Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
Biomedical physics & engineering express
Simulation-driven deep learning for the diagnosis of middle ear pathologies using wideband acoustic immittance
Wideband acoustic immittance (WAI) provides comprehensive frequency-dependent information for diagnosing middle ear pathologies. However, the scarcity of clinical data and complex response patterns significantly hinder automated diagnosis, particularly in data-limited scenarios. To address this issue, this study proposes a simulation-driven computer-aided diagnosis framework for WAI based on finite element (FE) modeling. Latin hypercube sampling was employed to systematically perturb key physiological parameters of the human ear FE models, generating a standardized virtual WAI dataset comprising 12 000 samples across the 0.2-6 kHz frequency range. The dataset includes four middle ear conditions: normal ear, ossicular chain discontinuity, ossicular chain fixation, and otitis media with effusion. Based on this dataset, a lightweight convolutional neural network tailored for multi-channel WAI inputs, termed WAIHybrid, was developed. It was benchmarked against traditional feature-based machine learning models and five representative deep learning architectures on simulated data and subsequently evaluated on an external clinical dataset comprising 206 ear-level WAI records. WAIHybrid achieved a macro-F1 of 96.30% and a balanced accuracy of 96.29% on an independent simulated test set. On the external clinical dataset, the corresponding values were 87.76% and 88.07%, respectively. Response-level comparisons, learned-representation analyses, and Integrated Gradients maps identified partial class-related correspondence between the simulated and clinical data, residual simulation-to-clinical discrepancy, and class-dependent channel-frequency attribution patterns. These findings support a simulation-driven proof of concept for automated WAI analysis in data-limited middle ear assessment. Further evaluation in larger, more balanced, and clinically heterogeneous cohorts is needed.
19 July 2026
Read appraisal →Medicine
Predicting depressive symptoms in older adults with hearing impairment development and validation of NHANES-based machine-learning models: A cross-sectional study
Depressive symptoms frequently co-occur with hearing impairment in older adults, yet available prediction tools for this high-risk subgroup remain limited in practicality and applicability. We developed and internally validated prediction models for clinically relevant depressive symptoms among older adults with hearing impairment. We analyzed cross-sectional data from 5 National Health and Nutrition Examination Survey cycles (2005-2006, 2009-2010, 2011-2012, 2015-2016, and 2017-2018). Adults aged ≥60 years with hearing impairment were identified using the 2021 World Health Organization criterion (better-ear pure-tone average at 0.5/1/2/4 kHz ≥20 dB). Depressive symptoms were defined as a Patient Health Questionnaire-9 score ≥10. Candidate predictors included sociodemographic factors, comorbidities, lifestyle behaviors, and sensory/functional limitations; missing covariates were handled using multiple imputation. Participants were randomly split into training and validation sets (7:3). Predictors were selected using the Boruta algorithm followed by least absolute shrinkage and selection operator regression, yielding 6 predictors (age, poverty-income ratio, self-rated health, sleep disorder, memory difficulty, and physical functional limitation). Logistic regression and 6 machine-learning algorithms were developed. Model performance was assessed by discrimination (area under the receiver operating characteristic curve [AUC]), calibration (calibration curves and Brier score), and clinical utility (decision-curve analysis). The analytic sample included 2123 participants, of whom 154 (7.25%) had depressive symptoms. In the validation set, AUCs across models ranged from 0.799 to 0.862. Logistic regression achieved the highest discrimination (AUC 0.862, 95% CI 0.800-0.911) with good calibration (Brier score 0.053) and favorable net benefit across clinically relevant thresholds. A nomogram, a dynamic nomogram, and an online calculator were developed to facilitate individualized risk estimation. Sensitivity analyses showed broadly consistent results, except for attenuated discrimination in the severe hearing-loss subgroup. A parsimonious 6-variable model demonstrated strong discrimination, good calibration, and potential clinical utility for risk stratification and targeted screening among older adults with hearing impairment. External validation and prospective evaluation are warranted before clinical implementation.
