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Hearing loss is associated with poor cognitive performance and incident dementia and may contribute to cognitive decline. Treating hearing loss with hearing aids may ameliorate cognitive decline. The purpose of this study was to test whether use of hearing aids was associated with better cognitive performance, and if this relationship was mediated via social isolation and/or depression. Structural equation modelling of associations between hearing loss, cognitive performance, social isolation, depression and hearing aid use was carried out with a subsample of the UK Biobank data set (n = 164,770) of UK adults aged 40 to 69 years who completed a hearing test. Age, sex, general health and socioeconomic status were controlled for as potential confounders. Hearing aid use was associated with better cognition, independently of social isolation and depression. This finding was consistent with the hypothesis that hearing aids may improve cognitive performance, although if hearing aids do have a positive effect on cognition it is not likely to be via reduction of the adverse effects of hearing loss on social isolation or depression. We suggest that any positive effects of hearing aid use on cognition may be via improvement in audibility or associated increases in self-efficacy. Alternatively, positive associations between hearing aid use and cognition may be accounted for by more cognitively able people seeking and using hearing aids. Further research is required to determine the direction of association, if there is any direct causal relationship between hearing aid use and better cognition, and whether hearing aid use results in reduction in rates of cognitive decline measured longitudinally.

Healthy hearing depends on sensitive ears and adequate brain processing. Essential aspects of both hearing and cognition decline with advancing age, but it is largely unknown how one influences the other. The current standard measure of hearing, the pure-tone audiogram is not very cognitively demanding and does not predict well the most important yet challenging use of hearing, listening to speech in noisy environments. We analysed data from UK Biobank that asked 40-69 year olds about their hearing, and assessed their ability on tests of speech-in-noise hearing and cognition. About half a million volunteers were recruited through NHS registers. Respondents completed 'whole-body' testing in purpose-designed, community-based test centres across the UK. Objective hearing (spoken digit recognition in noise) and cognitive (reasoning, memory, processing speed) data were analysed using logistic and multiple regression methods. Speech hearing in noise declined exponentially with age for both sexes from about 50 years, differing from previous audiogram data that showed a more linear decline from <40 years for men, and consistently less hearing loss for women. The decline in speech-in-noise hearing was especially dramatic among those with lower cognitive scores. Decreasing cognitive ability and increasing age were both independently associated with decreasing ability to hear speech-in-noise (0.70 and 0.89 dB, respectively) among the population studied. Men subjectively reported up to 60% higher rates of difficulty hearing than women. Workplace noise history associated with difficulty in both subjective hearing and objective speech hearing in noise. Leisure noise history was associated with subjective, but not with objective difficulty hearing. Older people have declining cognitive processing ability associated with reduced ability to hear speech in noise, measured by recognition of recorded spoken digits. Subjective reports of hearing difficulty generally show a higher prevalence than objective measures, suggesting that current objective methods could be extended further.

Tinnitus, a phantom auditory sensation, is associated with hearing loss in most cases, but it is unclear if hearing loss causes tinnitus. Phantom auditory sensations can be induced in normal hearing listeners when they experience severe auditory deprivation such as confinement in an anechoic chamber, which can be regarded as somewhat analogous to a profound bilateral hearing loss. As this condition is relatively uncommon among tinnitus patients, induction of phantom sounds by a lesser degree of auditory deprivation could advance our understanding of the mechanisms of tinnitus. In this study, we therefore investigated the reporting of phantom sounds after continuous use of an earplug. 18 healthy volunteers with normal hearing wore a silicone earplug continuously in one ear for 7 days. The attenuation provided by the earplugs simulated a mild high-frequency hearing loss, mean attenuation increased from <10 dB at 0.25 kHz to >30 dB at 3 and 4 kHz. 14 out of 18 participants reported phantom sounds during earplug use. 11 participants presented with stable phantom sounds on day 7 and underwent tinnitus spectrum characterization with the earplug still in place. The spectra showed that the phantom sounds were perceived predominantly as high-pitched, corresponding to the frequency range most affected by the earplug. In all cases, the auditory phantom disappeared when the earplug was removed, indicating a causal relation between auditory deprivation and phantom sounds. This relation matches the predictions of our computational model of tinnitus development, which proposes a possible mechanism by which a stabilization of neuronal activity through homeostatic plasticity in the central auditory system could lead to the development of a neuronal correlate of tinnitus when auditory nerve activity is reduced due to the earplug.

