Aaron C. Moberly

Purpose: The three-alternative forced-choice design of the spectral-temporally modulated ripple test (SMRT) may capture both auditory and neurocognitive functioning. The relationships between neurocognitive functions and SMRT performance remain unexplored in middle-aged and older adults, as does the degree to which hearing loss may affect these relationships. This study hypothesized that better neurocognitive functions and better hearing would predict better SMRT performance and that hearing loss and neurocognitive functions would interact in contributing to SMRT performance. Method: Data were collected from 81 adults recruited from a single tertiary care medical center with hearing abilities ranging from normal hearing to profound hearing loss. Relationships were examined among SMRT performance; unaided pure-tone average (PTA) at 500, 1000, and 2000 Hz; age; nonverbal reasoning (Raven's Progressive Matrices [Raven's]); and short-term memory capacity (visual forward digit span). Results: Bivariate analyses revealed that PTA, digit span, and Raven's scores were significantly associated with SMRT performance, whereas age was not. Multivariable linear regression confirmed these three as independent, significant predictors; age again was not. Interaction terms of PTA × Digit Span and PTA × Raven's were not significant predictors of SMRT performance. Conclusions: Neurocognitive functions of nonverbal reasoning and short-term memory capacity, as well as hearing ability, independently contribute to SMRT performance. Nonsignificant interactions suggest that the neurocognitive effects on SMRT are constant across degrees of hearing loss. These findings support ongoing use of SMRT in middle-aged and older adults with hearing loss, although the independent effects of neurocognitive functions should be accounted for, or at least considered, when interpreting SMRT performance. Supplemental Material: https://doi.org/10.23641/asha.34595052

Objective: To identify factors independently contributing to preoperative hearing-related quality of life (HRQOL) in adult cochlear implant (CI) candidates. Study design: Retrospective cross-sectional analysis. Setting: Tertiary academic medical center. Patients: A total of 171 adults were evaluated for CI candidacy from 2018 to 2024. Main outcome measures: Cochlear Implant Quality of Life-10 Global (CIQOL Global) scores served as the main outcome measure. Independent variables included the 10-item Vanderbilt Fatigue Scale (VFS-A-10), Tinnitus Handicap Inventory (THI), age, duration of deafness, and preoperative AzBio sentence recognition in quiet (AzBioQ) scores. Results: Bivariate analyses revealed significant correlations between CIQOL Global scores and both VFS-A-10 ( r =−0.56, P r =−0.31, P =0.005). No significant correlations were found between CIQOL Global and age, duration of deafness, or AzBioQ performance. In multivariable linear regression (n=67), VFS-A-10 was the sole independent predictor of preoperative CIQOL Global (β=−0.55, P <0.001). THI, age, duration of deafness, and AzBioQ performance did not contribute additional explanatory value. Sensitivity analysis in a larger sample of adult CI candidates (n=144) confirmed these findings. Conclusions: Listening fatigue was the primary independent factor associated with preoperative HRQOL among CI candidates, whereas traditional audiologic measures and perceived tinnitus did not contribute independently. These findings highlight the importance of assessing listening fatigue as part of CI candidacy evaluation and suggest that interventions targeting fatigue management may improve patient well-being. Routine assessment of listening fatigue could enable more personalized counseling and identify CI candidates who might benefit from earlier intervention.

Objectives: Speech recognition outcomes following cochlear implantation vary widely among users, potentially due to differences in neuroplasticity. The cholinergic system plays a critical role in cortical reorganization and sensory learning; yet, its potential to enhance auditory plasticity in cochlear implant (CI) users has not been explored. The aim of this study is to investigate the effects of donepezil, a cholinergic agonist, on speech perception and cortical plasticity in adults with CIs. Design: This pilot randomized clinical trial was conducted at a single tertiary academic center from April 2023 to December 2024. Adult CI recipients with a postlingual onset of deafness and at least 6 months of device experience were eligible for inclusion. Participants were randomized to oral donepezil 5 mg (DPZ) or placebo (PL) daily for 90 days. Both groups were encouraged to increase their daily device use during the study. The primary outcome measure was the change in consonant-nucleus-consonant word recognition scores for the implanted ear. Secondary outcomes included binaural word recognition, sentence recognition in quiet, signal to noise ratio loss for sentence recognition in noise, and questionnaires related to hearing satisfaction, listening fatigue, and quality of life. The questionnaires included the Speech, Spatial, and Quality of Hearing Scale, Vanderbilt Fatigue Scale, and CI Quality of Life Profile. Cortical plasticity was assessed using functional near-infrared spectroscopy. Results: Thirteen experienced CI users were enrolled in this pilot study, with nine completing the 90-day protocol and included in the group descriptive analyses (DPZ: n = 4, PL: n = 5). Four participants (45%) were female, and the median age was 68 years. All study participants increased their device use, with a mean increase of 3.1 hr per day in both groups. Donepezil treatment was associated with a 14.5-point increase in mean CI-only consonant-nucleus-consonant word recognition, surpassing the 10-point threshold for clinical significance, whereas the placebo group decreased by 0.8 points ( d = 0.88). Binaural word recognition, sentence recognition, and speech-in-noise performance also improved in the DPZ group relative to PL. Subjective measures showed greater improvements in speech perception (Speech, Spatial, and Quality of Hearing Scale) and reduced listening fatigue (Vanderbilt Fatigue Scale) in the DPZ group, while CI-related quality of life was similar between groups. Neuroimaging analyses revealed significant Group × Time interaction effects, with DPZ increasing left frontal cortex activation during a speech-in-noise task ( β = 3.721, p < 0.001). Conclusions: These findings provide preliminary evidence that cholinergic enhancement with donepezil may improve speech perception and facilitate neuroplasticity in multisensory and cognitive brain regions in CI users. In addition, the neuroimaging analyses support cholinergic-induced neuroplasticity with DPZ treatment. While this pilot study was underpowered to determine the clinical efficacy of donepezil, pharmacological interventions like donepezil represent a promising novel approach to optimizing CI outcomes, and we offer recommendations for future clinical trials in this population.

