Research Articles (Speech-Language Pathology and Audiology)

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Severe-to-profound hearing loss and mental health : initial evidence that cochlear implantation helps alleviate symptoms of anxiety and stress
McIlhiney, Paul; Almeida, Osvaldo P.; Sucher, Catherine M.; Eikelboom, Robert H.; Jayakody, Dona M. P. (Wiley, 2025-09)
OBJECTIVES : Mental-health issues accounted for 418 million disability-adjusted life years in 2019, costing the world economy approximately $5 trillion. Untreated hearing loss is a well-known modifiable risk factor for mental-health issues, with severe-to-profound hearing loss having the largest impact. Therefore, treatment of severe-to-profound hearing loss, namely with cochlear implantation, could help to alleviate psychological distress. However, previous studies have failed to include comprehensive measures of mental health or adequate controls. The current study thus aimed to conduct a controlled, longitudinal investigation of how cochlear implantation affects depression, anxiety and stress levels. PARTICIPANTS : Participants were 87 adults assigned to conditions based on hearing status: normal hearing (n = 44), received cochlear implant (n = 26) or untreated hearing loss (n = 17). MAIN OUTCOMES MEASURES : The short-form Depression Anxiety Stress Scale was given at four timepoints (baseline, 3 months, 6 months, 12 months). Data were analysed using linear mixed-effects modelling. RESULTS : Results showed that cochlear implants helped to stabilise anxiety and stress symptoms, while depression symptoms were observed to worsen over time despite treatment. CONCLUSION : Our findings suggest that treatment of severe-to-profound hearing loss with cochlear implantation was associated with a lessening of anxiety and stress scores, although the clinical significance of such changes remains uncertain. Due to the current study's non-randomised treatment allocation, future randomised controlled trials are required for confirmation. The present findings help inform clinical and societal interventions for mental-health issues associated with hearing loss. SUMMARY • Severe-to-profound hearing loss can negatively impact mental health. • We longitudinally assessed cochlear implants' influence on mental health. • A cochlear-implanted group was compared to untreated and normal controls with linear mixed-effects analyses. • Cochlear implantation was associated with lessening of anxiety and stress, but not depressive symptoms. • The current findings encourage post-implantation mental-health care for cochlear-implant recipients.
Cochlear implantation in Australia : a retrospective analysis of 23 years of activity
Eikelboom, Robert H.; Sucher, Catherine M.; Bellekom, Sandra R.; Atlas, Marcus D. (Wiley, 2025-09)
OBJECTIVES : To report the number of cochlear implantation procedures and recipients in Australia since 2000 by age, and to estimate the adult uptake of cochlear implants. METHODS : This was a retrospective analysis of data, using publicly available data on private and public hospital procedures undertaken in Australia between 2000/01 and 2022/23. The main outcome measures were: (i) Number of cochlear implants per financial year, by paediatric, adult, or 10-year age groups, and population adjusted. (ii) Adult uptake rate of cochlear implants, adjusted for explantation and replantation rates, and bilateral implantation rates. This study followed STROBE guidelines for reporting. RESULTS : 25 611 devices were implanted between July 2000 and June 2023, with annual numbers rising from 200 per year to over 1400 per year. Despite females having a 50% lower prevalence of hearing loss than males, approximately an equal number of males and females are implanted. Paediatric implantation has declined since 2016. The adult uptake rate of cochlear implants is estimated to be 10.5%. CONCLUSIONS : Despite the known economic and social benefits of cochlear implants, and the rising number of people with hearing loss, the initial increase in rates of implantation appeared to have slowed, and the uptake rate remains low. Public health and hospital policy should be directed to improving public education, awareness, and referral and assessment pathways, especially for males. SUMMARY • Cochlear implants provide economic and social benefits to recipients. • The number of devices implanted in Australia since 2000 has steadily increased but plateaued since 2016. • The uptake of cochlear implants by potentially eligible adults in Australia is estimated to be 10.5%. • The uptake by females is higher than by males, despite the latter having higher rates of hearing loss. • Greater public awareness of cochlear implants, and improved access to referral, assessment and surgical services are required.