S-acylation is a major posttranslational modification, catalyzed by the zinc finger DHHC domain containing (zDHHC) enzyme family. S-acylated proteins can be modified by different fatty acids; however, very little is known about how zDHHC enzymes contribute to acyl chain heterogeneity. Here, we used fatty acid-azide/alkyne labeling of mammalian cells, showing their transformation into acyl-CoAs and subsequent click chemistry-based detection, to demonstrate that zDHHC enzymes have marked differences in their fatty acid selectivity. This difference in selectivity was apparent even for highly related enzymes, such as zDHHC3 and zDHHC7, which displayed a marked difference in their ability to use C18:0 acyl-CoA as a substrate. Furthermore, we identified isoleucine-182 in transmembrane domain 3 of zDHHC3 as a key determinant in limiting the use of longer chain acyl-CoAs by this enzyme. This study uncovered differences in the fatty acid selectivity profiles of cellular zDHHC enzymes and mapped molecular determinants governing this selectivity.

Background Hearing loss is prevalent and disabling, yet little is known about the extent of recreational noise exposure and hearing protection use. The aim of the present research was to estimate the extent of recreational noise exposure and hearing protection use in a sample representative of the UK adult population. Methods We conducted a cross-sectional survey of 10,401 UK adults who were representative of the population. Results More than 7000 people ( n  = 7590, 73.0%) reported exposure to recreational noise excluding headphone and earphone use in the last 12 months. Just 158 people (2.1%) reported wearing hearing protection for every noisy recreational activity. Age (younger people) and beliefs of a behavioral (as opposed to genetic) cause of hearing loss were predictive of both higher recreational noise exposure and greater hearing protection use. Men were more exposed to recreational noise but women were less likely to use hearing protection. Conclusions For the first time, the present research quantifies the recreational noise exposure and low levels of hearing protection use in a representative sample of the UK population. The biggest public health gains are likely to be achieved through interventions targeted at younger people and in explaining behavioral (as opposed to genetic) causes of hearing loss.

Background Excessive earwax causes unwanted symptoms such as hearing loss, tinnitus, discomfort and changes in the quality of one’s own voice. The NHS Audiology Wax Removal Service in North Wales recommends the use of olive oil as a pretreatment wax softener administered as either drops or spray prior to microsuction. For one in four patients microsuction is unsuccessful at the first attempt. Anecdotal evidence suggests that the administration of olive oil as a spray is a more effective pretreatment. This trial aims to explore whether administering olive oil pretreatment softener is more effective when administered as drops or spray. Methods This two-arm cluster randomised control trial will be conducted within the existing NHS Audiology wax removal service in North Wales from January to July 2025. This pragmatic trial involves 26 NHS GP practices (clusters) and compares the administration methods of olive oil pretreatment via drops and spray. A sample size of 1,742 participants (67 in each of the 26 practices) was calculated as sufficient to determine a clinically significant difference. Presumed consent is used for all eligible patients seen within the wax removal service. Patients will be advised to source and self-administer three drops or sprays of olive oil for seven days before attending a wax removal microsuction appointment with an audiology practitioner where routine anonymized data will be collected. The primary outcome is whether wax removal is successful, as assessed via visual examination. The secondary outcomes include: improvements in self-reported symptoms, the amount of residual wax following microsuction and the number of adverse events. Statistical analyses will be conducted with an intention-to-treat design to compare outcomes between the groups. Discussion This RCT aims to investigate whether administering olive oil as a pretreatment wax softener via drops or spray affects the outcome of wax removal. The outcome of this trial will inform future recommendations to patients and improve service effectiveness and efficiency by reducing the need for repeat visits. The results will be shared nationally and used to inform national guidance on wax removal. Trial registration ISRCTN, ISRCTN28211073. Registered 23 December 2024, https://www.isrctn.com/ISRCTN28211073?q=earwax&filters=&sort=&offset=1&totalResults=3&page=1&pageSize=10 .

