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This chapter examines the central role of Christianity in shaping early modern understandings of deafness. It demonstrates that while the Church was responsible for promoting deaf inclusion, it was also a powerful source of enduring prejudice about deafness. Across England and Europe, clerics routinely enabled deaf people to marry, make confession, and receive the Eucharist using sign language. This acceptance of sign language as a legitimate alternative to speech had significant legal implications, enabling people to demonstrate their rational capacity. Ecclesiastical acceptance promoted the idea that deaf people were legally capable, able to consent, testify, and participate fully in early modern society. Yet the Church also generated some of the most damaging and long-lived ideas about deafness. The association of hearing with spiritual growth meant that deaf people continued to face prejudice throughout the period. The chapter argues that this tension between inclusion and suspicion defined the early modern religious experience of deaf people: it also suggests that encounters with deaf people changed contemporary perceptions about the sensory nature of salvation.
Chapter 3 focuses on the literature concerning the physical health of international adoptees before, during, and after adoption. As the literature indicates, specific health issues characteristic of international adoptees are directly linked to (1) the public health care systems in their countries of origin and (2) the policies of those countries toward orphaned children. This chapter provides a brief summary of what is known about the health challenges faced by international adoptees upon arrival in their new countries and the systems of care developed to address these challenges. It also briefly examines the situations of children with special needs.
This study examined the longitudinal associations between self-reported residual hearing and loneliness, and whether associations differed by age and sex. Using comprehensive cohort data from the Canadian Longitudinal Study on Aging (CLSA; n = 30,097 at baseline), cross-lagged path models (CLPMs) assessed associations across three timepoints (Baseline, Follow-Up 1 [FU1], and FU2). Among females 45–64 years, we observed statistically significant bi-directional associations (hearing to loneliness β = .018, p = .027; loneliness to hearing β = .015, p = .026). For males 65+ years, associations from self-reported residual hearing to loneliness were statistically significant (β = .02, p = .038). After adjustment for cardiovascular covariates, bi-directional associations remained significant only among females aged 45–64 years. Overall, the findings provide evidence of small sub-group-specific associations between hearing and loneliness and highlight the importance of including demographic and broader health-related factors when examining hearing and psychosocial well-being in the aging population.
This study aimed to assess long-term audiological outcomes in 465 primary myringoplasties and evaluate factors influencing surgical success.
Methods
A retrospective analysis was conducted on 442 patients (465 procedures) between 2001 and 2024. Outcomes were evaluated based on perforation location and surgical period.
Results
Mean air–bone gap improved from 19.1 dB to 9.8 dB post-operatively. Air–bone gap closure less than 10 dB was achieved in 53 per cent of patients. Posterior perforations yielded significantly better outcomes (8.7 dB vs. 10.2 dB; p = 0.0226).
Conclusion
A residual air–bone gap of 8–12 dB is common despite anatomical success. Accurate reporting must include long-term data and high-frequency (4 kHz) analysis.
Tinnitus is a common and potentially distressing symptom associated with chronic ear disease. Its burden in patients with chronic suppurative otitis media in low-resource settings is not well characterised.
Methods
A cross-sectional study was conducted during an ear surgery camp in Nepal. One hundred patients with chronic suppurative otitis media completed the validated Nepali Tinnitus Handicap Inventory. Severity was categorised using established grading systems. Associations between sex and severity were assessed using chi-squared analysis.
Results
Nepali Tinnitus Handicap Inventory scores ranged from 0 to 94. Overall, 62 per cent of patients reported moderate or worse tinnitus, and 36 per cent reported severe or catastrophic symptoms. Female patients demonstrated a greater burden, with a higher proportion in severe and catastrophic categories. This difference was statistically significant (χ2 = 11.05; df = 4; p = 0.026).
Conclusion
Patients undergoing surgery for chronic suppurative otitis media experience a substantial and under-recognised tinnitus burden. Routine assessment may support more comprehensive, patient-centred care.
Up to 60 per cent of patients with enlarged vestibular aqueduct syndrome experience sudden hearing loss. This review analyses treatment options and outcomes when sudden hearing loss occurs.
