To investigate the functionalities of the neural pathways through the auditory evoked potentials of the brainstem and the contralateral stapedial acoustic reflexes in normal-hearing individuals with type 1 diabetes mellitus, in order to detect possible alterations in the central auditory pathways.This is a cross-sectional study with a comparison group and a convenience sample, consisting of 32 individuals with type 1 diabetes mellitus and 20 controls without the disease. All subjects had hearing thresholds within normal limits and type A tympanometric curves. The acoustic reflex arc and brainstem auditory potentials were investigated. Statistical analyses were performed using the SPSS 17.0. The Chi-square test, Student´s t-test, and Multiple linear regression were used.The auditory thresholds of the acoustic reflex were statistically lower in the group with the disease at frequencies of 0.5 kHz and 1.0 kHz in the left ear . The absolute latencies III and V of the auditory potentials of the brainstem in the right ear and V in the left ear were increased in subjects with type 1 diabetes mellitus .The findings suggest that subjects with type 1 diabetes mellitus are more likely to present alterations in the central auditory pathways, even with auditory thresholds within normal limits. It is estimated that the global T1DM prevalence rate is approximately 5% to 10%.Type 1 diabetes mellitus (T1DM) is a multifactorial disease, the environmental, genetic, and immunological factors of which can interact. These complex interactions culminate in the autoimmune reaction that damages the pancreatic beta cells, causing a complete insulin deficiency in the body,4.The association between diabetes mellitus and impaired auditory pathways remains contentious amongst researchers, as studies suggest the frequency of hearing loss in diabetic patients can range anywhere between 5,17% and 48%, besides premature metabolic complications such as non-enzymatic glycation related to the hyperactivity of free oxygen radicals. Thus, it is possible that for diabetes mellitus, the hearing loss may have endocochlear, retrocochlear, or combined sites of origin.The proposed etiopathogenic mechanisms are associated with chronic complications of the disease. These include microangiopathy of the capillaries of the inner ear and neuropaty,8 as well as injury to the central auditory structures, as evidenced by an increase in absolute latencies when the auditory brainstem evoked potentials were analyzed,10.The audiometric test does not adequately assess the structures most vulnerable to injuries in individuals with T1DM; therefore, it does not present a method capable of detecting subclinical abnormalities. There is a consensus in the literature about the factors that promote clinical complications, attesting that the most affected site is located predominately in the central nervous system, secondary to inadequate metabolic control and early start of the disease in this population. Studies indicate that irregular metabolic control has potentially deleterious effects on the auditory pathways and may contribute to the onset of peripheral auditory disordersGiven the above, it is not clear in the literature whether type 1 diabetes mellitus can affect the central auditory pathways early. The results are still controversial and based on different clinical designs, with heterogeneous samples, with much of the information in the literature based on older patients and many already with other associated comorbidities. Thus, it makes it difficult to understand the real pathophysiological processes of DM1 in hearing at early ages of development, which would be essential for monitoring associated comorbidities and better quality of life for these patients.Therefore, This study aimed to investigate the neural synchrony of the auditory pathway in T1DM with hearing thresholds within the normal range through brainstem auditory evoked potentials (BAEPs) and contralateral acoustic reflex thresholds to detect possible hearing loss in the absence of psychoacoustic alteration, thereby confirming the presence of subclinical changes in this population.This is a cross-sectional study with a comparison group comprised by a sample of outpatients, which included 32 T1DM patients and 20 nondiabetic controls. In the T1DM group, 56.3% of the patients were male, with a mean age of 21.0 ± 6.1 years, and the average duration of the disease was 8.0 ± 1.7 years. The experimental group comprised all patients who sought care at the Public and Reference Center  for the treatment of diabetes mellitus. Eligibility included confirmed diagnosis of T1DM through the patient’s clinical history and fasting blood glucose test. Additionally, the participants required audiometry results with hearing thresholds ≤20 dB HL and normal tympanometry., such as hearing loss detected in the threshold tonal audiometry and immittanciometry.The control group, which comprised individuals who frequented a popular pharmacy near PRC, had 56.0% male participants, with a mean age of 22.7 ± 7.6 years, presenting with normal capillary blood glucose levels. The exclusion criteria were as follows: a history of neurological or psychiatric disease, history of adverse hearing conditions, disabling motor difficulties, other forms of metabolic diseases other than T1DM to avoid associated comorbidities.With regard to the capillary fasting blood glucose levels (VR≤101 mg/dL), the average of the last three results recorded in the participant’s medical records was used, along with the glycated hemoglobin (HbA1c) levels (VR=3.7%–6.5%) recorded over the previous three months and contralateral acoustic reflex thresholds at 0.5 Hz, 1 Hz, and 2 kHz present at normal levels,13.The audiological evaluation was divided into two parts. The first one sought to exclude or include individuals from the study’s sample. In this part, all the participants were subjected to the following audiological evaluations. a) Otoscopy was performed to rule out the presence of cerumen or foreign objects that could interfere with obtaining correct audiometric and tympanometric results. b) Audiometry was performed in a sound-treated booth using a Danplex DA65 audiometer , with supra-aural TDH-39 headphones. Air-conduction thresholds at 0.25 kHz, 0.5 kHz, 1 kHz, 2 kHz, 3 kHz, 4 kHz, 6 kHz, and 8 kHz were obtained in both ears, followed by determination of the speech recognition threshold (SRT) and speech discrimination index (SDI), performed in an acoustically-treated cabin. Individuals with thresholds up to 20 dBHL at all tested frequencies were considered c) Immittance tests were conducted to determine the tympanogram (tympanometry using 226-Hz probe tone) considered normal when classified in type A curve.BAEP testing was performed using the Interacoustics EP25 device . The stimuli were broadband clicks presented at one intensity (80 dB HL), two polarities , and one rate (30 clicks/second) in each ear, monaurally. The BAEP was recorded differentially using a gold surface electrode secured to the ipsilateral mastoid for the active (inverting) channel. A surface electrode attached to the high forehead (Fz) served as the reference (noninverting) electrode, and a surface electrode attached to the brow (Fpz) served as the ground. Efforts were made to maintain electrode impedances below 3 Ω. The recorded signal was amplified , filtered (0.3–3.0 kHz), and digitized for subsequent analyses. The BAEPs were collected as two samples of 2000 runs for each stimulus polarity. The averages of the two samples were compared to determine whether BAEP morphology was replicable. Adopting as normality criteria recommended by HoodThe research was approved by the Committee of Ethics in Research of CEDEBA and the approval number is 13.11.09. The patients were informed about the procedures, and those involved signed the Free and Informed Consent Form.Statistical analyses were performed using the SPSS software  version 17.0 . The chi-square test was adopted to analyze the association between qualitative variables. The Student´s t-test was used to verify the comparison between the average of two groups. Multiple linear regression was used to verify relationships between age, age at diagnosis, time since diagnosis, and hearing thresholds with BAEPs and acoustic reflex thresholds.+ 6.1 years. The average patient age at diagnosis was 9.0 + 4.1 years, and average time since diagnosis was 8.0 + 1.7 years. In the control group, 56.0% were male, with a mean age of 22.7 ± 7.6 years. There was no statistically significant difference between the study and control groups concerning age and sex (p > 0.05).In the group T1DM, 56.3% subjects were male, with a mean age of 21.0 Tonal hearing threshold frequencies were 4 kHz in the right ear (p<0.01) and 2 kHz (p=0.04) and 4 kHz (p=0.04) in the left ear. The hearing threshold in the T1DM group was elevated, compared with the results for the same in the control group .In the group T1DM, 84% of individuals had inadequate metabolic control of capillary blood glucose (77% hyperglycemia and 7% hypoglycemia) and 90.0% had higher levels of glycated hemoglobin. All subjects in the control group had normal glucose levels.As regards the association with glycemic control, the tonal hearing thresholds at frequencies of 8 kHz were worse in the subjects T1DM without glycemic control , suggesting worse hearing in this subgroup. No statistically significant difference was observed between the tonal hearing thresholds in the T1DM and those without adequate control of their HbA1c.In the T1DM group there was a statistically significant correlation between tonal hearing thresholds and age at the frequencies of 3 kHz  and 4 kHz  in the right ear and 6 kHz  in the left ear. There was also an association between tonal hearing thresholds and patient´s age at diagnosis at the frequencies of 3 kHz  and 4 kHz  in the right ear and 6 kHz  in the left ear.The higher the age of the patient at diagnosis, the worse the tonal hearing threshold, i.e. the higher the level of hearing impairment. No statistically significant association between the tonal hearing thresholds and the time elapsed since diagnosis was observed.In the T1DM group, acoustic reflexes thresholds were elicited using lower intensity sounds at the frequencies of 0.5 and 1 kHz in the left ear. .Similarly, the acoustic reflexes thresholds were elicited by lower intensity sounds at the frequency of 0.5 kHz in the left ear in the subgroup of individuals T1DM without control of their HbA1c .With regard to capillary blood glucose, there was no association observed between this variable and the contralateral acoustic reflexes thresholds in the group T1DM. Moreover, the association between the values of contralateral acoustic reflexes thresholds with sex, age or tonal hearing threshold in the group T1DM was not statistically significant.With respect to the patient´s age at diagnosis, there was a positive correlation between contralateral acoustic reflexes thresholds at the frequency of 0.5 kHz in the right ear . However, in the control group, an inverse correlation was observed between contralateral acoustic reflexes thresholds at the frequency of 0.5 kHz  and 2000 Hz  in the left