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Background and objective: Speech comprehension in a foreign language under noise conditions presents an increased cognitive demand. For multilingual patients with cochlear implants (PwCI), this poses a particular challenge, as audiological routine diagnostics are typically conducted in the language of the clinical environment. This study investigates speech understanding in noise as well as the subjectively perceived listening effort in PwCI compared to normal-hearing (NH) individuals under both native and nonnative language conditions.

Materials and methods: PwCI and NH completed the Oldenburg Sentence Test (OLSA) in both German and English. The SNR₅₀ and the subjectively perceived mental effort, measured using the Rating Scale Mental Effort (RSME), were assessed. In addition, the subjective language competence in English as a foreign language was collected using the Common European Framework of Reference for Languages (CEFR).

Results: A total of 28 individuals with German as a first language and English as a foreign language (14 PwCI, 14 NH) were included. Among PwCI, the German version of the OLSA was significantly more intelligible than the English version (p = 0.010), whereas no significant difference was found for NH between language conditions. Listening effort was significantly higher during the English version of the OLSA in both PwCI (p = 0.003) and NH (p = 0.003). No correlation was found between self-assessed English language proficiency and perceived effort in either group.

Conclusion: The significantly reduced performance of PwCI in their foreign language under noise conditions reflects the established finding that multilingual individuals experience greater difficulty understanding speech in noise. The additionally reduced automatization of linguistic processing as well as a limited use of top-down listening strategies, that is the use of prior knowledge, context and expectations to fill gaps in the acoustic signal, make understanding in the presence of background noise more difficult, which can lead to increased listening effort and more frequent comprehension gaps. These effects appear to be particularly pronounced in multilingual individuals. These results highlight the importance of individualized, linguistically and culturally sensitive approaches in the clinical management of PwCI.

This article describes the surgical treatment of superior semicircular canal dehiscence syndrome (SCDS) by isolating the dehiscence using transmastoid two-point canal plugging while preserving the high-frequency vestibulo-ocular reflex (VOR) of the affected semicircular canal. The superior semicircular canal is opened via a transmastoid approach anterior (as far from the ampulla as possible) and posterior to the dehiscence and then plugged with connective tissue and bone dust. In two clinical exemplary cases, vestibular testing showed that the VOR measured by video head impulse (vHIT) test was preserved (patient 1: gain preoperative 0.7, long-term postoperative 0.75; patient 2: gain preoperative 0.64, long-term postoperative 0.79; reduction of corrective saccades in each case) with a simultaneous reduction in pathologically increased amplitudes of vestibular evoked myogenic potentials (VEMPs) and a significant improvement in clinical symptoms with almost complete freedom from symptoms. One possible explanation for preservation of the high-frequency VOR of the superior semicircular canal would be the deformability of the endolymphatic space described at high stimulation frequencies, which can lead to endolymph movements in the area of the ampulla with deflection of the cupula despite blockage of the semicircular canal.

Background: The diagnosis of third window syndromes often poses a challenge in clinical practice.

Objective: This paper provides an overview of diagnostic procedures in third window syndromes, with special emphasis on superior canal dehiscence syndrome (SCDS), large vestibular aqueduct syndrome (LVAS), and X-chromosomal malformation of the cochlea.

Materials and methods: A literature search was performed in PubMed up to December 2023. Furthermore, a selection of the authors' own cases is presented.

Results: Audiovestibular tests for the diagnosis of third window syndromes are most often reported for patients with SCDS in the literature. In this context, cut-off values with different sensitivities and specificities have been defined for different outcome parameters of vestibular evoked myogenic potentials. Current developments include the application of electrocochleography, broadband tympanometry, video head impulse testing, and vibration-induced nystagmus. Genetic analyses are increasingly applied in LVAS.

Conclusion: The diagnosis of third window syndromes is always based on the synthesis of patients' symptoms, clinical signs, audiovestibular test results, and imaging.