Integrating lived experience in preprofessional training in speech pathology and audiology
Glade, Rachel; Hussain, Saira; Wilkes, Claire; Hunter, Christine; Mahomed-Asmail, Faheema (Wiley, 2025-10)
BACKGROUND : Incorporating persons with lived experience (PWLE) has proven effective in supporting pre-professionals in their training by providing authentic insights that foster empathy, compassion and critical thinking. However, limited research exists on its integration into audiology and speech-language pathology courses. This project aimed to determine the benefits of incorporating lived experience engagements into preprofessional audiology and speech-language pathology training. METHOD : Preprofessional students enrolled for a course in adult auditory (re)habilitation and engaged with PWLE during scheduled class sessions. Six PWLE from different countries, each with unique hearing experiences and various hearing technologies, interacted with the students. Students reflected on their experiences using Gibbs' Reflective Cycle; their reports were retrospectively analysed using inductive content analysis. RESULTS : Sixty-four pre-professionals across three universities consented to have their reflections analysed. The value of the engagement resulted in three overarching categories: student experience, patient reported experience and professional practice. Subcategories contributing to the student experience included emotions, perceptions and career goals, with the patient experience category including lack of care, passive listening, setting and significant others. The professional practice category included active listening, trust and care decisions. CONCLUSION : Incorporating opportunities for PWLE to share their hearing healthcare journey allows preprofessional students the opportunity to be reflective on aspects such as communication, person-centred care and empathy. Students can utilise these experiences to identify practical tips for enhancing their own clinical skills and highlight core values for their future roles.
Orofacial myofunctional therapy : investigating a novel therapeutic approach for pediatric obstructive sleep apnea in children with and without down syndrome-a study protocol
Verbeke , Jolien; Meerschman, Iris; Dhondt , Karlien; De Leenheer, Els; Wilekens, Julie; Van Lierde, K.M. (Kristiane); Claeys, Sofie (MDPI, 2025-06-06)
BACKGROUND/OBJECTIVES : Pediatric obstructive sleep apnea (OSA) is a prevalent medical condition, affecting 1–5% of non-syndromic children and 30–90% of children with Down syndrome. Given the severity of the condition and the associated health risks, early and effective treatment is crucial. However, current treatment modalities are often invasive or suffer from poor patient adherence. Additionally, adenotonsillectomy, the first-line treatment in pediatric OSA, seems not to be effective in every child, leaving children with residual OSA postoperatively. These challenges are particularly pronounced in high-risk populations, such as children with Down syndrome, highlighting the need for alternative therapeutic strategies. Therefore, a protocol is presented to evaluate the effectiveness of orofacial myofunctional therapy (OMT) as a treatment for OSA in two pediatric populations: (1) Non-syndromic children aged 4–18 years: 10 weeks of OMT. (2) Children with Down syndrome aged 4–18 years: 20 weeks of OMT. Effects of the OMT program will be evaluated on: sleep parameters (e.g., obstructive Apnea–Hyponea Index (oAHI), snoring frequency); orofacial functions (e.g., breathing pattern, tongue position at rest); quality of life outcomes. METHODS : A pretest–posttest design will be used to evaluate the effectiveness of OMT in both children with and without Down syndrome and OSA. Both objective measures and patient-reported outcomes are being collected. RESULTS : OMT is expected to improve orofacial functions, reduce OSA severity and symptoms, and enhance quality of life in both non-syndromic and syndromic children. CONCLUSIONS : This multidisciplinary research protocol, involving collaboration between ENT specialists and speech-language pathologists, aims to provide a comprehensive understanding of the potential benefits of OMT in treating OSA.