ear. The older the patient was, the lower the intensity needed to elicit acoustic reflexes.There was no association observed between the nerve conduction times in the auditory pathway , capillary blood glucose, and HbA1c values  in the group with T1DM. Likewise, no association was found between the results of the BAEP and the patient´s age at diagnosis. Whereas, the time since the diagnosis was associated with the absolute latency of wave V for both the right ear  and the left ear . No association was observed between BAEP and age or tonal hearing threshold in the group T1DM or the control group.The present study highlights the possible subclinical hearing alterations in T1DM patients., however, hyperglycemia is the condition most directly related with the appearance of several morphological alterations in the auditory system. It is also involved in the decrease of the Na+-K+-ATPase pump activity, causing labyrinthine hydrops by hyperosmolarity secondary to the accumulation of sodium in the endolymph,17.Most of the participants presented inadequate metabolic control and clinically harmful conditions to homeostasis in the auditory system. The hypoglycemia and hyperglycemia may change the normal function. Histopathological findings of the inner ear of individuals with T1DM also favor this hypothesis, because they demonstrate the thickening of the capillary walls of the stria vascularis, the presence of hemorrhage and endolymphatic hydrops, a decreased number of fibers of the spiral blade, degenerative changes in the organ of Corti, and a reduction in external hair cells.This consequence can be seen in the difference between the hearing thresholds of individuals with and without T1DM; it can be seen that the group with T1DM presented higher hearing thresholds, despite being within the normal standards. When analyzing only the group with T1DM, it was found that the hearing thresholds were worse when there was inadequate glycemic control. Thus, T1DM may compromise the physiology of the inner ear at a subclinical level. In a previous literature review study, we investigated otoacoustic emissions, and a reduced amplitude was seen in patients with T1DM. It also showed a worsening hearing prognosis with an increase in age, without following a similar standard for presbycusis.However, the present study did not aim to describe alterations in the tonal auditory threshold, but the mean differences between the analyzed, it was verified that the high frequencies were more affected by the disease, particularly in conditions of inadequate metabolic control, corroborating with the existing data in the literature or an increase in the acoustic reflex of individuals with T1DM.It should be noted that this study found a reduced level of contralateral acoustic reflex thresholds, independent of hearing thresholds, between individuals with and without T1DM. To the best of our knowledge, this is the first study that has shown this result. Others have not found differences in the thresholds of the contralateral acoustic reflex in young T1DM patients17, which leads to a decrease of the endocochlear potential, affecting the eliciting reflex threshold. It can also be due to a probable presence of musculoskeletal alterations of the stapedial muscle secondary to diabetic microangiopathy,16 located in the middle and inner ear.This reduction in the contralateral reflexes could be explained, initially, as secondary to the notorious hyperglycemic conditions in the sample, considering that this clinical condition decreases the hearing sensitivity due to intracellular hyperosmolarity. In the auditory system, these neural changes can be verified through the inoperability of the efferent system, since in diabetic individuals in situations of hyperglycemia, there is a high bioelectrical activity of the cochlear amplifier, recorded through the increase in the amplitude of otoacoustic emissions, which makes the auditory system more sensitive to sound during decompensation of these metabolic alterations.Other morphological alterations such as injury to the motor nerves, myelin degeneration, and damage to axons contribute to the knowledge of the absence and/or reduction of the acoustic reflexes in this population, showing that auditory damages in diabetes may occur in isolated or combined sites of the auditory system,24,25. The increase in the absolute latency of wave V had a positive correlation with the time since the diagnosis, which was not observed in other studies.The BAEP analysis in the present study ratified the endocochlear and/or retrocochlear alterations, which can be seen as an extension of the absolute latencies of waves III and V in T1DM compared with the control group. The increase in absolute latencies in the analysis of BAEP has also been observed in other studiesThese studies were conducted in developed countries, where differences in the healthcare systems and public awareness may favor greater effectiveness of glycemic control compared with the population in this study. The population in this study is financially challenged and has poor access to healthcare, such as difficulties in making appointments and obtaining proper medication, among others, leading to a poor metabolic control. Furthermore, with inadequate metabolic control, chronic complications tend to worsen over time., in BAEP testing, indicated that in pediatric cases of type T1DM, the increase in latencies is indicative of retrocochlear alterations. According to Wu et al., wave III is changed by many structures in the brainstem; thus, it is possible to suggest medial superior olivary complex damage in diabetic individuals. Other studies have determined that there may be changes in the medial olivocochlear efferent neurons in diabetic patients and diabetic rats27, particularly those without hearing loss.Acar et al.Considering the aforementioned findings, the present study, besides contributing toward the basic understanding of the pathophysiology of diabetes mellitus in the auditory system, highlights some clinical implications that attest the need for early intervention, as well as the development of a methodology to monitor the hearing health of this population, on pointing out the existence of subclinical alteration signs in T1DM patients. Furthermore, this study’s limitation in comparing similar findings in subject-specific literature emphasizes that there is a shortage of studies in this field, such as a variety of studies with different protocols and evaluation methods, which is required for the normalization of the included parameters.The results of this study suggest that individuals with T1DM present a predisposition to the development of hearing loss, particularly in a subclinical manner, observed in the study of brainstem auditory evoked potentials and contralateral acoustic reflex, without presenting specific sites of injury in the auditory pathways, although the central pathways emerge as the most susceptible.


To compare the cortical auditory evoked potential responses pre-and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis.This is a pilot, prospective, randomized, single-blind study.Eight presbiacusis elderly people between 65 and 80 years, new hearing aid users, divided into two groups participated in the study: Hearing Aid Group: use of hearing aid; and Auditory Training Group: use of hearing aid in addition to musical auditory training for 16 sessions. All participants were submitted to cortical auditory evoked potential tests with verbal stimulation in two different moments: Initial assessment, carried out before hearing aid adaptation and auditory training, and after three months, final assessment at the end of the auditory training sessions. All participants were adapted bilaterally with digital mini hearing aids.There was a decrease in the P3a latency component for the Auditory Training Group when initial and final assessment were compared.There was a change in the cortical auditory evoked potential in elderly people with presbycusis in response to the Musical Auditory Training associated with the use of hearing aids in elderly people with presbycusis. Hearing loss associated with aging—presbycusis—affects not only the peripheral auditory system; but changes in the anatomy and physiology of the central auditory system of the elderly can also occur, in addition to the changes caused by the aging process itself .Even in mild hearing loss, a fundamental impact on the organization and functioning of the auditory cortex follows, as there is the recruitment of other sensory systems, such as the somatosensory system in an attempt to regulate the deficient neural processing of auditory information .The impacts resulting from hearing deprivation in the elderly can be reduced with the appropriate intervention for hearing loss , 3.Hearing rehabilitation may include hearing aid adaptation and auditory training, which is essential for the development of central auditory skills, such as auditory closure, auditory figure-ground, temporal ordering (duration pattern and frequency pattern), binaural separation and binaural integration .The objective of auditory training, according to Bamford  is to deChermak and Musiek  state thMusical Auditory Training (MAT) is an auditory training program developed to meet the needs of elderly hearing aid users, focused mainly on the auditory skills of temporal processing—resolution and temporal ordering—and selective attention. After the MAT application in elderly hearing aid users, an improvement in temporal auditory skills was found, proven by behavioral tests, evidencing the benefit of MAT in these skills –10. HoweThe mechanism that enables this change in the auditory behavior, resulting from a neural reorganization, is neural plasticity . The rehThe electrophysiological measure is one of the means of investigating the functions of the central auditory pathways and has been an important instrument in monitoring the therapeutic evolution of the elderly in the auditory rehabilitation process , 14. CorDecreased latency of auditory evoked potentials is understood as a neurophysiological correlate of neuronal plasticity. This can be observed even before a behavioral manifestation, as it depends on the integration between conscious perception and more central cognitive processes –19. OtheConsidering the complexity of the factors that may be associated with hearing difficulties in the elderly, aging has been the subject of several studies in the area. Understanding the central auditory mechanisms involved in the auditory adaptation and rehabilitation process in this population is a challenge. Thus, this study seeks to investigate the therapeutic evolution at a central level in the elderly through Electrophysiology, more specifically the CAEP.The hypothesis is that auditory rehabilitation through Musical Auditory Training (MAT) associated with the use of hearing aids is capable of generating changes in the auditory function in elderly people with presbycusis. If the hypothesis is confirmed, there may be a change in the clinical routine, favoring the indication of controlled auditory training programs, which added to the benefits obtained from the use of hearing aids can contribute to