Open research questions in Hearing Loss and Rehabilitation

What the literature leaves open

• Whether the side of hearing loss (left versus right) yields distinct electroencephalography (EEG) spectral and lateralization patterns remains unclear.

  Altered Neural Oscillations and Hemispheric Asymmetry in Single-Sided Deafness · 2026 · DOI

• Abstract Background Central Auditory Processing Disorder (CAPD) requires specialized clinical pathways; there is limited data on how these services are implemented in the Indian context.

  Survey of audiologists’ training and professional practices in pediatric auditory processing disorders in India · 2026 · DOI

• 876 877 878 879 880 881 882 883 884 885 886 887 888 889 890 891 892 893 894 895 896 897 898 899 900 901 902 903 904 905 906 907 908 909 910 911 912 913 914 915 916 917 918 The use of logatome tests as speech material consti- tutes a limitation of this study, as everyday communi- cation relies primarily on sentence-level information.

  Speech intelligibility in halls with Reverberation Enhancement Systems · 2026 · DOI

• Strengths and limitations of this studyO_LIData were collected across two pandemic waves (April-May 2020 and July-August 2022) from 184 countries, allowing us to analyze hearing status on a global level, beyond any single national context or health system.

  Non-Medical COVID-19 Impacts and Hearing Status: A Global Study of Differential Health Impact Among Deaf, Hard of Hearing, and Hearing Populations · 2026 · DOI

• ObjectivesOutcomes following cochlear implantation vary substantially across adult recipients, and the cognitive and perceptual factors contributing to this variability are not fully understood.

  Auditory Working Memory and Sound Segregation Ability Predict Speech-in-Noise in Adult Cochlear Implant Users · 2026 · DOI

• In this study, the relationships between age, education, degree of hearing loss, and duration of hearing loss on the use of communication strategies were not investi- gated. Further, limited data assessed the influence of employment status and use of hearing aids. Additionally, the influence of these parameters on third-party disability was not assessed. Furthermore, self-reported communication strategies could be veri- fied in real-life situations, providing greater insight into communication dynamics between individuals with hearing loss and their communication partners. Funding Open access funding provided by Manipal Academy of Higher Education, Manipal. This study did not receive any funding.

  Self-reported Communication Strategies Used by Individuals with Hearing Loss and its Influence on the Hearing Loss Related Quality of Life of their Communication Partners · 2026 · DOI

• Additionally, factors such as education level, socioeco- nomic status, occupational and noise exposure history, hearing-aid model, processing features, fitting protocols, real-ear verification, and participation in formal or infor- mal auditory rehabilitation were not systematically con- trolled. In particular, hearing-aid fitting and verification procedures were not fully standardized across partici- pants, and variations in signal-processing features, fine- tuning adjustments, and verification practices may have influenced speech perception outcomes. Consequently, the observed improvements cannot be attributed solely to hearing-aid wear time independent of fitting quality or device characteristics. Future studies employing stan- dardized fitting protocols and verification procedures are needed to further clarify the independent contribution of daily hearing-aid use to rehabilitative outcomes. the strong Furthermore, statistical associations observed in the present study may partially reflect the clear behavioral separation between usage groups and the observational nature of the study design. The post- hoc classification of participants into distinct usage cat- egories may have strengthened observed associations, and unmeasured behavioral factors such as motivation, communication demands, and social engagement may have influenced both hearing-aid use patterns and speech perception outcomes. Future studies employing more heterogeneous usage patterns and prospective controlled designs are needed to further evaluate the generalizabil- ity of these findings.

  Dose–response effects of daily hearing-aid use on speech perception and auditory threshold stability in adults with sensorineural hearing loss · 2026 · DOI

• Several limitations need to be addressed. Published lit- eratreure on CT imaging parameters is heterogeneous and comprises mainly of retrospective studies with a lack of high-level prospective data and formal consensus guide- lines for the suggested thresholds. In addition, there is variability in the CT acquisition protocols, reconstruction techniques, and workstation software across institutions with limited evidence on reproducibility across observ- ers and institutions. Although this article has proposed a standardisation of facial recess width measurements ● Preoperative temporal bone CT is essential for cochlear implant planning, as it identifies anatomical variations that directly influence surgical approach, feasibility, and risk of complications. ● Key CT parameters include scalp and calvarial thick- ness, mastoid pneumatisation, tegmen tympani height, vascular anomalies, facial recess width <3 mm which increases risk of facial nerve injury, round window anat- omy, and cochlear duct length. ● This review article highlights and addresses areas of am- biguity in the current literature, including inconsistent parameter definitions and a lack of consensus in measure- ment and scanning techniques. Addressing these gaps with a structured approach is essential for communication with otologists and to ensure accurate surgical planning.