Methods
Embase, Ovid MEDLINE and Web of Science databases were the data sources. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. The number of patients, episodes, treatments, baseline hearing and change in hearing thresholds after intervention and return to baseline were extracted.
Results
The final analysis included 60 episodes of hearing loss from 11 studies, from a search of 1,064 studies. The treatment groups were: 1, no treatment; 2, systemic steroids; 3, salvage hyperbaric oxygen therapy in steroid partial or non-responders. The hearing improvement across the groups was 9.1 per cent, 50 per cent and 89.5 per cent, respectively.
Conclusion
Enlarged vestibular aqueduct patients with sudden hearing loss may first be treated with systemic steroids. Salvage hyperbaric oxygen therapy can be considered in steroid non-responders to improve further chances of recovery.
Increased use of personal listening devices such as headphones and earphones can lead to noise-induced hearing loss, especially with prolonged use and high volume. This study aimed to assess hearing status among medical trainees and its relationship with unsafe personal listening device usage.
Methods
Cross-sectional study was conducted among 177 medical trainees at a medical college in Western Rajasthan. An online questionnaire assessed personal listening device usage patterns, and hearing status was evaluated.
Results
Most preferred in-the-ear personal listening devices (78 per cent) at moderately loud volume (61.6 per cent) for more than 1 hour daily (58.2 per cent). Although 54.2 per cent reported slight hearing loss in at least one ear, no significant association was found between hearing loss and personal listening device type, volume or duration. However, hearing loss was significantly higher in males than females.
Conclusion
Contrary to earlier studies, no significant relationship was observed between personal listening device usage patterns and hearing loss, highlighting the need for larger studies using standardised sound exposure assessments.
Whether listening to different talkers improves or impedes word identification has important implications for theory and practice. Yet, past research on children with hearing devices shows discrepant findings. This study tested 22 children with typical hearing (mean 5;0) and 20 with hearing devices (mean 4;11) on a remote, online 4-alternative forced-choice task (with a 4-picture display) delivered on iPads, with blocks containing 1 vs. 6 different talkers. All words were familiar to young children and were minimal pairs contrasting in voicing and place of articulation in the word-initial and word-final positions. Word identification was worse for place contrasts occurring word finally when listening to different talkers, but no effect was found for voicing contrasts. A consistent position effect was also found, where word identification was poorer across all word-final contrasts. However, no group differences were detected. These results suggest that even when listening to familiar words in good listening environments, the word-final position remains vulnerable to word misidentification, which can be further impeded by listening to different talkers. These effects impact children with and without hearing devices to a similar degree.
Drop attacks are a rare, debilitating symptom of Ménière’s disease that affect an individual’s physical and mental health. The aim of this series was to assess the response to treatment regimens in patients presenting with drop attacks.
Methods
A retrospective case series of 8 patients with Ménière’s disease and drop attacks was followed up for an average of 67 months (range, 17–120 months).
Results
All patients were initially managed with intratympanic steroids, with four patients having a complete response. The four non-responding patients were treated with intratympanic gentamicin, with one patient responding. Three patients were treated with triple canal occlusion. Two patients demonstrated drop attack resolution and one had a partial response. Seven out of 8 patients (87.5 per cent) suffered from depression.
Conclusion
Steroid injections had a 50 per cent success rate in complete resolution of drop attacks. Gentamicin injections and triple semi-circular canal occlusion can bring benefits in patients failing steroid treatment.
Existing reviews on mental health disparities between deaf and hard‐of‐hearing (DHH) and hearing populations have focused predominantly on children, adolescents, or older adults, leaving a gap for working-age adults. We conducted a systematic review comparing the prevalence, incidence, and severity of any DSM-5-TR or ICD-11 mental disorder between DHH and hearing adults aged 18–60 years. We aimed to quantify disparities and examine disorder-specific patterns to inform future research, policy, and service development.
