this gap, we developed EarSD , a lightweight and unobtrusive ear-worn system to detect seizure onsets by measuring physiological signals behind the ears. This system can be integrated into earphones, headphones, or hearing aids, providing a convenient solution for continuous monitoring. EarSD is an integrated custom-built sensing - computing - communication ear-worn platform to capture seizure signals, remove the noises caused by motion artifacts and environmental impacts, and stream the collected data wirelessly to the computer/mobile phone nearby. EarSD 's ML algorithm, running on a server, identifies seizure-associated signatures and detects onset events. We evaluated the proposed system in both in-lab and in-hospital experiments at the University of Texas Southwestern Medical Center with epileptic seizure patients, confirming its usability and practicality.

Energy-Aware Register Allocation for VLIW Processors

AbstractThe efficiency of VLIW processors can be improved by reducing the energy consumption associated with accessing the register-file. This paper presents an energy-aware register allocation approach to reduce the dynamic energy consumption of a scheduled program by using an evolutionary algorithm approach and a register access transition energy model. Additionally, the influence of instruction scheduling on energy-aware register allocation is analyzed. By using the proposed energy-aware compiler backend on synthetic applications with random data in the register-file, the dynamic energy consumption of the total processor core for an exemplary VLIW processor can be reduced by up to $$\varvec{21\%}$$ 21 % compared to a heuristic register allocation. In real-world applications from the domain of hearing aids, energy consumption can be reduced by up to $$\varvec{42.7\%}$$ 42.7 % for single applications, and $$\varvec{17.6\%}$$ 17.6 % average across a range of applications.

Sequential auditory grouping reduces binaural pitch fusion in listeners with normal hearing, hearing aids, and cochlear implants

Binaural pitch fusion, the perceptual integration of dichotically presented stimuli that evoke different pitches, can be considered a type of simultaneous grouping. Hence, auditory streaming cues such as temporally flanking stimuli that promote sequential grouping might compete with simultaneous dichotic grouping to reduce binaural fusion. Here, we measured binaural pitch fusion using an auditory streaming task in normal-hearing listeners and hearing-impaired listeners with hearing aids and/or cochlear implants. Fusion ranges, the frequency or electrode ranges over which binaural pitch fusion occurs, were measured in a streaming paradigm using 10 alterations of a dichotic reference/comparison stimulus with a diotic capture stimulus, with fusion indicated by perception of a single stream. Stimuli were pure tones or electric pulse trains depending on the hearing device, with frequency or electrode varied across trials for comparison stimuli. Fusion ranges were also measured for the corresponding isolated stimulus conditions with the same stimulus durations. For all groups, fusion ranges decreased by up to three times in the streaming paradigm compared to the corresponding isolated stimulus paradigm. Hearing-impaired listeners showed greater reductions in fusion than normal-hearing listeners. The findings add further evidence that binaural pitch fusion is moderated by central processes involved in auditory grouping or segregation.

Effects of speech tracking method using hearing aids for hearing disorder in older people.

Speech tracking is defined as a complex act or task of listening in which the learner tracks the speech heard and repeats it as accurately as possible while paying attention to incoming contextual information. This ability involves auditory input, speech output, repetition, and divided attention. In this small-scale study, we aimed to use a speech-tracking method to train older adults with hearing loss and examine its effects on hearing loss from multiple perspectives, including hearing handicap, frailty, and neuropsychological testing. Auditory rehabilitation was provided to older patients who purchased hearing aids at the clinic and wanted to engage in rehabilitation. The Hearing Handicap Inventory for the Elderly, Nursing Home Hearing Handicap Index, speech-tracking rate, Token Test, Communication Activities of Daily Living, Kihon Checklist, Mini-Mental State Examination, Digit Symbol Substitution Test, symbol search, and word recall were used for assessments before and after rehabilitation using the speech-tracking method. Changes in scores of each assessment item and sub-item were examined using Wilcoxon's signed-rank test, and changes per question were examined using the sign test. The speech tracking rate (p<0.001), Token Test score (p<0.001), and Mini-Mental State Examination score (p=0.035) improved significantly after the training. Notably, the speech-tracking rate improved for 31 of the 33 participants, with a maximum increase of 19.6 phrases per minute. The combination of a hearing aid and the speech-tracking method improved auditory comprehension.

