Here’s a look at a selection of phone captioning products available to open up the lines of communication for audiology clients.

CapTel Captioned Telephone

1-800-233-9130; CapTel@CapTel.com; www.CapTel.com

The inventor of captioned telephones, CapTel shows captions of what a caller says, empowering people with hearing loss to enjoy talking on the phone again with confidence. CapTel offers multiple phones—traditional models and touch screen options, using high speed Internet or analog phone lines—giving users control of how calls are captioned, either automatically or with assisted captions. All CapTel phones caption answering machine and voice mail messages, include a powerful speakerphone for “hands free” calling, and provide 24/7 one-touch help. Most importantly, CapTel enables people to re-connect over the phone. Assembled in USA.

ClearCaptions

888-870-8114; hcp@clearcaptions.com; clearcaptions.com/providers

Hearing loss can make phone calls with loved ones difficult, but what if you could see every word they say, as they say it? The ClearCaptions Phone provides near real-time phone captioning services for the hard of hearing at no cost to eligible individuals. So they can stay connected to those who matter most. Features include:

• Word-for word captions of conversations

• Easy-to-use phone with touchscreen display

• Large buttons and speakerphone amplification

• Free in-home installation, training, and support

ClearCaptions is available in the United States and its territories only

FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON.

IP Captioned Telephone Service may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. There is a cost for each minute of captions generated, paid from a federally administered fund. No costs are passed along to individuals who qualify for the service.

Hamilton CapTel

877-455-4227; info@hamiltoncaptel.com; www.hamiltoncaptel.com

Since 2003, Hamilton CapTel has made more than 400 million captioned telephone conversations possible for individuals with hearing loss, providing the ability to listen and read captions of what’s said over the phone. Whether looking for a traditional telephone experience, an option for at work, or a mobile app for on-the-go—Hamilton CapTel solutions offer clarity, confidence, and independence. Learn more at HamiltonCapTel.com

InnoCaption

support@innocaption.com; www.innocaption.com

InnoCaption is a free, FCC-certified mobile app that provides real-time captions for phone calls, empowering individuals with hearing loss to communicate with confidence. Users can choose between live stenographers or automated speech recognition—switching modes even mid-call. Designed for ease and independence, the app also features call forwarding, visual voicemail, saved transcripts, and Bluetooth hearing aid compatibility. InnoCaption helps bridge communication gaps, making phone calls more accessible, reliable, and stress-free.

Nagish

833-362-4474; hello@nagish.com; www.nagish.com

Certified by the FCC, Nagish captions phone calls in real time and makes it easy to communicate using text or voice. It’s designed to be fast, private, and accurate. The free AI-powered app captions calls and in-person conversations with no time limits and allows users to keep their existing phone number.

Featured image: ID 98363270 © Syda Productions | Dreamstime.com

Key Takeaways:

• Auracast technology enables high-quality, low-latency audio to reach unlimited compatible devices, expanding accessibility beyond traditional assistive listening to include multilingual commentary and audio description.
• Listen Technologies and Bluetooth SIG leaders will present on July 1, sharing strategies for making stadiums and arenas Auracast-enabled to improve fan engagement and future-proof venues.
• Auri, developed with Ampetronic, offers a practical solution for venues to adopt Auracast now, reflecting a shift from compliance-driven accessibility to innovative, inclusive fan experiences.

Listen Technologies, a provider of advanced wireless listening solutions for 27 years, will join the Bluetooth Special Interest Group (SIG) as an exhibitor at SEAT 2025 in Nashville from June 29 to July 2, 2025. Listen Technologies will showcase Auri, which the company says is the first Auracast broadcast audio-based assistive listening system. Members of the Listen Technologies and Bluetooth SIG teams will also present at the conference, offering attendees an in-depth look at how Auracast broadcast audio is transforming the way fans engage in stadiums and arenas.

SEAT (Sports & Entertainment Alliance in Technology) is dedicated to the executives, decision makers, and professionals who work across the worldwide sports, collegiate, and entertainment industry. The core mission of SEAT is to provide an opportunity for the leaders of sports and entertainment venues to network directly with industry peers and to share innovative technology solutions, lessons learned, and case studies.

