Hearing Loss and Cognitive Impairment: Epidemiology, Common Pathophysiological Findings, and Treatment Considerations

Association between obstructive sleep apnea and hearing loss among a cohort of emergency responders

PURPOSE

We sought to determine whether risk for obstructive sleep apnea (OSA) and OSA severity are associated with sensorineural hearing loss (HL) among emergency responders.

METHODS

We evaluated two independent variables: OSA risk, categorized using Berlin Questionnaire criteria, and OSA severity, determined by polysomnogram (PSG) apnea-hypopnea indices (AHI). Logistic regression, adjusted for confounders, was used to assess the association between each OSA exposure and the outcome of HL among a cohort of emergency responders.

RESULTS

The study cohort included 13,909 participants with audiometric data, 12,834 with Berlin Questionnaire data, and 4,024 participants with PSG data. Those with high and very high OSA risk showed significantly elevated odds of HL at speech frequencies, with adjusted odds ratios (OR) of 1.34 (95% CI: 1.14-1.58; p < 0.01) and 1.56 (95% CI: 1.30-1.88; p < 0.01), respectively, compared to those with no OSA risk. Combining very high and high risk validated category groupings for the Berlin, those individuals had 41% higher odds for HL over speech frequencies compared to those with no risk (OR = 1.41; 95% CI = 1.21-1.65; p < 0.01). Those with PSG-determined severe OSA had higher adjusted odds of HL at speech frequencies than those with no OSA; OR of 1.33 (95% CI: 1.00-1.78; p = 0.04).

CONCLUSIONS

We report a significant association between OSA and HL among emergency responders. Our results underscore a need for an analysis of the longitudinal association between OSA and HL to identify potential causality and for integrated health interventions that target both conditions in this responder population.

Social Media Depictions of the Impact of Noise Pollution on Communication and Mental and Physical Health

Noise pollution is known to have harmful consequences on various facets of human health, as is recognized by the United States Centers for Disease Control and Prevention as well as by the World Health Organization. Even though noise pollution is a ubiquitous and global problem, the public may not be cognizant of its ill-effects. Often, people go online first to obtain information, and YouTube is the second most used social media platform. For these reasons, the objective of this study was to examine the information available by YouTube to the public about parameters pertaining to noise pollution. The most viewed one-hundred videos in English were obtained for examination from YouTube, searching for "noise pollution." Each video was assessed regarding the pertinent information (content) it displayed, as well as for the date it was uploaded, the source of its upload (professional or consumer/public), the duration of the video (in seconds), number of times it was viewed, and the number of "likes" it received. Descriptive statistics, Mann-Whitney U tests, Fisher's exact tests, or Chi-square tests were applied as appropriate. Analysis of video characteristics indicated that the 100 most viewed videos on YouTube on the topic of noise pollution were uploaded from 2009 to 2023, with the highest frequency of uploads occurring in 2022 (16%), with 27% originating from the general public and 73% originating from professional health organizations. Cumulatively, the videos were viewed over 15 million times, and those uploaded by consumers had a greater median view tally (17,000), were longer in duration, and were "liked" more compared to videos uploaded by professionals (5,100). However, these differences were not statistically significant. Analysis of video content provided a breadth of data, with statistically significant differences (p < 0.05) between consumer and professional videos in their presentations of noise characteristics, discussions of official and anecdotal complaints regarding noise, health problems attributed to noise pollution, general effects of noise on the community, and reactions from community administrators. Further topics shown equally in consumer and professional videos, from tinnitus to communication difficulties are discussed. Whereas of the one hundred most viewed videos, 73 were uploaded by professionals compared to 27 uploaded by the public, the fact that the professional videos had a somewhat lower median number of views (5,100 compared to 17,000), may point to a likely preference of consumers for videos by "peers." It may be worthwhile for professional organizations to consider this tendency so as to enhance the public's accessing of curated professional videos. Concerning the content available, the findings reveal that there is a respectable professional presence on YouTube videos on noise pollution. Nonetheless, certain issues were not adequately addressed, including the significant cognitive, communication, and physical harmful effects, or possible information that could be useful to the public on noise exposure.