  Key pre-operative CT parameters for cochlear implantation: a focused radiologic review with surgical relevance · 2026 · DOI

• An important limitation of the present study concerns the composition of the background noise. To rigorously control acoustic and speaker-related features across all conditions, the same speaker was used for both the target language and the background noise. This approach minimized potential confounding factors related to dierences in voice identity, pitch, timbre, articulation, and prosody, thus allowing us to more accurately isolate the eects of background noise and listening status on neural frequency-tagging responses. However, this design does not fully replicate the complexity of natural multi-speaker listening situations, where competing speech streams are typically generated by several speakers with distinct voice characteristics. Using dierent competing speakers could have increased the demands on information masking and required stronger auditory stream separation processes, potentially leading to a greater strain on attentional neural resources. Consequently, our interpretation that compensatory attentional mechanisms can facilitate auditory stream separation in multi-speaker background noise should be considered within the context of the present experimental design. Future studies using more ecologically valid multi-speaker sound conditions will be important to determine how speaker variability aects neural speech processing and auditory stream separation in old age and HL. A further limitation of the present study is that it cannot be conclusively determined whether the observed frequency-tagging responses reflect syllable-level processing per se or are instead primarily driven by lower-level acoustic properties, in particular envelope modulation. Accordingly, a more cautious interpretation is that neural activity in the syllable-rate range likely reflects an interaction between acoustic and linguistic processes. Given that the speech envelope inherently contains periodic structure at syllabic rates, a portion of the observed neural synchronization may be explained by responses to amplitude fluctuations in the acoustic signal. A further methodological consideration is the focus on a narrow frequency band (4–5.6 Hz) as the primary analysis window. This range was selected based on the syllable rate of the stimulus material and was intended to maximize sensitivity to neural activity time-locked to syllabic dynamics while improving signal-to-noise ratio. This approach follows established frequency-tagging studies of continuous speech that target stimulus-defined rhythmic rates. Importantly, this choice does not imply that the observed eects are specific to this frequency range or exclusively reflect syllable-level processing, but rather represents an analysis strategy optimized for the dominant temporal structure of the input.

  Neural frequency-tagging of syllables in naturalistic speech is sensitive to background noise and age-related hearing loss · 2026 · DOI

• The main limitation is the observational design of most included studies, with potential confounding. Outcome mea- sures and reporting were heterogeneous, limiting compara- bility. Importantly, inter-implant delay was inconsistently reported and usually only at the study level, precluding cal- culation of pooled patient-level delay distributions. Additional sources of heterogeneity included variability in speech-in-noise paradigms and signal-to-noise ratios, use of free-field versus ear-specific testing, inconsistent report- ing of contralateral hearing-aid use in unilateral CI compari- sons, and wide variation in vestibular assessment methods ranging from objective testing to parental report. These fac- tors limit direct comparability across studies and should be considered when interpreting pooled effect sizes. 1 3European Archives of Oto-Rhino-Laryngology Regarding the timing of the second implant in sequential cases, our analysis reveals a clear distinction in outcomes based on the inter-implant interval. The majority of the stud- ies showing optimal bilateral benefits reported a relatively short delay of 1–3 years [8, 23, 26, 29]. In contrast, consis- tent with the concept of a critical period for bilateral audi- tory development, cohorts that included long-gap sequential cases exceeding 5 years [18, 19, 22, 44] often exhibited more heterogeneous outcomes, particularly in complex sound localization tasks. Language outcomes are also influenced by family envi- ronment and socioeconomic factors, which could not be controlled for in this meta-analysis [50]. Despite the observational nature of most included studies, consistent cohort characterization and generally complete fol- low-up contributed to moderate to high methodological quality overall (Table 2); however, causal inferences remain limited.