the full restoration of the hearing function of elderly people with difficulty in speech recognition in noise.To compare the cortical auditory evoked potential responses pre- and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis.The present study was a pilot, prospective, randomized, single-blind study. It was carried out after approval by the Research Ethics Committee of the Faculty of Philosophy and Sciences–UNESP campus of Marília, under number 02848918.2.0000.5406, in accordance with Resolution 466/2012. To participate in the sample the patients signed a form of free and informed consent after being given information about the research.The sample selection of the study evaluated 22 individuals; 12 individuals were excluded, according to the exclusion criteria and two dropped out during the research.Eight individuals participated in this study, divided into 2 groups (G) by random allocation:Hearing Aid Group (HAG): composed of four individuals who had been recently adapted with hearing aids.Auditory Training Group (ATG): composed of four individuals recently adapted with hearing aids and who participated in an auditory training program.The inclusion criteria for participant selection were: age equal to or over 60 years; diagnosis of bilateral, symmetrical sensorineural hearing loss, with tonal audibility threshold between 30 and 70dB HL at frequencies of 3, 4, 6, and 8 kHz and ≤ 25 dB HL at frequencies of 0.25, 0.50, 1 and 2 kHz; percentage index of speech recognition equal to or over 60%, bilaterally; complaints of difficulty understanding speech in noise; hearing aid adaption referred by an otolaryngologist.The exclusion criteria to rule out individuals were: presence of middle ear abnormality detected by tympanometry, when the tracings were not classified as type A, to ensure that sound transmission occurred without deficit in the peripheral auditory system; positive screening for cognitive impairment detected by the instrument Montreal Cognitive Assessment—Basic (MoCA-B), developed from the Montreal Cognitive Assessment (MoCA) original version, developed by Ziad Nasreddine and adapted to the Brazilian population by Daniel Apolinario  with theSaúde sem Limite” by the National Health System from Brazil, which includes hearing aid adaptation and hearing rehabilitation [The individuals who participated in the study were patients from a Specialized Rehabilitation Center, thus, the hearing rehabilitation mentioned in this study follows the procedures described in the Hearing Rehabilitation Instruction of the program “litation .The participants were new hearing aid users and were adapted bilaterally, with mini hearing aids, from the same manufacturer and with the same digital signal processing, with the same prescriptive rule NAL-NL2 and open adaptation technology, adjusted according to their individual audiograms. The gain of the hearing aids was verified through insertion gain, ensuring they were over 90% on target for all participants. The adaptation was completed in up to one month following the protocol mentioned above.Some variables were considered to assess group homogeneity. They were age, sex, score obtained on the MoCA instrument, school level, time of hearing deprivation and average hours of using hearing aids daily. The average hours of hearing aid use was consulted in the data logging of manufacturer’s software. School level and duration of hearing deprivation were self-reported by the participants and were considered because the school level interferes with cognitive functions and hearing deprivation can cause functional consequences for the individual’s hearing, such as reduced speech recognition in noise and in cognitive skills functions that contribute to speech comprehension, such as working memory and speed in processing acoustic information .The CAEP was performed using the two-channel equipment Biologic’s Evoked Potential System (EP) , and free-field system FF-70 with adapter compatible with evoked potential system was calibrated according to the ANSI S3.43 1992 / ISO 7566 and ANSI S3.6 1996/ISO R389 parameters.The potential was recorded using five copper electrodes, positioned in: Fpz the ground electrode, Fz and Cz, which were the active electrodes, in reference to electrodes A1 and A2. Each electrode impedance did not exceed 5 k ohms and did not exceed 2k ohms between them. In order to obtain wave reproducibility in a simultaneous recording of Cz and Fz, ipsilateral assembly was performed using the jumper at A2 and then at A1.The The CAEP procedure was performed on the research patients in two moments: initial assessment and reassessment after three months of hearing aid adaptation. The individuals did not use hearing aids at the time of the test. During the interval between the two assessments, ATG underwent auditory training.Latencies and amplitudes of the P1-N1-P2-N2-P3a wave complex were analyzed. As the test was performed passively, that is, participants were not requested to identify the rare stimulus, the P3a component was analyzed, which occurs automatically in response to major differences in stimuli, whether or not the individual is responding to the stimulus sequence , 25.Considering the best wave morphology, the marking was performed on the infrequent Cz trace, and the P1-N1-P2-N2 components were marked and identified in the appearance of the first three waves, at the highest peak, in sequence, in the negative—positive—negative polarities, respectively, between 50 ms and 300 ms, and the P3a component was identified after the P1-N1-P2-N2 complex, between 220 ms and 400 ms .The lead researcher was responsible for the auditory training application. Electrophysiological assessments were carried out by a second invited examiner, to ensure the groups were not identified and to eliminate possible detection bias. The wave marking was carried out by two expert researchers in the area.Treinamento Musical Auditivo, developed by Dr. Katya Guglielmi Marcondes Freire was used, available on the website www.treinamentoauditivomusical.com.br [For the auditory training, the program l.com.br . The webl.com.br . Two porTo analyze the main group and time effect, and the group and time interaction, a mixed ANOVA of repeated measures was performed based on the equality of covariance matrices through the Box’s Test. Post-Hoc comparisons within the group and within time were performed through the Holm-Sidak test. The adopted significance level was 5% , and the data were analyzed using the SPSS software (version 24.0). The values are described by the mean and standard deviation (SD).Following, Based on these data, the statistical analysis was performed to verify group homogeneity, as shown in There was a statistically significant difference for the P3a component in the ATG when initial and final assessment were compared, indicating a time effect within the group, with a latency decrease in this component after hearing rehabilitation.There was no statistically significant difference in relation to the amplitudes of the P1-N1-P2-N2-P3a complex considering the analysis of the group and time effect, and the interaction between group and time.Auditory rehabilitation process involves several factors that can interfere with the successful hearing aid adaptation and the benefits obtained with hearing training programs. Among them, the time of hearing deprivation, adherence to the use of hearing aids, among other factors that influence each case toward a different prognosis and require careful evaluation by the involved professionals .Considering these factors, it is important to initially reckon the characteristics of the study sample. The groups were homogeneous in relation to age, education level, score obtained on the MoCA instrument, time of hearing deprivation and average hours of using hearing aids daily. There are no significant differences between them. In general, most of the elderly participants in the study were between 60 and 70 years old, had good cognitive level, time of hearing deprivation of up to 5 years, and systematic hearing aid use.However, we must consider that the use of Fisher’s exact test in Assuming that AEPs provides rich information for reasoning and understanding the neuroelectrophysiological processes that are part of auditory and linguistic information processing, this investigation chose to assess the CAEP. This measure investigates the detection, attention, discrimination and recognition of sound automatically, without the need for active patient participation, which minimizes the negative interference of factors related to age, such as memory and cognitive processes .Some studies report Long Latency Auditory Evoked Potentials (LLAEP) increased latency in the elderly , 30 whenThe comparison between the measures obtained in the initial and final assessments between the HAG and ATG identified a positive effect of auditory training for the elderly in the ATG, with a significant decrease in the latency of the P3a component after hearing rehabilitation compared to the values of the initial assessment. For the other components of the wave complex, a decrease in latency was observed in the final assessment in ATG, but no statistically significant differences.When latency decreases are observed after interventions, we can understand that the time of processing the acoustic information by CANS was reduced , 34. SpeThe P3a component reflects the automatic process of attention and perception of the distinctive acoustic characteristics of the rare stimulus during the CAEP examination. Studies show that P3a and P3b have different neural generators, and that P3a originates from frontal attention mechanisms . A studyStudies involving auditory evoked potentials describe decreased latencies as a neurophysiological correlate of neural plasticity , 18. ChaOther studies assessing the effects of AT with electrophysiological measures showed an improvement in the neural representation of speech in noise after training , 39. TheSome studies report P3 amplitude increase after auditory training , 40. In The amplitude represents the magnitude of electrical activity involved in performing a task. When an increase in amplitude after interventions is observed, it is understood that there was activation of synaptic activity and an improvement in processing quality. And related to the P3a component, it reflects this activation for the process of redirecting attention to the automatic detection of the relevant acoustic stimulus .The present study analyzed the CAEP measurements in sound field, in order to assess the neural responses to binaural hearing, considering its importance for the ability to recognize speech in noise in elderly people and your auditory and communicative decline related to age.The sample size can be considered a limiting factor to this study, whose initial proposal was to have more participants in the groups. However, such results aroused the researchers’ interest in continuing the study to promote longitudinal assessments and to investigate long-term effects.There was a decrease in the latency of the P3a component of the Cortical Auditory Evoked Potential in the comparison pre- and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis.


