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Objectives: The present study aimed to evaluate hearing performance in a homogeneous group of adults with asymmetric hearing wearing the same CI device in the poorer ear and adapted to an identical in the ear with residual hearing. Material and Methods: 10 bimodal patients implanted with Med-El devices, average age 55.3 years and average SNHL duration was 27.3 years, were involved in a A-B-A study (ownstudy- own HA) where they were adapted to a 15 channel Widex fusion-440 p (study-HA) . Measures included ff-PTA, sentences recognition quiet, SRT50Italian Matrix Test and pitch discrimination at 200 Hz. Speech perception was measured after one months from each HA best fitting condition. Results: Bimodal stimulation provides better results than any monaural hearing mode, regardless of whether it involves the use of a hearing aid alone or a cochlear implant alone. ff-PTA was on average better for bimodal hearing with study than own HA both at 125-250 (respectively 25 and 31.4 dB and 500-2000 Hz (respectively 22.3 and 28.3). Median values in CI and bimodal condition with own/ study HA were: quiet = 51.6, 98.5 and 88.5 % respectively; SRT50 = 12, 9.6 and 5.7 dB SNR respectively. Pitch discrimination median values in CI and own/study HA were 61, 9 and 14 JND respectively. Results obtained with own- HA were not significantly different between pre-post 15- CH assessment. Discussion: Bimodal hearing has the potential of providing access to bilateral, binaural cues, such as better pitch perception of F0, to overcome some shortcomings in unilateral CI performance. Outcomes and subjective quality perception are influenced by demographical and audiological factors, but also by technical variables such as prescription procedures and number of channels for HA, and coding strategy and channel numbers for CI. These variables should be fully studied in each subject in order to evaluate the effective benefit and support indication to bimodal approach. [ABSTRACT FROM AUTHOR]

Objective: In professional singers, allergic rhinitis can lead to dysphonia and alterations in resonance. Each episode of laryngeal inflammation increases the risk of vocal strain or forces singers to cancel performances. This study aimed to analyze differences between allergic and nonallergic professional singers in self-evaluation of voice quality, objective examination of voice, and limitations of professional activities due to voice troubles., Methods: Two groups, one with 30 subjects diagnosed with allergic rhinitis (the study group) and the other with 30 subjects without allergic rhinitis (the control group), were recruited from a pool of 167 professional pop singers. All subjects underwent comprehensive rhinological and phoniatric evaluations. The rhinological evaluation included nasal endoscopy, rhinomanometry, and 22-item Sinonasal Outcome Test (SNOT-22) questionnaire. The phoniatric evaluation included laryngostroboscopy, the Voice Handicap Index (VHI) and Singing Voice Handicap Index (SVHI) questionnaires, and the Dysphonia Severity Index (DSI). Statistical analysis was conducted using the Statistical Package for Social Sciences 25.0 (SPSS)., Results: Dust mite allergy was the main cause of symptoms in our series of allergic singers, particularly when associated with seasonal allergens. Comparing singers with allergic rhinitis to those without, the study group had significantly higher scores on the SNOT-22, VHI, and SVHI assessments. Although the median DSI value indicated a good quality of voice in all subjects, it was significantly lower in the allergic group compared with the control group. The odds ratio (OR) indicated an increased risk for allergic singers of needing to postpone performances (OR 3.7), singing with laryngeal inflammation (OR 4.4), or changing the song pitch (OR 22.2)., Conclusions: Allergic singers experienced severe limitations in their professional activities. Our results suggest that careful management of allergic rhinitis is essential for singers to avoid conditions that could lead to vocal strain., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Listening difficulties may frequently occur in school settings, but so far there were no tools to identify them for both hearing and hearing-impaired Italian students. This study performed cross-cultural adaptation and validation of the Listening Inventory for Education-Revised for Italian students (LIFE-R-ITA)., Methods: The study procedure followed the stages suggested by the Guidelines for the Process of Cross-cultural Adaptation of Self-Report Measures. For the content validation, six cochlear implanted students (8-18 years old) pre-tested the initial version. Whenever any situation did not occur in Italy, the item was adapted to more typical listening situations in Italy. The final version of LIFE-R-ITA was administered to a sample of 223 hearing students from different school settings and educational degrees in order to collect normative data., Results: For the LIFE-R-ITA, hearing students showed an average score of 72.26% (SD = 11.93), reflecting some listening difficulties. The subscales (LIFE total, LIFE class, and LIFE social) indicated good internal consistency. All items were shown to be relevant. Most challenging situations happened when listening in large rooms, especially when other students made noise. LIFE social scores were significantly worse than those of LIFE class ( p < 0.001)., Conclusions: The present study provides cross-cultural adaptation and validation for the LIFE-R-ITA along with the normative data useful to interpret the results of students with hearing loss. The LIFE-R-ITA may support teachers and clinicians in assessing students' self-perception of listening at school. Such understanding may help students overcome their listening difficulties, by planning and selecting the most effective strategies among classroom interventions.

