This study examined (1) the utility of a clinical system to record acoustic change complex (ACC, an event-related potential recorded by electroencephalography) for assessing speech discrimination in infants, and (2) the relationship between ACC and functional performance in real life. Participants included 115 infants (43 normal-hearing, 72 hearing-impaired), aged 3-12 months. ACCs were recorded using [szs], [uiu], and a spectral rippled noise high-pass filtered at 2 kHz as stimuli. Assessments were conducted at age 3-6 months and at 7-12 months. Functional performance was evaluated using a parent-report questionnaire, and correlations with ACC were examined. The rates of onset and ACC responses of normal-hearing infants were not significantly different from those of aided infants with mild or moderate hearing loss but were significantly higher than those with severe loss. On average, response rates measured at 3-6 months were not significantly different from those at 7-12 months. Higher rates of ACC responses were significantly associated with better functional performance. ACCs demonstrated auditory capacity for discrimination in infants by 3-6 months. This capacity was positively related to real-life functional performance. ACCs can be used to evaluate the effectiveness of amplification and monitor development in aided hearing-impaired infants.

Background: Many older Australian adults with cochlear implants (CI) lack funding for replacement sound processors, risking complete device failure and reduced quality of life. The need for replacement CI devices for individuals with obsolete sound processors and no access to funding poses an increasing public health challenge in Australia and worldwide. We aimed to investigate the clinical and cost-effectiveness of upgrading obsolete CI sound processors in older adults. Methods: Alongside an Australian Government-funded upgrade program, a prospective, mixed-methodology design study was undertaken. Participants were aged 65 and over, with obsolete Cochlear™ sound processors and no funding for replacements. This study compared speech perception in noise, as well as self-reported outcome measures, including cognition, listening effort, fatigue, device benefit, mental well-being, participation, empowerment and user experiences, between upgraded and obsolete hearing aid processors. The economic impact of the upgrade was evaluated using two state-transition microsimulation models of adults using CIs. Results: The multi-site study ran from 20 May 2021 to 21 April 2023, with recruitment from June 2021 to May 2022. A total of 340 Cochlear™ sound processors were upgraded in 304 adults. The adults’ mean age was 77.4 years (SD 6.6), and 48.5% were female. Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech understanding in noise and reduced communication difficulties, self-reported listening effort and fatigue. Semi-structured interviews have revealed that upgrades alleviated the anxiety and fear of sudden processor failure. Health economic analysis found that the cost-effectiveness of upgrades stemmed from preventing device failures, rather than from access to newer technology features. Conclusions: Our study identified significant clinical and self-reported benefits from upgrading Cochlear™ sound processors. Economic value came from avoiding scenarios where a total failure of device renders its user unable to access sound. The evidence gathered can be used to inform policy on CI processor upgrades for older adults.

Background/Objectives: Speech intelligibility (SI) is a key indicator of spoken language development, especially for children with hearing loss, as it directly impacts communication and social engagement. However, due to logistical and methodological challenges, SI assessment is often underutilised in clinical practice. This study aimed to evaluate the accuracy and consistency of an artificial intelligence (AI)-based transcription model in assessing SI in young children with cochlear implants (CI), hearing aids (HA), or normal hearing (NH), in comparison to naïve human listeners. Methods: A total of 580 speech samples from 58 five-year-old children were transcribed by three naïve listeners and the AI model. Word-level transcription accuracy was evaluated using Bland–Altman plots, intraclass correlation coefficients (ICCs), and word error rate (WER) metrics. Performance was compared across the CI, HA, and NH groups. Results: The AI model demonstrated high consistency with naïve listeners across all groups. Bland–Altman analyses revealed minimal bias, with fewer than 6% of sentences falling outside the 95% limits of agreement. ICC values exceeded 0.9 in all groups, with particularly strong agreement in the NH and CI groups (ICCs > 0.95). WER results further confirmed this alignment and indicated that children with CIs showed better SI performance than those using HAs. Conclusions: The AI-based method offers a reliable and objective solution for SI assessment in young children. Its agreement with human performance supports its integration into clinical and home environments for early intervention and ongoing monitoring of speech development in children with hearing loss.