"Do You Hear What I Hear?" Speech and Voice Alterations in Hearing Loss: A Systematic Review

Background: Although hearing loss influences voice characteristics, such changes may be under-recognized during clinical consultations. This systematic review examines voice alterations in adults with post-lingual hearing loss, considering diagnostic and rehabilitative implications. Methods: A comprehensive search of PubMed, Scopus, and Google Scholar was conducted following PRISMA guidelines, targeting studies reporting quantitative data on vocal parameters in adults with sensorineural hearing loss. Exclusion criteria included pre-lingual hearing loss and non-English studies. Data extraction focused on pitch, loudness, and prosody, with study quality assessed using NIH tools. Results: Eleven case-control studies, involving 594 patients with sensorineural hearing loss and 326 control patients, were analyzed. Patients with untreated hearing loss exhibited elevated fundamental frequency, F0 (males: 158-169 Hz; females: 206-251 Hz) and loudness levels (males: 79-96 dB; females: 89-116 dB) compared to controls (F0-males: 75-150 Hz; females: 150-300 Hz; loudness-males: 30-70 dB; females: 40-68 dB). Alterations in jitter, shimmer, and maximum phonation time (MPT) contributed to the distinct "hearing loss voice". Cochlear implants (CIs) and hearing aids improved vocal parameters, with CIs reducing F0 by approximately 12-15 Hz. Continuous hearing aid use normalized pitch and loudness within four months. Prosody alterations, such as monotone speech, were reported in long-term cases. In noisy environments, individuals with hearing loss exhibited exaggerated increases in pitch and loudness, indicative of compensatory mechanisms. Conclusions: Post-lingual hearing loss disrupts the central regulation of voice, altering pitch, loudness, and other vocal parameters. Recognizing these changes, particularly in noisy environments, could facilitate the early diagnosis and timely rehabilitation of hearing deficits, potentially mitigating associated risks of cognitive decline.

VASCilia (Vision Analysis StereoCilia): A Napari Plugin for Deep Learning-Based 3D Analysis of Cochlear Hair Cell Stereocilia Bundles

Cochlear hair cells are essential for hearing, and their stereocilia bundles are critical for mechanotransduction. However, analyzing the 3D morphology of these bundles can be challenging due to their complex organization and the presence of other cellular structures in the tissue. To address this, we developed VASCilia (Vision Analysis StereoCilia), a Napari plugin suite that automates the analysis of 3D confocal microscopy datasets of phalloidin-stained cochlear hair cell bundles. VASCilia includes five deep learning-based models that streamline the analysis process, including: (1) Z-Focus Tracker (ZFT) for selecting relevant slices in a 3D image stack; (2) PCPAlignNet (Planar Cell Polarity Alignment Network) for automated orientation of image stacks; (3) a segmentation model for identifying and delineating stereocilia bundles; (4) a tonotopic Position Prediction tool; and (5) a classification tool for identifying hair cell subtypes. In addition, VASCilia provides automated computational tools and measurement capabilities. Using VASCilia, we found that the total actin content of stereocilia bundles (as measured by phalloidin staining) does not necessarily increase with bundle height, which is likely due to differences in stereocilia thickness and number. This novel biological finding demonstrates the power of VASCilia in facilitating detailed quantitative analysis of stereocilia. VASCilia also provides a user-friendly interface that allows researchers to easily navigate and use the tool, with the added capability to reload all their analyses for review or sharing purposes. We believe that VASCilia will be a valuable resource for researchers studying cochlear hair cell development and function, addressing a longstanding need in the hair cell research community for specialized deep learning-based tools capable of high-throughput image quantitation. We have released our code along with a manually annotated dataset that includes approximately 55 3D stacks featuring instance segmentation (https://github.com/ucsdmanorlab/Napari-VASCilia). This dataset comprises a total of 502 inner and 1,703 outer hair cell bundles annotated in 3D. As the first open-source dataset of its kind, we aim to establish a foundational resource for constructing a comprehensive atlas of cochlea hair cell images. Ultimately, this initiative will support the development of foundational models adaptable to various species, markers, and imaging scales to accelerate advances within the hearing research community.