Auditory acclimatization in new adult hearing aid users : a registered systematic review of magnitude, key variables, and clinical relevance
Wentzel, Clarissa; Swanepoel, De Wet; Mahomed-Asmail, Faheema; Beukes, Eldre; Dawes, Piers; Munro, Kevin; Almufarrij, Ibrahim; Manchaiah, Vinaya (American Speech-Language-Hearing Association, 2025-07-08)
PURPOSE : Auditory acclimatization refers to changes in auditory performance over time due to hearing aid modifications, extending beyond task-specific or training effects. This preregistered systematic review expands on previous ones by examining a broader range of outcomes, including auditory (e.g., speech recognition, electrophysiological responses) and selected nonauditory (e.g., self-reported outcomes) measures. It aimed to assess acclimatization's presence, magnitude, and influencing factors, focusing on controlled trials comparing postfitting aided outcomes with a control group. This is the first review to comprehensively report self-reported outcomes, advancing the field. METHOD : A systematic literature search was conducted in CINAHL, PubMed, and Web of Science in March 2024. Eligible studies followed the Population, Intervention, Comparison, Outcome, Study Design, and Timeline framework, including new adult hearing aid users with sensorineural hearing loss using air-conduction hearing aids. Studies were required to report outcomes, with a comparator and at least two data points in the same condition. Exclusions applied to studies involving children, advanced feature devices, surgical implants, non–peer-reviewed work, or uncontrolled studies. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. A planned meta-analysis was excluded due to missing data. RESULTS : The review included 25 controlled studies on auditory acclimatization. Of these, 18 examined speech recognition, with 10 reporting acclimatization, one mixed, and seven no acclimatization. Among eight studies with self-reported outcomes, three supported acclimatization, three showed mixed results, and two found no evidence. For electrophysiological outcomes, four of seven studies reported acclimatization, and three did not. Consistent hearing aid use and hearing loss severity influenced acclimatization, while cognitive abilities and age had no significant impact. Of the 25 studies, 16% were rated good quality, 80% were rated fair, and 4% were rated poor, with common issues including lack of randomization, blinding, and insufficient sample size reporting. CONCLUSIONS : This review highlighted the complexity of auditory acclimatization, influenced by various factors. Evidence suggested acclimatization occurred in some users and outcomes, though improvements were modest and variable. The most consistent gains were in speech recognition in noise and self-reported measures (e.g., Abbreviated Profile of Hearing Aid Benefit, Hearing Handicap Inventory for the Elderly, Glasgow Hearing Aid Benefit Profile), though changes were generally modest. Future studies should include essential statistical data, prioritize randomized controlled trials, and ensure early baseline and key interval measurements to better isolate and quantify acclimatization effects.
Uncertainty avoidance, perceptions of emergency remote education, and university commitment : a cross-country analysis
Donohue, Dana K.; Bornman, Juan; Osborne, Randall; Tidikis, Viktoria; Buzdar, Muhammad Ayub; Graham, Marien Alet (Routledge, 2025)
Worldwide, there were significant changes in university courses due to COVID-19. One was a rapid transition to online courses, described as emergency remote education. The purpose of this research was to examine how students’ uncertainty avoidance (UA) affected their university commitment (UC) and whether their perceptions of emergency remote education (PERE) mediated this relationship. The b path of the mediation analysis (from PERE to commitment) was expected to be moderated by two variables: income and perceived quality of instruction. Students from universities in three countries (i.e., the United States (US), Pakistan, and South Africa (SA)) were assessed. The findings revealed that there were direct and indirect effects for this relationship for students from Pakistan, with a partial moderated mediation effect of perceived quality of instruction for students from Pakistan. Positive main effects of UA on UC were found for students from the United States, Pakistan,
Developing a contextually relevant ECD milestone guide for South African practitioners
Charge, Keren; Du Toit, Linette; Du Plessis, Danielle; Köstlin, Tabea; Wagner, Julia; Eccles, Renata; Van der Linde, Jeannie; Du Toit, Maria (AOSIS, 2025-07-17)
BACKGROUND : Two hundred and fifty million children under five in low- and middle-income countries are at risk of not achieving their developmental potential. High-quality milestone guides can help mitigate these risks but are often not contextually appropriate for countries like South Africa, because of unavailable resources and its inappropriateness in multilingual group contexts. AIM : This study aimed to develop and pilot a contextually relevant ECD milestone guide for practitioners working with preschool children (3–5 years 11 months) in low-resourced South African communities. SETTING : This study focused on ECD practitioners within low-resourced South African communities. METHODS : Data collection involved four phases: (1) An initial questionnaire and an abridged milestone guide were reviewed by an expert panel, who suggested contextual adaptations and activities, (2) The Delphi method was used to rank suggestions, (3) Virtual focus group addressed six milestones that required further consensus, (4) a pilot of the language and communication domain was conducted where six practitioners provided feedback on its usability. RESULTS : Practitioners found the milestone guide valuable and usable, supporting their work with young children in low-resourced communities. Feedback informed further refinements to improve usability and contextual relevance. CONCLUSION : The adapted milestone guide equipped practitioners in low-resourced ECD classrooms with tools to promote age-appropriate development and identify developmental delays early. By addressing these delays, the guide helps break cycles of disadvantage, enabling children to thrive and reach their full potential. CONTRIBUTION : This study offers a framework for developing contextually relevant milestone guides to support ECD practitioners in low-resourced settings.