Vertigo and hearing loss are both prevalent in the elderly. This study retrospectively analyzed hearing test results from elderly patients experiencing vertigo and dizziness at ENT outpatient over a 10-year period, in order to study the patterns of hearing loss in this patient population.Nine thousand three hundred eighty four patients over 50 years old underwent retrospective collection and screening of outpatient diagnosis, pure tone audiometry, acoustic immittance measurement (tympanogram) and auditory brainstem response (ABR) test. The patient's audiograms are divided into 7 subtypes according to a set of fixed criteria. Meanwhile, K-Means clustering analysis method was used to classify the audiogram.P < 0.001). K-Means clustering analysis suggested that the optimal number of clusters was three, with sample sizes for the three clusters being 2,747, 2,413, and 4,139, respectively. The ANOVA statistical results of each characteristic value showed P < 0.001.The Jerger classification of tympanogram in elderly patients with vertigo and dizziness showed the majority falling under type A. The leading audiogram shapes were flat (27.81% in right ear and 26.89% in left ear), high-frequency gently sloping (25.97% in right ear and 27.34% in left ear), and high-frequency steeply sloping (21.60% in right ear and 22.53% in left ear). Meniere's disease , benign recurrent vertigo , and benign paroxysmal positional vertigo  were the most common etiologies in elderly vestibular diseases. We observed statistically significant differences in hearing thresholds among these vestibular diseases (The elderly patients often have mild to moderate hearing loss as a concomitant symptom with vertigo. Female patients have better hearing thresholds than males. The dominant audiometric shapes in this patient population were flat, high-frequency gently sloping, and high-frequency steeply sloping according to a set of fixed criteria. This study highlights the need for tailored strategies in managing hearing loss in elderly patients with vertigo and dizziness. Previous studies indicate that vertigo is prevalent in the elderly population, with estimates of incidence ranging from 20 to 58%  tests from January 2010 to December 2021. Participants were patients over 50 years old with vertigo and dizziness, visiting the General Hospital of the People's Liberation Army in the Chinese People's Republic. A total of 9,384 patients  with hearing loss were included. The study was approved by the PLA General Hospital's Ethics Committee (No. S2022-673-01), and all procedures complied with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Post-routine otolaryngology examinations and history collection, the Astera pure tone audiometry  was used to obtain the hearing threshold. The EAR-3A insert phones were applied  and Titan tympanometer , with a probe tone of 226 Hz. Tympanograms were classified into five types  according to the Liden-Jerger classification criteria.ABR tests were conducted using the Eclipse EP25 platform  with insert earphones . Alternating short-duration clicks with a repetition rate of 19.3 Hz were used as stimuli. Parameters for the test are detailed.To facilitate the diagnostic classification of hearing loss in elderly patients, we adopted a typing criterion for pure-tone audiograms based on clinical observations and a review of existing literature see  Demeest. We defi(1) Age ≥ 50 years;(2) Diagnosed by a careful interview and vestibular function results by an otologist, and another specialist reviewed the clinical notes to confirm the diagnosis. All diagnoses could be divided into benign recurrent vertigo (BRV)  The complete binaural  air conduction  and bone conduction  based on the data of pure-tone threshold;(4) The results of acoustic immittance test and auditory brainstem response (ABR) test.Participants were excluded from the study if they:(1) Had incomplete data from the pure tone audiometry (either not done or if the air bone conduction threshold data was incomplete).(2) Had missing age, gender, or diagnostic information.P < 0.05, there is a statistical difference). Least-significant difference (LSD) was used for Post-hoc Multiple Comparisons.In this study, the descriptive analysis was mainly used. The counting data was expressed as frequency (percentage). Comparison of pure tone hearing threshold and acoustic immittance measurement applied one-way ANOVA , was classified as “mild.”As depicted in Each wave latency and inter-wave period fell within the normal range, as shown in However, n = 9,299), K-Means clustering analysis suggested that the optimal number of clusters was three , benign recurrent vertigo , and benign paroxysmal positional vertigo . The distribution of these diseases is presented in P < 0.001). Detailed results from multiple comparisons of hearing thresholds for different diseases are provided in Auditory examination results from the eight main types of vestibular syndrome  were analyzed, with the corresponding auditory thresholds depicted in From the overall result of elderly patients with vertigo and dizziness, 83.10% of them were aged from 60 to 79. Among them, the grading of hearing loss was mainly in level 1 (44.63%) and 2(20.89%), indicating that elderly patients with vertigo and dizziness generally have mild to moderate hearing loss in this age range. Previous studies abroad have shown that caloric test responses depend on several factors that could be affected by age, such as ear canal volume, temporal bone thickness, and blood supply to the temporal bone  and high-frequency steeply sloping (HFSS). Due to the large oxygen consumption of the cochlea bottom, the metabolic rate is high. Compared with the cochlea top, the blood supply of the cochlea bottom is poor, and its auditory hair cell is more vulnerable to damage. The cause of deafness in patients with dizziness involves a wide range of surrounding organs, affecting the vestibular area. Moreover, as a result of the bottom of the cochlea near the vestibule, patients with dizziness may have relatively severe cochlear damage, and their inner ear may have a larger or deeper degree of ischemia , and high-frequency steeply sloping (HFSS). Importantly, we identified significant differences in hearing thresholds across various vestibular diseases.The original contributions presented in the study are included in the article/The studies involving humans were approved by PLA General Hospital's Ethics Committee (No. S2022-673-01). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.QW performed the methodology and writing—original draft. AC performed the data curation. MH performed the formal analysis. XL performed the writing—review and editing. YD performed the visualization. ZW performed the supervision. FJ performed the conceptualization, project administration, and funding acquisition. All authors contributed to the article and approved the submitted version.


Background: Few studies have reported on the etiology, severity, or device usage of unilateral sensorineural hearing loss (UHL) compared to bilateral hearing loss. Therefore, this study investigated the characteristics of UHL in adults and children. Methods: We performed a survey using questionnaires for secondary and tertiary otolaryngology institutions. Results: We included 15,981 patients  from 196 institutions with otolaryngology residency programs and 2844 patients (336 children and 2508 adults) from 27 institutions with board members of the Japan Audiology Society. The latter submitted audiological data. Among children, most diagnoses were made at age 0. Approximately half of them had profound hearing loss, and 37 children (2.2%) used hearing devices. Among adults, the number of cases increased with age, but decreased when people reached their 80s and 90s. More than half of them had moderate hearing loss. Sudden sensorineural hearing loss was the most common cause of UHL of all ages; 4.4% of UHL patients used hearing devices, and most of the device users (98.6%) selected a conventional hearing aid. Conclusions: Hearing aid use is limited in children and adults with UHL in Japan. There could be many candidates with UHL for intervention such as a cochlear implant. Humans have two ears so that they can communicate with each other in difficult situations effectively. Binaural hearing enables good coordination between the two ears, giving the benefit of the binaural summation effect, the squelch effect, and the head shadow effect. Binaural summation results in binaural redundancy and benefit beyond increased loudness ,2,3. TheOn the other hand, unilateral sensorineural hearing loss (UHL), a condition where hearing is normal in one ear but is impaired in the other ear, has fewer advantages than binaural hearing and several negative effects on hearing in both children ,8,9 and Adults with UHL as well have less ability to localize sounds and awareness of incoming sounds and understand speech in noise . This leRecently, several options such as hearing aids with the contralateral routing of signals (CROS) ,26, boneDespite its importance, there are only a few reports on etiological and audiological data for UHL compared to bilateral hearing loss. In Japan, there are no guidelines or recommendations as to other treatment modalities for UHL, such as CROS hearing aid or bone-anchored devices, and CI for UHL is not approved by the national insurance system. Information on the incidence, etiology, severity, and device usage of UHL is essential for considering the options for UHL. Therefore, we investigated these parameters in adults and children with UHL in Japan to identify patients who are far from hearing device intervention.We conducted a questionnaire survey of institutions with otolaryngology residency programs including institutions with board members of the Japan Audiological Society (JAS) . The medUHL was defined as moderate, severe or profound hearing loss (≥40 dB HL) in one ear and normal hearing (<20 dB HL) in the other ear . PatientWhen the severity of hearing loss was not filled in, the severity of the patient’s hearing was defined as unknown. The ABR threshold or average ASSR was used as a substitute for pure-tone average in children who could not be assessed with pure-tone audiograms.For the subset collected from the institutions with JAS board members, hearing loss was also categorized into low-tone and high-tone hearing loss. Low-frequency ascending (LFA) hearing loss was defined as when the low-tone threshold  was 20 dB worse than the high-tone threshold . High-frequency sloping (HFS) loss was defined as when the high-tone threshold was 20 dB worse than the low-tone threshold.We sent the questionnaires to 592 institutions that have the otolaryngology residency program and 31 institutions that JAS board members belong to. Completed questionnaires were obtained from 196 of 592 institutions in the otolaryngology residency program and from 27 of 31 institutions with JAS board members. We analyzed data of 15,981 patients  from the former institutions and 2844 patients (336 children and 2508 adults) with audiogram data from the latter institutions. n = 483) of cases , followed by severe  and moderate  hearing loss , of which air-conductive hearing aids were used in 19 (62%), followed by CROS hearing aids in 10 (32%) A. In theing loss B. The ran = 694; 30s, n = 981; 40s, n = 1823; 50s, n = 2546; 60s, n = 3443; 70s, n = 3637) and decreased in the 80s and 90s . SSHL was the most common cause of UHL of all ages (49–66%), followed by unknown causes (8.6–33%) and Ménière’s disease (5.2–13%). Ménière’s disease was more frequent between the ages of 40 and 70 than other ages (11–13% vs. 5.2–9.3%), acoustic tumor was more frequent between the ages of 40 and 60 (5.7–6.7% vs. 2.3–4.1%), and mumps and acoustic trauma were more frequent in the 20s and 30s .n = 7904) had moderate hearing loss. Severe and profound hearing loss accounted for almost half of the remainder . SSHL was a major cause of UHL in all types of severity . The rate of Ménière’s disease decreased with increased severity .In severity, more than half of the patients , followed by HFS type  and LFA type . Regarding acoustic tumors, there was a higher percentage of HFS type than LFA type , but in Ménière’s disease, the percentage was similar .In the type of audiogram, the horizontal (flat) type of hearing loss was the most common  used a hearing aid . Moderate hearing loss was predominant  among hearing aid users, followed by profound  and severe  hearing loss (n = 63), 6.9% (n = 113), and 2.3% (n = 4), respectively  was used in 581 patients (4.0%), in which most  may have been performed less frequently, especially in children, to avoid radiation exposure. This factor could have underestimated the presence of cochlear malformation or cochlear nerve deficiency. Previous studies reported that the etiology of UHL in children could not be identified in 40%  to 65%  of casesIn children considered to experience congenital hearing loss, CNCS was the most common cause, which corresponds to findings in previous reports ,44,45,46In adults, cases increased with age until the 70s, but decreased in the 80s and 90s. This may come from the effect of age-related hearing loss in the better ear. The distribution of severity in adults differed from that in children. Most adults with UHL had moderate hearing loss compared with children, who had severe to profound hearing loss in >60% of cases. This may come from the difference in etiology as SSHL was the major cause of UHL in adults, and 70% of patients with sudden hearing loss achieved a recovery of average pure tone audiogram being better than 60 dB HL . StudiesMénière’s disease was the major cause of UHL in the 40s and 70s, and mumps or acoustic trauma was the major cause in the 20s and 30s. Our results are consistent with the reported etiology of these diseases ,55,56,57In our study, the severity of hearing loss did not differ with regard to the use of a hearing aid. In previous investigations of bilateral hearing loss, severity or hearing difficulty was a major factor determining the use of a hearing aid ,59. HoweHearing aids were reported to be beneficial for UHL patients , but ourAlthough there are no guidelines regarding the treatment of UHL in children, there are several options including amplification systems such as conventional hearing aids, CROS hearing aids, and surgical approaches such as bone-anchored hearing aid systems and CI . PreviouOur study had several limitations. It was based on questionnaires provided to secondary and tertiary medical institutions, which could have resulted in selection bias. Moreover, the diagnosis was made by doctors at each institution, and it was not possible to find out what additional indicators were used to determine the etiology or to rule out the possibility that some children had conductive hearing loss and that some of the children who were considered as having congenital hearing loss had experienced sudden hearing loss or that some children who were considered as having an unknown cause of hearing loss had other causes. We could not fully differentiate between the being congenital and the etiology being congenital. However, these institutions are staffed by board-certified specialists, which could lend greater credibility to the diagnosis. This survey used standard 3 frequencies to assess the hearing level, which poses limitations in understanding hearing loss configuration and how the hearing loss impacts important speech information. Another limitation lies in the time when the audiological data was obtained. Some patients had progressive hearing loss and other patients achieved hearing recovery. The survey could not obtain the time course of each patient’s hearing level. Furthermore, we cannot ignore the fact that patients who had been already diagnosed were included in our study, because the data were collected when the patients visited the institutions for the first time, and we did not ascertain whether they had consulted other institutions before presentation. However, our study is the first national survey of UHL to include a large number of participants and offers reliable data about the etiology and device use in UHL.We performed a national survey of UHL in children and adults. The age distribution and the severity of each disease observed in this study were apparently not different from those reported previously. As to treatment modalities, however, the ratio of hearing aid usage or CI was different from other studies, which we consider due to Japanese government policy. Newborn hearing screening seems effective for identifying UHL in children, and hearing aid use and CI are limited in children and adults. Many patients with severe to profound UHL are far from benefiting from interventions in Japan and require further interventions such as hearing aids and CI.


