Abstract Background: To explore and characterize balance problems in subjects with Ménière’s disease (MD). Methods: A total of 539 people with MD with a mean age of 61.9 years, mean disease history of 15.6 years, and 79.5% females were recruited. The online questionnaire, consisting of 39 questions, including both structured and open-ended questions, focused on symptoms of MD, balance problems, impacts of the complaints, and quality of life (QoL). Results: After hearing loss (58%) and tinnitus (50%), balance problems (44%) were among the most commonly reported MD complaints, even higher than the impact of vertigo (40%). However, only 22% reported that those balance problems made obvious impacts in their daily lives. The most common balance problem that significantly reduced QoL was tripping (34%). Swaying (25%) had a limited impact on QoL,whereas rocking (10%) was less common but caused a significant impact on QoL. Non-defined balance problems were reported at 18%; these were occasional and correlated with vertigo attacks. Older participants had more frequent tripping problems. Younger participants more frequently reported swaying and rocking. Conclusions: Risk factors predicting poor postural control were mostly related to complaints reflecting otolith pathology. Different types of postural problems require different strategies to manage balance control and cope with the disease.

Abstract Background: Schwannomas of the vestibulocochlear nerve are benign, slow-growing tumors, arising from the Schwann cells. When they originate from neural elements within the vestibule or cochlea, they are defined as intralabyrinthine schwannomas (ILSs). Cochlear implant (CI) has been reported as a feasible solution for hearing restoration in these patients. (2) Methods:Two patients with single-sided deafness (SSD) due to sudden sensorineural hearing loss and ipsilateral tinnitus were the cases. MRI detected an ILS. CI was positioned using a standard round window approach without tumor removal. (3) Results: The hearing threshold was 35 dB in one case and 30 dB in the other 6 mo after activation. Speech audiometry with bisillables in quiet was 21% and 27% at 65 dB, and the tinnitus was completely resolved or reduced. In the localization test, a 25.9◦ error azimuth was obtained with CI on, compared to 43.2◦ without CI. The data log reported a daily use of 11 h and 14 h. In order to not decrease the CI’s performance, we decided not to perform tumor exeresis, but only CI surgery to restore functional binaural hearing. (4) Conclusions: These are the sixth and seventh cases in the literature of CI in patients with ILS without any tumor treatment and the first with SSD. Cochlear implant without tumor removal can be a feasible option for restoring binaural hearing without worsening the CI’s performance.

Abstract Usher syndrome (USH) is the most common genetic condition responsible for combined loss of hearing and vision. Balance disorders and bilateral vestibular areflexia are also observed in some cases. The syndrome was first described by Albrecht von Graefe in 1858, but later named by Charles Usher, who presented a large number of cases with hearing loss and retinopathy in 1914. USH has been grouped into three main clinical types: 1, 2, and 3, which are caused by mutations in different genes and are further divided into different subtypes. To date, nine causative genes have been identified and confirmed as responsible for the syndrome when mutated: MYO7A, USH1C, CDH23, PCDH15, and USH1G (SANS) for Usher type 1; USH2A, ADGRV1, and WHRN for Usher type 2; CLRN1 for Usher type 3. USH is inherited in an autosomal recessive pattern. Digenic, bi-allelic, and polygenic forms have also been reported, in addition to dominant or nonsyndromic forms of genetic mutations. This narrative review reports the causative forms, diagnosis, prognosis, epidemiology, rehabilitation, research, and new treatments of USH.

Abstract This study aimed to develop and validate a Japanese version of the Tinnitus Acceptance Questionnaire (TAQ), an instrument that measures the process of intentional acceptance of adverse experiences associated with tinnitus. A total of 125 patients with chronic tinnitus from multiple insti tutions participated in this study. Participants completed the Japanese versions of the TAQ, Tinnitus Handicap Inventory, Valuing Questionnaire, Acceptance and Action Questionnaire-II, and Hos pital Anxiety and Depression Scale. A second TAQ was administered 1–2 weeks later. Because the model fitted poorly in confirmatory factor analysis, exploratory factor analysis was conducted,which yielded a two-factor structure that was divided into forward and reversed item groups. Hy potheses regarding criterion and construct validity were clearly supported. A high Cronbach’s α coefficient value was obtained for the TAQ total score (0.88). The interclass correlation coefficient for test–retest reliability was within the acceptable range (0.95). The results of the exploratory factor analysis were considered to be due to artifacts caused by the characteristics of the Japanese lan guage. The present study confirmed the validity and reliability of the Japanese version of the TAQ in measuring tinnitus-specific receptivity.