Developmental outcomes of small infants at a high-risk clinic : a short-term longitudinal study
Macaskill, Tayla-Ann; Du Toit, Maria; Eccles, Renata; Graham, Marien A.; Van der Linde, Jeannie (AOSIS, 2025-08-14)
BACKGROUND : Small infants face more developmental risks than their full-term peers, necessitating early intervention and long-term monitoring. OBJECTIVES : This study examined the longitudinal developmental and hearing outcomes of small infants attending a high-risk clinic in a South African low-income community setting. METHOD : A Short-term longitudinal within-subject descriptive study design was employed, where 28 participants underwent hearing and developmental screenings and assessments at two follow-up appointments (T1 and T2), at 6- and 12-month corrected age. Developmental outcomes, such as communication, motor and daily living skills, were evaluated using developmental screening tools (Parents Evaluation of Developmental Status [PEDS]), hearing screening (ABR MB11) and developmental assessments (Vineland-3). RESULTS : All participants underwent hearing screening, with four (14.3%) failing twice (T1 and T2) and being referred for diagnostic evaluation. Developmental screening at T1 identified concerns in communication, gross motor and social-emotional skills (28.5%). Concerns persisted across T1 and T2 in the PEDS tool, with fine motor skills emerging as a key issue at T2. Vineland-3 assessments showed improvement from T1 to T2; initial concerns in daily living (M = 104.12; standard deviation [s.d.] = 38.99) and motor skills (M = 88.82; s.d. = 45.26) were no longer present at T2, where all participants had age-appropriate developmental scores. CONCLUSION : The findings highlight the need for comprehensive, routine developmental monitoring and early intervention to address delays in small infants. Continued follow-up care and support from birth to 12 months corrected age can improve outcomes and caregiver developmental literacy. CONTRIBUTION : This study provides valuable insights for caregivers, healthcare policymakers and early intervention professionals by emphasising the importance of early screening, continuous monitoring and caregiver education in optimising developmental outcomes for small infants.
Hearing loss configurations in low- and middle-income countries
Newall, John; Kim, Rebecca; Dawes, Piers; Alnafjan, Fadwa; Vaughan, Glyn; Carkeet, Donna; Ghannoum, Heba; Mcpherson, Bradley; Patel, Nitish Ranjan; Sasidharan, Megha; Damam, Nitin K.; Goswami, S.P.; Chinnaraj, Geetha; Sartika, Dahlia Eka; Alhanbali, Sara; Bartlett, Rebecca A.; Ismail, Afzarini Hasnita; Smith, Mike C.F.; Ghimire, Anup; Shah, Shankar; Martinez, Norberto V.; Ramos, Hubert D.; Alparce, Ultima Angela; Tavartkiladze, George A.; Bakhshinyan, Vigen; Boboshko, Maria; Kasper, Annette; Pifeleti, Sione; Swanepoel, De Wet; Myburgh, Hermanus Carel; Frisby, Caitlin; Pitathawatchai, Pittayapon; Atas, Ahmet; Serbetcioglu, Bulent; Sennaroglu, Gonca; Konukseven, Ozlem; Yilmaz, Suna Tokgoz; Turkyilmaz, Meral Didem; Batuk, Merve; Kara, Eyyup; Senkaya, Duygu Hayir; Babaoglu, Gizem; Oruc, Yesim; Ozkan, Melek Basak; Cetinkaya, Merve Meral; Ceyhan, Aysenur Kucuk; Adali, Inci (Taylor and Francis, 2025-10)
OBJECTIVE : The majority of individuals with hearing loss worldwide reside in low- and middle-income countries (LMICs), but there is limited information regarding the characteristics of hearing loss in these regions. This descriptive study aims to address this knowledge gap by analysing audiogram patterns in LMIC populations. Greater knowledge about the properties of hearing loss in LMICs allows for improved planning of interventions. STUDY SAMPLE : Retrospective data from 23 collaborating centres across 16 LMICs were collected. All participants were adults seeking help for hearing problems. A machine learning approach was utilised to classify the hearing threshold data and identify representative profiles. The study comprised 5773 participants. RESULTS : The results revealed mildly sloping audiometric patterns with varying severity. The patterns differed from previous studies conducted in high-income regions which included more steeply sloping losses. The findings also indicated a higher proportion of more severe levels of hearing loss. CONCLUSIONS : These variations could be attributed to population-level differences in the causative mechanisms of hearing loss in LMICs, such as a higher prevalence of infectious disease-related hearing loss. The results may also reflect differences in health seeking behaviours. This study highlights the need for tailored, scalable, hearing interventions for LMICs.