Making Audio More Inclusive for Fans

Kasey Kaumans, market development manager at Listen Technologies, and Chuck Sabin, vice president of technology and market development at Bluetooth SIG, will present ‘Breaking Barriers: How Auracast Broadcast Audio is Redefining Accessibility in Sports & Entertainment Venues’ on July 1 at 2 p.m. CST.

“In the evolving landscape of fan experience, accessibility is no longer just about compliance; it is about inclusion, innovation, and elevating the event for everyone,” said Kaumans.

Auracast is a new capability from Bluetooth technology. It enables high-quality, low-latency audio to be transmitted to an unlimited number of compatible devices, unlocking a revolutionary listening experience for all attendees at sports and entertainment venues, not just those with hearing loss. Whether it’s clearer play-by-play commentary, multilingual broadcasts, or audio-described content for visually impaired fans, Auracast opens a world of possibilities.

How to Make Venues Auracast Enabled

Consumer devices featuring Auracast technology are available, and more are being announced. Auracast is quickly becoming a new standard feature in hearing aids, smartphones, earbuds, and headphones, enabling these devices to receive broadcasts from Auracast transmitters.

Kaumans will outline how venues can leverage Auracast technology to connect with fans and future-proof stadiums and arenas as adoption of Auracast-compatible devices increases. He will demonstrate Auri in-room during the presentation and at Booth #12 during the conference. Listen Technologies and its strategic partner, Ampetronic, developed Auri so venues and guests can benefit from this technology now.

“From enhancing assistive listening to enriching the in-venue audio experience for the masses, this session will demonstrate how Auracast broadcast audio is transforming sports and entertainment, and why accessibility is the new frontier of premium fan engagement,” said Sabin.

To learn more about SEAT 2025, visit https://seatconference.com/.

Key Takeaways:

1. Biomimicry breakthrough: The new aerogel mimics owl feathers and skin to create a dual-layer structure that absorbs a broad range of sound frequencies.
2. Superior performance: It absorbs 58% of incoming soundwaves and reduces engine noise by nearly 9 decibels—outperforming top existing noise control materials.
3. Durability and potential use: The material is lightweight, resilient through repeated use, and shows promise for real-world applications in automotive and industrial soundproofing.

If you’ve seen an owl fly, you probably didn’t hear a thing. That’s because their skin and feathers dampen sound by absorbing high- and low-frequency flight noise. Inspired by this natural soundproofing, researchers publishing in ACS Applied Materials & Interfaces from the American Chemical Society (ACS) developed a two-layer aerogel that mimics the structures inside owl feathers and skin to mitigate sound pollution. This new material could be used in cars and manufacturing facilities to reduce traffic and industrial noise.

Noise pollution is more than a nuisance; excessive noise can cause hearing loss and can worsen health conditions such as cardiovascular disease and type 2 diabetes. When eliminating the source of noise pollution isn’t feasible, soundproofing materials help dampen it. However, traditional materials absorb either high-frequency sounds, like squealing breaks, or low-frequency sounds, like the deep rumbling from a car engine. This means engineers often layer multiple types of soundproofing materials to achieve full-spectrum noise control, which adds weight and bulk. 

To overcome this, Dingding Zong and colleagues turned to an unlikely acoustic expert: the owl. The owl uses its soft feathers and porous skin to remain whisper-quiet during flight. The researchers’ goal was to engineer a similarly versatile broadband sound absorber.

The researchers froze droplets of hexane into a layer of soft material, using a technique called emulsion-templated freeze-reconstruction. Removing the frozen hexane revealed a honeycomb-like pattern in the material. They added a second layer with silicon nanofibers instead of hexane droplets to create a fibrous pattern. The resulting light, porous two-layer aerogel mimics the structures in owl skin and feathers: The bottom porous layer resembles the bird’s skin with microscopic cavities that cancel out low-frequency noise; and the top feather-inspired layer, made of fluffy nanofibers, dampens high-frequency sounds.