Purpose: This study aimed to investigate the effects of low frequency (LF) pitch perception on speech-in-noise and music perception performance by children with cochlear implants (CIC) and typical hearing (THC). Moreover, the relationships between speech-in-noise and music perception as well as the effects of demographic and audiological factors on present research outcomes were studied., Methods: The sample consisted of 22 CIC and 20 THC (7-10 years). Harmonic intonation (HI) and disharmonic intonation (DI) tests were used to assess LF pitch perception. Speech perception in quiet (WRSq)/noise (WRSn + 10) were tested with the Italian bisyllabic words for pediatric populations. The Gordon test was used to evaluate music perception (rhythm, melody, harmony, and overall)., Results: CIC/THC performance comparisons for LF pitch, speech-in-noise, and all music measures except harmony revealed statistically significant differences with large effect sizes. For the CI group, HI showed statistically significant correlations with melody discrimination. Melody/total Gordon scores were significantly correlated with WRSn + 10. For the overall group, HI/DI showed significant correlations with all music perception measures and WRSn + 10. Hearing thresholds showed significant effects on HI/DI scores. Hearing thresholds and WRSn + 10 scores were significantly correlated; both revealed significant effects on all music perception scores. CI age had significant effects on WRSn + 10, harmony, and total Gordon scores (p < 0.05)., Conclusion: Such findings confirmed the significant effects of LF pitch perception on complex listening performance. Significant speech-in-noise and music perception correlations were as promising as results from recent studies indicating significant positive effects of music training on speech-in-noise recognition in CIC., (© 2024. The Author(s).)

Despite the proven effectiveness of cochlear implant (CI) in the hearing restoration of deaf or hard-of-hearing (DHH) children, to date, extreme variability in verbal working memory (VWM) abilities is observed in both unilateral and bilateral CI user children (CIs). Although clinical experience has long observed deficits in this fundamental executive function in CIs, the cause to date is still unknown. Here, we have set out to investigate differences in brain functioning regarding the impact of monaural and binaural listening in CIs compared with normal hearing (NH) peers during a three-level difficulty n-back task undertaken in two sensory modalities (auditory and visual). The objective of this pioneering study was to identify electroencephalographic (EEG) marker pattern differences in visual and auditory VWM performances in CIs compared to NH peers and possible differences between unilateral cochlear implant (UCI) and bilateral cochlear implant (BCI) users. The main results revealed differences in theta and gamma EEG bands. Compared with hearing controls and BCIs, UCIs showed hypoactivation of theta in the frontal area during the most complex condition of the auditory task and a correlation of the same activation with VWM performance. Hypoactivation in theta was also observed, again for UCIs, in the left hemisphere when compared to BCIs and in the gamma band in UCIs compared to both BCIs and NHs. For the latter two, a correlation was found between left hemispheric gamma oscillation and performance in the audio task. These findings, discussed in the light of recent research, suggest that unilateral CI is deficient in supporting auditory VWM in DHH. At the same time, bilateral CI would allow the DHH child to approach the VWM benchmark for NH children. The present study suggests the possible effectiveness of EEG in supporting, through a targeted approach, the diagnosis and rehabilitation of VWM in DHH children., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The synthesis of quaternary carbons often requires numerous steps and complex conditions or harsh reagents that act on heavily engineered substrates. This is largely a consequence of conventional polar-bond retrosynthetic disconnections that in turn require multiple functional group interconversions, redox manipulations, and protecting group chemistry. Here, we report a simple catalyst and reductant combination that converts two types of feedstock chemicals, carboxylic acids and olefins, into tetrasubstituted carbons through quaternization of radical intermediates. An iron porphyrin catalyst activates each substrate by electron transfer or hydrogen atom transfer, and then combines the fragments using a bimolecular homolytic substitution (S H 2) reaction. This cross-coupling reduces the synthetic burden to procure numerous quaternary carbon---containing products from simple chemical feedstocks.