TMPRSS3-associated sensorineural hearing loss (SNHL) reporting overall beneficial outcomes. These outcomes are, however, based on variable follow-up times of, in general, 1 year or less. Therefore, we aimed to 1. evaluate long-term outcomes after CI implantation of speech recognition in quiet in subjects with TMPRSS3-associated SNHL, and 2. test the spiral ganglion hypothesis using the TMPRSS3-group.The spiral ganglion hypothesis suggests that pathogenic variants in genes preferentially expressed in the spiral ganglion nerves (SGN), may lead to poor cochlear implant (CI) performance. It was long thought that TMPRSS3 was particularly expressed in the SGNs. However, this is not in line with recent reviews evaluating CI performance in subjects with TMPRSS3-associated SNHL. The phoneme scores at 70 dB with CI in the TMPRSS3-group were compared to a control group of fully genotyped cochlear implant users with post-lingual SNHL without genes affecting the SGN, or severe anatomical inner ear malformations. CI-recipients with a phoneme score ≤ 70% at least 1-year post-implantation were considered poor performers and were evaluated in more detail.This retrospective, multicentre study evaluated long-term CI performance in a Dutch population with TMPRSS3 group consisted of 29 subjects (N = 33 ears), and the control group of 62 subjects (N = 67 ears). For the TMPRSS3-group, we found an average phoneme score of 89% after 5 years, which remained stable up to 10 years post-implantation. At both 5 and 10-year follow-up, no difference was found in speech recognition in quiet between both groups . Despite these overall adequate CI outcomes, six CI recipients had a phoneme score of ≤ 70% and were considered poor performers. The latter was observed in subjects with residual hearing post-implantation or older age at implantation.The TMPRSS3-associated SNHL have adequate and stable long-term outcomes after cochlear implantation, equal to the performance of genotyped patient with affected genes not expressed in the SGN. These findings are not in line with the spiral ganglion hypothesis. However, more recent studies showed that TMPRSS3 is mainly expressed in the hair cells with only limited SGN expression. Therefore, we cannot confirm nor refute the spiral ganglion hypothesis.Subjects with The online version contains supplementary material available at 10.1186/s40463-023-00680-3. TMPRSS3 is one of these genes and encodes for a type II transmembrane serine protease. Pathogenic variants in TMPRSS3 cause autosomal recessively inherited sensorineural hearing loss (SNHL) that accounts for 0.7% up to 11% of cases with autosomal recessive NSHL, depending on the geographic origin [TMPRSS3-associated SNHL may present with congenital severe-to-profound SNHL or post-lingual onset high-frequency (sloping) SNHL with relatively unaffected hearing at the lower frequencies [Hearing loss is one of the most common and frequently diagnosed sensory disorders, with 50–70% of cases attributable to genetic causes . Currentquencies . RehabilTMPRSS3 have been reported in multiple studies, showing inconsistent outcomes [TMPRSS3-associated hearing loss and concluded that pathogenic variants in genes expressed in the spiral ganglion neurons (SGN) or in the auditory nerve, negatively affect CI outcomes. According to the spiral ganglion hypothesis, poor CI performance is expected when the SGNs and/or auditory nerves degenerate over time, while good CI performance is anticipated when only the hair cells (HCs) are affected [TMPRSS3-associated SNHL based on an almost identical set of publications [Cochlear implantation (CI) outcomes in subjects with pathogenic variants in outcomes –12. Eppsaffected . Three rications , 14. TheTMPRSS3-associated SNHL might be the consequence of dysfunctional HCs and not due to dysfunctional SGNs. Chen et al. further showed that pathogenic variants in Tmprss3 result in rapid HC degeneration, causing delayed-onset progressive SGN degeneration [TMPRSS3-associated SNHL since these findings may indicate that CI performance will deteriorate over time. The aims of this study were to 1. present the results of long-term CI performance in a large Dutch population of subjects with TMPRSS3-associated SNHL, and 2. to evaluate the spiral ganglion hypothesis using the outcomes of these subjects.Although previous studies reported Tmprss3 expression in SGNs in mice , 16, Cheneration . This maTMPRSS3-associated SNHL. The Radboud University Medical Centre assembled a study cohort with genotyped CI recipients. Subjects were included in this cohort when they 1. had a confirmed genetic diagnosis based on monoallelic or biallelic (likely) pathogenic variants in respectively dominant or recessive inherited genes associated with SNHL; 2. received a cochlear implant between 1996 and 2021; 3. had at least 1-year of follow-up measurements of the speech recognition. Subjects were excluded from this study when aged ≥ 70 years at implantation, or when they had SNHL related to other causes, i.e., prenatal TORCH  infections, aminoglycoside exposure, otoacoustic trauma, meningitis, or hyperbilirubinemia. The TMPRSS3-subjects were selected from this study cohort, and additional subjects were recruited from the other academic centres in the Netherlands that are part of the DOOFNL consortium. A TMPRSS3-group was created and included subjects with a confirmed genetic diagnosis based on biallelic (likely) pathogenic variants in TMPRSS3 with at least 1 year of follow-up measurements of speech recognition scores. Subjects with at least 5 years of follow-up were separately evaluated to objectify long-term CI performance and were compared to the long-term outcomes of a control group. This control group was created from the same study cohort of genotyped CI recipients from the Radboud University Medical Centre by enrolling subjects with a confirmed genetic diagnosis of postlingual SNHL. Subjects with pathogenic variants in genes known to affect the spiral ganglion neurons or auditory nerve  were excluded from the control group, as were subjects with severe cochleovestibular abnormalities on imaging. Subjects with an enlarged vestibular aqueduct (EVA) were not excluded from the control group because these subjects have progression of SNHL in the same age segment as the TMPRSS3-group. Additionally, previous studies categorized EVA as the most subtle detectable inner ear malformation [This retrospective, observational, multicentre cohort study evaluated CI performance in CI recipients with ormation , 18. MorDemographic factors were collected by chart review and included gender, age of onset of SNHL, use of hearing aids, learning difficulties, and age at time of implantation. All pre- and postoperative audiovestibular examinations were evaluated. Vestibular testing was performed by calorisation, and rotatory chair, using electronystagmography (ENG). Furthermore, the video head impulse test (vHIT) was used to assess bilateral semicircular canal function. Results of imaging were included to assess cochleovestibular abnormalities. The surgical approach and side of implantation were collected to evaluate surgical factors. The type of implant and electrode  were also recorded. The genetic diagnosis was gathered by scoring the variant(s) with the associated protein change(s), affected domain(s), type of variant (truncating or missense), and classification (according to the AMG association guidelines ). No add0.5–4kHz). In the TMPRSS3 group, not all subjects used hearing aids prior to implantation because of significant residual hearing at the lower frequencies. We assessed the best-aided/unaided-PTA and -phoneme scores to compare the pre-implantation hearing performance with the performance post-implantation. These best-aided/unaided scores were calculated from aided scores from subjects using hearing aids prior to implantation and combined with the unaided scores from subjects not using hearing aids prior to implantation. Where aided scores from subjects using hearing aids were not available, unaided scores were used. Residual hearing preservation (HP) post-implantation was defined by the Hearing Preservation Classification System as reported by Skarzynski et al. [Hearing was evaluated by standard pure tone and speech audiometry according to current standards. Phoneme scores were presented at 70 dB HL in quiet and were assessed both aided and unaided. The pure tone average (PTA) was calculated using thresholds at 500, 1000, 2000, and 4000 Hz .TMPRSS3 group and the control group, while the mean age at implantation, self-reported duration of hearing loss, PTA, and phoneme scores between these groups were compared using the Mann–Whitney U test. This test was also used to compare phoneme scores and HP% between different types of electrodes. The mean PTA and phoneme scores at other follow-up moments within the TMPRSS3 group were compared using the Wilcoxon signed-rank test. The Kruskal–Wallis test was used to compare the mean PTA, phoneme scores, and HP% between the different surgical approaches. Univariate regression analysis was performed to study the correlation between residual hearing post-implantation and non-/limited CI use. The same analysis was performed to test whether the age of implantation correlated with the postimplantation phoneme scores. A multiple regression analysis was used to further assess this correlation while correcting for confounders. The Pearson correlation coefficient was used for multicollinearity testing. A p value < 0.05 was considered statistically significant.A Chi-squared test was used to compare categorical data  between the TMPRSS3 variants were included in the TMPRSS3 group. In 33 ears, cochlear implantation was performed (Tables 0.5-4kHz was significantly lower in these twelve subjects (P = 0.024), see Table TMPRSS3 group and the control group (p = 0.002) as in the first group, we aimed to preserve residual low-frequency hearing. Further, the number of EVAs was significantly higher in the control group (p = 0.045).After evaluation of in- and exclusion criteria, 27 subjects with bi-allelic pathogenic d Tables , 2. A co0.5-4kHz was 90 ± 17 dB HL (N = 33 ears), and this increased to 99 ± 16 dB HL (N = 26 ears) at 6 ± 5 months postoperatively (p < 0.001). There was no significant difference in HP% between the different surgical approaches (p = 0.273). We compared two TMPRSS3 groups of subjects who underwent cochlear implantation; one group had previously used a hearing aid, and the other group had not used a hearing aid as their residual hearing was sufficient.  