Notably, the researchers found that their owl-inspired aerogels can:

• Absorb 58% of soundwaves that strike it, surpassing the threshold for effective noise control materials.
• Reduce 87.5 decibels of automobile engine noise to a safe level of 78.6 decibels, which is a better reduction than existing high-end noise absorbers.
• Maintain structural integrity through 100 compression cycles, with only 5% deformation.

The researchers believe this study paves the way for high-performance, lightweight and durable sound-absorbing materials that can significantly alleviate noise pollution from industrial equipment and traffic.

The authors acknowledge funding from the Natural Science Foundation of Tianjin and the Open Project Program of the Ministry of Education Key Laboratory for Advanced Textile Composite Materials, Tiangong University.

Note: ACS does not conduct research but publishes and publicizes peer-reviewed scientific studies.

Featured image: A new soundproofing material (fluffy white disk, right image) that mimics the structure of owl skin and feathers reduced the rumble of a car engine more than a traditional felt fiber soundproofing material (fluffy white disk, left image). Credit: Adapted from ACS Applied Materials & Interfaces 2025, DOI: 10.1021/acsami.5c04691

Starkey participated in the 2025 Twin Cities Hearing Loss Association of America (HLAA) Walk4Hearing, joining thousands of advocates across the country working to break down barriers and empower people with hearing loss. With more than 100 employees, friends, and family walking together, the event underscored Starkey’s role in health education and advocacy.

Starkey President and CEO Brandon Sawalich, who also serves as the national Walk4Hearing Co-chair, helped lead the charge on behalf of the company’s ongoing commitment to community engagement through Starkey Cares—an initiative focused on bringing hearing health resources to those who need them most.

“Starkey sets the standard for what it means to lead in hearing health,” says Sawalich. “We are driving change through innovation, advocacy, and education. Starkey Cares’ participation in the Walk4Hearing reflects our commitment to breaking down barriers, building community, and empowering people with hearing loss to reach their full potential.”

As a Hear4Life sponsor, Starkey’s partnership with HLAA supports programs that raise awareness, advocate for accessibility, and bring hope to millions of Americans living with hearing loss. The Walk4Hearing movement takes place in 20 cities nationwide, uniting families, HLAA Chapters, schools, professionals, and partners around a shared goal: to help people thrive.

To learn more about Starkey Cares, visit https://www.starkey.com/starkeycares.

Key Takeaways:

1. Public sector leads growth: NHS hearing instrument sales surged by 23% in Q1 2025, highlighting increased public engagement with hearing health services.
2. Private and ROI markets also up: Private sales rose by 7% and Republic of Ireland sales by 15%, continuing the positive momentum from late 2024.
3. Rechargeables on the rise: Rechargeable hearing aid sales climbed 18%, indicating growing consumer preference for sustainable and user-friendly technology.

BIHIMA – the British and Irish Hearing Instrument Manufacturers Association – has released the latest Q1 2025 data on hearing instrument usage in the UK and the Republic of Ireland (ROI), revealing a positive boost in market sales across the board.

After 2024 ended on a high for recorded unit sales, 2025 has continued the trend with impressive sales across public, private, ROI, and rechargeable product categories. While private sales hit 130,661 – an increase of 7% – the ROI reported a promising 26,830 in sales, up by 15% on the quarter previous.

However, it is public (NHS) sales that have truly flourished; Q1 saw 491,194 hearing instrument sales, a rise of 23% from Q4 2025.

Speaking about the BIHIMA Q1 2025 results, Paul Surridge, BIHIMA chairman, said, “This data marks a promising moment for the industry, suggesting a much-needed shift in demand, which could be attributed to public awareness, clinical access, and the destigmatization of hearing loss. The surge in public sales indicates that more people are not only recognizing their hearing health needs but also trusting the system to deliver. It’s an achievement that reflects progress in both technology and societal attitudes.

“As we witness sustained growth across all sectors, the real question becomes: how do we ensure this momentum translates into long-term hearing health equity? Access, innovation, and awareness must go hand in hand; every hearing instrument fitted isn’t just a product sold, it’s a life reconnected.”