Objectives: The aims of this study were to report the audiological characteristics of children with congenital unilateral hearing loss (UHL), examine the age at which the first reliable behavioural audiograms can be obtained, and investigate hearing changes from diagnosis at birth to the first reliable behavioural audiogram.Method: This study included a sample of 91 children who were diagnosed with UHL via newborn hearing screening and had reliable behavioural audiograms before 7 years of age. Information about diagnosis, audiological characteristics and etiology were extracted from clinical reports. Regression analysis was used to explore the potential reasons influencing the age at which first reliable behavioural audiograms were obtained. Correlation and ANOVA analyses were conducted to examine changes in hearing at octave frequencies between 0.5 and 4 kHz. The proportions of hearing loss change, as well as the clinical characteristics of children with and without progressive hearing loss, were described according to two adopted definitions: Definition 1: criterion (1): a decrease in 10 dB or greater at two or more adjacent frequencies between 0.5 and 4 kHz, or criterion (2): a decrease in 15 dB or greater at one octave frequency in the same frequency range. Definition 2: a change of ≥20 dB in the average of pure-tone thresholds at 0.5, 1, and 2 kHz.Results: The study revealed that 48 children (52.7% of the sample of 91 children) had their first reliable behavioural audiogram by 3 years of age. The mean age at the first reliable behavioural audiogram was 3.0 years (SD 1.4; IQR: 1.8, 4.1). We found a significant association between children's behaviour and the presence or absence of ongoing middle ear issues in relation to the delay in obtaining a reliable behavioural audiogram. When comparing the hearing thresholds at diagnosis with the first reliable behavioural audiogram across different frequencies, it was observed that the majority of children experienced deterioration rather than improvement in the initial impaired ear at each frequency. Notably, there were more instances of hearing changes (either deterioration or improvement), in the 500 Hz and 1,000 Hz frequency ranges compared to the 2,000 Hz and 4,000 Hz ranges. Seventy-eight percent (n = 71) of children had hearing deterioration between the diagnosis and the first behavioural audiogram at one or more frequencies between 0.5 and 4 kHz, with a high proportion of them (52 out of the 71, 73.2%) developing severe to profound hearing loss. When using the averaged three frequency thresholds (i.e., definition 2), only 26.4% of children (n = 24) in the sample were identified as having hearing deterioration. Applying definition 2 therefore underestimates the proportion of children that experienced hearing changes. The study also reported diverse characteristics of children with or without hearing deterioration.Conclusion: The finding that 78% of children diagnosed with UHL at birth had a decrease in hearing loss between the hearing levels at first diagnosis and their first behavioural audiogram highlights the importance of monitoring hearing threshold levels after diagnosis, so that appropriate intervention can be implemented in a timely manner. For clinical management, deterioration of 15 dB at one or more frequencies that does not recover warrants action.

To describe the development and evaluation of the NAL-NL3 Comfort in Noise Module; a new algorithm for determining hearing-aid gain that is part of the NAL-NL3 fitting system. Single-site multi-study design with each study and subsequent perceptual modelling informing refinements to module gain targets. Participants completed laboratory studies to investigate gain preferences and to evaluate the effect of the module on speech understanding in noise. Participants also completed real-world evaluations using a smartphone-based Ecological Momentary Assessment app with different brands of hearing aids. 83 adult hearing aid users with mild to severe hearing loss. The new module selectively reduced gain (compared with the NAL-NL3 Prescription) by imposing a limit on the total loudness. Iterative refinements led to progressive increases in user preferences favouring the new module over the NAL-NL3 Prescription in noise with respect to listening comfort. Laboratory-based testing identified no detrimental impact on speech perception in noise. Reducing the level of prescribed gain for hearing aid users in noise compared to in quiet improves comfort without significantly degrading speech understanding. This work supports the broader philosophy of the NAL-NL3 fitting system to provide specialised targets for different populations, situations and device technologies.