Enhancing audiology students’ understanding of person-centered care : insights from an multi-national virtual student conference
Mahomed-Asmail, Faheema; Nicholson, Nannette; Metcalfe, Louise; Rutherford, Cherilee; Graham, Marien Alet; Watson, Victoria; Regan, Catherine; Hussain, Saira (Taylor and Francis, 2025-04)
OBJECTIVE : This project sought to investigate the impact of a multi-national peer learning initiative in facilitating a student-led conference on person-centred care (PCC). The primary objective was to assess students’ comprehension of PCC elements before and after engaging in the opportunity, with a concurrent evaluation of the efficacy of the opportunity. DESIGN : A mixed-methods study protocol was followed. Following the conference, participants completed a four-part survey including (a) demographics, (b) retrospective pre-post Likert scale, (c) Likert rating of conference experience and (d) five open-ended questions. STUDY SAMPLE : One hundred and four participants (92.4% female) with a mean age of 21 years (0.07 SD) participated in the study. RESULTS : A significant difference in awareness pre-post conference was demonstrated across all topics (WSR, p < 0.001) with participants satisfied with the conference. Qualitative analysis revealed three main themes: (a) application of PCC; (b) perspectives of PCC; and () barriers to PCC; with nine sub-themes. CONCLUSION : The conference was beneficial in enhancing students’ awareness of topics and principles of PCC. Innovative pedagogical approaches should be considered in order to enhance healthcare education allowing future clinicians to better meet the dynamic needs of their clients.
An overview of World Health Organization guidance aiming to increase global access to critical hearing aid services
Dillard, Lauren K.; Der, Carolina; Laplante-Levesque, Ariane; Swanepoel, De Wet; Thorne, Peter R.; Mcpherson, Bradley; De Andrade, Victor; Newall, John; Ramos, Hubert D.; Kaspar, Annette; Nieman, Carrie L.; Clark, Jackie L.; Chadha, Shelly (Taylor and Francis, 2025-10)
OBJECTIVE : Equitable access to hearing aids and related services remains a global health challenge, particularly in resource-limited settings. A major barrier to access is the lack of diagnostic and rehabilitative services, which is substantially attributable to the persistent shortage of ear and hearing care specialists. This discussion article provides an overview of limitations in the ear and hearing care workforce, the relevance of task sharing to ear and hearing care, and a new, evidence-based World Health Organization (WHO) technical resource aimed at improving access to hearing aids worldwide. DESIGN AND STUDY SAMPLE : A synthesis of current research and expert opinion. RESULTS : First, this article describes the global shortage of qualified ear and hearing care specialists. Next, it describes how community-based care, supported by task sharing among trained non-specialist providers and qualified ear and hearing care providers, could overcome these workforce limitations, and describes the critical role of qualified ear and hearing care providers in task sharing. Finally, this article provides an overview of a WHO resource which provides practical information for hearing aid service provision in resource-limited settings. CONCLUSION : Innovative strategies to expand the ear and hearing care workforce are essential to advance efforts towards equitable access to hearing aids and related services.