The data also reports a sharp rise in overall rechargeable hearing instrument sales. Across all sectors, rechargeable products rose to 152,180 – up by 18% compared to the previous quarter.

“We hope that the rise in rechargeable hearing instruments is more than a trend and reflects how sustainability, convenience, and user experience are becoming integral to hearing care. People want solutions that fit seamlessly into their lives, and this growth shows the industry is listening. It also signals a welcome move towards greener practices, setting the groundwork for future innovation that prioritizes both people and the planet,”added Paul.

Download the full Q1 report here

As a voice for hearing technology, BIHIMA regularly monitors the market and releases the results of its members every quarter. 

For more information about BIHIMA, visit https://www.bihima.com.

Key Takeaways:

1. New branding and format: The event’s former “Future Friday” will now be called Sound of Future, featuring short, trend-focused presentations in a redesigned EUHA Live Area.
2. Expanded accessibility and engagement: Talks will occur in the center of the exhibition hall with headphone-based audio and live translation, making it easier for attendees and exhibitors to participate.
3. Keynote highlights: Futurologists Tristan Horx and Anja Kirig will deliver back-to-back keynote speeches on the future of work and preventive health in hearing acoustics on Sound of Future day, October 24.

The future focus of the EUHA Congress is getting a new name: Sound of Future. The organizers, the European Union of Hearing Aid Acousticians (EUHA), and the Federal Association of the Hearing Aid Industry (BVHI) have set themselves the goal of constantly integrating new, modern formats into the event in order to increase its appeal.

“The look of the event has been revamped, the new EUHA Live Area has been created as a networking and stage platform, and topics such as best practices in the hearing care industry have been included in the program of the EUHA Live Area,” says Tobias Bartels, managing director of EUHA e.V. “We want to offer hearing care professionals an attractive package.” 

Adds Dr Stefan Zimmer, managing director and chairman of the BVHI, “It is important to us that more visitors from hearing care businesses take part in the industry event.” 

When the EUHA Congress takes place October 22-24, 2025 at the Nuremberg Exhibition Centre, top experts will present the future trends in the industry. Beginning Thursday October 23, 2025, the short presentations on the topics of the future will start in the EUHA Live Area in Hall 7. Friday October 24 will be the Sound of Future day.

The highlight of this part of the event is expected to be the two keynote speeches by futurologists Tristan Horx and Anja Kirig. Horx will speak Friday October 24 at 12:30 on the topic of “How we will work in the future – attracting and retaining young talent with future skills” and Kirig in her keynote speech directly following will address the topic of “Health as a resource: the future of prevention in hearing acoustics.”

For the first time, the presentations will take place on the stage of the EUHA Live Area in the center of the industry exhibition. This will enable visitors and exhibitors to take part in the program without having to travel long distances. The presentations in the EUHA Live Area will take place on all three days of the event with a silent system via headphones.

Simultaneous translation from German to English and English to German will be provided. The presentations in the EUHA Live Area are a supplement to the Scientific Lecture Program, which will take place in NCC East.

The stage program of the EUHA Live Area and the scientific lecture program will be published soon at euha.org/en.

Key Takeaways:

1. Over 70 Oticon team members joined the 5K event in person and virtually to raise funds and awareness for veterans in need.
2. Oticon hosted an educational booth at the event and emphasized its ongoing collaboration with federal agencies to support veterans with hearing loss.
3. The company continues to provide advanced hearing solutions and specialized training to enhance care within the Veterans Health Administration.

Employees from Oticon and Demant once again joined forces with the Oticon Government Services team to participate in Community Hope’s Flag Day 5K Run/Walk in Lyons, NJ, on June 12, 2025. This marks the team’s seventh year supporting the annual event, which raises funds and awareness for military veterans in need.

Team Oticon was represented by over 70 participants at this year’s Flag Day 5K event, both in person at the Lyons VA Medical Center in New Jersey and virtually from across the country.  On site, the team hosted an informational booth featuring educational materials and resources for event participants. 