31 May 2026
Read appraisal →Medicine
Prevalence of GJB2 gene mutations in nonsyndromic hearing impairments: A systematic review and meta-analysis
BACKGROUND: Nonsyndromic hearing impairment (NSHI) is the most common type of inherited hearing loss. Mutations in GJB2, which encodes connexin 26, are a major cause worldwide, but their prevalence and variant distribution vary across populations. To systematically evaluate the global prevalence of GJB2 mutations and 5 hotspot variants (c.35delG, c.176_191del16, c.235delC, c.299_300delAT, and c.109G > A) in NSHI patients, and assess their diagnostic relevance. METHODS: A meta-analysis was conducted on studies published between January 2019 and June 2024 retrieved from PubMed, Scopus, Web of Science, and Cochrane Library. Only high-quality studies (Newcastle-Ottawa Scale ≥ 7) with molecular diagnostic data were included. Pooled prevalence, 95% confidence intervals, and heterogeneity (I2) were calculated. Subgroup and meta-regression analyses were performed according to geographic region. RESULTS: Fifty-one studies from 24 countries covering 18,968 patients with NSHI were included. The overall prevalence of GJB2 mutations was 25.9% (95% confidence intervals: 21.7-30.1%; I2 = 96%). The variant-specific rates included c.235delC (15.2%), c.35delG (12.0%), c.109G > A (7.6%), c.299_300delAT (3.1%), and c.176_191del16 (0.7%). The highest prevalence occurred in the Middle East (38.5%), whereas Africa had the lowest (11.1%). CONCLUSION: GJB2 mutations show marked geographic and ethnic variability in populations with NSHI. These findings support region-specific genetic screening to improve the early diagnosis, counseling, and targeted interventions for hereditary hearing loss.
31 May 2026
Read appraisal →PloS one
Effects of galvanic vestibular stimulation on bodily ownership and postural control: An experimental examination with counterbalanced randomization of stimulus conditions
Vestibular stimulation influences both bodily ownership and postural control. Although previous studies in the literature have examined the effects of galvanic vestibular stimulation (GVS) on body ownership and balance separately, their combined and time-dependent effects remain insufficiently explored. This study investigated how GVS modulates multisensory integration over time by assessing bodily ownership and postural control within the same participants. A within-participant design was used with four conditions: Baseline (pre-GVS), Sham (60-min post-GVS placebo), 30-min post-GVS, and 60-min post-GVS. Forty-eight healthy adults completed all conditions. Balance performance was assessed via the Single-Leg Stance (SLS) and Fukuda Stepping Test (FST), while bodily ownership was measured using the Rubber Hand Illusion (RHI) questionnaire. Balance performance on the SLS showed a significant reduction at 30 minutes post-GVS, with values returning toward baseline by 60 minutes. In contrast, angular deviation on the FST decreased significantly at both 30 and 60 minutes post-GVS. RHI ownership scores increased at both post-stimulation time points, with the most pronounced increase observed at 60 minutes. The sham condition also elicited increases in RHI scores, indicating possible expectancy-related effects. Overall, these findings indicate time-dependent and task-specific effects of GVS on bodily ownership and postural control. The results are consistent with adaptive sensory reweighting processes that differentially affect static and dynamic balance measures. Further research in clinical populations and using longer stimulation protocols is required to determine the extent to which these short-term effects translate into sustained functional benefits.
12 May 2026
Read appraisal →JAAPA : official journal of the American Academy of Physician Assistants
Barriers to hearing aid adoption in hearing loss
More than one-fifth of the US population has hearing loss, a condition associated with higher risk of falls, depression, isolation, cognitive decline, dementia, and all-cause mortality. Treatment of hearing loss has been shown to correlate with decreased risk of cognitive decline, dementia, and mortality, as well as an improved quality of life. Surprisingly, however, fewer than 1 in 10 Americans with hearing loss use hearing aids. As the prevalence and burden of hearing loss grow, clinicians must understand factors influencing hearing aid use to increase treatment rates. This article reviews key barriers to hearing aid adoption-including low hearing health knowledge, inadequate screening, stigma, cost, and difficulty of use-and discusses recent changes that may influence these barriers.