Methods
On 13 December 2025, we searched Ovid Medline, Embase, APA PsycINFO and Web of Science. We included analytical observational studies involving DHH and hearing adults aged 18–60 years, reporting mental disorder prevalence, incidence, or severity. Two researchers independently extracted data, and risk of bias (RoB) was assessed using the modified CLARITY tool. We narratively synthesised findings by aggregating outcomes at the study level using two approaches: summary and majority of the effect directions within a study. Subgroup syntheses examined outcome type, study RoB, age group and mental disorder category.
Results
Sixty studies (n = 8 578 466) met inclusion. In the summary-direction synthesis, 58.3% (35/60) of studies reported higher mental disorder outcomes for DHH adults, 21.7% (13/60) found no difference and 20.0% (12/60) had mixed findings; none indicated lower mental disorder outcomes for DHH. Under the majority-direction approach, 65.0% (39/60) showed higher mental disorder outcomes and 35.0% (21/60) no difference. These patterns were consistent across prevalence (62.8–72.1% higher) and severity (61.1% higher). Studies with higher RoB more often reported higher mental disorder outcomes (66.7–72.2%) than lower-RoB studies (54.8–61.9%), though both mirrored the overall synthesis. Effects were similar across younger (61.9–71.4%) and older adult samples (61.1–66.7% higher). Disorder-specific syntheses identified psychotic disorders, post-traumatic stress disorder and suicidal outcomes as having the strongest disparities (≥72.2% higher), followed by general mental disorders, anxiety and depression. Fewer than five studies examined each of the other disorders, thereby limiting conclusions for these disorders.
Conclusions
Most available evidence indicates that the prevalence and severity of mental disorders are higher among DHH adults aged 18–60 years than among hearing adults, with limited evidence on incidence. No studies reported lower aggregated mental disorder outcomes for DHH adults. Addressing these disparities requires targeted intervention research, supported by population-based, longitudinal and (quasi-)experimental studies including comprehensive reporting of participant characteristics. This will inform more tailored interventions, improve screening and ultimately contribute to better mental health and quality of life for DHH adults.
In addition to symptoms classically associated with the post-intensive care syndrome (PICS), survivors of critical illness often report debilitating physical symptoms affecting their comfort and appearance. Fatigue and chronic pain are among the most common symptoms, and standardized scoring systems have been developed to measure these symptoms in survivors. Moreover, patients who undergo intensive care are at risk for joint contractures, heterotopic ossification, pressure injuries and ulcerations, sexual dysfunction, urinaruy complications, sensory deficits, and skin, hair, and nail changes. A thorough review of systems can identify patients in need of specialty care. Early identification and prompt treatment of symptoms may improve the quality of life for many survivors of critical illness.
To examine the effects of age and hearing loss on travelling wave delay by comparing frequency-specific action potential latencies obtained with electrocochleography.
Methods
A cross-sectional design was applied. Tympanic membrane electrocochleography recordings at 0.5 and 4 kHz were analysed in 85 ears from 49 adults. Participants were divided into four groups: older adults with hearing loss (n = 22), older adults with normal hearing (n = 18), younger adults with hearing loss (n = 19) and younger adults with normal hearing (n = 26).
Results
Age and hearing loss significantly influenced action potential latencies. At 0.5 kHz, the older adults with hearing loss showed the longest latencies (p < 0.001). At 4 kHz, older adults with hearing loss differed from older adults with normal hearing (p = 0.027). Travelling wave delay varied across groups (p < 0.001), with the shortest travelling wave delay in younger adults with normal hearing and the longest travelling wave delay in older adults with hearing loss.
Conclusion
Ageing and hearing loss slow travelling wave velocity, providing an indirect but sensitive marker of early cochlear transmission deficits.
Caregiver–child interactions reflect an important dynamic that supports spoken language development in deaf and hard-of-hearing (DHH) children. This study examined how child effortful control interacts with caregiver language and parenting stress to affect child expressive language. Fifty-nine DHH children (mean age = 5;9) and their primary caregiver participated in a play interaction where expressive language was measured. Caregivers completed questionnaires measuring child effortful control and parenting stress. When caregivers used higher quality language, DHH children demonstrated stronger expressive language regardless of effortful control level compared to when caregivers used lower quality language. Additionally, a trend suggested DHH children with higher effortful control showed stronger expressive language skills when parenting stress was low. However, this trend was not observed when caregivers reported greater levels of parenting stress. These findings support the need to investigate caregiver characteristics that support DHH children in leveraging their inherent regulatory abilities to achieve better language outcomes.