Objectives: Emotional abilities (EAs) are particularly important during preadolescence/adolescence, two challenging periods characterized by significant biological, physical, and cognitive changes. The present study attempted to a holistic EA approach in preadolescents/adolescents with cochlear implants (CI) and typical hearing (TH), considering various aspects such as perception, cognitive facilitation, comprehension, and management of emotions. A secondary aim was to identify significant demographic and audiological factors of EA development., Methods: CI/TH groups were matched for chronological age, nonverbal IQ, gender, economic income, and maternal level of education. Each group consisted of 43 participants (age range 10-18 years). EAs were evaluated by using the multi-trait/method IE-ACCME test. Auditory-linguistic assessments included participants' lexical skills and Matrix performance as well., Results: EA performance for perception and cognitive facilitation did not show any statistically significant CI/TH group differences (p > 0.05). Significant CI/TH differences emerged for emotion comprehension and management: CI group performed significantly worse in understanding emotional blends (t = 2.56, p = 0.014) but better in personal emotion management (t = -2.01, p = 0.048). For the CI group, gender showed statistically significant effects on cognitive facilitation in sensations, with males performing better than females (U = 129, p = 0.018). TH preadolescents showed significantly lower scores in understanding emotional changes in comparison to TH adolescents (U = 125.5, p = 0.01). Emotional blends understanding showed a weak negative correlation with Matrix performance (r = - 0.38, p = 0.013) and a moderate positive correlation with lexical skills (r = 0.40, p = 0.008). Relationships management showed various significant correlations: weak negative correlations with age at CI (r = - 0.38, p = 0.011) and Matrix performance (r = - 0.36, p = 0.016) as well as weak positive correlations with nonverbal-IQ (r = 0.38, p = 0.013) and positive moderate correlations with lexical skills (r = 0.49, p < 0.001)., Conclusion: Cochlear implantation seems to show significant positive effects on emotional development in children, allowing them to achieve age appropriate EAs as they grow up and become preadolescents/adolescents. EA assessment in CI users may not only support monitorization of EA trajectory, but also early identification of any EA disorders, so that subjects with low EA profiles could be timely and properly intervened., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Executive functions (EF) play a fundamental role in planning and executing goal-driven behaviours. The purpose of this systematic review and meta-analysis was to investigate EF skills mastered by preschool/school-age cochlear implanted children (CIC) without morpho-functional abnormalities and to compare their outcomes with typically hearing children (THC)., Methods: Bibliographic search for observational studies of any language/date up to 16 December 2022 was performed with the following electronic databases: PubMed, Scopus, and Web of Science. After removal of duplicates, 2442 records were subjected to a three-stage screening process and 83 potentially eligible articles were identified. A total of 15 studies was included in the final analysis: 9 articles directly meeting the eligibility criteria plus 6 more studies thanks to the authors sharing their data set, specifically for participants who met present inclusion criteria., Results: Meta-analysis showed a statistically significant difference only for verbal short-term memory, whereas group differences for visuospatial short-term memory and verbal/visuospatial working memory were not significant. For fluency skills, meta-analysis revealed statistical significance for the semantic fluency task but not for the rapid naming test. Qualitative analysis reflected group similarities in flexibility but CIC's difficulties in auditory attention/planning skills. Controversial findings for inhibitory control skills were observed., Conclusions: EF performance comparisons between CIC and THC show inter-skill and inter-test variances. Due to the paucity of existing studies, present findings should be interpreted with caution. Future research in this domain is strongly recommended., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Vocal singing skills in pediatric CI users are not much known due to the limited number of studies. The principal aim of the present study was to evaluate vocal singing skills in Italian pediatric CI users. A further aim was to investigate factors that may significantly influence their performance., Methods: The participants were twenty-two implanted children and twenty-two hearing peers. Their vocal singing skills for familiar ("Happy Birthday to You") and unfamiliar songs ("Baton Twirler" from Pam Pam 2- Tribute to Gordon) were evaluated in relation to their music perception (the Gordon test). Acoustic analysis was performed using Praat and MATLAB software. Nonparametric statistical tests and principal component analysis (PCA) were used to analyze the data., Results: Hearing children outperformed implanted peers in both music perception and vocal singing tasks (all measures regarding intonation, vocal range, melody, and memory for the familiar song versus measures regarding intonation and overall