Chronic tinnitus is a common symptom of the auditory system. Its pathophysiology remains incompletely understood, primarily due to its multifactorial etiology, which resembles that of other chronic conditions. As a result, effective clinical management requires interdisciplinary diagnostics and personalized therapeutic strategies. A search in PubMed using the keyword "tinnitus" covering the period from September 2023 to September 2024 yielded 1079 publications, of which the most relevant were selected and analyzed for this review summarizing current knowledge. Recent advances in tinnitus research have further refined our understanding of its pathophysiology, diagnosis, and treatment. Tinnitus is frequently triggered by cochlear damage, leading to central neuronal alterations and maladaptive plasticity. Progress in neuroimaging and psychoacoustic testing is improving diagnostic precision, while multidisciplinary treatment approaches are gaining clinical relevance and should be increasingly emphasized.

Continuous monitoring of the technical and physiological function of cochlear implants (CI) is a central part of the care process. Despite worldwide efforts to standardise procedures, there is still considerable variation between CI centres, particularly in terms of the methods used, their practical implementation and the definition of meaningful target parameters. A standardised structured test procedure is needed for reliable quality assurance and better comparability. Against this background, the ADANO Working Group for Evoked Response Audiometry (AG-ERA), in close cooperation with the Cochlear Implants and Implantable Hearing Systems Committee of the German Society of Audiology (DGA), developed a minimum standard for audiological and technical functional testing of CIs in an open consensus process. This standard defines basic requirements for performance and documentation and serves as a practical recommendation for CI centres. It is intended to improve interdisciplinary cooperation, increase the quality of care and enable structured long-term optimised care for CI patients.

Background: Vertigo and dizziness belong to the most common leading symptoms in clinical practice. Their differential diagnosis, however, often imposes a challenge.

Objective: This work aims to provide evidence-based and practice-oriented recommendations for diagnosis and treatment of vertigo and dizziness for primary care providers.

Materials and methods: The consensus statement of an interdisciplinary working group following a national survey among Swiss primary care physicians and neurotology specialists (neurologists, otorhinolaryngologists) is presented. The associated literature search in PubMed was conducted up to October 2024.

Results and conclusion: Structured history taking and clinical neurotological examination form the basis for the differential diagnosis of the various acute (AVS), episodic (EVS), and chronic (CVS) vestibular syndromes (AVS: e.g., stroke or acute unilateral vestibulopathy; EVS: e.g., benign paroxysmal positional vertigo [BPPV], Menière's disease, vestibular migraine, vestibular paroxysmia; CVS: e.g., bilateral vestibulopathy, persistent postural perceptual dizziness). The present paper covers the following topics: i) "red flags" for a potentially dangerous cause in patients with acute vertigo/dizziness/gait and balance disorders; ii) essential clinical neurotological examination steps; iii) diagnostic and therapeutic maneuvers for posterior and lateral canal BPPV; iv) the most important therapeutic strategies for the vestibular syndromes named above; and v) the top 10 recommendations regarding history taking, diagnosis, and treatment of vertigo and dizziness in clinical practice. This review aims to serve as a clinical companion for physicians of all specialties dealing with the primary diagnosis and treatment of vertigo and dizziness.

Background: To date, data on the prevalence and age at first management of permanent childhood hearing loss in Germany are lacking.

Objective: This study aims to depict how often and at what age children and adolescents receive their (first) hearing technology.

Materials and methods: In this study, we analyzed claims data from a large German statutory health insurance company (BARMER). A cross-sectional study determined the provision of hearing devices and cochlear implants for children and adolescents aged under 18 years with permanent hearing loss from 2010 to 2020. A longitudinal analysis of a cohort of children born in 2010 was performed to gain insights about age at first management with hearing technology during the first 10 years of life.

Results: Between 2010 and 2020, approximately 2800 to 3600 children and adolescents per year were provided with hearing devices and 10 to 30 with cochlear implants. In the 2010 birth cohort, 1.22% of children received their first prescription for hearing devices before the age of 10. The proportionately highest number of first prescriptions was found between 3 and 6 years. In 2020, particularly few children gained access to hearing technology.

Conclusion: The analysis of the prescribed hearing systems reveals inaccuracies in documentation but also a possible care gap in hearing loss management. For a large percentage of children and adolescents, management of hearing loss took place after the age of 1. The frequent initial provision of hearing technology at preschool age indicates that the proportion of hearing loss that is acquired, detected late, or treated late remained quite high even after the introduction of newborn hearing screening. There is an obvious need for comprehensive tracking of children who fail newborn hearing screening and for other screening and hearing tests. The data for 2020 suggest that hearing loss was diagnosed and treated later due to the COVID-19 pandemic.