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Stapedotomy is performed to restore ossicular chain sound transmission by inserting a piston prosthesis that couples the long process of the incus to the oval window, thereby addressing conductive hearing loss associated with otosclerosis. This study investigates the effects of crimping force, prosthesis material, and loop geometry on incus to optimize fixation while minimizing complications such as incudal necrosis. Finite element analyses were performed to quantify interface pressures and von Mises stresses for titanium prostheses with loop-band widths of 0.2, 0.3, and 0.5 mm under crimping forces of 300–500 mN and for polytetrafluoroethylene (PTFE) prostheses with loop outer diameters (OD) of 1.2, 1.4, and 1.8 mm. The analysis results showed that PTFE prostheses generated significantly lower interface pressures and stress compared to titanium. For PTFE prostheses, the equivalent von Mises stresses remained well below the critical threshold, with values ranging from 3.5 MPa up to peaks of approximately 43 MPa depending on the loop’s outer diameter. In contrast, titanium prostheses exhibited a marked dependency on crimping force and band width. At a force of 300 mN, stresses were modest (approximately 16–24 MPa). However, when increasing the force to 400 mN, stresses approached the critical threshold (up to approximately 53 MPa). With crimping forces of 500 mN, especially with band widths greater than 0.3 mm, stresses exceeded the cortical bone strength threshold (approximately 61–64 MPa), indicating an increased risk of mechanical overload and potential incudal necrosis. These findings highlight the importance, in a clinical context, of controlling the crimping force and selecting the material and geometry of the prosthesis to achieve secure coupling while preserving the incus’s structural integrity.

This study investigates, for the first time, using finite element analysis (FEA), the differential impact of middle ear prosthesis diameter on hearing gain in two distinct surgical techniques: stapedotomy and partial stapedectomy. The model represented the cochlea as two fluid-filled straight channels separated by the basilar membrane and considered pistons of 0.4 mm and 0.6 mm diameters. The results demonstrated that in stapedotomy, a 0.6 mm diameter piston yielded a significantly better reduction in ABG (8.31 dB) compared to the 0.4 mm piston (10.67 dB), indicating improved hearing gain. Conversely, in partial stapedectomy, the smaller 0.4 mm piston was more effective, reducing ABG to 11.2 dB versus 12.12 dB with the larger piston. These findings highlight that the optimal prosthesis diameter varies according to surgical technique, emphasizing the need for tailored prosthesis selection.

Sudden sensorineural hearing loss (SSNHL) is defined as a sensorineural hearing loss of 30 dB or greater on at least three contiguous audiometric frequencies occurring within a 72 h period. Although SSNHL is commonly encountered in clinical audiology and otolaryngology practice, its etiopathogenesis continues to be poorly understood. Scientific investigations have highlighted the vulnerability of cochlear microcirculation to blood flow alterations. Even mild hypoperfusion can lead to immediate dysfunction in the organ of Corti, given the heightened susceptibility of cochlear hair cells to hypoxia and ischemic damage. The purpose of this review paper is to present evidence of endothelial and vascular involvement in SSNHL and the risk factors, such as metabolic syndrome, that may negatively impact the inner ear’s vascular supply, influencing the onset pattern, incidence, and prognosis of SSNHL. By addressing these variables, we can deepen our comprehension of the mechanisms underlying SSNHL and potentially uncover strategies for prevention.

IntroductionPost-surgical care following cochlear implantation is a pivotal part of the rehabilitation journey for cochlear implant (CI) recipients. However, frequent in-clinic visits, particularly in the first year following CI activation, can place a significant burden on CI recipients. Moreover, the growing number of CI recipients may pose a challenge for CI clinics to provide consistent and lifelong care. Cochlear Remote Care is a platform that enables the delivery of post-surgical care through remote hearing assessments and remote video appointments, offering an opportunity to enhance clinic efficiency, eliminate geographical barriers, reduce financial burdens and provide flexible post-surgical options. The primary objective of this study is to compare self-reported hearing ability in daily life among CI recipients who receive post-surgical care through Remote Care with those receiving routine in-clinic care during the first year following CI activation. Additionally, the study will assess the time and costs associated with these care models for both the clinic and patients.Methods and analysisThis multi-centre randomised controlled trial is set to be conducted across 11 clinics in the United Kingdom, Italy, the Netherlands, Belgium and Australia, with an anticipated sample size of 148 participants. All participants will be adults with post-lingual deafness and unilateral CIs. Following baseline measurements at 3 months post-activation, participants will be randomly assigned to either in-clinic visits or Remote Care appointments. At six and 12 months after activation, participants will complete a comprehensive battery of audiometric tests and questionnaires on patient-reported outcomes, usability and resource utilisation.Ethics and disseminationEthics approval has been obtained for each clinical site. Study findings will be disseminated widely through peer-reviewed publications, lay language summaries and conference presentations.Trial registration numberNCT05552118.