Background/Objectives: Accurate diagnosis of middle ear disease remains challenging because otoscopic interpretation is subjective, while many artificial intelligence models depend on manually selected still frames from video examinations. We aimed to develop and internally evaluate LUCID, a systematic framework for automatically identifying the most informative frames in otoscopy videos. Methods: We analyzed 713 otoscopy videos from 491 patients. LUCID combines a ResNet-50 classifier for coarse eardrum-visibility assessment, BC-AdvCAM for weakly supervised eardrum localization and coverage estimation, and an otoscope-specific blur/focus assessment into a within-video frame-ranking score. Automated selections were compared with expert-selected frames through blinded human review and downstream classification. To separate ranking quality from the effects of bag size and multi-frame aggregation, a matched 12-frame control using uniform temporal sampling was evaluated with the same ResNet-50 and attention-based multiple instance learning (ABMIL) pipeline. Results: Among 293 video pairs with complete ratings, algorithm-selected frames were rated equal to or better than expert-selected frames in 74.7% of evaluations on average. However, when an evaluator expressed a non-Equal preference, the expert frame was favored in 71.7% and 70.7% of cases by the two evaluators, respectively; among concordant non-Equal ratings, 80.0% favored the expert frame. BC-AdvCAM achieved an intersection over union of 0.6717 and a Dice similarity coefficient of 0.7924 on a held-out manually segmented test subset. For downstream diagnosis, patient-level mean accuracy for the matched single-frame comparison was 68.79% for LUCID Top-1 versus 72.17% for the expert-selected frame (difference, −3.38 percentage points; 95% exact sign-flip-inversion CI, −6.79 to 0.00; two-sided exact patient sign-flip p = 0.0540). In the matched 12-frame comparison, LUCID Top-12 achieved 78.13% versus 59.41% for Uniform-12 using the identical ABMIL pipeline (difference, +18.71 percentage points; 95% exact sign-flip-inversion CI, +15.79 to +21.63; two-sided exact patient sign-flip p = 2.33 × 10⁻¹⁰). Conclusions: In the matched single-frame comparison, the expert-selected frame had the higher observed patient-level mean accuracy, whereas LUCID provided an automated ranking of the full video that substantially improved matched 12-frame ABMIL performance relative to uniform temporal sampling. These results support LUCID as an automated frame-ranking and multi-frame evidence-selection tool, while external validation remains necessary before clinical deployment.