Update on the state of audiology in South Africa
Mothemela, Bopane; Ramma, Lebogang; Swanepoel, De Wet (Taylor and Francis, 2025)
In 2006 the state of audiology in South Africa was reported in the International Journal of Audiology (Swanepoel 2006). Since this time, however, significant changes have occurred within the profession and within the socioeconomic landscape. The country’s population has grown rapidly, from 41.5 million people in 2002 to 60.6 million people in 2022 (Statistics South Africa [Stats SA], 2022) with a predominantly youthful population, with 34% falling between the ages of 15 and 34 (Stats SA, 2022) and only 9.2% 60 years and older. Despite a younger average population age, the country faces many environmental risks for hearing loss including poverty, with approximately 55.5% of the population living below the poverty line, along with a high prevalence of chronic diseases such as diabetes, tuberculosis (TB) and HIV/AIDS (World Bank Group 2020; Stats SA, 2020; Wandai et al. 2017). This letter provides an update on the current state of the audiology profession in South Africa since 2006, with a special focus on training, human resources, and service delivery. Finally, the authors provide a brief commentary on the future of the profession in South Africa.
Using secondary data analysis to compare core vocabulary lists and elicitation duration of two data sets of typically developing preschool Afrikaans-speaking children
Winter, Petria; Van der Linde, Jeannie; De Wet, Febe; Graham, Marien Alet; Bornman, Juan (Karger Publishers, 2025)
INTRODUCTION : Core vocabulary lists provide an evidence-based method for describing the vocabulary of individuals across various age groups, categorised by different parts of speech. Despite its value, there is a paucity of core vocabulary lists in nonmainstream languages. Resource limitations contribute to this paucity; therefore, more efficient methods for developing core vocabulary lists are needed. This study aimed to compare two sets of previously collected language samples from typically developing 5–6-year-old Afrikaans-speaking children to compare two different elicitation methods for developing a core vocabulary list. We also compared the duration of the language samples to inform the duration required for accurate and representative language samples for the development of core vocabulary lists. METHODS : Using secondary data analysis, we compared the core vocabulary lists from two existing data sets in terms of the number of different words, the frequency of use of each of these words, type-token ratio, and parts of speech used by typically developing 5–6-year-old Afrikaans-speaking children. RESULTS : The average recording time for data set A was 60 min in a single session. The corresponding value for data set B was 250 min, recorded over a period of 1–3 days. A perfect positive Spearman correlation was observed between the results for the two data sets for all parts of speech except interjections and enclitics. Code switching formed part of data set B’s core words but did not appear in data set A’s core word list. CONCLUSION : The findings demonstrate that similar core vocabulary lists can be obtained for 5–6-year-old children using a less invasive and time-effective 60-min elicited method for language samples compared to naturalistic samples collected over 1–3 days. Proposing a more robust and less time- and resource-intensive method of developing vocabulary lists may further support the development of core word lists across ages and in other languages.
Help-seeking among adults with tinnitus : examination of a tinnitus cohort from the Busselton healthy ageing study
Carmody, Natalie; Hunter, Michael; Eikelboom, Robert H. (Taylor and Francis, 2025)
The aim of this study was to examine the help-seeking behaviour of adults with tinnitus and the factors associated with help-seeking. A tinnitus cohort (n = 131) from the Busselton Healthy Ageing Study (BHAS) completed surveys assessing demographic and clinical factors, tinnitus characteristics and distress, health status, and help-seeking behaviour. The study found that of the 131 participants that took part 43.5% sought help for tinnitus. Binomial logistic regression was used to examine the association of health status (Glasgow Health Status Inventory – all purpose (GHSI) total score) and tinnitus distress (Tinnitus Reaction Questionnaire (TRQ) total score) with self-reported hearing loss and self-reported anxiety. The results of the binomial logistic regression found that help-seeking was significantly associated with higher tinnitus distress (odds ratio [OR] 1.04, 95% confidence interval [CI] [1.01, 1.07], p = 0.01) and lower self-reported anxiety levels (OR 0.43, 95% CI [0.18, 1.00], p = 0.05). However, no significant association was found between help-seeking and self-reported hearing loss. Whilst increased tinnitus distress can be expected to be associated with help-seeking, lower anxiety may encourage help-seeking or may be barrier to seeking help. Further work is needed to better understand the relationship with tinnitus, anxiety and help-seeking.