“Oticon Government Services is honored to continue our partnership with Community Hope in this vital fundraising event that aids veterans and families in overcoming homelessness,” said Sarah Draplin, AuD, CCC-A, F-AAA, senior manager, Training and Education, Oticon Government Services. “Our dedicated team collaborates daily with the U.S. Department of Veterans Affairs, the Department of Defense, and other federal agencies to deliver innovative technology that significantly benefits veterans with hearing loss. The Flag Day celebration is a wonderful opportunity for us to show our gratitude and admiration for the brave men and women who have served our country.”

Oticon is a recognized provider of high-quality hearing solutions to the Veterans Health Administration. Throughout the year, Oticon Government Services offers in-depth learning opportunities and practical training designed to support VA audiologists and technicians in delivering exceptional care and outcomes for their patients.

To watch a video recap of the event, visit oticon.com/solutions/for-veterans#givesback.

By Robert M. DiSogra, AuD

It has been five years since the COVID-19 pandemic started in the United States. Each of us has dealt with the impact of COVID-19 personally and professionally. In 2019, there were many unknowns about the virus’s effect on the many parts of the auditory system: hearing, tinnitus, balance, auditory processing, and cognition. Although it was tempting to make early declarations regarding the impact of COVID-19 on these areas, the aggregated peer-reviewed literature points to a more realistic picture.

Introduction

As of June 17, 2025, the National Library of Medicine (NLM), a division of the National Center for Biotechnology Information (NCBI), part of the National Institutes of Health (NIH), PubMed website had documented 61,991 peer reviewed books, documents, clinical trials, meta-analyses, randomized controlled trials, and reviews (including systematic review) on the topic of COVID-19.

Also, as of June 17, 2025, the NIH’s website identifying ongoing clinical trials (www.clinicaltrials.gov), listed only three ongoing studies using the following parameters: COVID-19, Corona virus, Recruiting studies, Phase (Early Phase, Phases 1, 2, 3), and Interventional studies. These studies were taking place in the USA and India.

The American Academy of Audiology lists 239 articles when you Search “COVID-19.” 

This manuscript will summarize what we, as a profession, have learned about COVID-19 and its impact on the auditory system: hearing, balance, auditory processing, and cognition. Details can be found in the referenced literature.

Main Sources for Current COVID-19 Information (2025)

1. World Health Organization (WHO): (www.who.net)

2. Centers for Disease Control and Prevention (CDC): www.cdc.gov

3. Food and Drug Administration (FDA): www.fda.gov; Search COVID-19

4. Peer-reviewed COVID research from 2019: www.pubmed.ncbi.nlm.nih.gov

COVID-19 Vaccine Information (2025)

U.S. Department of Health and Human Services (HHS): www.hhs.gov

Centers for Disease Control and Prevention: www.vaccines.gov

To report a vaccine adverse reaction: Vaccine Adverse Event Reporting System (VAERS): https://vaers.hhs.gov

COVID-19 Dietary Supplements

There are no over-the-counter (OTC) dietary supplements for COVID-19 approved by the U.S. Food and Drug Administration (FDA). However, if an adverse reaction occurs from any dietary supplement, it should be reported to the FDA’s VAERS program (https://vaers.hhs.gov). NOTE: VAERS is a voluntary reporting program.

COVID-19 

As of 1/23/2025, there were three pharmaceuticals that were FDA approved or authorized drugs to reduce the risk of hospitalization or death for patients with mild to moderate COVID-19: Paxlovid (nirmatrelvir and ritonavir), Veklury (remdesivir), Lagevrio (molnupiravir), and Pemgarda. Lagevrioand Pemgarda have been authorized under Emergency Use Authorization (EUA). Additional information about EUA can be found on the FDA’s website (search Emergency Use Authorization).

Auditory-Related Vaccine Side Effects (2024)

Vaccine adverse effects are published monthly by the National Vaccine Information Center(www.medalerts.org). Table 1 shows the auditory-related adverse events from FDA-approved vaccines and Table 1a lists the top 10 adverse reactions as reported in December 2024.