Establishment of reference audiometric norms for the elderly population: A community-based study on mean and median hearing thresholds

Background

This investigation quantifies the mean and median hearing thresholds and assesses the prevalence of age-related hearing loss within the senior population of Taipei.

Methods

In a substantive geriatric assessment supported by government initiative, 1696 individuals from a community hospital partook in this cross-sectional study (2016-2018). Detailed audiometric evaluations logged pure-tone thresholds across critical frequencies (0.5k, 1k, 2k, 4k Hz), in conjunction with participant ages, genders, and HHIE-S questionnaire results.

Results

The findings indicated mean and median pure tone averages (PTA) of 25.3 ± 15.6 dB HL and 22.5 dB HL, respectively. Gender-based analysis showcased higher PTAs for males than females. The study illuminated a progressive increase in hearing thresholds with age and higher frequencies. A 41 % prevalence of hearing impairment was recorded, with a notable 15.2 % deemed disabling, and a potential candidacy for cochlear implantation in 1.5 % of the study group.

Conclusions

Hearing loss was prevalent in 41 % of the non-hospitalized elderly demographic, chiefly characterized as mild. However, older age groups, particularly those over 85, presented an elevated occurrence of moderate hearing loss.

Influence of auditory-based cognitive training on auditory resolution, executive function, and working memory skills in individuals with mild cognitive impairment - a pilot randomized controlled study

Background

Age-related central auditory processing disorder and mild cognitive impairment (MCI) can be concomitant in older adults, making it difficult to communicate, especially in challenging listening conditions. This preliminary study investigated the efficacy of auditory-based cognitive training on the auditory processing abilities and cognitive functions of older adults with MCI.

Methods

In this randomized controlled trial twenty-two older adults with mild cognitive impairment (MCI) were randomly assigned to either an experimental (n=11) or a control group (n=11). The experimental group received 15 cognitive training sessions through tasks involving the auditory domain. The outcome measures of this study included auditory resolution (Temporal gap detection, frequency discrimination, and modulation detection) and cognitive measures (Trail making tests and digit recall), which were administered at three-time points (before training, post-training, and follow-up). The linear mixed model computed the effects of training on the outcome measures.

Results

A significant improvement was observed in the modulation detection threshold between baseline and follow-up and between post-training and follow-up sessions. However, GDT and FD thresholds did not reveal any statistically significant difference. In the trail making test, Part B showed consistent significance across the time points, whereas Part A and the delayed recall task showed no significant difference.

Conclusion

Auditory-based cognitive training may improve auditory processing and executive function in older adults with mild cognitive impairment (MCI).

Trial registration

CTRI/2019/01/017073, registered on 14.01.2019.

Improve the behavioral auditory attention training effects on the Speech-In-Noise perception with simultaneous electrical stimulation in children with hearing loss: A randomized clinical trial

BACKGROUND

Auditory attention is an important cognitive factor that significantly affects speech perception in noisy environments. Hearing loss can impact attention, and it can impair speech perception in noise. Auditory attention training improves speech perception in noise in children with hearing loss. Could the combination of transcranial electrical current stimulation (tES) and auditory attention training enhance the speed and effectiveness of stability potentiation improvements? This investigation explores whether applying electrical stimulation alongside targeted auditory tasks can lead to more pronounced and rapid enhancements in cognitive function.

METHODS

In this study, 24 children with moderate to severe S.N hearing loss were examined. The monaural-selective-auditory-attention test (mSAAT) and the test of everyday-attention-for-children (TEA-CH) were used to investigate auditory attention. The words-in-noise tests evaluated speech perception in noise. A go/no-go task was conducted to record auditory P300 evoked potential. Children were divided into three groups. Group A received auditory attention training. Group B received tDCS. Group C received combined method. The tests were repeated immediately and one month after training.

RESULTS

Attention and speech perception improvement was significantly higher for the group that received the combined method compared to the groups that received auditory attention training with sham or tDCS alone (P < 0.001). All three groups showed significant changes one month after the training ended. However, the group that received only tDCS demonstrated a significant decrease in improvement.

