Prospective evaluation of hearing aid fitting adjusted toward one-third functional gain in patients with sensorineural hearing loss.

Initial High-Frequency Amplification Accuracy Predicts Long-Term Hearing Aid Fitting Outcomes: A Real Ear Measurement-Based Study

Background: To investigate whether the accuracy of initial hearing aid amplification verified by real ear measurement (REM) predicts long-term fitting outcomes after one year, and to identify frequency-specific predictors associated with sustained fitting precision. Methods: This retrospective study included 426 ears from 269 patients who underwent initial REM during hearing aid fitting and repeat REM at 9–15 months after fitting. The primary outcome was the absolute difference between real ear insertion gain (REIG) and target gain (TG) for middle-level input sounds at one-year follow-up. Multivariable linear regression analysis was performed to evaluate demographic, audiologic, and initial REM-related predictors. Results: At initial fitting, the discrepancy between REIG and TG increased progressively toward higher frequencies, with the largest deviation observed at 6000 Hz (16.2 ± 9.5 dB). Multivariable analysis demonstrated that initial REM discrepancy at 6000 Hz was the strongest predictor of poorer fitting accuracy at one year (B = 0.129, p < 0.001). Initial discrepancies at 250 Hz and 500 Hz were also significant but showed weaker associations. Higher aided pure-tone thresholds and poorer aided word recognition scores were independently associated with less accurate long-term fitting outcomes. Conclusions: Initial amplification accuracy, particularly at high frequencies, plays a critical role in long-term hearing aid fitting stability. Achieving sufficient gain at 6000 Hz during the first fitting session may improve long-term fitting outcomes and reduce suboptimal hearing aid use.

Objective and Subjective Evaluation of Voice Across Different Degrees of Sensorineural Hearing Loss.

OBJECTIVE To determine whether increasing severity of untreated bilateral sensorineural hearing loss is associated with severity-related alterations in perceptual, acoustic, aerodynamic, videolaryngostroboscopic, and patient-reported voice outcomes. METHODS This prospective cross-sectional study included 150 adults allocated equally to five hearing-threshold groups: normal hearing (<25 dB HL), mild hearing loss (26-40 dB HL), moderate hearing loss (41-55 dB HL), moderately severe hearing loss (56-70 dB HL), and severe hearing loss (71-90 dB HL). Voice evaluation included GRBAS ratings, videolaryngostroboscopy, maximum phonation time, s/z ratio, acoustic analysis, and the Voice Handicap Index-10 (VHI-10). Overall group comparisons used the Kruskal-Wallis H test or chi-square tests. Dunn-Bonferroni tests were used for post-hoc comparisons. Spearman correlation assessed ordered trends, and age- and sex-adjusted regression analyses evaluated independent associations. RESULTS Voice complaints (Fisher-Freeman-Halton exact P < 0.001), shouting behavior (Fisher-Freeman-Halton exact P < 0.001), and vocal loudness category (χ²(8) = 21.11, P = 0.007) differed among groups and were most prominent in Group 5. Videolaryngostroboscopic regularity (H(4) = 18.99, P < 0.001), GRBAS total score (H(4) = 18.35, P = 0.001), fundamental frequency (H(4) = 22.36, P < 0.001), and VHI-10 (H(4) = 16.99, P = 0.002) also differed among groups. Ordered associations were observed for vibratory irregularity (ρ = 0.288), GRBAS total score (ρ = 0.281), fundamental frequency (ρ = 0.350), and VHI-10 (ρ = 0.263; all P ≤ 0.001). CONCLUSION Greater hearing-loss severity was associated with subtle but measurable changes in perceptual voice quality, vibratory regularity, pitch, and self-reported voice handicap. These findings demonstrate association rather than causation; impaired auditory feedback is a plausible mechanism that requires confirmation in longitudinal or interventional studies.

Hearing preservation in 41 cochlear implant recipients with preimplant low-frequency residual hearing.

BACKGROUND Hearing preservation (HP) is an important objective in cochlear implantation for patients with residual low-frequency hearing, but its long-term clinical relevance remains uncertain. OBJECTIVE To evaluate long-term hearing preservation, functional residual hearing, and speech recognition following cochlear implantation. MATERIAL AND METHODS This retrospective cohort study included 41 adults (42 ears) with a preoperative low-frequency pure-tone average (LFPTA) ≤80 dB HL. Hearing preservation was assessed using the HEARRING and low-frequency threshold shift (dPTA) classifications. Linear mixed-effects models evaluated longitudinal changes in LFPTA and speech recognition, and Kaplan-Meier analysis estimated retention of functional residual hearing. RESULTS Hearing preservation was frequently achieved according to both classification systems. LFPTA deteriorated by 20.5 dB HL during the first 6 postoperative months and declined by 2.46 dB HL annually thereafter (p = 0.020). Functional residual hearing decreased from 66.7% to 41.7% during follow-up. In contrast, speech recognition improved significantly after implantation (all p < 0.001) and remained stable. Retained functional residual hearing was not associated with superior speech recognition. CONCLUSIONS AND SIGNIFICANCE Although residual hearing declined progressively, speech recognition remained robust irrespective of retained functional residual hearing. Hearing preservation remains a worthwhile surgical objective but was not associated with improved long-term speech recognition.