27 Apr 2026
Read appraisal →Renal failure
Decoding the renal-cochlear axis: explainable machine learning and phenotype clustering reveal high-risk hearing loss subtypes in CKD
This study develops a dual-level machine learning framework for risk stratification and phenotyping of hearing loss (HL) in patients with chronic kidney disease (CKD) using data from the National Health and Nutrition Examination Survey (NHANES). From a cohort of 3,402 CKD patients, feature selection via univariate and multivariate logistic regression identified key predictors, which were used to construct predictive models with nine machine learning algorithms. The eXtreme Gradient Boosting (XGBoost) model demonstrated superior performance, with mean area under the curve (AUC) values of 0.984 (training), 0.984 (validation), and 0.939 (testing). SHapley Additive exPlanations (SHAP) interpretation identified age as the predominant risk determinant. Subsequent Gaussian mixture modeling (GMM) clustered patients into two distinct subtypes: a low-risk subgroup (n = 1,075) with a 1.58% HL prevalence and a high-risk subgroup (n = 2,316) characterized by older age, elevated blood urea nitrogen and bicarbonate levels, and a 48.2% HL prevalence. A classifier trained on these subtypes achieved discrimination (AUC = 0.99974). A clinically a web-based tool was also developed based on the six most influential features. The findings establish a dual-level predictive framework integrating explainable ML and unsupervised clustering for HL risk assessment in CKD. This approach provides a robust strategy for the precision screening of high-risk subpopulations and supports the integration of hearing assessments into routine CKD.
24 Apr 2026
Read appraisal →Journal of Korean medical science
Comparison of the Hearing Benefits and User Satisfaction With Hearing Aids and Personal Sound Amplification Products: A Multicenter Prospective Randomized Crossover Trial
BACKGROUND: While hearing aids (HAs) remain the primary intervention for hearing loss, their high cost creates barriers to access. Personal sound amplification products (PSAPs) are a more affordable alternative, but few studies have compared their efficacy to those of HAs. This multicenter, prospective, randomized, crossover trial was conducted to compare audiologic performance and user satisfaction between HAs and PSAPs to evaluate PSAP potential as alternatives for hearing rehabilitation. METHODS: A total of 73 participants with sensorineural hearing loss was enrolled. Participants used one hearing device (HA or PSAP) for 3 months before changing to the other for 3 months. Outcome measures were pure-tone audiometry, word recognition score, and Hearing in Noise Test score. Subjective satisfaction was measured using standardized questionnaires-the Abbreviated Profile of Hearing Aid Benefit and the International Outcome Inventory for Hearing Aids-and two custom surveys. RESULTS: HAs showed superior performance in high-frequency functional gain, speech perception in noise, and user satisfaction compared to PSAPs. Premium HAs demonstrated better performance than basic HAs, while basic HAs significantly outperformed both high-end and basic PSAPs. No significant differences were found between high-end and basic PSAPs. CONCLUSION: The superior audiologic performance of and user satisfaction with HAs compared to PSAPs support their continued preference for hearing rehabilitation. Although PSAPs offer a more affordable option, they may not meet the needs of individuals with hearing loss, particularly in terms of high-frequency gain and speech perception. TRIAL REGISTRATION: iCreaT Identifier: C220078.