CONCLUSION

The study showed that combining auditory attention training with tDCS can improve speech perception in noise for children with hearing loss. Combining behavioral training with tDCS has a more significant impact than using behavioral training alone, and combined method leads to more stability improvements than using tDCS alone.

Multimorbidity Patterns, Leisure Activities, and Cognitive Function: A Population-Based Longitudinal Study

BACKGROUND

There is limited knowledge about the effect of leisure activities on cognitive decline related to different multimorbidity patterns. The study aimed to examine the role of leisure activities in the association between multimorbidity patterns and cognitive function.

METHODS

We conducted a community-based cohort study based on the 2002-2018 Chinese Longitudinal Health Longevity Survey. Multimorbidity patterns were examined by exploratory factor analysis. Multivariable linear and logistic regression models were used to assess the associations between multimorbidity, leisure activities, and cognitive function.

RESULTS

The study included 14 093 older adults. Those with specific multimorbidity patterns had lower Mini-Mental State Examination (MMSE) scores. Compared with individuals with cardiometabolic and sensory patterns who frequently engaged in activities such as housework, garden work, and watching TV/listening to the radio, those who participated in these activities less regularly had lower MMSE scores. Furthermore, a higher frequency change of participation and a greater variety of leisure activities were associated with better cognitive function.

CONCLUSIONS

The older individuals with multimorbidity are associated with lower MMSE scores, while those who participated in more leisure activities had higher cognitive function. Diverse and frequent leisure activities may help delay cognitive decline in Chinese older adults with different multimorbidities.

Comparative study on structural and functional brain differences in mild cognitive impairment patients with tinnitus

Objective

Tinnitus may be associated with various brain changes. However, the degenerative changes in patients with tinnitus have not been extensively investigated. We aimed to evaluate degenerative, structural, and functional brain changes in patients with mild cognitive impairment (MCI) who also suffer from tinnitus.

Materials and methods

This study included participants aged 60 to 80 years with MCI and a hearing level better than 40 dB. The participants were classified into two groups: MCI with tinnitus (MCI-T) and MCI without tinnitus (MCI-NT). All patients underwent Tinnitus Handicap Inventory (THI), 3 T brain MRI, F18-florapronol PET, and F18-FDG PET.

Results

The MCI-T group exhibited higher β-amyloid deposition in the superior temporal gyrus, temporal pole, and middle temporal gyrus compared to the MCI-NT group (p < 0.05 for all). Additionally, the MCI-T group showed increased metabolism in the inferior frontal gyrus, insula, and anterior cingulate cortex (ACC) (p < 0.005 for all). The THI score was strongly correlated with increased volume in the insula, ACC, superior frontal gyrus, supplementary motor area, white matter near the hippocampus, and precentral gyrus (p < 0.05 for all). Moreover, the MCI-T group demonstrated higher metabolic activity in the default mode network (DMN) and lower activity in the executive control network (ECN) (p < 0.05 for all). In the MCI-T group, the posterior DMN was positively correlated with the visual network and negatively with the ECN, whereas in the MCI-NT group, it correlated positively with the ECN.

Conclusion

The MCI-T group exhibited greater β-amyloid accumulation in the auditory cortex and more extensive changes across various brain networks compared with the MCI-NT group, potentially leading to diverse clinical symptoms such as dementia with semantic deficits or depression. Tinnitus in MCI patients may serve as a biomarker for degenerative changes in the temporal lobe and alterations in brain network dynamics.