Background Prevalence of hearing loss increases with age. Its estimated prevalence is 40–50 % in people over 75 years of age. Recent studies agree that declinein hearing threshold contribute to deterioration in sociality, sensitivity, cognition, and quality of life for elderly subjects. The aim of the study presented in this paper is to verify whether or not rehabilitation using first time applied Hearing Aids (HA) in a cohort of old people with hearing impairment improves both speech perception in a noisy environment over time and the overall health-related quality of life. Methods The monocentric, prospective, repeated measurements, single-subject, clinical observational study is to recruit 100 older adults, first-time HA recipients (≥ 65 years).The evaluation protocol is designed to analyze changes in specific measurement tools a year after the first HA usage in comparison with the evaluation before HA fitting. Evaluations will consist of multiparametric details collected through self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in speech perception in noise to be used is the Italian version of Oldenburg Satz (OLSA) test whereas the indicator of changes in overall quality of life will be the Assessment of Quality of Life (AQoL) and Hearing Handicap Inventory for the Elderly (HHIE) questionnaires. The Montreal Cognitive Assessment (MoCA) will help in screening the cognitive state of the subjects. Discussion The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare the effects of HA rehabilitation in the older adults immediately before first HA usage (Pre) and after 1 year of experience (Post). This broad approach will lead to a greater understanding of how useful hearing influences the quality of life in older individuals, and therefore improves potentials for healthy aging. The data is to be analyzed by using an intrasubject endpoint comparison. Outcomes will be described and analyzed in detail. Trial registration This research was retrospectively registered underno. NCT04333043at ClinicalTrials.gov (http://www.clinicaltrials.gov/) on the 26 March 2020. This research has been registered with the Ethics Committee of the Area Vasta Emilia Nord under number 104, date of approval 17/07/2017.

Single sided deafness (SSD) is characterized by significant sensorineural hearing loss, severe or profound, in only one ear. SSD adversely affects various aspects of auditory perception, including causing impairment in sound localization, difficulties with speech comprehension in noisy environments, and decreased spatial awareness, resulting in a significant decline in overall quality of life (QoL). Several treatment options are available for SSD, including cochlear implants (CI), contralateral routing of signal (CROS), and bone conduction devices (BCD). The lack of consensus on outcome domains and measurement tools complicates treatment comparisons and decision-making. This narrative overview aims to summarize the treatment options available for SSD in adult and pediatric populations, discussing their respective advantages and disadvantages. Rerouting devices (CROS and BCD) attenuate the effects of head shadow and improve sound awareness and signal-to-noise ratio in the affected ear; however, they cannot restore binaural hearing. CROS devices, being non-implantable, are the least invasive option. Cochlear implantation is the only strategy that can restore binaural hearing, delivering significant improvements in speech perception, spatial localization, tinnitus control, and overall QoL. Comprehensive preoperative counseling, including a discussion of alternative technologies, implications of no treatment, expectations, and auditory training, is critical to optimizing therapeutic outcomes.