23 Apr 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
A Speech-Segregation Algorithm for Spatial Hearing Aids to Operate With Multiple Sound Sources
PURPOSE: Hearing-aid users often face challenges in noisy environments due to time, level, and spectral cues being compromised by current generation hearing aids. This study explored a physiologically based speech-segregation algorithm that selectively removes or attenuates unwanted sound sources. METHOD: In our previously developed localization algorithm, the time-frequency responses after a unique normalization approach always reside inside the unit circle of the model space. Given the "sparseness" property of daily sound, the model forms distinct clusters that correspond to the source locations. In the present study, the localization model was adapted to segregate speech by using a binary mask to remove the cluster of unwanted sound. The speech target was one of 200 intelligible sentences. The interfering sound was time-reversed sentences in a random sequence spoken by the same speaker. Automatic speech recognition transcribed the sound mixture before and after the segregation algorithm. RESULTS: When both target and noise were located at the front, applying a hard mask (i.e., 1 or 0) almost perfectly removed the energy of noise. When the sound sources moved to the side or back with smaller angular separations, clusters were less distinguishable, leading to worse intelligibility performance. Applying a soft mask (i.e., 1 or 0.2) instead showed slightly lower performance for the front but improved performance for the back and side. CONCLUSION: Our algorithm performs localization and segregation in a combined and straightforward manner, potentially for spatial hearing aids to function better in challenging listening environments.
12 Apr 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Auditory-Somatosensory Interactions in Speech Perception in Individuals With Hearing Impairment: An Exploratory Case Study
OBJECTIVES: Individuals with hearing impairment can perceive speech sounds with the help of cochlear implants or hearing aids. Recent studies have shown that orofacial somatosensory inputs may modify speech perception. This study explored the potential role of such somatosensory inputs in speech perception in individuals with hearing impairment. DESIGN: Twenty-one native French-speaking participants with various profiles of bilateral hearing impairment and wearing hearing aids and/or cochlear implants were tested to explore the extent to which an orofacial somatosensory stimulation, consisting in facial skin stretch provided by a robotic device, would affect their speech perception performance in a vowel identification task, in comparison with 25 participants with normal hearing. This potential somatosensory effect was evaluated in relation to their hearing ability assessed by both their hearing threshold of digits in acoustic noise and their audiological profile, and with their production ability assessed by variability in a vowel production task. RESULTS: The somatosensory effects varied depending on participants' hearing ability, with three different profiles. A first group of eight participants, who were able to identify the vowels auditorily though with thresholds in noise higher than for individuals with normal hearing, did not show any somatosensory effect, with identical vowel identification scores without and with facial deformation. The other 13 participants were unable to auditorily identify the vowels and had high thresholds in noise. Among them, eight participants who had used a hearing device for a long duration (≥ 18 years) showed a strong somatosensory bias modifying vowel identification when facial deformation was present. These participants also showed greater variability in vowel production. The last five participants in this second group showed no somatosensory effect at all. CONCLUSION: These three profiles were related to the role of auditory experience and hearing ability in the development of auditory-somatosensory integration.
12 Apr 2026
Read appraisal →Language, speech, and hearing services in schools
Intervention Efficacy for Children With Mild Bilateral Sensorineural Hearing Loss
PURPOSE: This study aimed to compare the efficacy of hearing aid (HA) and frequency modulation (FM) systems in improving language, articulation, and speech perception outcomes among children with mild bilateral sensorineural hearing loss (MBHL) over a 12-month intervention period. METHOD: A prospective repeated-measures design was employed, enrolling 43 Cantonese-speaking children aged 6-7 years, with a pure-tone average of 26-40 dB HL. Participants were randomly assigned to either the HA group (n = 16) or the FM group (n = 16). A nontreatment control group (n = 11) was formed from children who declined the intervention. The outcome measures included the Hong Kong Cantonese Articulation Test, the Hong Kong Cantonese Oral Language Assessment Scale, and the Cantonese Hearing-in-Noise Test. Assessments were conducted at baseline and 12 months post-intervention. RESULTS: The FM group demonstrated significant improvements in language abilities (p < .01, Cohen's d = 0.53), particularly in word definition, expressive vocabulary, and Cantonese grammar, outperforming both the HA and control groups (p < .05). Articulation improvements were greater in the FM group, with significant gains in consonant production (p < .01). No significant improvements were observed in speech perception across the groups. CONCLUSIONS: FM systems are more effective than HAs in enhancing language and articulation outcomes in children with MBHL, particularly in noisy classroom environments. These findings highlight the importance of individualized intervention strategies and the potential of FM systems to support auditory access and language development. Future research should explore long-term outcomes and the role of contextual factors in intervention efficacy.
5 Apr 2026
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