Table 1: Auditory-Vestibular-Cognitive Related Vaccine Side Effects

n = 2,652,032 (as of 12/27/2024)

Symptom¹                                                   n           Percentage (rounded)       

Auditory Disorder (unspecified)                                   225                           0.0085

Auditory Hallucination (not specified)                         283                           0.0107

Auditory Nerve Disorder                                                 21                           0.0008

Auditory Neuropathy Spectrum Disorder                         1                           0.00004

Brain Fog                                                                    1,071                           0.0404

Central Auditory Processing Disorder                              2                           0.00008           

Cognitive Disorder                                                     2,475                           0.0933

Cognitive Linguistic Impairment                                    10                           1.0194

Sudden Sensorineural HL                                           2,077                           0.0783

Deafness² – total                                                          3,639                           0.1372

Bilateral                                                             346                           0.0130

Conductive                                                           23                           0.0009

Congenital                                                             3                           0.0001

Mixed                                                                     6                           0.0002

Neonatal                                                                2                           0.00008

Neurosensory                                                     681                           0.0258

Permanent                                                           24                           0.0009

Transitory³                                                         114                           0.0043

Traumatic                                                              7                           0.0003

Unilateral                                                       2,433                           0.0917

Dizziness – total                                                      128,201                           4.8341

     Exertional                                                                 189                           0.0071

     Postural                                                                 2,142                           0.0808

     Persistent postural perceptual                                    59                           0.0022

     Procedural                                                                  10                           0.0004

Hearing Disability                                                           39                           0.0015

Otitis Media (includes acute,                                         245                           0.0092

     allergic, bacterial, chronic

     and viral)

Tinnitus⁴                                                                    26,063                          0.9827

Vertigo – total                                                             17,424                          0.6570

     CNS Origin                                                                  15                          0.0005

     Cervicogenic                                                                  1                          0.00004

     Labyrinthine                                                                21                          0.0008

     Phobic postural                                                           17                          0.0006             

     Positional                                                                   810                          0.0305

     Vertigo                                                                  16,560                          0.6242

Vascular Cognitive Impairment                                         2                          0.00008

1. No formal language requirement exists when reporting auditory impairments (including balance, tinnitus and cognitive disorders

2. It appears that the terms “hearing disability, “deafness,” “conductive deafness” are being used interchangeably with sensorineural (neurosensory) or mixed hearing loss. These were the terms used by those reporting to the VAERS

3. Duration not specified

4. Duration, uni-/bilateral, continuous or pulsatile or description not specified

_____________________________________________________________________________

Table 1. The number of auditory-related adverse events from FDA approved vaccines that were voluntarily reported to the Vaccine Adverse Event Reporting System as of 12/27/2024.

Table 1a: Top 10 Vaccine Reactions for December 2024

Reaction                                                         Reports                                                                      

Dizziness                                         126,201

Tinnitus                                             26,063

Vertigo                                              17,424

Deafness                                             3,639

Cognitive Disorder                                2,475

Sensorineural HL                                 2,077

Brain Fog                                            1,071 

Auditory Hallucinations*                         283

Otitis Media                                            245

Auditory Disorder*                                  225

*unspecified                                     

__________________________________________________________________

Table 1a. The top 10 adverse reactions as reported in December 2024 from the National Vaccine Information Center. See Table 1 for details.

What Is Known About the Impact of COVID-19 on Hearing, Balance, and Cognition

The following is a summary of information that the PubMed website identified when the specific search term was used.

Cerumen

There has been evidence of the COVID-19 virus in cerumen (Hanege, 2021; Celik, 2021). It is recommended that there be an increase in the use of personal protective equipment (PPE); cerumen disposal does not have to be handled any differently, as long as one is following Universal Precautions per the CDC (DiSogra, 2021).

CPT Code 99072 can be used for billing for the time spent pre-screening patients before the visit; time spent checking patients for symptoms onsite; PPE for the patient, clinician, and staff; and for cleaning supplies needed for disinfecting equipment and rooms after each encounter. Unfortunately, there is no guarantee of payment depending on the insurance coverage the patient has.