Step Length and Gait Speed Estimation Using a Hearing Aid Integrated Accelerometer: A Comparison of Different Algorithms.

Gait is an indicator of a person's health status and abnormal gait patterns are associated with a higher risk of falls, dementia, and mental health disorders. Wearable sensors facilitate long-term assessment of walking in the user's home environment. Earables, wearable sensors that are worn at the ear, are gaining popularity for digital health assessments because they are unobtrusive and can easily be integrated into the user's daily routine, for example, in hearing aids. A comprehensive gait analysis pipeline for an ear-worn accelerometer that includes spatial-temporal parameters is currently not existing. Therefore, we propose and compare three algorithmic approaches to estimate step length and gait speed based on ear-worn accelerometer data: a biomechanical model, feature-based machine learning (ML) models, and a convolutional neural network. We evaluated their performance on a step and walking bout level and compared it with an optical motion capture system. The feature-based ML model achieved the best performance with a precision of 4.8cm on a walking bout level. For gait speed, the machine learning approach achieved an absolute percentage error of 5.4 % ( ± 4.0 %). We find that the ML model is able to estimate step length and gait speed with clinically relevant precision. Furthermore, the model is insensitive to different age groups and sampling rates but sensitive to walking speed. To our knowledge, this work is the first contribution to estimating step length and gait speed using ear-worn accelerometers. Moreover, it lays the foundation for a comprehensive gait analysis framework for ear-worn sensors enabling continuous and long-term monitoring at home.

Middle Ear Malformations

Middle ear malformations (MEMs) represent a diverse group of congenital anomalies with significant implications for auditory function. These malformations, which occur in approximately 0.5 to 3% of conductive hearing loss cases, can arise from various genetic and environmental factors. They often manifest unilaterally and may occur in isolation or as part of a syndromic condition. MEMs are closely associated with abnormalities of the external ear and less frequently with inner ear anomalies.Embryologically, the middle ear develops from the first and second pharyngeal arches, with interactions between the ectoderm and endoderm contributing to the formation of essential structures such as the tympanic membrane, ossicles and Eustachian tube. Disruptions in these developmental processes can lead to a spectrum of MEMs, ranging from minor defects to severe malformations affecting multiple middle ear components.Clinical management of MEMs requires a multidisciplinary approach, involving otolaryngologists, pediatricians, and audiologists. Early intervention with appropriate hearing aids, including conventional hearing aids and bone conduction devices, is essential to mitigate the impact of conductive hearing loss on speech and language development, particularly in children.Surgical planning involves comprehensive preoperative assessment, including high-resolution computed tomography imaging to evaluate middle ear anatomy, the facial nerve course, and vascular anomalies. Traditional surgical approaches such as stapesplasty and tympanoplasty remain mainstays for correcting specific middle ear defects, while advances in technology have expanded the role of active middle ear implants in treating special cases.In conclusion, MEMs represent a heterogeneous group of congenital anomalies with diverse etiologies and clinical implications. A thorough understanding of their embryological basis, genetic underpinnings, and surgical management strategies is crucial for optimizing outcomes in affected individuals.

Age-related hearing loss and "hearables": An agenda for moral considerations.

Rapid advances in digital hearing technologies, also known as hearables, are expected to disrupt the direct-to-consumer health market. For older adults with higher incidence of hearing loss, such disruption could reduce hearing problems, increase accessibility to hearing aids, and mitigate related stigmas. This paper delves into the intersection of disruptive innovation and hearables within the realm of biomedical ethics. Through a comprehensive exploration, we shed light on the ethical implications surrounding hearables. By critically evaluating the key ethical advantages and drawbacks, we find that no single concern presents an insurmountable a priori objection to hearables. We conclude with some ideas to maximize the benefits of hearables and further promote opportunities for equitable hearing health.