Objectives: The purpose of this pilot study was to investigate (1) if the Speech Intelligibility Index (SII) could be used to identify ears that meet cochlear implant (CI) candidacy beyond the "60/60" referral guidelines and (2) investigate the relationship between SII from patients' own hearing aids (HAs) and SII from optimally fit clinic-stock HAs such that a patient's own HAs can act as a proxy for an optimally fit HA and thus as a referral metric. Design: Prospective study of 23 participants (≥ 18 years) with bilateral moderate to profound sensorineural hearing loss who were CI candidates in at least one ear. SII-Clinic (SII-C) values were recorded with probe-microphone measures using a Verifit II device (NAL-N2 targets) with speech stimuli presented at 60 dB A during patient CI evaluation in either their own HAs or clinic-stock HAs. SII values from participants' own HAs were recorded as part of a larger research protocol, thus SII-Personal (SII-P), with probe-microphone measures using a Verifit I device (NAL-RP targets) with pink noise stimuli presented at 65 dB A. Participants that did not wear HAs did not have SII-P calculated. Data was collapsed across ears. Correlation analysis between SII and best-aided consonant-nucleus-consonant (CNC) was conducted. Benchmark SII values were extrapolated using a best-fit line and CI candidacy rates reflecting various aided CNC scores that could be applied across CI centers. Nested logistic regression models were used to determine if the SII-C could improve model fit beyond the revised ear-specific 60/60 referral guideline. The relationship between SII-C and SII-P was assessed with Wilcoxon signed-rank test and Spearman correlation. Results: Correlation between SII-C and aided CNC score was r = 0.82 (p < 0.001), and the correlation between SII-P and aided CNC was r = 0.46 (p = 0.014). Extrapolated benchmarks of SII were calculated based on different CNC candidacy cutoffs, and benchmarks were able to capture at least 83% of the ears that met CNC candidacy cutoffs. SII was also found to improve model fit with word recognition score (WRS) and pure tone average (PTA) for 60% CNC candidacy cutoff (χ ² = 9.7; p = 0.002) and increased discrimination (AUC = 0.89 to AUC = 0.99). There was no significant difference between SII-C and SII-P using the Wilcoxon signed-rank test (p = 0.559). Conclusions: A larger study is needed that includes more ears that do not qualify for a CI; however, the results of this study demonstrate that (1) SII has the potential to be used in conjunction with the 60/60 referral guideline for CI candidacy evaluations and (2) SII can be used as a marker of audibility across different devices, including patients' own HAs, making SII an accessible metric during HA fittings and fine tunings.

Objective: To investigate whether neighborhood‐level sociodemographic deprivation, measured by the Area Deprivation Index (ADI), is associated with speech recognition and hearing‐related quality of life (QoL) prior to and following cochlear implant (CI) surgery. Methods: A retrospective review of 515 adult CI recipients (2017–2022) was conducted. Home addresses were geocoded to ADI percentiles representing neighborhood‐level sociodemographic deprivation. Assessments collected pre‐CI and at 6‐ and/or 12‐months post‐CI included speech recognition (CNC words, AzBio sentences in quiet—AzBioQ, and in noise—AzBioN) and patient‐reported outcome measures (Speech, Spatial and Qualities‐12—SSQ, Cochlear Implant Quality of Life‐10—CIQOL). Bivariate Spearman correlations and multivariable linear regressions controlling for age, sociodemographic variables, duration of deafness, and electrode type evaluated associations between ADI and assessment measures. Results: Participants from more deprived neighborhoods (i.e., with larger ADIs) demonstrated significantly poorer pre‐CI CNC ( r _s = −0.11), AzBioQ ( r _s = −0.12), AzBioN ( r _s = −0.18), SSQ ( r _s = −0.13), and CIQOL ( r _s = −0.30) (all p < 0.05). In multivariable models, larger ADI remained an independent predictor of poorer pre‐CI speech recognition and worse CIQOL ( p 's < 0.05). However, ADI was not associated with any post‐CI outcomes ( p 's > 0.05). Conclusion: Greater neighborhood‐level deprivation is associated with poorer speech recognition and patient‐reported outcome measures at CI evaluation but not with postimplantation benefit. These findings suggest that socioeconomic disparities primarily influence access to intervention rather than outcomes following implantation. Incorporating ADI into clinical workflows may help identify patients at risk for delayed CI access. Level of Evidence: 4.

Otalgia is a common and potentially vexing symptom for both patient and provider. Primary and secondary sources of otalgia are possible and should be considered when evaluating patients. Thorough evaluation is important to ensure that an occult and sinister pathology is identified, if present. Treatment of otalgia generally depends on the source of the symptom, and multidisciplinary patient management may be necessary.

Objective: To examine the relative impact of advancing age on clinical speech recognition performance before and after cochlear implantation across tasks varying in auditory and cognitive demands. Study design: Retrospective review of prospectively collected data. Setting: Cochlear implant (CI) center. Patients: Seventy-five CI recipients aged 20 to 88 years (mean=67.6, SD: 15.8). Interventions: Speech recognition before and after CI. Main outcome measures: Pre-CI performance and post-CI improvement on Consonant-Nucleus-Consonant (CNC) word recognition, AzBio sentences in quiet (AzBioQ), and AzBio sentences in noise (AzBioN); multivariate regression models accounting for relevant covariates. Results: Age negatively predicted pre-CI performance on AzBioQ (β=−0.18, P =0.025) and AzBioN (β=−0.17, P =0.024), but not CNC (β=0.00, P =0.988), when controlling for pure-tone average (PTA), duration of deafness (DoD), and sex. Older age predicted less post-CI improvement in AzBioN (β=−0.30, P =0.024), but not CNC (β=−0.24, P =0.054) or AzBioQ (β=−0.18, P =0.171), when controlling for DoD, CI usage, electrode type, and sex. Daily CI usage predicted post-CI improvement in CNC (β=3.80, P =0.001) and AzBioQ (β=3.07, P =0.009), but not AzBioN. Electrode type and sex were not significant predictors of post-CI improvements. Conclusions: Advancing age is associated with poorer pre-CI sentence recognition and smaller gains in post-CI sentence recognition in noise, likely reflecting combined auditory and cognitive changes. These findings highlight the importance of age-informed counseling and expectation-setting for older CI candidates. Level of Evidence: Level IV—Historical cohort or case-controlled studies. Indicate IRB: 240876.

