Traditional 226 Hz tympanometry has served as a routine clinical tool for middle-ear assessment for several decades; however, it provides a limited, single-frequency view of a complex, frequency-dependent system. Growing evidence supports the use of a more comprehensive and physiologically meaningful test battery that integrates wideband acoustic immittance, acoustic stapedial reflex assessment, and otoacoustic emissions. Together, these measures can improve clinical reasoning by providing complementary information about middle-ear transmission, cochlear function, and auditory pathway integrity.

This workshop will introduce the concept of a minimal yet clinically powerful test battery for assessing middle-ear function across the lifespan, including neonates, children, and adults. Emphasis will be placed on how wideband acoustic immittance, acoustic stapedial reflexes, and otoacoustic emissions can be interpreted together rather than in isolation. The session will focus on practical clinical applications, interpretation strategies, and case-based examples demonstrating how this integrated approach can improve the detection of conductive pathology, refine differential diagnosis, and support more evidence-based decision-making in audiology and otology settings.The workshop will be designed for audiologists, otologists, ENT specialists, hearing-care professionals, and researchers interested in improving the accuracy and clinical usefulness of middle-ear assessment. I recently delivered a related hands-on workshop at the World Congress of Audiology in Seoul, South Korea, and the topic generated strong interest and discussion among clinicians and researchers.

Proposed learning outcomes:

By the end of this workshop, participants will be able to:Describe the limitations of conventional 226 Hz tympanometry for assessing middle-ear function across different age groups.Describe the clinical significance of integrating wideband acoustic immittance, acoustic stapedial reflexes, and otoacoustic emissions into a fundamental middle-ear assessment battery.Interpret findings from wideband acoustic immittance, acoustic reflexes, and otoacoustic emissions in an integrated manner to support differential diagnosis.Apply an evidence-based minimal test battery concept to middle-ear assessment in neonates, children, and adults.Recognize clinical patterns that may suggest conductive involvement, cochlear dysfunction, or broader auditory pathway concerns.

Bone conduction hearing aids have become important in improving hearing of many patients, especially since the introduction of new transcutaneous active hearing aids. Basic research has used latest technology to better understand bone conduction. It has laid the ground to develop further bone conduction hearing aids. The lecture intends to present the learnings from basic research to clinical applications.

OTC Hearing Aids: Evolution, Current Evidence, and Real-World Use

Over-the-counter (OTC) hearing aids have introduced a fundamental change in hearing healthcare by shifting part of the rehabilitation pathway from a predominantly clinician-mediated model toward direct consumer access. Established as a distinct regulatory category in the United States in 2022, OTC hearing aids were designed to reduce persistent barriers related to cost, accessibility, service availability, and delayed help-seeking among adults with perceived mild-to-moderate hearing loss. Their emergence has expanded access to amplification while also redefining questions of candidacy, clinical oversight, and professional support.

This presentation critically examines the evolution of the OTC hearing aid model, current evidence for effectiveness, and the factors influencing successful real-world use. Available studies indicate that appropriately selected adults can achieve meaningful communication benefit from high-quality self-fitting hearing aids, with some controlled trials reporting outcomes comparable to professionally fitted devices. However, these findings should not be interpreted as evidence of universal equivalence. Current evidence remains concentrated on a limited number of devices, selected populations, and predominantly patient-reported outcomes, while considerable variability persists across products, users, and service models.

Successful OTC use depends on more than access to amplification. Users must be able to select an appropriate device, achieve an adequate physical and acoustic fit, manage setup and maintenance, evaluate everyday benefit, and recognize when self-directed care is insufficient. Medical warning signs, complex or asymmetric hearing difficulties, poor speech recognition, and limitations in manual, visual, cognitive, digital, or health-literacy abilities may substantially influence candidacy and required support.

OTC hearing aids are therefore best understood not as a replacement for audiological care, but as an additional entry point within a stepped, person-centred model of hearing care. Audiologists remain essential for candidacy assessment, verification, counselling, rehabilitation, troubleshooting, and escalation of care. The key clinical question is no longer simply whether OTC hearing aids can work, but for whom they work, under what conditions, and with what level of support.

Climate change, migration, and hearing healthcare: challenges in access and device continuity across borders

Hearing aids from past to present

Understanding the impact of hearing aid use on vestibular function helps clarify potential consequences on balance performance, fall risk, and activities of daily living. Therefore, the positive effects of auditory amplification, auditory gain, and balance and quality of life should be considered holistically.