Introduction: Functional near-infrared spectroscopy (fNIRS) has emerged as a promising neuroimaging modality for investigating cortical activity in auditory and vestibular domains. Its portability, device compatibility, and motion tolerance make it particularly suited for use in populations that are challenging to study with conventional neuroimaging techniques, such as infants and cochlear implant (CI) users. The present study aims to explore the potential and limitations of this neuroimaging technique in the audiological and vestibular fields, offering an integrated perspective across pediatric, adult and elderly populations. Methods: A narrative review of studies using fNIRS in hearing loss, tinnitus, and vestibular disorders was conducted through searches in PubMed and Scopus up to March 2025. Studies were included if they employed fNIRS to investigate cortical responses in individuals with diagnosed hearing loss, chronic tinnitus or to investigate vestibular function. Results: A total of 60 studies were reviewed: 36 on hearing loss, 11 on tinnitus, and 13 on vestibular disorders. In hearing research, fNIRS successfully identified cortical activation patterns related to auditory perception, speech processing, and cross-modal plasticity in CI users across development, adulthood and aging. The technique showed prognostic potential in predicting CI outcomes and monitoring listening effort and cognitive load. In tinnitus research, fNIRS consistently demonstrate hyper-activation in the auditory cortex and altered functional connectivity with frontal-limbic networks, reflecting sensory, cognitive, and emotional involvement. The technique was sensitive to treatment effects following interventions such as transcranial stimulation, acupuncture, and cochlear implantation. In vestibular research, fNIRS enabled the mapping of cortical networks involved in balance control and multisensory integration during various stimulation paradigms, including caloric testing, motion platforms, and optic flow in virtual environments. Although current applications are mostly exploratory, findings suggest fNIRS can capture vestibular-related cortical activity in real-world conditions. Conclusion: fNIRS offers a valuable, non-invasive, and ecologically valid method for investigating auditory and vestibular function across the lifespan. In hearing and tinnitus research, it shows strong potential for clinical translation, especially if methodological standardization is achieved. Applications in vestibular research remain preliminary but promising.

SignificanceDeaf and hard-of-hearing infants’ hemodynamic response function (HRF) has not yet been characterized. However, without an appropriate estimate of their HRF, neuroimaging modalities relying on hemodynamic responses, e.g., functional magnetic resonance imaging (fMRI) or functional near-infrared spectroscopy (fNIRS), cannot be used reliably in this population, e.g., prior to and following cochlear implantation. We contribute to better theoretical models of and more suitable therapeutic interventions for the neural changes induced by auditory and language deprivation in deaf infants.AimWe aim to characterize the parameters of the HRF of deaf and hard-of-hearing infants in response to Italian.ApproachWe measured 2- to 20-month-old Italian-exposed infants’ HRF to Italian using fNIRS in the bilateral temporal, i.e., auditory, cortices. We characterized the HRF for all infants and for three clinically relevant subsets: (i) monolingual Italian infants, (ii) genetically deaf infants, and (iii) infants aged 5 to 12 months. We computed the following parameters: peak amplitude, time-to-peak, full width at half maximum, and where present, the amplitude and latency of the initial dip and/or the final undershoot, using a model-based parameter fitting approach. We statistically compared these HRF parameters to those of typically hearing infants.ResultsDeaf and typically hearing infants showed largely similar HRFs, with both groups reaching comparable main peak amplitudes. Minor differences have been found in the latencies of some response components.ConclusionsOur results provide the first detailed characterization of the hemodynamic response to native-language speech in deaf and hard-of-hearing infants, improving clinical and therapeutic approaches through more accurate analysis of fMRI and fNIRS data.

Background: Auditory brainstem responses (ABRs) are widely used for objective hearing threshold estimation in both adults and children. Click and CE-Chirp stimuli differ substantially in cochlear activation and neural synchrony, yet their relative performance in patients with ski-sloping hearing loss remains insufficiently characterized, particularly with regard to pediatric diagnostic implications. Methods: This study compared ABRs elicited by click and CE-Chirp stimuli in adults with ski-sloping sensorineural hearing loss. The same comparison was also performed in a pediatric cohort including hearing-impaired and normal-hearing children. Adult subjects were further stratified according to audiometric configuration (DROP 1 kHz vs. DROP 2 kHz). ABR thresholds, wave V latency, amplitude, and detectability were analyzed across stimulus types and intensity levels. Associations between ABR thresholds and behavioral audiometric measures were also examined. Results: In adults with ski-sloping hearing loss, CE-Chirp stimulation yielded significantly lower ABR threshold estimates than click stimulation, particularly in the DROP 2 kHz subgroup, and showed stronger correlations with behavioral pure-tone averages across low-, mid-, and high-frequency ranges. Wave V latencies were consistently shorter with CE-Chirp stimulation, while wave V amplitudes did not differ significantly between stimuli at suprathreshold levels. In children, ABR thresholds obtained with CE-Chirp were generally equal to or lower than those obtained with clicks, although statistical significance was limited by sample size. CE-Chirp stimulation was associated with shorter wave V latencies in both hearing-impaired and normal-hearing children and produced larger wave V amplitudes at selected suprathreshold intensities in hearing-impaired children. Conclusions: Click and CE-Chirp stimuli provide complementary information in ABR assessment. While click stimulation remains essential for robust waveform identification, CE-Chirp stimulation appears to offer advantages in threshold estimation and neural synchrony, particularly in ski-sloping hearing loss and pediatric evaluations. Discrepancies between click- and CE-Chirp-derived ABR thresholds should not be attributed solely to maturational or synchrony-related factors but may warrant further frequency-specific audiological assessment to optimize diagnosis and rehabilitation strategies.