Background/Objectives: Age-related hearing loss (ARHL) is a major and growing public health concern, yet awareness of its nature, consequences, and management options remains inadequately studied in the Middle Eastern context. In Saudi Arabia, cochlear implantation is provided free of charge through the public healthcare system; however, adult uptake remains critically low, suggesting that awareness—rather than access—constitutes the primary barrier to timely intervention. In collective healthcare cultures, family members play a central role in healthcare decision-making for older individuals, making family-level awareness a critical determinant of early identification and treatment. This study aimed to assess public awareness, beliefs, and attitudes toward ARHL and its management options among adults in Saudi Arabia, applying the Health Belief Model (HBM) as a theoretical framework. Methods: A cross-sectional descriptive study was conducted using a structured questionnaire adapted from a previously validated survey, with cultural modifications for the Saudi context. The questionnaire was distributed electronically to adults aged 18 years and above across Saudi Arabia. A total of 506 consenting responses were included in the final analysis. Descriptive statistics were used to analyse frequencies, percentages, means, and standard deviations. Results: The majority of participants correctly identified hearing loss as a reduction in the ability to hear (84.6%), and 95.3% regarded good hearing as personally important. However, significant knowledge gaps were observed, with 53.8% believing hearing loss can be cured and 50.4% believing it can be halted. Notably, 34.2% believed cochlear implants benefit children exclusively. Doctors and the internet were the primary sources of medical information, yet 39.3% reported no preventive healthcare visits and 23.9% did not seek any information about hearing problems. When faced with a hypothetical hearing loss, 75.3% indicated they would consult an ENT specialist. Conclusions: Adults in Saudi Arabia demonstrate good awareness of the signs and consequences of hearing loss but exhibit significant knowledge gaps regarding its clinical course and available management options, most notably the belief that cochlear implantation is exclusively a pediatric intervention. These findings highlight the urgent need for culturally adapted awareness campaigns targeting family members of older adults, and support the development of community-based hearing health promotion strategies in Saudi Arabia and comparable collective healthcare societies.

Proximal junctional failure (PJF) is an important complication of adult spinal deformity (ASD) surgery. The association between the sagittal vertical axis (SVA) and PJF remains unclear. This study evaluated preoperative SVA, postoperative SVA, and change in SVA in relation to PJF. PubMed, Scopus, and Embase were searched for studies published from 2000 through July 2026, following the PRISMA 2020 guidelines. Cohort studies of adults undergoing ASD surgery that reported SVA in patients with and without PJF were eligible. Two reviewers independently extracted data, and quality was assessed using the National Institutes of Health (NIH) quality assessment tool for cohort studies. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Six retrospective cohort studies (1,347 patients; 136 with PJF) were included. Patients with PJF had significantly greater preoperative SVA (MD ≤ 18.26 mm, 95% CI 4.86 to 31.67; p ≤ 0.008; I² ≤ 11%). Postoperative SVA did not differ between groups (MD ≤ 2.62 mm, 95% CI âˆ'7.10 to 12.35; p ≤ 0.60). The reduction in SVA was greater in patients with PJF, but not significantly (MD ≤ âˆ'15.16 mm, 95% CI âˆ'30.70 to 0.37; P ≤ 0.06). The preoperative SVA association lost significance when either of the two most heavily weighted studies was omitted. Greater preoperative SVA was associated with PJF after ASD surgery, although this finding depended on the largest contributing studies. Postoperative SVA and change in SVA were not significantly associated. Preoperative sagittal malalignment should be considered during surgical planning.