melody production for the unfamiliar song). Music perception and vocal singing performances revealed strong correlations. For the familiar and unfamiliar songs, age-appropriate vocal singing was observed in 27.3% versus 45.4% of children, all implanted within 24 months of age. Age at implantation and duration of CI experience were moderately correlated with the total score obtained from the Gordon test., Conclusion: Implanted children show limited vocal singing skills in comparison to their hearing peers. However, some children implanted within 24 months of age seem to achieve vocal singing skills as good as their hearing peers. Future research could be useful to better understand the role of brain plasticity to implement specific training programs for both music perception and vocal singing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Long-term assessments of children with cochlear implants (CI) are important inputs to help guide families and professionals in therapeutic and counselling processes. Based on these premises, the primary aim of the present study was to assess the long-term speech and language outcomes in a sample of prelingually deaf or hard of hearing (DHH) adolescents and young adults with unilateral or bilateral implantation in childhood. The secondary aim was to investigate the correlations of age at implantation with long-term speech and language outcomes., Materials and Methods: Retrospective observational study on 54 long-term CI users, 33 unilateral and 21 bilateral (mean age at CI surgery 38.1 ± 24.6 months; mean age at last follow-up assessment 19.1 ± 4.3 years of age and mean follow-up time 16 ± 3.7 years). Means and standards were used to describe speech perception (in quiet, in fixed noise and in adaptive noise using It-Matrix) and morphosyntactic comprehension (TROG-2) outcomes. A univariate analysis was used to evaluate outcome differences between unilateral and bilateral patients. Bivariate analysis was performed to investigate the relationships between age at CI, audiological variables, and language outcomes. Finally, multivariate analysis was performed to quantify the relationship between It-Matrix, sentence recognition in quiet and at SNR+10 and TROG-2., Results: The participants showed good speech recognition performance in quiet (94% for words and 89% for sentences) whilst their speech-in-noise scores decreased significantly. For the It-Matrix, only 9.2% of the participants showed scores within the normative range. This value was 60% for TROG-2 performance. For both auditory and language skills, group differences for unilateral versus bilateral CI users were not statistically significant (p > 0.05). Bivariate analysis showed that age at CI correlated significantly with overall results at TROG-2 (r = -0.6; p < 0.001) and with It-Matrix (r = 0.5; p < 0.001). TROG-2 was negatively correlated with results for It-Matrix (r = -0.5; p < 0.001). In the multivariate analysis with It-Matrix as a dependent variable, the model explained 63% of the variance, of which 60% was related to sentence recognition and 3% to morphosyntax., Conclusions: These data contribute to the definition of average long-term outcomes expected in subjects implanted during childhood whilst increasing our knowledge of the effects of variables such as age at CI and morphosyntactic comprehension on speech perception. Although the majority of this prelingually DHH cohort did not achieve scores within a normative range, remarkably better It-Matrix scores were observed when compared to those from postlingually deafened adult CI users., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: The present study aimed to investigate in a group of elderly CI users working memory and attention, conventionally considered as predictors of better CI performance and to try to disentangle the effects of these cognitive domains on speech perception, finding potential markers of cognitive decline related to audiometric findings. Methods Thirty postlingually deafened CI users aged >60 underwent an audiological evaluation followed by a cognitive assessment of attention and verbal working memory. A correlation analysis was performed to evaluate the associations between cognitive variables while a simple regression investigated the relationships between cognitive and audiological variables. Comparative analysis was performed to compare variables on the basis of subjects' attention performance., Results: Attention was found to play a significant role in sound field and speech perception. Univariate analysis found a significant difference between poor and high attention performers, while regression analysis showed that attention significantly predicted recognition of words presented at Signal/Noise +10. Further, the high attention performers showed significantly higher scores than low attentional performers for all working memory tasks., Conclusion: Overall findings confirmed that a better cognitive performance may positively contribute to better speech perception outcomes, especially in complex listening situations. WM may play a crucial role in storage and processing of auditory-verbal stimuli and a robust attention may lead to better performance for speech perception in noise. Implementation of cognitive training in auditory rehabilitation of CI users should be investigated in order to improve cognitive and audiological performance in elderly CI users.