This study aimed to evaluate the effectiveness of the SmartNav in detecting tip fold-over during cochlear implantation and to compare angular insertion depth measurements obtained via SmartNav and transorbital X-ray imaging.
Methods
This retrospective multicentre study included patients with normal cochlear anatomy, comprising 163 individuals and 213 ears who underwent cochlear implantation using Nucleus CI522 and CI622 systems at Gazi University Faculty of Medicine and Gaziantep City Hospital.
Results
Of the 213 cochlear implantations, tip fold-over was detected in 4 implantations (1.88 per cent) intra-operatively with SmartNav. One case (0.47 per cent) of tip fold-over was not detected by SmartNav and identified post-operatively through X-ray imaging. SmartNav showed a sensitivity of 80 per cent, specificity of 100 per cent. A strong correlation was found between SmartNav and X-ray angular insertion depth measurements (p < 0.001).
Conclusion
The SmartNav is a reliable tool for the intra-operative detection of tip fold-overand the assessment of angular insertion depth in patients with normal cochlear anatomy.
This study examined the temporal and seasonal distribution of sudden sensorineural hearing loss admissions and audiogram types from 2015 to 2024 using seasonal-trend decomposition with locally estimated scatterplot smoothing.
Methods
A retrospective analysis included sudden sensorineural hearing loss patients admitted to a tertiary otorhinolaryngology clinic between January 2015 and December 2024. Demographics, admission dates and audiogram types were evaluated.
Results
Among 738 patients (mean age 45.7 ± 15.6 years; 58.4% male), admissions varied significantly across years, months and seasons, peaking from November to March. Winter admissions were highest, while autumn had the lowest. Seasonal-trend decomposition with locally estimated scatterplot smoothing confirmed recurring seasonal patterns. Although audiogram types showed no seasonal or pandemic association, their distribution differed significantly by month.
Conclusion
Sudden sensorineural hearing loss admissions demonstrate clear temporal and seasonal clustering, aligning with influenza-like illness peaks and suggesting a viral contribution. Monthly audiogram variations imply possible environmental influences.
This study describes the management and outcomes of temporal bone fractures resulting from falls.
Methods
We retrospectively reviewed patients with traumatic temporal bone fractures from 2018 through 2022.
Results
We analysed 171 patients with temporal bone fractures, 62 (36.3 per cent) of which occurred secondary to falls. Fall patients were significantly older than non-fall patients (mean age 46 vs. 38 years; p = 0.0079) and had higher Modified Frailty Index-5 scores (0.63 vs. 0.20; p = 0.0003). Fall patients had shorter hospital stays (10.1 vs. 15.8 days; p = 0.015), were more frequently discharged home (66.1 vs. 44.0 per cent; p = 0.007) and were less likely to experience non-resolving facial nerve weakness (6.5 vs. 21.1 per cent; p = 0.030).
Conclusion
Patients with temporal bone fractures from falls are older and frailer than non-fall patients and have unique preventative and rehabilitation needs.
Dengue fever, a mosquito-borne viral illness, has varied systemic manifestations, but its auditory effects remain underexplored. The objective of this study was to assess the association between dengue infection and hearing loss.
Methods
A prospective case-control study was conducted on 79 patients—40 dengue-positive (NS1 antigen confirmed) and 39 with other febrile illnesses. All participants underwent otological examination and pure tone audiometry.
Results
Hearing loss was observed in 15.2 per cent of dengue patients, with none in controls (p < 0.001). The odds ratio for hearing loss in dengue was 34.6 (95 per cent confidence interval: 1.97–610). Dengue patients exhibited significantly elevated air and bone conduction thresholds (p < 0.001). Lower platelet counts and higher C-reactive protein levels correlated with hearing loss, suggesting vascular and inflammatory mechanisms.