and remained stable over time , and further improved to 89 ± 10% at 4.9 ± 0.8 years post-implantation , which remained stable after a mean follow-up of 9.8 ± 3.7 years with 86 ± 10%  .The average best-aided/unaided preoperative phoneme score at 70 dB was 33 ± 28%  5 years after implantation, which remained stable at 85 ± 14% (N = 67) after a long-term follow-up of 8.7 ± 3.2 years. No significant differences were found between the control and the As shown in Figs. The fourth limited-user (Q1) had limited residual hearing pre-implantation in the low frequencies. Unfortunately, the unaided audiogram post-implantation was unavailable. This subject also faced additional personal challenges and experienced learning difficulties that negatively influenced the performance of the CI.The other two poor performers (N1 and T1) were implanted later in life, at 51 and 62 years, respectively. N1 had a phoneme score of 65% at 70 dB twelve months after implantation. Nevertheless, the subject reported a significant improvement in speech recognition and can converse on the telephone and in online meetings.Subject T1 struggled to get used to high-pitched sounds because of his long-lasting high-frequency SNHL. Over the years, different processor settings were tried, including switching off the basal electrodes with or without less amplifying power of the other electrodes. Despite the phoneme score of 62% six years after implantation, subject T1 reported being satisfied with the current speech recognition.TMPRSS3-group. The univariate regression analysis, shown in Additional file p < 0.001). Also, older age at implantation was significantly associated with a lower postoperative phoneme score .Univariate regression analyses were performed to test whether the age at implantation and residual hearing post-implantation factors correlated with CI performance in the 0.5-4kHz), residual hearing, gender, and the use of hearing aids prior to implantation. The self-reported duration of SNHL was excluded from this analysis due to collinearity with the age at implantation (r(25) = 0.897, p < 0.001). After correcting for these confounders, older age at implantation was still significantly associated with a lower postoperative phoneme score .A multiple regression analysis was performed to further study this second correlation while correcting for confounders including degree of hearing loss pre-implantation  received a hybrid-L electrode array (Cochlear CI23REH). Both subjects had a mean phoneme score of 91 ± 7% at a mean follow-up time of 8.5 years after implantation. This was not significantly higher than 16 subjects with a non-hybrid implant showing a mean phoneme score of 86 ± 11% (p = 0.549). Both subjects lost residual hearing in the lower frequencies over the years, while their aided PTA and phoneme score at 70 dB remained stable, with an unknown contribution from the acoustic component  or a peri-modiolar electrode , see, e.g., Adiitional file p = 0.594) was found between the groups, with an average phoneme score at 70 dB of 77 ± 15% and 80 ± 12% for the LWE and PME groups. Also, at the longest follow-up measurement of 10 years post-implantation, no significant difference was found between the groups .All implanted electrode arrays in the LWE; N = 5, 45% orTMPRSS3 were identified in the study population, as shown in Table Six missense and five truncating variants in TMPRSS3 affected three different domains, including LDLRA, SRCR, and Serine protease  and the variant type (results not shown). The found variants in TMPRSS3-associated SNHL showed favourable and consistent outcomes in both short- and long-term follow-up evaluations. These results were comparable to those obtained in a control group with genetic postlingual SNHL. These findings are in line with three recent literature reviews, which evaluated CI performance in this population with shorter follow-up times and more heterogeneous outcome measures [TMPRSS3-associated SNHL. Despite beneficial outcomes, there were six subjects with less beneficial outcomes. This included some children in puberty with sufficient residual hearing post implantation, which complicated rehabilitation. In addition, implantation in two patients at an older age, and therefore a longer duration of hearing loss, negatively influenced CI outcomes as well.This study showed that CI recipients with measures , 14. OurTMPRSS3-related SNHL. Existing hearing aids may not provide sufficient amplification of the mid-to-high frequencies required for speech perception, leading to poor outcomes [In addition, we found that a relatively high proportion of subjects (36%) did not use hearing aids prior to implantation, mainly due to absence of subjective benefit. This lack of usage may be attributed to the typical ski-slope high-frequency hearing loss associated with outcomes . Additiooutcomes .TMPRSS3-group. This hypothesis suggests that the spiral ganglion cells play a significant role in auditory processing of individuals with TMPRSS3 variants who received a cochlear implant. According to this hypothesis, pathogenic variants in genes preferentially expressed in the SGN, such as TMPRSS3, may lead to poor CI performance [The second aim of this study was to evaluate the spiral ganglion hypothesis proposed by Eppsteiner et al. using the formance .TMPRSS3-associated hearing loss led to poor CI performance in subjects with poor auditory nerve neurophonics (ANN), but intact cochlear microphonics (CMs), indicating SGN loss [TMPRSS3-associated SNHL who received cochlear implants achieve good long-term performance, equally to the control-group. This suggests that either TMPRSS3’s involvement in SGN may not be as significant as previously thought, or that the spiral ganglion hypothesis is incorrect. These results are consistent with studies demonstrating limited Tmprss3-expression in SGNs in mice [TMPRSS3-associated SNHL and supports the good long-term performance observed in our study. While these results do not entirely rule out the possibility of a general SGN hypothesis, evidence from mouse models and expression patterns in human inner ear organoids suggests that SGN involvement in TMPRSS3 is unlikely. Additional studies are needed in genotyped CI recipients with affected genes that are expressed in the SGN to confirm or refute this hypothesis.In the study by Shearer et al., SGN loss . However in mice , 26. In  in mice , which cTMPRSS3-related SNHL, in six CI recipients, CI performance remained behind. Poor performance was observed in subjects with high levels of residual hearing in the lower frequencies. These subjects had difficulty adapting to the sound of their CI, resulting in limited or non-use of the CI. Three of these subjects did not use hearing aids prior to implantation. In two subjects SNHL increased over time which ultimately led them to becoming CI users. The same is expected to apply to the other two in due time. These findings indicate that CI might be too early in children with high functional residual hearing in the lower frequencies without the subjective benefit of hearing aids prior to implantation.Despite the overall good CI outcomes in subjects with TMPRSS3. This was also likely the case in the two poor performers in the study of Eppsteiner et al. [Additionally, poor performance was significantly correlated with an older age at the time of implantation. This is likely because older age at implantation is often associated with a more extended period of lack of auditory stimulation, especially in the high frequencies of subjects with r et al. , and Sher et al. . Both far et al. .TMPRSS3-associated hearing loss, leading to a choice for a longer electrode to stimulate low-frequencies. Both subjects had good CI performance, with an unknown contribution from the acoustic component, but were not significantly better than the other CI recipients. In the study by Shearer et al., all three TMPRSS3 subjects were implanted with a hybrid electrode. Two of them had poor outcomes, of whom one did not use the acoustic component due to no measurable residual hearing at 500 Hz [The Hybrid-L electrode was developed as a shorter straight electrode to facilitate electrical and acoustic stimulation by preserving low-frequency hearing. Recipients with these electrodes had increased speech recognition compared to electric stimulation only . Althougt 500 Hz .TMPRSS3-associated SNHL.We found no significant difference in speech recognition or HP between LWE and PME electrodes. This is in line with previous inconclusive or contradictory studies regarding the position of the CI electrode close to the modiolus (PME) or following the lateral wall (LWE), and its effect on CI performance –31. AddiTMPRSS3). Additionally, they concluded the mutation in the DFNB8 family allowed some regular protein expression in contrast to the mutation in the DFNB10-family, accounting for the phenotypic difference between the two families [TMPRSS3-associated SNHL has been presumed to present with either profound prelingual SNHL (DFNB10) or postlingual, progressive SNHL (DFNB8) [Locus DFNB8 was identified as a disease locus for hearing loss in a family with post-lingual progressive SNHL in 1996 . In the families . Ever siIn 2021, Moon et al. proposed that the combination of a missense variant and a truncating variant resulted in DFNB8, whereas two truncating (or loss-of-function) pathogenic variants led to DFNB10 . The preTMPRSS3-associated SNHL at short- and long-term follow-up. Furthermore, to our knowledge, this is the largest study population in which CI performance is evaluated in patients with TMPRSS3-associated SNHL.This is the first study evaluating CI performance in subjects with TMPRSS3 group on two factors. Firstly, the control group included subjects with EVAs. Since these subjects have progression of SNHL in the same age category as the TMPRSS3-group, we did not want to exclude these subjects from the control group. We do not think the EVAs in the control group influenced the CI performance because previous studies showed that the outcomes in pediatric CI recipients with EVA are (broadly) comparable to results in pediatric CI recipients without inner ear malformations [The main limitation of this study is the retrospective design, which inevitably leads to missing data. Furthermore, the control group differed significantly from the rmations , 20. Alsrmations .TMPRSS3- and the control group. Since subjects with TMPRSS3-associated hearing loss have, in general, sufficient residual hearing in the lower frequencies, the round window approach was more frequently used since this technique is supposed to lead to better HP. However, a systematic review comparing the cochleostomy with the round window approach showed no benefit of one surgical procedure over the other regarding HP [Secondly, a significant difference was found in the surgical approach between the rding HP . MoreoveTMPRSS3-associated SNHL have an adequate outcome at both short- and long-term follow-up. Some subjects with residual hearing post-implantation or older age at implantation exhibited less favourable outcomes. Therefore, we would recommend not to wait too long with CI in adults. For children with poor low frequency thresholds pre-implantation, we recommend early implantation. However, in children with near-normal low frequency thresholds pre-implantation, specific preoperative counseling on potential difficulties during rehabilitation is required when residual hearing persists, especially in children who are in puberty. The type of electrode or surgical approach does not influence CI performance in subjects with TMPRSS3-associated SNHL. Furthermore, we identified a new likely pathogenic variant in TMPRSS3: c.936del (p.Pro33fs). Finally, since TMPRSS3 is mainly expressed in the HCs, we could not confirm nor refute the spiral ganglion hypothesis.In summary, CI-recipients with Additional file 1: Table S1. Classification of the implanted electrode types in the TMPRSS3-groep.Additional file 2: Fig. S1. Univariate logistic regressions in TMPRSS3-Patients