  Benefits of bilateral cochlear implantation in children: a systematic review and meta-analysis · 2026 · DOI

• Future research should adopt harmonised outcome measures and follow children into adolescence to capture educational, psychosocial, and cognitive outcomes. Advances in binau- ral CI processing may further enhance spatial hearing and speech-in-noise performance. Supplementary Information The online version contains supplementary material available at h t t p s : / / d o i . o r g / 1 0 . 1 0 0 7 / s 0 0 4 0 5 - 0 2 6 - 1 0 3 0 2 - z . Funding Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This manuscript has not received any funding.

  Benefits of bilateral cochlear implantation in children: a systematic review and meta-analysis · 2026 · DOI

• This study focused on hearing loss among older adults in Singapore, specifically exploring the health beliefs and factors influencing treatment seeking, an area that has been underexplored in the local context. Participants were recruited from the major ethnic groups in Singa- pore and included individuals who spoke either English or Mandarin, the two most commonly used languages among older adults locally [48]. This approach allowed the study to capture perspectives from a large proportion of the local older adult population. Lim et al. BMC Primary Care (2026) 27:158 Page 10 of 11 This study has several limitations. Participants were recruited solely from the polyclinic setting, which may not fully reflect the perspectives of older adults seeking care from private general practitioners or tertiary hos- pitals. Participants with lower educational levels were likely to be under-represented, which may have limited the diversity of perspectives captured, as this group could have differing levels of awareness and attitudes towards hearing loss and its management. Nevertheless, pur- posive sampling was employed to identify a wide range of views and factors affecting older adults’ help-seeking towards hearing loss. Hearing loss was identified primarily through self- report rather than objective audiometric testing, which may limit clinical characterisation of severity. However, as the study focused on perceptions and help-seeking behaviour, self-perceived hearing difficulty was consid- ered appropriate. This study did not include participants who identified as “deaf ” and primarily used sign lan- guage. As a result, the findings may not reflect the experi- ences, help-seeking pathways, and barriers specific to the “deaf ” community, which may differ from those of older adults with age-related hearing loss. While participants with varying hearing care experiences were included, this study did not undertake a formal comparative analysis between hearing aid adopters and non-adopters. Another limitation was that member checking was not performed due to constraints related to the project timeline and logistical challenges in re-engaging participants.

  Help-seeking behaviour of older adults towards hearing loss based on the health belief model: a qualitative research study · 2026 · DOI

• Future studies should focus on developing educational programmes that address common barriers to hear- ing care, facilitate access to appropriate resources for older adults, and evaluate the effectiveness of these interventions in raising public awareness and promot- ing value-based hearing loss management. Additionally, studies exploring the perspectives of family members and healthcare providers, such as primary care providers or audiologists, may reveal opportunities to enhance early detection and referral for hearing loss.

  Help-seeking behaviour of older adults towards hearing loss based on the health belief model: a qualitative research study · 2026 · DOI

• The present study tested for a heightened reliance on visual facial cues during audiovisual speech perception in OAHL to examine whether this may be a mechanism for the observed visual bias in OAHL. Results do not support the hypotheses that older adults with more hearing loss experience greater enhancement of speech perception when visual facial cues were present, compared to those with less hearing loss. OAHL also did not differentially 28 direct their gaze to a speaker’s mouth versus eyes during word perception. These findings are inconsistent with current literature suggesting visual behavioural advantages for speech perception in OAHL that may arise through compensatory processes such as cross-modal plasticity. Unlike the congruent audiovisual stimuli used in this study, biases toward vision in OAHL may involve increased cognitive recruitment during the perception of conflicting audio and visual signals. Future research should continue to explore the potential role of cognitive influences during audiovisual perception in OAHL as well as extending findings to those with more severe hearing loss.

  Influence of partial speaker face occlusion during audiovisual speech perception in age-related hearing loss · 2026 · DOI

• This study has limitations. First, we mostly tested adults with mild-to-moderate age- related hearing loss. Although cross-modal plasticity is apparent in this population through neuroimaging, influences on visual processing during speech perception may not be apparent until later stages of hearing decline. Additionally, we cannot extend claims about visual reliance and attention found in this study to older adults with severe-to-profound hearing loss. Second, we intentionally set auditory speech levels to participants’ individual 50% speech reception thresholds, which attempts to normalize individual differences in audio-only speech-in noise perception and rules out effects of compounding auditory degradation from both hearing loss and background noise in stimulus designs where the speech-to-noise ratio is fixed across participants. However, these conditions (−13 to −4 dB SNR) are uncommonly experienced in day-to-day listening (Wu et al., 2018). In everyday listening, unlike those with typical hearing, OAHL likely experience the accumulated effects of noise and hearing loss, and these conditions may necessitate dependence on visual speech cues.