Conclusion
Dengue fever may be associated with reversible sensorineural hearing loss, likely due to microvascular and inflammatory injury to the cochlea. Early audiological screening is recommended in dengue cases.
This study investigated the association between dietary flavonoid intake and hearing impairment in older adults aged ≥ 70 years, using cross-sectional data from the National Health and Nutrition Examination Survey 2009–2010 and 2017–2018. Flavonoid intake was estimated from two 24-h dietary recalls and categorised as low or high based on the median intake (85·4 mg/d). Hearing impairment was defined using a pure-tone average > 25 dB in one or both ears. Among the 1492 participants, 55·7 % had bilateral hearing impairment, 15·6 % had unilateral hearing impairment and 28·7 % had normal hearing. These categories were mutually exclusive, based on the presence of hearing impairment in one or both ears. After adjusting for sociodemographic, behavioural and dietary covariates, low flavonoid intake was associated with a 45 % greater odds of bilateral hearing impairment (adjusted OR = 1·45; 95 % CI 1·03, 2·04; P = 0·034), but not associated with unilateral impairment. Marginal associations were also observed for specific flavonoid subclasses, including flavan-3-ols and catechins. A significant interaction with age was observed, whereas no significant interactions were detected with race or sex. These findings suggest that low flavonoid intake may be a modifiable dietary factor associated with age-related bilateral hearing loss. Increasing dietary flavonoid consumption may be associated with benefits for sensory health and could play a modest role in reducing the risk of hearing impairment in older adults, though further research is needed to confirm these findings.
This review explored whether and how prescribers modify their prescribing behaviour for older people (≥65) with hearing, visual or dual impairment (hereafter referred to as sensory impairment) in primary care settings and identified what evidence sources exist to inform prescribing for these specific patient populations.
Background:
Older people with sensory impairment may experience substantial challenges with medicines management compared with older people without sensory impairment. The prevalence of sensory impairment and medicine use increases with age, as such, practitioners may need to consider how to modify their prescribing behaviour to improve the safe and effective use of medicines.
Methods:
This study was conducted to reflect the Joanna Briggs Institute [JBI] methodology for scoping reviews. Electronic databases were searched: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google, and Google Scholar. Qualitative and quantitative studies were included if published between January 2012 and April 2023. Grey literature sources, including Google and Google Scholar, were also searched. Studies were eligible for inclusion if they focussed on prescribing behaviour for older people with sensory impairment in primary care settings. Independent duplicate data extraction was undertaken of details about the participants, concept, context, study methods, outcomes, and key findings relevant to the review question.
Findings:
A total of 3,590 records were identified through database searching and 10 full text articles were retrieved. Grey literature identified a further 61 records. On examination, none of the articles fulfilled the inclusion criteria for this review.
Conclusions:
This review has highlighted a gap in the evidence regarding prescribing for these high risk patient populations. There may be a need for the development of resources, such as evidence based guidelines, to support the safe and effective use of medicines for these specific patient populations.
This study evaluates the effectiveness of a newly implemented protocol for the management of permanent childhood hearing impairment in a UK district general hospital.
Methods
A retrospective closed-loop audit was conducted over two 24-month cycles. Children diagnosed with permanent childhood hearing impairment, through the national hearing screening program, were included.
Results
Implementation of the new protocol led to significant improvements between the two cycles. The mean time from diagnosis to first ENT review reduced from 439.4 to 188.1 days. The interval from diagnosis to magnetic resonance imaging acquisition improved from 617.8 to 58.5 days (p < 0.05), whilst the mean age at magnetic resonance imaging reduced from 758.3 to 102.6 days (p < 0.05). Magnetic resonance imaging utilisation increased from 60 per cent to 100 per cent, and genetic referrals rose from 28.6 per cent to 100 per cent.
Conclusion
These findings highlight the effectiveness of a streamlined protocol in improving multidisciplinary care for children with permanent childhood hearing impairment, offering a model for broader adoption in similar healthcare settings