When the applied ultrasonic power was 150 W for 30 min and acid hydrolysis was applied for 3 days, the highest relative crystallinity of the starch nanocrystals was 52.8%. The modified nanocrystals can be more widely used in various applications such as food-packaging materials, fillers, pharmaceuticals, etc.This study provides a novel method of preparing lotus seed starch nanocrystals (LS-SNCs) using acid hydrolysis combined with ultrasonic-assisted acid hydrolysis (U-LS-SNCs) and evaluates the structural characteristics of starch nanocrystals using scanning electron microscopy; analysis of particle size, molecular weight, and X-ray diffraction patterns; and FT-IR spectroscopy. The results showed that the preparation time of U-LS-SNCs could be reduced to 2 days less than that for LS-SNCs. The smallest particle size and molecular weight were obtained after a 30 min treatment with 200 W of ultrasonic power and 5 days of acid hydrolysis. The particle size was 147 nm, the weight-average molecular weight was 3.42 × 10 Nelumbo nucifera Gaertn.). It is mainly grown in Asia and has high nutritional value [A lotus seed is the fruit or seed of the lotus  are nanosized crystals or semicrystals obtained after starch is modified to remove the amorphous region of starch particles . Its advUltrasonic radiation consists of sound waves with a frequency range of 105–108 Hz, and these are elastic mechanical waves . UltrasoDuring the last decade, our research group has been engaged in basic theoretical and applied research on lotus-seed-starch (LS)-related topics. Through in-depth exploration of the relationship between the structure of LS and its gelatinization and aging mechanisms, our research group used processing techniques such as ultra-high pressure , microwaIn the initial stage, our research team explored the conditions for preparing high-quality lotus seed starch nanocrystals (LS-SNCs) via acid hydrolysis  . On this2SO4), absolute ethanol, potassium bromide, and dimethyl sulfoxide (DMSO) were acquired from Sinopharm Chemical Reagent Co., Ltd. .Lotus seeds were purchased from Green Field Fujian Co., Ltd. . Sulfuric acid  starch suspension. LS was treated with ultrasonic waves of different powers  for 30 min. The ultrasonic-treated starch suspension was centrifuged at 3040× g for 10 min. The centrifuged sediment was dried in a 45 °C oven for 24 h and then ground through a 100-mesh sieve to obtain ultrasonic-treated LS, which was stored in a dryer for later use. The LS treated with different ultrasonic powers was treated according to the method reported in Treatment of LS via ultrasound was performed according to the method reported by Sujka and Jamroz  with a sThis was procedure was performed according to the method reported by Zhao et al. . The morm/v) were suspended in ultrapure water. The refractive indices of the dispersant and sample were 1.33 and 1.53, respectively. The measurements were performed three times for each sample.Particle size measurements of LS-SNCs and U-LS-SNCs were performed at 25 °C using a laser particle size meter . The samples . Ten-milligram samples of starch granules were dispersed in 10 mL of dimethyl sulfoxide (DMSO) at 100 °C for 2 h. The solution was continuously heated at 60 °C for 6 h with a magnetic stirrer. Then, the starch liquid was filtered through 0.45 μm nylon syringe filters before analysis. The dn/dc for calculation of the starch molecular weight was 0.072. The flow rate of the mobile phase was set to 0.5 mL/min.The This step was performed with reference to Zhao et al.’s method with some modifications. . XRD pat−1/1022 cm−1 as a sensitive indicator of the short-range ordered structure of starch.FT-IR spectral measurements of LS-SNCs and U-LS-SNCs were obtained using a Fourier Transform infrared spectrometer . The relative ratio of crystalline and amorphous regions of the starch structure was expressed using an absorbance ratio of 995 cmMw were recorded once. Origin Pro 8.5 software  was used to create an experimental chart, and DPS 9.5 Software  was used to analyze the data.All experiments were conducted in at least three parallel tests. Only SEM and The SEM results regarding LS-SNCs and U-LS-SNCs are illustrated in According to Mw distributions of the LS-SNCs and U-LS-SNCs were assessed using gel permeation chromatography to investigate the effect of ultrasonic-assisted acid hydrolysis on Mw. Mw and the number-average molecular weight (Mn) of the U-LS-SNCs were smaller than those of the LS-SNCs and that the higher the ultrasonic power, the lower the Mw and the Mn of the U-LS-SNCs. The latter effect occurred because when the starch was pretreated using ultrasonic radiation, mechanical action and cavitation effects induced by ultrasonic radiation would lead to the fracture of the starch molecular chain and Mw reduction [Mw and the Mn of SNCs. In addition, the degradation of natural dextrin using ultrasound mainly occurred in the macromolecular region, and the relative Mw degradation limited to natural dextrin via ultrasound was 4 × 104 Da. The Mw and the Mn of the LS-SNCs and U-LS-SNCs in 4 Da, indicating that acid hydrolysis was still the main reason for the reduction in the weight-average molecular weight (Mw) of the starch particles.The overall eduction . TherefoMw distributions of the LS-SNCs and U-LS-SNCs showed no obvious differences at the same hydrolysis time, and the polydispersion index (Mw/Mn) in Mw distributions: the Mw/Mn of all the LS-SNCs and U-LS-SNCs ranged from 1.73 to 2.15. The results show that ultrasonic treatment had little effect on the Mw distribution of the SNCs.In The XRD patterns of the LS-SNCs and U-LS-SNCs are shown in The calculation of relative crystallinity was performed according to the method reported Dome et al. . The res–1/1022 cm–1 was a parameter used to measure the ordered structure of starch, for which the larger the ratio, the higher the degree of order [–1/1022 cm–1 of the U-LS-SNCs  corresponded to 1.373, and under this condition, the relative crystallinity was also the highest; thus, the two results are in accordance.The FT-IR spectra of the LS-SNCs and U-LS-SNCs are presented in of order . The maxMw distribution, XRD patterns, and FT-IR spectra of LS-SNCs and U-LS-SNCs were compared. Compared with the preparation method for the LS-SNCs, the U-LS-SNCs had the advantage of a shorter preparation time, which was shortened from five days to three days. Compared with the structural characteristics of the LS-SNCs, the surface of the starch particles was destroyed after ultrasonic pretreatment, which increased the reaction area between starch and sulfuric acid and allowed the sulfuric acid to enter the starch particles and promote the acid hydrolysis reaction. Therefore, the U-LS-SNCs  had the smallest particle size and Mw. Ultrasonic treatment did not change the crystalline structure and composition structure of the starch particles, but ultrasonic treatment accelerated the acid hydrolysis speed after the destruction of the amorphous region. Therefore, the higher the ultrasonic power and the more days of acid hydrolysis, the greater the relative crystallinity of SNCs was reduced. The U-LS-SNCs  presented the maximum relative crystallinity. This study provides a novel concept for the preparation of SNCs. Reducing SNCs’ particle size is conducive to the preparation of a stabler Pickering emulsion [In this study, the SEM data, particle size, molecular weight, emulsion . SNCs haemulsion . In addiemulsion . Further


Conclusions: The overall prevalence of hearing aid use in Russian adults is very low with unmet needs in 98% of the cases of self-reported trouble with hearing, which is worse than in other populational studies and global estimates. The RLMS-HSE can be used for the monitoring of the national hearing health care system.Background: Hearing loss is a significant public problem affecting 466 million people worldwide. Hearing-impaired persons benefit from the use of hearing aids, but the need is unmet in 85% of the global population. For the Russian population, no data have been found on this issue. The purpose of this study is to estimate the prevalence of hearing aid use in the Russian adult population. Methods: data on hearing aid use and self-reported trouble with hearing were obtained from the open access database of the Russia Longitudinal Monitoring Survey—Higher School of Economics (RLMS-HSE) for the years 1994–2021. Results: the prevalence of hearing aid use in Russian adults ranged from 4.3 per 1000 (95% CI 3.2–5.9) to 8.8 per 1000 (95% CI 7.5–10.2). The mean rate of self-reported trouble with hearing was 22.2% (SD 0.8); of them, 2.2% (SD 0.2) used hearing aids, and it strongly correlated with older age ( Hearing loss is a great problem in the context of personal and public well-being. Depending on severity, it restricts the communicative abilities of a hearing-impaired person, affecting social, educational, occupational, and psychological fields of life ,2. PeoplThe World Health Organization estimates that, globally, at least 430 million people have disabling hearing loss, which is defined as an average threshold of speech frequencies at 0.5–4 kHz, loss of hearing at 35 dB or more in the better hearing ear, and requiring care ,10. MostOne of the main issues of ear and hearing care is the low use of hearing aids. Worldwide, there are 333.5 million people (83%) who are in need of hearing aids but do not use them, ranging from 75% in high-income countries to 85% in middle-income and to 91% in low-income countries . “In neeIn Russia, hearing aids are provided by state or private