Purpose: Auditory selective attention (ASA) is crucial to focus on significant auditory stimuli without being distracted by irrelevant auditory signals and plays an important role in language development. The present study aimed to investigate the unique contribution of ASA to the linguistic levels achieved by a group of cochlear implanted (CI) children., Methods: Thirty-four CI children with a median age of 10.05 years were tested using both the "Batteria per la Valutazione dell'Attenzione Uditiva e della Memoria di Lavoro Fonologica nell'età evolutiva-VAUM-ELF" to assess their ASA skills, and two Italian standardized tests to measure lexical and morphosyntactic skills. A regression analysis, including demographic and audiological variables, was conducted to assess the unique contribution of ASA to language skills., Results: The percentages of CI children with adequate ASA performances ranged from 50 to 29.4%. Bilateral CI children performed better than their monolateral peers. ASA skills contributed significantly to linguistic skills, accounting alone for the 25% of the observed variance., Conclusions: The present findings are clinically relevant as they highlight the importance to assess ASA skills as early as possible, reflecting their important role in language development. Using simple clinical tools, ASA skills could be studied at early developmental stages. This may provide additional information to outcomes from traditional auditory tests and may allow us to implement specific training programs that could positively contribute to the development of neural mechanisms of ASA and, consequently, induce improvements in language skills., (© 2022. The Author(s).)

This pilot study investigates the neurophysiological patterns of visual and auditory verbal working memory (VWM) in unilateral cochlear implant users (UCIs). We compared the task-related electroencephalogram (EEG) power spectral density of 7- to 13-year-old UCIs ( n = 7) with a hearing control group (HC, n = 10) during the execution of a three-level n-back task with auditory and visual verbal (letters) stimuli. Performances improved as memory load decreased regardless of sensory modality (SM) and group factors. Theta EEG activation over the frontal area was proportionally influenced by task level; the left hemisphere (LH) showed greater activation in the gamma band, suggesting lateralization of VWM function regardless of SM. However, HCs showed stronger activation patterns in the LH than UCIs regardless of SM and in the parietal area (PA) during the most challenging audio condition. Linear regressions for gamma activation in the PA suggest the presence of a pattern-supporting auditory VWM only in HCs. Our findings seem to recognize gamma activation in the PA as the signature of effective auditory VWM. These results, although preliminary, highlight this EEG pattern as a possible cause of the variability found in VWM outcomes in deaf children, opening up new possibilities for interdisciplinary research and rehabilitation intervention.

Background: Oropharyngeal dysphagia (OD) screening tests have improved patient management; however, the complex applicability and high percentage of false negatives do not allow these tests to be considered completely reliable if not supported by an instrumental investigation. The aim of the present study is to evaluate an OD screening test, the Dysphagia Standard Assessment (DSA®) with different volumes and viscosities., Materials and Methods: Prospective study of 72 patients evaluated for suspected OD through a double-blind methodology conducted by two operators. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) as a reference test and a separate DSA® test. DSA® was performed by administering boluses with different viscosities, with the signal of interruption of the test being: onset of the cough reflex, wet voice after swallowing, and/or desaturation of O2 ≥ 5%. The Penetration-Aspiration Scale (PAS) was evaluated by FEES. The cut-off identified to diagnose OD was PAS ≥ 3., Results: The test showed an accuracy of 82%, a sensitivity of 0.93 (95% C.I. 0.84-0.97), and a specificity of 0.78 (95% C.I. 0.67-0.87); positive predictive value 0.55 (95% C.I. 0.43-0.67); negative predictive value 0.97 (95% C.I. 0.90-0.99), positive likelihood ratio 4.37 (95% C.I. 3.6-5.2); likelihood negative ratio 0.08 (95% C.I. 0.06-0.09)., Conclusions: According to the preliminary results, the test showed good outcomes in determining the presence or absence of OD with a wide spectrum of applicability with some limitations that could be overcome by the selection of a target population. For this reason, a flowchart to address patient eligibility was developed., (© 2022. The Author(s).)