The associations of multimorbidity with fall- and fracture-related hospitalisations : the Busselton Healthy Ageing Study
Hoey, Mark A.; Zhu, Kun; Murray, Kevin; Bharat, Chrianna; Eikelboom, Robert H.; Hunter, Michael (Springer, 2025-08)
SUMMARY : In middle-aged adults, we evaluated the associations between multimorbidity count and patterns with fall- and fracture-related hospitalisations. Falls risk increased linearly with multimorbidity count, and certain multimorbidity patterns were associated with increased risks of falls and fractures. Multimorbidity count and pattern should therefore be considered when risk stratifying patients. PURPOSE : Although multimorbidity is recognised as a risk factor for falls and fractures, most studies are retrospective, and few have explored these relationships through statistically derived multimorbidity patterns. Our prospective cohort study with 4991 participants of the Busselton Healthy Ageing Study aged 45–69 years evaluated the associations of multimorbidity count and classes with incident fall- and fracture-related hospitalisations. METHODS : Twenty-one morbidities were assessed at baseline, and four multimorbidity classes were identified using latent class analysis. Fall- and fracture-related hospitalisations were captured through the Western Australian Data Linkage System over a median follow-up of 7.9 years. Associations were examined using Cox regression models adjusting for sex, baseline age, lifestyle factors, and prior falls/fractures. RESULTS : During follow-up, incident fall- and fracture-related hospitalisations were recorded for 177 (3.5%) and 197 (3.9%) participants, respectively. Each one-unit increase in multimorbidity count was associated with a 16% (95% CI, 7.8–25%) increased risk of fall-related hospitalisations. Multimorbidity scores of 9 and above (HR 2.32 [1.22–4.42]) showed an increased risk of fractures. Compared with the relatively healthy class, the cardiometabolic or mental health and musculoskeletal classes were associated with an increased risk of fall-related hospitalisations (HR 2.84 [1.76–4.59] and 1.78 [1.23–2.59], respectively). The cardiometabolic class was associated with an increased risk of fracture-related hospitalisations (HR 1.79 [1.04–3.07]). CONCLUSION : In middle-aged adults, we showed that multimorbidity count and certain multimorbidity patterns were associated with increased risk for fall- and fracture-related hospitalisations. Multimorbidity should therefore be considered when assessing a patient’s risk of falls and fractures.
Evidence-based strategies to promote hearing help-seeking and hearing aid uptake
Knoetze, Megan Clarissa; Manchaiah, Vinaya; Swanepoel, De Wet (Lippincott Williams and Wilkins, 2025-05)
Hearing loss is a prevalent and often undertreated condition significantly affecting quality of life across social, emotional, and cognitive domains. Despite advancements in hearing health care, many individuals who could benefit from hearing aids either delay seeking help or do not adopt rehabilitation strategies including hearing devices. This may be due to various audiological and non-audiological factors influencing help-seeking behavior and the decision to take up hearing aids.
A perspective on auditory wellness : what it is, why it is important, and how it can be managed
Humes, Larry E.; Dhar, Sumitrajit; Manchaiah, Vinaya; Sharma, Anu; Chisolm, Theresa H.; Arnold, Michelle L.; Sanchez, Victoria A. (Sage, 2024)
During the last decade, there has been a move towards consumer-centric hearing healthcare. This is a direct result of technological advancements (e.g., merger of consumer grade hearing aids with consumer grade earphones creating a wide range of hearing devices) as well as policy changes (e.g., the U.S. Food and Drug Administration creating a new over-the-counter [OTC] hearing aid category). In addition to various direct-to-consumer (DTC) hearing devices available on the market, there are also several validated tools for the self-assessment of auditory function and the detection of ear disease, as well as tools for education about hearing loss, hearing devices, and communication strategies. Further, all can be made easily available to a wide range of people. This perspective provides a framework and identifies tools to improve and maintain optimal auditory wellness across the adult life course. A broadly available and accessible set of tools that can be made available on a digital platform to aid adults in the assessment and as needed, the improvement, of auditory wellness is discussed.
Is there incremental benefit with incremental hearing device technology for adults with hearing loss?