Hearing preservation and efficacy outcomes in CI632 recipients with sloping high-frequency hearing loss: Multicenter trial results.

A Comparison of the Audiological Results and Quality of Life for BAHA and OSIA Users

This cross-sectional observational study with prospectively collected outcome data compared speech recognition in noise and patient-reported outcomes in adults with single-sided deafness (SSD) who had previously received either a Baha Connect or an Osia bone-conduction hearing implant. Thirty-five patients were invited, of whom 32 had complete data available for analysis (questionnaires alone: n = 34). Speech-in-noise performance was assessed using the Digits-in-Noise test and expressed as the speech reception threshold at 50% intelligibility (SNR50) in frontal and side presentation conditions. Subjective hearing benefit and hearing-related quality of life were evaluated using the Glasgow Benefit Inventory, the Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial and Qualities of Hearing Scale. No significant differences were observed between Baha Connect and Osia users in aided SNR50 thresholds or in any patient-reported outcome measure. A linear mixed-effects model showed a significant interaction between listening condition and presentation side (p = 0.023), indicating that speech-in-noise benefit depended on the spatial listening configuration rather than on device type. Both groups reported positive subjective outcomes, although spatial hearing remained the lowest-rated domain. Correlations between SNR50 improvement and questionnaire scores were weak and non-significant (Spearman’s ρ < 0.20; p > 0.29), suggesting that objective speech-in-noise improvement and perceived benefit capture partly different aspects of hearing rehabilitation. Baha Connect and Osia provided comparable objective and subjective outcomes in adults with SSD. Therefore, device selection should not be based solely on expected speech-in-noise performance, but should be guided by patient-specific surgical, practical and lifestyle factors.

Unilateral and Bilateral Hearing Aids for Age-Related Hearing Loss: A Randomized Clinical Trial.

Importance Age-related hearing loss (ARHL) is ubiquitous and is characterized as bilateral symmetrical sensorineural and mild to moderate in degree. When left untreated, significant impacts arise in domains including communication, psychosocial, cognitive and physical health. Data demonstrating the effectiveness of unilateral or bilateral hearing aids (HAs) as the standard treatment are lacking. Objective To determine whether bilateral HAs provide more benefit compared with a unilateral HA. Design, Setting, and Participants This single-blinded parallel-group randomized clinical trial was conducted at audiology clinics at Duke University Health System and Vanderbilt University from 2021 to 2024 with the primary outcome duration of 3 months. Participants were aged 50 years or older with ARHL with less than 3 months of prior HA use seeking HAs. Participants were randomly assigned to the bilateral or unilateral group. Analyses were based on intention to treat. Interventions Commercially available prescription receiver-in-the-canal HAs. Main Outcomes and Measures The hypothesis was that bilateral HAs would provide greater benefit than a unilateral HA. The primary outcome was HA benefit as measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) score. Benefit was defined as the difference in APHAB-global score at the 3-month primary end point (aided) from baseline (pretreatment/unaided) APHAB scores. The primary analysis was a linear regression of the APHAB benefit score at 3 months with clinical site and hearing aid assignment as covariates. Results A total of 275 participants were included (148 female [53.8%]; mean [SD] age, 70.9 [7.9] years). The mean (SD) APHAB benefit score was 14.41 (13.02) for the unilateral group (n = 136) and 19.74 (15.18) for the bilateral group (n = 139). These results indicate that both groups had benefit as demonstrated in APHAB benefit scores, with the bilateral group experiencing significantly higher benefit compared with the unilateral group with a mean difference in APHAB benefit score of -5.29% (95% CI, -8.79% to -1.80%) between the groups. Conclusions and Relevance The trial results indicate that bilateral HAs yield greater self-reported benefit than unilateral HAs; however, while statistically detectable, it is not clear whether this reaches the threshold for clinical meaningfulness. Both configurations produced individually meaningful improvements. These results inform, but do not yet establish, a standard-of-practice recommendation for bilateral fitting. Trial Registration ClinicalTrials.gov Identifier: NCT04739436.