Exploring Inner Ear and Brain Connectivity through Perilymph Sampling for Early Detection of Neurological Diseases: A Provocative Proposal

Recent evidence shows that it is possible to identify the elements responsible for sensorineural hearing loss, such as pro-inflammatory cytokines and macrophages, by performing perilymph sampling. However, current studies have only focused on the diagnosis of such as otologic conditions. Hearing loss is a feature of certain neuroinflammatory disorders such as multiple sclerosis, and sensorineural hearing loss (SNHL) is widely detected in Alzheimer's disease. Although the environment of the inner ear is highly regulated, there are several communication pathways between the perilymph of the inner ear and cerebrospinal fluid (CSF). Thus, examination of the perilymph may help understand the mechanism behind the hearing loss observed in certain neuroinflammatory and neurodegenerative diseases. Herein, we review the constituents of CSF and perilymph, the anatomy of the inner ear and its connection with the brain. Then, we discuss the relevance of perilymph sampling in neurology. Currently, perilymph sampling is only performed during surgical procedures, but we hypothesize a simplified and low-invasive technique that could allow sampling in a clinical setting with the same ease as performing an intratympanic injection under direct visual check. The use of this modified technique could allow for perilymph sampling in people with hearing loss and neuroinflammatory/neurodegenerative disorders and clarify the relationship between these conditions; in fact, by measuring the concentration of neuroinflammatory and/or neurodegenerative biomarkers and those typically expressed in the inner ear in aging SNHL, it could be possible to understand if SNHL is caused by aging or neuroinflammation.

A novel cell-free therapy using exosomes in the inner ear regeneration

Cellular and molecular alterations associated with hearing loss are now better understood with advances in molecular biology. These changes indicate the participation of distinct damage and stress pathways that are unlikely to be fully addressed by conventional pharmaceutical treatment. Sensorineural hearing loss is a common and debilitating condition for which comprehensive pharmacologic intervention is not available. The complex and diverse molecular pathology that underlies hearing loss currently limits our ability to intervene with small molecules. The present review focuses on the potential for the use of extracellular vesicles in otology. It examines a variety of inner ear diseases and hearing loss that may be treatable using exosomes (EXOs). The role of EXOs as carriers for the treatment of diseases related to the inner ear as well as EXOs as biomarkers for the recognition of diseases related to the ear is discussed.

Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus

OBJECTIVES

The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool.

METHODS

This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire.

RESULTS

MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean).

CONCLUSION

Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.

Links across disabilities: unveiling associations between functional domains

BACKGROUND

Persons with disabilities experience higher risks of mortality as well as poorer health as compared to the general population. The aim of this study is to estimate the correlations between functional difficulties across several domains in six countries.

METHODS

National census data with questions on disability from six countries (Mauritius, Morocco, Senegal, Myanmar, Vietnam, and Uruguay) was used in this study. We performed logistic regressions to assess the extent to which having a functional difficulty in one domain is correlated with having a functional difficulty in each of the other domains and report weighted odds ratios (ORs) overall and within age-groups ('18-44' years and '45+' years). Models adjust for age, sex, and location (rural or urban). Sensitivity analyses around different choices of predictors and response variables were conducted.

FINDINGS

For all countries, reporting a functional difficulty in one domain was consistently and significantly positively correlated with reporting a functional difficulty in other domains (overall) and for each of the two age-groups considered - '18-44' years and '45+' years. All ORs were greater than one. Cognition, mobility, and hearing were the domains that were the most correlated ones with other domains. The highest pairwise correlations were for i/ hearing and cognition; ii/ mobility and cognition. Results were robust to changing the severity thresholds for functional difficulties. Across countries, Uruguay, the only high-income country among the six countries under study, had the lowest correlations between functional domains.

CONCLUSIONS

There are consistent positive associations in the experience of functional difficulties in various domains in the six countries under study. Such correlations may reflect barriers to social services including healthcare services and resources (e.g. assistive devices) that may lead to an avoidable deterioration of functioning across domains. Further research is needed on the trajectories of functional difficulties and on structural barriers that people with functional difficulties may experience in their communities and in healthcare settings in particular. This is important as some functional difficulties may be preventable.

Recent Therapeutic Progress and Future Perspectives for the Treatment of Hearing Loss

Up to 1.5 billion people worldwide suffer from various forms of hearing loss, with an additional 1.1 billion people at risk from various insults such as increased consumption of recreational noise-emitting devices and ageing. The most common type of hearing impairment is sensorineural hearing loss caused by the degeneration or malfunction of cochlear hair cells or spiral ganglion nerves in the inner ear. There is currently no cure for hearing loss. However, emerging frontier technologies such as gene, drug or cell-based therapies offer hope for an effective cure. In this review, we discuss the current therapeutic progress for the treatment of hearing loss. We describe and evaluate the major therapeutic approaches being applied to hearing loss and summarize the key trials and studies.