Abstract The aim of this study was to compare the reliability of the medial olivocochlear reflex (MOCR) between men and women. The strength of the MOCR was measured in terms of the sup pression of transiently evoked otoacoustic emissions (TEOAEs) by contralateral acoustic stimulation (CAS). The difference between TEOAEs with and without CAS (white noise) was calculated as raw decibel TEOAE suppression as well as normalized TEOAE suppression expressed in percent. In each subject, sets of measurements were performed twice. Reliability was evaluated by calculating the intraclass correlation coefficient, the standard error of measurement, and the minimum detectable change (MDC). The study included 40 normally hearing subjects (20 men; 20 women). The estimates of MOCR for both genders were similar. Nevertheless, the reliability of the MOCR was poorer in men, with an MDC around twice that of women. This can be only partially attributed to slightly lower signal-to-noise ratios (SNRs) in men, since we used strict procedures calling for high SNRs (around 20 dB on average). Furthermore, even when we compared subgroups with similar SNRs,there was still lower MOCR reliability in men.

Abstract Speech frequency following responses (sFFRs) are increasingly used in translational audi tory research. Statistically-based automated sFFR detection could aid response identification and provide a basis for stopping rules when recording responses in clinical and/or research applica tions. In this brief report, sFFRs were measured from 18 normal hearing adult listeners in quiet and speech-shaped noise. Two statistically-based automated response detection methods, the F-test and Hotelling’s T2 (HT2) test, were compared based on detection accuracy and test time. Similar detection accuracy across statistical tests and conditions was observed, although the HT2 test time was less variable. These findings suggest that automated sFFR detection is robust for responses recorded in quiet and speech-shaped noise using either the F-test or HT2 test. Future studies evaluating test performance with different stimuli and maskers are warranted to determine if the interchangeability of test performance extends to these conditions.

Abstract Stationary visual targets often become far more salient when they move against an otherwise static background–the so-called “pop out” effect. In two experiments conducted over loudspeakers, we tested for a similar pop-out effect in the auditory domain. Tone-in-noise and noise-in-noise detection thresholds were measured using a 2-up, 1-down adaptive procedure under conditions where target and masker(s) were presented from the same or different locations and when the target was stationary or moved via amplitude-panning. In the first experiment, target tones of 0.5 kHz and 4 kHz were tested, maskers (2–4, depending on the condition) were independent Gaussian noises, and all stimuli were 500-ms duration. In the second experiment, a single pink noise masker (0.3–12 kHz) was presented with a single target at one of four bandwidths (0.3–0.6 kHz, 3–6 kHz, 6–12 kHz, 0.3–12 kHz) under conditions where target and masker were presented from the same or different locations and where the target moved or not. The results of both experiments failed to show a decrease in detection thresholds resulting from movement of the target.

Abstract In most cases, cochlear implantation is a straightforward procedure. Nevertheless, there are clinical situations in which the presence of the middle ear may compromise access and/or the outcome in terms of complications. This article includes a series of patients for whom we eliminated the middle ear to facilitate placement of the electrode array of the implant and/or reduce potential complications. A total of 92 cases in 83 patients, managed by the senior author, are included in this series. Different indications are outlined that justify associating a subtotal petrosectomy technique with cochlear implantation. The steps of the technique are described. We include complications from this series that compare favorably with standard techniques.

Abstract The aim of this study was to evaluate the vestibulo-ocular reflex (VOR) gain and the saccade regrouping pattern PR score of the Video Head Impulse Test (vHIT) and its relationship with the slow-phase velocity (SPV) of skull vibration-induced nystagmus (SVIN) in recovery after a unilateral vestibular loss (UVL). A total of 36 patients suffering from vestibular neuritis (VN) were recruited and followed up for twelve months. In every visit, horizontal vHIT and an SVIN were performed, as well as VOR gain; PR score and the SPV of SVIN were measured. We observed a positive association between the VOR gain difference and the SPV of SVIN over time (probability greater than 0.86). Additionally, we obtained a positive association between the SPV of SVIN and the PR score in successive visits (odds ratio (OR) = −0.048; CI [0.898, 1.01]), with a probability of 0.95.Our results confirm that SPV of SVIN; VOR gain difference; and PR score decrease over time after a UVL. Both tests are useful in the follow-up of VN, as they could reflect its clinical compensation or partial recovery.