Manchaiah, Vinaya; Dhar, Sumit; Humes, Larry; Sharma, Anu; Taylor, Brian; Swanepoel, De Wet (MDPI, 2025-06)
OBJECTIVE : This paper reviews the current research on hearing device technology, outlines key challenges, and identifies priorities for future investigation. METHOD : This paper presents an informal narrative review of the current literature on hearing technology, supplemented by expert insights to identify key challenges and future directions. RESULTS : The proliferation of direct-to-consumer (DTC) hearing devices with varied features and prices underscores the need to assess whether advanced technologies offer meaningful improvements. Understanding these incremental benefits is critical for determining the minimum technology required for optimal outcomes. The paper highlights the limitations in current clinical trials, which often suffer from selection bias, and the inadequacies of existing hearing aid outcome measures that may not capture real-life benefits. It emphasizes the need for real-world evidence and the development of assessment tools that better reflect everyday experiences. While existing research provides some insights into the potential benefits of incremental advances in hearing device technology, the evidence remains inconclusive. CONCLUSIONS : Addressing the cost, accessibility, and technological diversity of hearing devices is crucial to advancing hearing healthcare. Future research should prioritize the development of affordable, high-quality devices and establish comprehensive outcome measures that capture real-world benefits. A deeper understanding of these factors can lead to more accessible and effective hearing care, ultimately improving quality of life for individuals with hearing loss.
How much should consumers with mild to moderate hearing loss spend on hearing devices?
Manchaiah, Vinaya; Taddei, Steve; Bailey, Abram; Swanepoel, De Wet; Rodrigo, Hansapani; Sabin, Andrew (MDPI, 2025-06)
BACKGROUND: This study examined the relationship between hearing device price and sound quality. METHOD : A novel consumer-centric metric of sound quality (“SoundScore”) was used to assess hearing devices’ audio performance. Each hearing device is tested with two fittings. The “Initial Fit” is designed to approximate the most likely fitting for an individual with a mild-to-moderate sloping sensorineural hearing loss. The “Tuned Fit” includes adjusting parameters optimized to hit prescriptive fitting targets (NAL NL2) on an acoustic manikin. Each fitting is evaluated across five dimensions. Both fittings are combined using a weighted average to create a single number from 0 to 5 representative of a device’s overall audio performance. Seventy-one hearing devices were tested. RESULTS : A strong positive correlation was found between hearing device price and SoundScore. The average SoundScore increased dramatically as the price approached USD 1000, with marginal improvements beyond this point. SoundScore was consistently poor for devices under USD 500, highly variable between USD 500–1000, and consistently good over USD 1000. CONCLUSIONS : There is a strong but nonlinear relationship between hearing device price and sound quality. This information can aid consumers in making informed decisions while also assisting hearing healthcare professionals in providing comprehensive guidance to their patients.
Impact of preschool hearing screening in low-income communities : program outcomes and caregiver perspectives
Odendaal, Tara; Le Roux, Talita; Swanepoel, De Wet (American Speech-Language-Hearing Association, 2025-04)
PURPOSE : This study aimed to describe the impact of a preschool hearing screening program in a low- and middle-income country (LMIC) in terms of referral outcomes and caregiver perspectives. METHOD : This study included two components. First, a review of outcomes from a large-scale community-based hearing screening program, facilitated by community health workers (CHWs), for preschool children who failed their hearing screening. Second, telephonic surveys were conducted with (a) 25 caregivers whose children attended follow-up appointments and were diagnosed with hearing loss and (b) 33 caregivers whose children did not attend follow-up appointments. RESULTS : Over 21 months, 13,322 children underwent hearing screening, with an initial referral rate of 6% (809). Follow-up tests at preschools covered 86.2% (697) of children who failed the initial hearing screening, of whom 47.8% (387) presented with hearing loss and were referred for further evaluation. Among the 190 attending follow-up appointments, 54.8% (104) were diagnosed with hearing loss. Of these, 71.1% (74) had conductive hearing loss, 12.5% (13) had sensorineural hearing loss, and 13.5% (14) had mixed hearing loss. Caregivers strongly supported (96%) community-based hearing screening for preschool-aged children. Notably, attendance varied significantly between preschool rescreenings (86.2%) and health care facility follow-up appointments (49.1%). Caregivers highlighted barriers to attend hearing services including work commitments, long waiting times at health care facilities, miscommunication about referrals and appointments, relocations, and COVID-19 appointment cancellations. CONCLUSIONS : This study highlights the effectiveness of community-based hearing screenings in LMICs, led by CHWs. It emphasizes strong caregiver support and the importance of culturally relevant communication. Challenges in follow-up attendance persist, emphasizing the need for improved accessibility and communication within health care systems. Prioritizing caregiver concerns and promoting culturally sensitive education are essential for improving outcomes.

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