Background This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers. Methods This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels. Results Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness. Conclusion This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS.

Purpose: Visual cues from a speaker's face may benefit perceptual adaptation to degraded speech, but current evidence is limited. We aimed to replicate results from previous studies to establish the extent to which visual speech cues can lead to greater adaptation over time, extending existing results to a real-time adaptation paradigm (i.e., without a separate training period). A second aim was to investigate whether eye gaze patterns toward the speaker's mouth were related to better perception, hypothesizing that listeners who looked more at the speaker's mouth would show greater adaptation. Method: A group of listeners (n = 30) was presented with 90 noise-vocoded sentences in audiovisual format, whereas a control group (n = 29) was presented with the audio signal only. Recognition accuracy was measured throughout and eye tracking was used to measure fixations toward the speaker's eyes and mouth in the audiovisual group. Results: Previous studies were partially replicated: The audiovisual group had better recognition throughout and adapted slightly more rapidly, but both groups showed an equal amount of improvement overall. Longer fixations on the speaker's mouth in the audiovisual group were related to better overall accuracy. An exploratory analysis further demonstrated that the duration of fixations to the speaker's mouth decreased over time. Conclusions: The results suggest that visual cues may not benefit adaptation to degraded speech as much as previously thought. Longer fixations on a speaker's mouth may play a role in successfully decoding visual speech cues; however, this will need to be confirmed in future research to fully understand how patterns of eye gaze are related to audiovisual speech recognition.

This systematic review, the first on this topic, aimed to investigate if probe-tube verification of real-ear hearing aid amplification characteristics improves outcomes in adults. The review was preregistered in the Prospective Register of Systematic Reviews and performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. After assessing more than 1,420 records from seven databases, six experimental studies (published between 2012 and 2019) met the inclusion criteria; five were included in the meta-analyses. The primary outcome of interest (hearing-specific, health-related quality of life) was not reported in any study. There were moderate and statistically significant positive effects of probe-tube real-ear measurement (REM), compared with the manufacturer’s initial fit, on speech intelligibility in quiet settings (standardized mean difference [SMD]: 0.59) and user’s final preference (proportion difference: 52.2%). There were small but statistically significant positive effects of REM on self-reported listening abilities (SMD: 0.22) and speech intelligibility in noise (SMD: 0.15). The quality of evidence for these outcomes ranged from high to very low. The findings show that REMs improve outcomes statistically, but this is based on a small number of studies and a limited number of participants. It is currently unclear if the benefits are of material importance because minimum clinically important differences have not been established for most of the outcomes. Ultimately, there needs to be a cost-effectiveness analysis to show that statistically significant benefits, which exceed the minimum clinically important difference, are worth the cost involved.

[Based on the experience and opinion of the Guideline Committee (GC)] Most adults have hearing loss as a consequence of age or chronic noise exposure, which requires no further investigation of cause. Red flags for referral for hearing loss Sudden onset or rapidly progressive hearing loss Hearing loss and additional localising symptoms and signs Otalgia and otorrhoea in an immunocompromised patient Otorrhoea (not wax) from either ear that has not resolved, has not responded to prescribed treatment, or recurs A middle ear effusion unrelated to upper respiratory tract infections in a person of Chinese or South-East Asian family origin (nasopharyngeal carcinoma is common in this ethnic group) Abnormal appearance of the ear canal or drum: polyp or squamous debris, posterior or superior perforation, mass, unexplained bleeding How quickly should people be referred for a specialist medical opinion? Consider MRI of the internal auditory meati for adults with sensorineural hearing loss and no localising signs if there is an asymmetry on pure tone audiometry of 15 dB or more at any two adjacent test frequencies, using test frequencies of 0.5, 1, 2, 4, and 8 kHz. Taking measures, such as reducing background noise, to ensure that the clinical and care environment is conducive to communication for people with hearing loss, particularly in group settings such as waiting rooms, clinics, and care homes.