Purpose: The aim of the study was to investigate the listening comprehension (LC) skills in deaf and hard of hearing children (DHH) using cochlear implants (CI). Besides, personal and audiological variables that could influence the levels of competence reached were analyzed., Methods: Thirty-four children using CI were enrolled. LC skills were assessed through the standardized Italian test "Comprensione Orale-Test e Trattamento" (CO-TT). A univariate analysis was conducted to compare LC with gender, listening mode (unilateral or bilateral), maternal level of education and family income. A bivariate analysis was performed to search possible connections between children's performances and their individual characteristics, audiological conditions, and language levels. Finally, a multivariate analysis was performed using a stepwise hierarchical linear regression model which included all variables whose p value resulted  ≤ 0.05., Results: Twenty-one children using CI (61.8%) showed adequate performances in terms of chronological age, while 13 (38.2%) showed difficulties in LC. Maternal level of education, age at diagnosis and non-verbal cognitive level accounted for 43% of the observed variance. Auditory attention skills explained an additional 15% of variance. Morphosyntactic comprehension added a further 12% of variance., Conclusion: CI can really help many DHH children to reach adequate LC skills, but in some cases difficulties remain. Factors influencing LC need to be early investigated and considered when planning an appropriate rehabilitative intervention., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study investigated the psychological characteristics of online learning on Italian students with and without hearing loss (HL) and on their parents, who were forced into isolation during the Covid-19 pandemic. An online survey collected information on socio-demographic data and opinions concerning online learning from 61 children (mean age 11; 25 males, 36 females), including 43 with HL and also from their parents; additionally, school wellbeing and anxiety were assessed. The results showed that, in both the student and parent groups, no significant effect of HL on school wellbeing and anxiety was found. Additionally, in parents, State Anxiety was significantly higher than Trait Anxiety, suggesting one possible impact of lockdown on psychological wellbeing. Differences due to HL were observed and discussed in correlation analyses. The Authors believe that this study is the first contribution to the psychological evaluation of the impact of online learning on families with hearing-impaired children, from the perspective of a successful, inclusive didactic., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Psychology in the Schools published by Wiley Periodicals LLC.)

Introduction: The present study aimed to evaluate the effects of the Active Communication Education (ACE) program on the social/emotional impacts of hearing loss (HL) in a group of older adults with a cochlear implant (CI)., Design: Prospective cohort study design, with a "within-subject" control procedure., Study Sample: Twenty adults over-65 post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive level, have no significant psychiatric conditions and/or diagnosed incident dementia, and used CI for at least 9 months., Materials and Methods: Twenty participants were assessed using the Hearing Handicap Inventory for the Elderly (HHIE), the Geriatric Depression Scale (GDS), and the Speech, Spatial, and Qualities of Hearing Scale (SSQ) before, during, and after ACE program, with a one and 6-month follow up. The cognitive and audiological evaluation was carried out before commencing the ACE program., Results: The ACE program had a positive impact by reducing HL's social/emotional effects. Participants benefited from a rehabilitative approach by improving multilevel skills: comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategies, and interaction and sharing of experiences with peers., Conclusion: Although targeting the older adults with moderate HL, the ACE program also seemed to benefit older adult CI users. An improvement in social and emotional adaptation to hearing difficulties can, in turn, significantly promote optimal use of CI in the older adults, thereby possibly reducing the risk of losing motivation and engagement in device use and in rehabilitation protocols., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Giallini, Nicastri, Inguscio, Portanova, Magliulo, Greco and Mancini.)

Exploration of specific brain areas involved in verbal working memory (VWM) is a powerful but not widely used tool for the study of different sensory modalities, especially in children. In this study, for the first time, we used electroencephalography (EEG) to investigate neurophysiological similarities and differences in response to the same verbal stimuli, expressed in the auditory and visual modality during the n-back task with varying memory load in children. Since VWM plays an important role in learning ability, we wanted to investigate whether children elaborated the verbal input from auditory and visual stimuli through the same neural patterns and if performance varies depending on the sensory modality. Performance in terms of reaction times was better in visual than auditory modality ( p  = 0.008) and worse as memory load increased regardless of the modality ( p  < 0.001). EEG activation was proportionally influenced by task level and was evidenced in theta band over the prefrontal cortex ( p  = 0.021), along the midline ( p  = 0.003), and on the left hemisphere ( p  = 0.003). Differences in the effects of the two modalities were seen only in gamma band in the parietal cortices ( p  = 0.009). The values of a brainwave-based engagement index, innovatively used here to test children in a dual-modality VWM paradigm, varied depending on n-back task level ( p  = 0.001) and negatively correlated ( p  = 0.002) with performance, suggesting its computational effectiveness in detecting changes in mental state during memory tasks involving children. Overall, our findings suggest that auditory and visual VWM involved the same brain cortical areas (frontal, parietal, occipital, and midline) and that the significant differences in cortical activation in theta band were more related to memory load than sensory modality, suggesting that VWM function in the child's brain involves a cross-modal processing pattern., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Bianca Maria Serena Inguscio et al.)