Emerging Relations among Cognitive Constructs and Cochlear Implant Outcomes: A Systematic Review and Meta-Analysis

OBJECTIVE

Hearing loss has a detrimental impact on cognitive function. However, there is a lack of consensus on the impact of cochlear implants on cognition. This review systematically evaluates whether cochlear implants in adult patients lead to cognitive improvements and investigates the relations of cognition with speech recognition outcomes.

DATA SOURCES

A literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating cognition and cochlear implant outcomes in postlingual, adult patients from January 1996 to December 2021 were included. Of 2510 total references, 52 studies were included in qualitative analysis and 11 in meta-analyses.

REVIEW METHODS

Proportions were extracted from studies of (1) the significant impacts of cochlear implantation on 6 cognitive domains and (2) associations between cognition and speech recognition outcomes. Meta-analyses were performed using random effects models on mean differences between pre- and postoperative performance on 4 cognitive assessments.

RESULTS

Only half of the outcomes reported suggested cochlear implantation had a significant impact on cognition (50.8%), with the highest proportion in assessments of memory & learning and inhibition-concentration. Meta-analyses revealed significant improvements in global cognition and inhibition-concentration. Finally, 40.4% of associations between cognition and speech recognition outcomes were significant.

CONCLUSION

Findings relating to cochlear implantation and cognition vary depending on the cognitive domain assessed and the study goal. Nonetheless, assessments of memory & learning, global cognition, and inhibition-concentration may represent tools to assess cognitive benefit after implantation and help explain variability in speech recognition outcomes. Enhanced selectivity in assessments of cognition is needed for clinical applicability.

Intranasal delivery of NGF rescues hearing impairment in aged SAMP8 mice

Hearing loss impacts the quality of life and affects communication resulting in social isolation and reduced well-being. Despite its impact on society and economy, no therapies for age-related hearing loss are available so far. Loss of mechanosensory hair cells of the cochlea is a common event of hearing loss in humans. Studies performed in birds demonstrating that they can be replaced following the proliferation and transdifferentiation of supporting cells, strongly pointed out on HCs regeneration as the main focus of research aimed at hearing regeneration. Neurotrophins are growth factors involved in neuronal survival, development, differentiation, and plasticity. NGF has been involved in the interplay between auditory receptors and efferent innervation in the cochlea during development. During embryo development, both NGF and its receptors are highly expressed in the inner ears. It has been reported that NGF is implicated in the differentiation of auditory gangliar and hair cells. Thus, it has been proposed that NGF administration can decrease neuronal damage and prevent hearing loss. The main obstacle to the development of hearing impairment therapy is that efficient means of delivery for selected drugs to the cochlea are missing. Herein, in this study NGF was administered by the intranasal route. The first part of the study was focused on a biodistribution study, which showed the effective delivery in the cochlea; while the second part was focused on analyzing the potential therapeutic effect of NGF in senescence-accelerated prone strain 8 mice. Interestingly, intranasal administration of NGF resulted protective in counteracting hearing impairment in SAMP8 mice, ameliorating hearing performances (analyzed by auditory brainstem responses and distortion product otoacoustic emission) and hair cells morphology (analyzed by microscopy analysis). The results obtained were encouraging indicating that the neurotrophin NGF was efficiently delivered to the inner ear and that it was effective in counteracting hearing loss.

Protecting cognitive function in older adults with age-related hearing loss: Insights from The Irish Longitudinal Study on Ageing (TILDA) and the role of hearing aids

BACKGROUND

Age-related hearing loss (ARHL) is prevalent in adults over 70, impairing hearing sensitivity and speech perception. ARHL has been linked to an increased risk of cognitive decline and dementia. However, most affected adults are not receiving adequate treatment, including hearing aids.

OBJECTIVE

This study aimed to evaluate the impact of ARHL on cognitive decline in older adults participating in the Irish Longitudinal Study on Aging (TILDA).