  Influence of partial speaker face occlusion during audiovisual speech perception in age-related hearing loss · 2026 · DOI

• Akshita Bhargava1, Avina Kharat2, Sudha Patel3, Yogesh Patel4, Sunita Vishwakarma5 1MS (ENT), Senior Resident, Dept. of Otorhinolaryngology, Virendra kumar saklecha medical college, Neemuch, MP. 2MD (Pharmacology) Assistant Professor, Dept. of Pharmacology, ESIC Medical College and Hospital Indore, MP. 3MD (Pharmacology) Assistant Professor, Dept. of Pharmacology, Peoples Medical college and research centre, Bhopal, MP. 4MD (Radiodiagnosis), PG Resident, Dept. of Radiodiagnosis, Gandhi Medical College and Hamidia Hospital, Bhopal, MP. 5MD (community medicine), Senior Resident, Dept. of community medicine, Sunderlal Patwa Govt. Medical College, Mandsaur, MP. ABSTRACT Background: Hearing loss is a common but often neglected health problem among the elderly, significantly affecting communication, quality of life, and social interaction. Early detection through community-based screening can help reduce disability and improve outcomes.Objectives: To assess the prevalence of hearing loss among the elderly population and evaluate associated risk factors from a community medicine perspective.Methods: A cross-sectional study was conducted among individuals aged ≥60 years in a defined community area. Hearing screening was performed using the whispered voice test and pure tone audiometry (where feasible). Data on sociodemographic factors, comorbidities, and risk exposures were collected using a structured questionnaire.Results: Out of 300 participants, 162 (54%) were found to have some degree of hearing impairment. Age, male gender, history of chronic diseases, and exposure to noise were significantly associated with hearing loss (p < 0.05).Conclusion: Hearing loss is highly prevalent among the elderly and often underdiagnosed. Community-based screening programs are essential for early identification and intervention. Keywords: Hearing loss, elderly, screening, community medicine, presbycusis. INTRODUCTION Hearing loss is one of the most common chronic health conditions affecting the elderly population worldwide and represents a significant public health loss, also known concern. Age-related hearing as presbycusis, bilateral sensorineural impairment that primarily affects highfrequency speech discrimination. According the World Health Organization, over 430 million people globally experience disabling hearing loss, and this number is progressive, perception sound and to is a expected to rise due to population ageing and increased exposure to risk factors such as noise pollution and ototoxic medications (1). to lack of awareness, In India, the burden of hearing impairment among older adults is substantial but often under-recognized due to audiological services, and sociocultural barriers. Hearing impairment in the elderly is not merely a sensory deficit; it is strongly associated with adverse outcomes such as social isolation, depression, reduced functional independence, and cognitive decline (2,3). limited access Relevant conflicts of interest/financial disclosures: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

  Screening for Hearing Loss Among Elderly Population: A Cross-Sectional Study from a Community Medicine Perspective · 2026 · DOI

• Service delivery aspects such as self-fitting, acclimatization programs, remote support, behavioral incentivization, and payment options should be investigated for their potential role in OTC hearing aid outcomes.

  Comparing Hearing Aid Outcomes in Adults Using Over-the-Counter and Hearing Care Professional Service Delivery Models · 2023 · DOI

• However, many biomarkers are preliminary and need to be validated and their role in the diagnosis and treatment of ASD needs to be defined (Frye, Vassall, Kaur, Lewis…

  Early identification of hearing and communication disorders in the pediatric population in India: Need for new thinking · 2023 · DOI

• A deeper examination of the critical barriers to a more standard narrative and approach is warranted to guide the advancement of comprehensive AR for adults with CIs.

  Cross-Disciplinary Practices and Perspectives of Auditory Rehabilitation for Adults With Cochlear Implants · 2022 · DOI

• PURPOSE: Human studies of noise-induced cochlear synaptopathy using physiological indicators identified in animal models (auditory brainstem response [ABR] Wave I amplitude, envelope following response [EFR], and middle ear muscle reflex [MEMR]) have yielded mixed findings.