Background/Objectives: Cochlear implant (CI) candidacy has expanded beyond traditional bilateral hearing loss (HL) to include single-sided deafness (SSD) and asymmetric hearing loss (AHL), yet baseline differences in speech recognition and patient-reported outcome measures (PROMs) between these groups—bilateral HL, SSD, and AHL—remain poorly characterized. The objective of this study was to characterize and compare preoperative speech recognition performance and PROMs between traditional bilateral HL and SSD/AHL CI candidates, and to examine associations between preoperative word recognition scores and PROMs across the full cohort. Methods: Sixty-eight adults (mean age 71.6 years, SD 7.4) undergoing preoperative CI evaluation were enrolled (31 bilateral HL, 12 SSD, and 25 AHL). Consonant–Nucleus–Consonant (CNC) word recognition and AzBio sentence recognition were assessed for both the ear-to-be-implanted (CI ear) and the contralateral ear. The following PROMs were evaluated: the Speech, Spatial and Qualities of Hearing Scale (SSQ-12); Cochlear Implant Quality of Life–35 (CIQOL-35); Patient Health Questionnaire-2 (PHQ-2); Tinnitus Handicap Inventory (THI); and the Instrumental Activities of Daily Living (IADL). Group comparisons used Mann–Whitney U tests and t-tests. CNC, SSQ-Mean, and CIQOL-Global associations were assessed using multivariable linear regression analysis. Results: Preoperative CI-ear speech recognition did not differ between the bilateral HL and SSD/AHL groups. SSD/AHL candidates had significantly higher contralateral-ear speech recognition performance, better SSQ-12 scores across all domains, and higher CIQOL-35 Global, Communication, Entertainment, and Environment scores compared to bilateral HL candidates. However, the CIQOL-35 Emotional, Listening Effort, and Social domains, PHQ-2, THI, and IADL did not differ significantly between the bilateral HL and SSD/AHL groups. Across our entire sample of candidates, CI-ear CNC scores were not significantly associated with preoperative SSQ-Mean or CIQOL-Global scores, while contralateral-ear CNC scores showed moderate, significant associations with both measures. Conclusions: Traditional bilateral and SSD/AHL CI candidates exhibit distinct preoperative PROM profiles (namely, the SSQ-12 and CIQOL-35) despite having no significant differences in CI-ear speech recognition. Contralateral-ear CNC scores—but not CI-ear scores—were significantly associated with the SSQ-Mean and CIQOL-Global, suggesting that contralateral-ear CNC scores may offer relevant insight into CI candidates’ functional hearing. These findings support population-specific counseling and highlight the complementary value of PROMs and audiometric data in CI candidacy evaluations.

Purpose: An Adult Cochlear Implant Aural Rehabilitation Special Interest Group was formed in 2023. Members represent interdisciplinary collaborators, including audiologists, speech-language pathologists, surgeons, nonclinical administrators, manufacturer/industry representatives, and researchers. Current perspectives of adult cochlear implant (CI) recipients regarding aural rehabilitation (AR) remain unknown and understudied. The aim of this study is to survey adult CI recipients to determine their perspectives on the AR process. Method: A web-based national survey was sent to adult CI recipients through multiple channels. The survey asked recipients about their demographics, state of residence, hearing loss history, and device configuration. Questions probed recipients' experiences of learning about AR options, services used, definitions of AR, and perceived value of services received. Questions were also asked about barriers to AR services, preoperative counseling, and satisfaction with their decision to pursue a CI. Results: A total of 115 CI recipients responded to the survey. Results revealed a relative lack of information provided to many CI recipients regarding AR services. Many CI recipients reported wishing they had received additional resources in the areas of music training and equipment troubleshooting. Most participants reported that both one-on-one clinician-guided AR and independent listening practice were effective methods of AR. Conclusions: Findings shed light on current gaps in providing the most effective AR services, which will need to be addressed to optimize hearing health care and outcomes for adult CI recipients. Future work should include outreach to a broader representation of CI users to expand our understanding of AR resources, education, and limitations.