DESIGN

METHODS: Data from four TILDA waves, a 6-year follow-up, was collected and analyzed using zero-inflated Poisson regression. The primary outcome, cognitive function, was assessed using Mini-Mental State Examination (MMSE) total score and error counts.

RESULTS

Our analysis revealed that age, education, use of aids to help with hearing, and history of stroke were significantly associated with error counts at baseline. Additionally, poor hearing was associated with a negative change in MMSE score from wave 4, indicating the potential role of ARHL in cognitive decline. When further adjusted for age, sex, history of stroke, hypertension, any emotional, nervous, or psychiatric problem, polypharmacy, and hearing aids, the zero-inflated Poisson model indicated that poor hearing, use of hearing aids, stroke, hypertension, and polypharmacy all predicted MMSE error counts in follow-up assessments. Moreover, the use of hearing aids was associated with a decreased likelihood of cognitive decline.

CONCLUSION

ARHL was independently associated with cognitive decline, underscoring the importance of addressing hearing loss in older adults. Future research should explore the potential of hearing aids to protect cognitive functioning in older adults.

Deep intracochlear injection of triamcinolone-acetonide with an inner ear catheter in patients with residual hearing

Introduction

In a previous study, an inner ear catheter was used to deliver low- and high-dose steroids into the cochlea prior to cochlear implant electrode insertion. With this approach, more apical regions of the cochlea could be reached and a reduction of electrode impedances in the short term was achieved in cochlear implant recipients. Whether intracochlear application of drugs via the catheter is a safe method also for patients with residual hearing has not been investigated hitherto. The aim of the present study was therefore to investigate the effect of intracochlear triamcinolone application in cochlear implant recipients with residual hearing.

Patients and methods

Patients with residual hearing were administered triamcinolone-acetonide (4 mg/ml; n = 10) via an inner ear catheter just prior to insertion of a MED-EL FLEX28 electrode. Impedances were measured at defined time points (intra-operatively, post-operatively and at first fitting) and retrospectively compared with a control group (no steroid application) and low- and high-dose group. Hearing thresholds were measured preoperatively, 3 days after surgery and at first fitting by pure tone audiometry. Pre- to postoperative hearing loss was determined at first fitting and compared to results from a previous study.

Results

The median hearing loss after implantation (125-1,500 Hz) was 20.6 dB. Four patients (40%) showed a median hearing loss of less than 15 dB, three patients (30%) between 15 and 30 dB and three patients (30%) more than 30 dB. The median hearing loss was similar to the results obtained from our previous study showing a median hearing loss of 24 dB when using FLEX28 electrode arrays.

Conclusion

No difference in residual hearing loss was found when comparing application of triamcinolone-acetonide using an inner ear catheter prior to the insertion of a FLEX28 electrode array to the use of the FLEX28 electrode array without the catheter. Thus, we conclude that application of drugs to the cochlea with an inner ear catheter could be a feasible approach in patients with residual hearing.

Extracellular Vesicles in Inner Ear Therapies-Pathophysiological, Manufacturing, and Clinical Considerations

(1) Background: Sensorineural hearing loss is a common and debilitating condition. To date, comprehensive pharmacologic interventions are not available. The complex and diverse molecular pathology that underlies hearing loss may limit our ability to intervene with small molecules. The current review foccusses on the potential for the use of extracellular vesicles in neurotology. (2) Methods: Narrative literature review. (3) Results: Extracellular vesicles provide an opportunity to modulate a wide range of pathologic and physiologic pathways and can be manufactured under GMP conditions allowing for their application in the human inner ear. The role of inflammation in hearing loss with a focus on cochlear implantation is shown. How extracellular vesicles may provide a therapeutic option for complex inflammatory disorders of the inner ear is discussed. Additionally, manufacturing and regulatory issues that need to be addressed to develop EVs as advanced therapy medicinal product for use in the inner ear are outlined. (4) Conclusion: Given the complexities of inner ear injury, novel therapeutics such as extracellular vesicles could provide a means to modulate inflammation, stress pathways and apoptosis in the inner ear.