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

Background: Little is known regarding fitting parameters and receptive and expressive language development in cochlear-implanted children (CCI) with profound sensorineural hearing loss (SHL) who are diagnosed with Autism Spectrum Disorder (ASD). The aim of the study was to evaluate a group of ASD CCI users in order to describe their ASD clinical features and CCI outcomes; report on the average electrical charge requirements; and evaluate the possible correlations between electrical and psychophysical outcomes with ASD characteristics., Materials and Methods: A multicentre observational study of 22 ASD children implanted in four cochlear implant (CI) centers. Data concerning profound SHL diagnosis, ASD diagnosis, CI timing and CI compliance were collected. Sound Field (SF) was assessed through repeated behavioural measurements. Categories of Auditory Perception (CAP) and Categories of Language (CL) were used to evaluate speech perception and language skills at short (≤2 yrs), medium (5 yrs) and long term (>10 yrs) follow-up. Fitting parameters such as comfortable thresholds, pulse-width (pw, μsec) and clinical units converted into units of charge/phase were collected. The diagnosis of ASD was acquired by the referral neuropsychiatric department and severity was assessed through the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the Childhood Autism Rating Scale (CARS)., Results: At the final follow-up session the median SF threshold for CI outcomes was 30 dB HL (min 15 - max 60). CAP score was extremely variable: 45.5% showed no improvement over time and only 22% of children reached CAP scores of 5-7. CL 45.5% showed no improvement over time and score was 1-2 in the majority of ASD children (72.7%), while only 18.2% reached the highest level of language skills. There were no statistically significant differences at each follow-up between subjects with or without comorbidities. CAP and CL were inversely correlated with DSM-V A and B domains, corresponding to lower speech and language scores in children with more severe ASD symptoms, and maintained their correlation at mid and long follow-ups whilst controlling for age at CI. Electrical charge requirements did not correlate with SF or age at implant but did inversely correlate with ASD severity. With regards to CI compliance: only 13.6% children (3) with severe DSM-V A/B levels and CARS score were partial/intermittent users., Conclusion: The present study is a targeted contribution to the current literature to support clinical procedures for CI fitting and audiological follow-up in children with ASD. The findings indicate that the outcomes of CI use and the fitting procedures are both influenced by the severity of the ASD symptoms rather than the demographic variables or associated disorders., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: Executive Functions (EFs) are fundamental to every aspect of life. The present study was implemented to evaluate factors influencing their development in a group of preschools orally educated profoundly deaf children of hearing parents, who received CI within 2 years of age., Methods: Twenty-five preschool CI children were tested using the Battery for Assessment of Executive Functions (BAFE) to assess their flexibility, inhibition, and non-verbal visuo-spatial working memory skills. The percentage of children performing in normal range was reported for each of the EF subtests. Mann-Whitney and Kruskal-Wallis were performed to assess differences between gender, listening mode, and degree of parents' education subgroups. The Spearman Rank Correlation Coefficient was calculated to investigate the relationship between EF scores of audiological and linguistic variables., Results: Percentages ranging from 76 to 92% of the children reached adequate EF scores at BAFE. Significant relations (p < 0.05) were found between EFs and early intervention, listening, and linguistic skills. Furthermore, CI children from families with higher education level performed better at the response shifting, inhibitory control, and attention flexibility tasks. Economic income correlated significantly with flexibility and inhibitory skills. Females performed better than males only in the attention flexibility task., Conclusions: The present study is one of the first to focus attention on the development of EFs in preschool CI children, providing an initial understanding of the characteristics of EFs at the age when these skills emerge. Clinical practice must pay increasing attention to these aspects which are becoming the new emerging challenge of rehabilitation programs.