Abstract Background: Despite clinical practice utilizing the Dumas test (SVINT), some questions remain unanswered, including the age-related changes in frequency (FN) and slow-phase angular velocity (SPAV). This study aims to retrospectively evaluate their variations in subjects affected by unilateral peripheral vestibular loss (UPVL). Methods: We evaluated the selected samples based on the results of the SVINT, the results of the vestibular-evoked potentials (C-VEMP and O-VEMP), and the results of the head impulse test (HIT) and we compared the results against the age of the patients. We calculated the timing between the onset of UPVL and clinical evaluation in days. The presence or absence of VEMP indicated the UPVL severity. UPVL and BPPV patients with spontaneous or pseudo spontaneous nystagmus were compared. Results: Statistical analysis showed changes in the FN and SPAV depending on age and the side of the application of the stimulus. We also observed that, in the UPVL, the severity of the disease modifies the SPAV, but not the frequency. Conclusions: The SVINT is a simple, reliable, and straightforward test that, if evaluated instrumentally, can show significant differences with aging. Further studies need to be performed to refine the clinical significance of the test and clarify its physiological background.

Abstract Older adults with hearing loss have difficulties during conversation with others because an elevated auditory threshold reduces speech intelligibility, especially in noisy environments. Listening and comprehension often become exhausting tasks for hearing-impaired elders, resulting in social isolation and depression. The aim of the present study was to investigate the advantages of hearing aid use in relation to relief from listening-related fatigue, which is still controversial. Participants included a sample of 49 hearing-impaired elders affected by presbycusis for whom hearing aids were prescribed. The Modified Fatigue Impact Scale was used to assess cognitive, physical and psychosocial fatigue. The vitality subscale of the Short Form Health Survey 36 and a single item of the multi-dimensional Speech, Spatial and Quality Hearing Scale (“Do you have to put a lot of effort to hear what is being said in conversation with others?”) were also used. The Cognitive Failures Questionnaire was used to investigate daily errors related to lack of memory and reduced mindedness. Hearing aids rehabilitation resulted in improved speech intelligibility in competing noise, and a significant reduction in cognitive and psychosocial fatigue and listening effort in conversation. Vitality was also improved and a significant reduction in the Cognitive Failures Questionnaire scores was observed. Findings from the study indicate that the use of hearing aids in older impaired listeners provide them not only with an increased auditory function but also with a reduction in listening-related fatigue and mindedness.

Abstract Paroxysmal positional vertigo is a frequent cause for consultation. When approaching these patients, we try to differentiate central from peripheral causes, but sometimes we find manifestations that generate diagnostic doubts. In this review, we address atypical paroxysmal positional vertigo, reviewing the literature on the subject and giving a provisional definition of atypical positional vertigo as well as outlining its causes and pathophysiological mechanisms.

Abstract Objectives: (1) To analyze the preferential pathways of sound transmission and sound waves travelling properties in the skull and (2) to identify the location(s) on the skull where bone conduction to the cochlea is optimal. Study design: Basic research Methods: Nine cadaveric heads were placed in an anechoic chamber and equipped with six Bone Anchored Hearing Aids (BAHA™) implants (Cochlear™, Sydney, NSW, Australia) and fifteen accelerometers. A laser velocimeter was used to measure cochlear response by placing a reflector on the round window. Different frequency sweeps were applied to each implant, and measurements were recorded simultaneously by the laser velocimeter and accelerometers. Results: Low-frequency sound waves mostly travel the frontal transmission pathways, and there is no clear predominant pattern for the high frequencies. The mean inter-aural time lag is 0.1 ms. Optimal sound transmission to the cochlea occurs between 1000 and 2500 Hz with a contralateral 5 to 10 dB attenuation. The implant location does not influence mean transmission to the cochlea. Conclusion: There is a pattern of transmission for low frequencies through a frontal pathway but none for high frequencies. We were also able to demonstrate that the localization of the BAHA™ implant on the skull had no significant impact on the sound transmission, either ipsi or contralaterally.

Abstract Ethical standards in audiology have been continuously improved and discussed, leading to the elaboration of specific regulatory guidelines for the profession. However, in the field of auditory rehabilitation, audiologists are still faced with circumstances that question their ethical principles, usually associated with the support of the hearing aids industry. The study explores the decision-making process and ethical concerns in auditory rehabilitation as they relate to the practice of audiology in Portugal. An online questionnaire constructed by the authors was used and sent to the email addresses of a list of audiologists, registered with the Portuguese Association of Audiologists. The questionnaire was answered by 93 audiologists with clinical experience in auditory rehabilitation for more than one year. The collected data demonstrated that audiometric results and clinical experience are the most important factors for decision-making in auditory rehabilitation practice. Moreover, incentives from the employers or manufacturers were identified as the main cause of ethical dilemmas. This study highlights the ethical concerns regarding the clinical practice of auditory rehabilitation in Portugal, revealing that the decision-making process is complex and, specifically in this field, the current practice may not be adequate for effective compliance with professional ethical standards.