  The Impacts of Noise Exposure on the Middle Ear Muscle Reflex in a Veteran Population · 2022 · DOI

• Further research on a bigger sample and using more complex ML algorithms and explainability techniques is needed to fully investigate the role of input features (including additional features such as risk factors and individual responses to low-/high-frequency stimuli) in predicting hearing loss.

  Evaluation of Machine Learning Algorithms and Explainability Techniques to Detect Hearing Loss From a Speech-in-Noise Screening Test · 2022 · DOI

• To date, no studies have explored whether differences may exist between the pronunciation skills of students who elect to complete a human anatomy and physiology course online versus in a face-to-face (FTF) format.

  A Comparison of Face-to-Face Versus Online Instruction in the Correct Pronunciation of Anatomical Terms in Communication Sciences and Disorders. An Initial Investigation · 2020 · DOI

• Results As the WHO-HI grade progressed from “normal” to “severe” (insufficient data from older adults were available for the “profound” category), each step in this progression led to a significant difference in functional communication relative to all other WHO-HI grades.

  Examining the Validity of the World Health Organization's Long-Standing Hearing Impairment Grading System for Unaided Communication in Age-Related Hearing Loss · 2019 · DOI

• Hearing loss may represent a risk for developing social skills difficulties; however, little is known about the potential risk resulting from unilateral or mild bilateral hearing loss (UMHL).

  Social skills in preschool children with unilateral and mild bilateral hearing loss · 2017 · DOI

• However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

  Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions · 2017 · DOI

Most-cited papers in Hearing Loss and Rehabilitation

• The world report on hearing, 2021 · Bulletin of the World Health Organization · 2021 · 466 citations
• Objective measures for predicting speech intelligibility in noisy conditions based on new band-importance functions · The Journal of the Acoustical Society of America · 2009 · 349 citations
• Gender differences in a longitudinal study of age-associated hearing loss · The Journal of the Acoustical Society of America · 1995 · 338 citations
• Temporal integration and multiple looks · The Journal of the Acoustical Society of America · 1991 · 296 citations
• Acoustic effects of medical, cloth, and transparent face masks on speech signals · The Journal of the Acoustical Society of America · 2020 · 222 citations
• Hearing Loss and Depression in Older Adults · Journal of the American Geriatrics Society · 2013 · 214 citations
• Factors influencing intelligibility of ideal binary-masked speech: Implications for noise reduction · The Journal of the Acoustical Society of America · 2008 · 186 citations
• Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans · Journal of Aging and Health · 2015 · 186 citations
• Depressive Symptoms in Older Adults with Hearing Impairments: The Blue Mountains Study · Journal of the American Geriatrics Society · 2009 · 154 citations
• Dual Sensory Impairment in Older Age · Journal of Aging and Health · 2011 · 138 citations

Most recent work

• Cognitive Skills and Academic Performance in Children With Minimal to Mild Conductive Hearing Loss: The Roles of Listening Effort and Subjective Fatigue · American Journal of Audiology · 2026
• A multicenter multifunctional assessment of large language models in pure-tone audiogram interpretation for patients · npj Digital Medicine · 2026
• Hearing Aids for Adults With Mild to Moderate Hearing Loss · JAMA · 2026
• Self-reported Communication Strategies Used by Individuals with Hearing Loss and its Influence on the Hearing Loss Related Quality of Life of their Communication Partners · Ageing International · 2026
• Psychology and Audiology: A Proposed Guide for Collaborative Care for Hearing Loss and Cognitive Decline · American Journal of Audiology · 2026
• Help-seeking behaviour of older adults towards hearing loss based on the health belief model: a qualitative research study · BMC Primary Care · 2026
• Social participation trajectories and self-reported hearing impairment among Chinese older adults: Evidence from the Chinese longitudinal healthy longevity study over 10 years · Medicine · 2026
• Prevalence and sex differences in moderate-to-severe hearing loss among older adults: a cross-sectional study · BMC Geriatrics · 2026
• Evaluation of Brain Age on Magnetic Resonance Imaging Using Machine Learning Techniques in Patients With Hearing Loss · Ear & Hearing · 2026
• Screening for Hearing Loss Among Elderly Population: A Cross-Sectional Study from a Community Medicine Perspective · Journal of Pharmaceutical Sciences · 2026

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