Aim: The aim of this study was to assess the subjective experiences of adults with different cochlear implant (CI) configurations—unilateral cochlear implant (UCI), bilateral cochlear implant (BCI), and bimodal stimulation (BM)—focusing on their perception of speech in quiet and noisy environments, music, environmental sounds, people’s voices and tinnitus. Methods: A cross-sectional survey of 130 adults who had undergone UCI, BCI, or BM was conducted. Participants completed a six-item online questionnaire, assessing difficulty levels and psychological impact across auditory domains, with responses measured on a 10-point scale. Statistical analyses were performed to compare the subjective experiences of the three groups. Results: Patients reported that understanding speech in noise and tinnitus perception were their main concerns. BCI users experienced fewer difficulties with understanding speech in both quiet (p < 0.001) and noisy (p = 0.008) environments and with perceiving non-vocal sounds (p = 0.038) compared to UCI and BM users; no significant differences were found for music perception (p = 0.099), tinnitus perception (p = 0.397), or voice naturalness (p = 0.157). BCI users also reported less annoyance in quiet (p = 0.004) and noisy (p = 0.047) environments, and in the perception of voices (p = 0.009) and non-vocal sounds (p = 0.019). Tinnitus-related psychological impact showed no significant differences between groups (p = 0.090). Conclusions: Although speech perception in noise and tinnitus remain major problems for CI users, the results of our study suggest that bilateral cochlear implantation offers significant subjective advantages over unilateral implantation and bimodal stimulation in adults, particularly in difficult listening environments.

Background: The COVID-19 pandemic rapidly spread through Europe in the first months of 2020. On the 9th of March 2020, the Italian government ordered a national lock-down. The study’s objectives were: to investigate the effect of lockdown on CI users; and to detect the difference in the perception of discomfort existing between unilateral cochlear implant (UCI) users and bilateral cochlear implant (BCI) users, due to the lockdown experience. Methods: A 17-item, web-based, anonymous online survey was administered to 57 CI users, exploring hearing performance, emotions, practical issues, behavior, and tinnitus. Participation in the study was voluntary. Results: all CI users obtained an abnormal score in all questionnaire themes. For the emotion theme and the practical issue theme, the age range 61–90 showed a significant difference between UCI and BCI users in favor of BCI users (emotion theme: UCI mean = 3.9, BCI mean = 2.3, p = 0.0138; practical issues: UCI mean = 4, BCI mean = 3, p = 0.0031). Conclusions: CI users experienced the lockdown negatively as regards behavior, emotions, hearing performance, and in practical issues. CI subjects with UCI in old age suffered more from the experience of lockdown than subjects with BCI in the same age, with regards to emotions and practical issues.

Background: Vestibular Schwannomas are benign tumors arising from the VIII CN. Surgical treatment is indicated in case of tumors larger than 2.5 cm in the cerebellopontine angle or in the case of cranial nerve dysfunction. The aim of the present study was to evaluate the QoL by means of the PANQOL questionnaire in a group of surgically treated patients mainly affected by large and giant VS Methods: All patients underwent preoperative and postoperative otoneurological evaluation and gadolinium enhanced MRI and they completed, independently, the PANQOL questionnaire at last follow up. Results: 70% of patients presented with large Koos III or IV VS Each domain of PANQOL showed a strong correlation with the total PANQOL score. In relation to the postoperative facial nerve function, patients with poorer function showed significantly lower score in the facial dysfunction and pain, patients with postoperative balance problems showed a significantly lower PANQOL score for domains of balance and pain. Conclusions: This study showed that postoperative QoL of patients was acceptable even if there were some domains that were more affected, such as hearing and balance domains; therefore, the lowest scores suggest the need for vestibular rehabilitation programs and strategies that improve postoperative hearing.

Objects: This study aimed to evaluate the Executive Function (EF) domains in a group of profoundly deaf children treated with cochlear implant (CI) in comparison to normal hearing (NH) children. The secondary aim was to evaluate the influence exerted by the age at cochlear implant activation on EFs. Materials and Methods: 32 children were enrolled into two groups: group A of 17 CI users with a mean age of 8.78 years and group B of 15 NH subjects with a mean age of 7.99 years (SD + 2.3). All subjects were tested using the following tests: the subtests for working memory of the neuropsychological evaluation battery for the developmental age (Batteria di valutazione neuropsicologica per l’età evolutive), inhibition and control of the impulsive response—CAF, and the tower of London test. Results: No children with CIs scored within the normal range in the tests administered for the evaluation of EF domains. The same scores were significantly lower when compared with scores obtained by NH children. Children with younger age at CI activation showed better executive performances in planning, working memory (backward digit span), and cognitive flexibility (categorical fluency). Conclusion: The results of this study highlight that cochlear implantation plays a role in improving hearing and consequently influences the development of EFs in deaf children.