audiological centers. People with severe and profound hearing loss can get disabled person status and receive a hearing aid and individual earmolds paid by the Federal Social Fund. Some regional budgets also provide hearing aids for moderate hearing loss cases. The cost of hearing aids purchased in private centers can be totally or partially reimbursed . The number of hearing aid users in Russia can hardly be assessed. There are no big data or strong populational studies on adult hearing loss prevalence and hearing aid use in Russia. National censuses do not collect information on hearing health. Data on primary hearing aid fitting are reported by state audiological centers to regional public health authorities but are not available for analysis. Private audiological centers, distributors of hearing aids, and manufacturers are not obligated to report their dispensing outcomes. According to the Ministry of Labor and State Statistical Service, in 2016, 116,053 hearing aid units were provided from the federal budget [The official national statistical data are supposed to underestimate the real prevalence of hearing loss due to methodological issues. In 2021, 642,959 adults or 5.5 per 1000 were diagnosed with permanent hearing loss of any severity—of them, 486,712 were diagnosed with bilateral sensorineural hearing loss, which can be totaled at 4.2 per 1000 . The only national populational study where the data on self-reported hearing and hearing aid use were found is the Russia Longitudinal Monitoring Survey—Higher School of Economics (RLMS-HSE), which is a series of nationwide representative surveys ,24. The The analysis of hearing aid use by Russian adults based on the national survey is the aim of this study.https://rlms-hse.cpc.unc.edu (accessed on 20 July 2023), https://www.hse.ru/org/hse/rlms (accessed on 20 July 2023)).The data on hearing aids use were extracted from the open access database of the RLMS-HSE. This study was conducted by the National Research University “Higher School of Economics” and LLC “Demoscope” together with the Carolina Population Center, University of North Carolina at Chapel Hill, and the Institute of Sociology of the Federal Center of Theoretical and Applied Sociology of the Russian Academy of Sciences  with available answers being “Very good”, “Good”, “Moderate”, “Bad”, and “Very bad”. If the answer was from “Moderate” to “Very bad”, the second question “Do you use a hearing aid?” was posed (variable m66) with available answers being “Yes” and “No”. For unknown reasons, since round 12, the question about self-reported hearing was excluded from the questionnaire, and all respondents have only been asked a question about HA use. These additional variables were analyzed in the dataset of round 30: age , sex , and general health . χ2 criterion was used with statistical significance p < 0.05. The Pearson coefficient was used to reveal the correlation of hearing aid use with age and severity. Statistical analysis was performed using the RStudio Integrated Development Environment for R.The prevalence of self-reported hearing loss and hearing aid use was calculated per 1000 with 95% confidential intervals (CI) of the sample of respondents giving meaningful answers . Means and standard deviations (SD) were calculated for year prevalence and rate values. For comparison of frequencies, the The prevalence of hearing aid use among the Russian adult population ranges from 4.3 to 8.8 per 1000, The distribution by age, sex, and general health status were analyzed from the round 30 dataset. χ2 = 374.019, p < 0.01), as can be seen in r = 0.889) as shown in The distribution by age in the hearing aid users’ group and in the whole sample differs significantly ; the median for the whole sample was 46 years old . Taking into account the significant difference in the age structure, subgroups of 66–82-year-old hearing aid users and the whole sample were formed to compare the distribution by sex and general health. χ2 = 14.971, p < 0.001), as shown in Among hearing aid users, the proportion of males was significantly higher than in the whole sample—58% and 31%, respectively , as shown in General health is much better in the whole sample subgroup of 66–82-year-olds (The respondents were asked about their hearing status during rounds 5–11. The mean rate of self-reported very good hearing was 14.8% (SD 2.2), good—62.8% (SD 1.8), moderate—16.6% (SD 0.6), bad—5% (SD 0.4), and very bad hearing—0.7% (SD 0.1), as shown in The moderate, bad, and very bad hearing groups were merged into trouble hearing; very good and good hearing status—into generally good hearing. The mean rate of all trouble hearing was 22.2% (SD 0.8). The mean rate of hearing aid use was 2.2% (SD 0.2). It can be noticed that both rates were rather stable throughout the period of the monitoring of hearing status (1994–2002), as seen in r = 0.938) but remains rather low even in the very bad hearing group.In the moderate hearing group, the mean rate of hearing aid use was 0.7% (SD 0.2); in the bad hearing group—4.7% (SD 0.7); and in the very bad hearing group—22.8% (SD 2.6), as seen in The RLMS-HSE is the only national survey known to the authors that provides data on hearing aid use and self-reported trouble with hearing. The prevalence of hearing aid use among the Russian adult population ranges from 4.3 to 8.8 per 1000, which is about ten times lower than in other national surveys. Dillon et al. (2020) reported that in about 5–7% of the participants of a Welsh household survey who had ever used a hearing aid, among them, about 20% never used it, 30%—used it occasionally, and 50%—used it most of the time. The sample size (10–16 thousand participants), age (16 years and older), and survey years (2004–2018) were similar to the RLMS-HSE study . L. HumeThe lower prevalence of hearing aid use in Russian adults can probably be explained by the high cost of the devices and the population’s low awareness of the impact of hearing loss on well-being. For this reason, this issue is to be explored in further studies. The hearing aid purchasing system in Russia is multivariant. People with bilateral severe and profound hearing loss can obtain the official status of a disabled person and receive a hearing aid and individual earmolds in state audiological centers paid by the Federal Social Fund. More than 100 thousand hearing aid units are provided yearly from the federal budget for primary fitting or the renewal of destroyed devices. Some regional budgets also provide hearing aids for moderate hearing loss cases ,20. The There are many articles in the published literature based on other national survey datasets that restrict the study sample to older persons and/or the moderate and worse hearing. They usually report much higher hearing aid use prevalence. The Korean national survey with the same study design as NHANES shows the prevalence of hearing aid use as being 12.7% in a group of participants aged 40 years and older and with bilateral moderate or worse thresholds . In the The prevalence of hearing aid use estimates appears to be sensitive to posed questions. Prevalence values were constantly lower when only respondents with trouble hearing were asked about hearing aid use (5 per 1000) than all individuals (7.8 per 1000). It can be explained by the mention of the hearing aid in this question about hearing status: “How is your hearing without a hearing aid?” aimed to obtain information on both trouble hearing and its severity. The reason for why this question was excluded from the round 12–30 questionnaires is unknown. To our knowledge, an analysis on hearing outcomes based on the RLMS-HSE dataset has never been conducted before. A similar type of question was used in a Welsh national survey , NHANES, and NHIS (“Which statement best describes your hearing (without a hearing aid or other listening device)?”) ,26,27. AOther different aspects can affect the results of hearing outcomes within large-scale populational surveys such as the methodology of data collection . These circumstances are discussed in detail by Dillon et al. in a study of hearing conducted via survey within a Welsh household . The validity of self-reporting trouble with hearing was considered acceptable for epidemiological purposes , despiteThe results obtained from the RLMS-HSE study support findings that hearing aid use correlates with older age and hearing loss severity in many studies included in a systematic analysis by Knoetze et al. . A signiA significant sex difference between hearing aid users and the whole sample adjusted by age were revealed in this study. Males used hearing aids 1.4 times more than females, whereas, in the older population, the proportion of females was much higher. In NHANES and NHIS, the prevalence of the hearing aid uptake in the male population was also constantly higher than in the female population in all age groups and in the sample overall ,27. A siIn this study, self-reported general health was better in the whole sample adjusted by age to hearing aid users. No one in the hearing aid user group aged 66–82 years reported very good and good general health in comparison with 7.5% of the whole sample group respondents. Not good not bad general health was noted by 50% of hearing aid users and 61% of the whole sample; bad and very bad—by 50% and 31.5%, respectively. Literature findings on the correlation between hearing aid use and general health are controversial. Sawyer et al. found a positive correlation when hearing aid users have generally worse health, whereas Meyer and colleagues relate hearing aid uptake to better health ,35.There is a variety of ear and hearing care and hearing aid delivery systems in different countries, including type and training of providers, hearing aid purchasing pathways, and costs . MultiplThe strength of this study is its large sample size, whose range is 8415–18,601 participants in different rounds, according to the change in population numbers in Russia during the monitoring period. Another strong factor is its combined longitudinal and cross-sectional design (repeated samples with split panel), but only cross-sectional data were presented without an analysis of the longitudinal reporting of hearing aid use by regular participants, which will be the scope of future research. The weakness of the presented study is missed data on sex, comorbidity, and some demographic characteristics, as education and income levels are to be analyzed further.Data on hearing aid use based on the RLMS-HSE study can add new information to the global pool of epidemiological studies on hearing. They can also serve as a key performance indicator for the continuous improvement of the national hearing health care system.