Middle Ear Pathology

The coronavirus can colonize in the middle ear and mastoid region. The resulting otitis media should be referred to an ENT specialist for intervention (Frazier, 2020). 

Cochlear Hearing Loss

Because the virus is systemic, you can expect bilateral sensorineural hearing loss. Satar (2020) found that COVID-19-associated hearing loss occurs within one month of the diagnosis. 

Cochlear Hearing Loss – Subjective Testing

COVID-19-associated sensorineural hearing loss (SNHL) is usually high frequency ( >4kHz) and often above 8kHz) (Jafari, 2020). Hearing thresholds can recover to pre-COVID levels, but not in all cases (Mustafa, 2020).

Cochlear Hearing Loss – Objective Testing

1. Distortion Product Otoacoustic Emission (DPOAE) Testing

DPOAE parameters are no different for the COVID patient than for any other patient complaining of hearing loss. Loss of outer hair cells can be identified with this test procedure. Interpretation is the same. A baseline test including all available frequencies above 2000Hz should be established to monitor stability, recovery, or progression of the loss.

• Auditory Brainstem Response Test (ABR)

Early on in the COVID-19 pandemic, neuroauditory problems could not be ruled out as having been caused by the virus (Sriwijitalai and Wiwanitkit, 2020). Therefore, the ABR is an excellent procedure to support the DPOAE test with either the presence or absence of a Wave I. If subsequent waves are absent or the morphology of the response is poor, then the Middle Latency Test (MLR) becomes the test of choice for looking at other areas of the auditorypathway.

• Middle Latency Response Test (MLR)

The MLR test visualizes the electrical activity of the primary auditory cortex, the auditory thalamus-cortical pathways, and the temporal processing of linguistic information (Frizzo,2015). A latency shift and abnormal morphology raises suspicions that the virus has affected cells in the brainstem.

NOTE: an abnormal ABR (Waves II – V) and/or MLR (delayed Na wave or smaller Pa wave amplitude) could occur in the presence of a normal pure tone audiogram.

Sudden Sensorineural Hearing Loss (SSNHL)

SSNHL has been reported after a COVID vaccination, but the incidence has not been shown to be greater than pre-COVID-19 with the general population (Formeister, 2022).

Word Recognition Scores

There has been no research specifically looking at changes in word recognition scores (WRS) with COVID-19 patients (Mikhail and Perez, 2024). Therefore, WRS remains a dubious test at best, but does appear to be essential as expected based on the degree of SNHL.

Tinnitus

According to the American Tinnitus Association (2020), pre-existing behavioral conditions could contribute to COVID-19-related tinnitus. These include stress, depression, social isolation, infection, and avoidance. Also, current medication side effects must be considered as possible causes (DiSogra, 2021). Therefore, tinnitus remains a case-by-case situation based on the patient’s medical history, comorbidities, and/or medication use. No changes have been suggested in the current tinnitus assessment or management protocols for patients with COVID-19.

NOTE: Additional information about a patient’s medications and known side effects can be obtained from four reliable sources: the patient’s pharmacist, the drug’s manufacturer, and two online websites: www.rxlist.com and www.drugs.com (not an endorsement by the author or publisher).

Vestibular Assessment

Vestibular complaints can be evaluated and managed using recognized balance assessment tests that would be used for a non-COVID patient. There are no changes in management strategies either. 

In an unpublished data review (n = 250 adults), the most sensitive tests were Bithermal Calorics and the High Frequency Head Shake Test (McClung, 2024). The most common diagnoses in this group were benign paroxysmal positional vertigo (BPPV), labyrinthitis, and vestibular neuronitis. Meniere’s disease has also been reported in COVID-19 patients (Jafari, 2022). Recovery from this condition is similar to that for vestibular pathologies; however, symptoms may persist for more than 70% of the population up to a month post-diagnosis (Aedo-Sanchez (2023).

Vestibular Rehabilitation

McClung (2024) reports that a “small percentage” of COVID-19 patients are referred to physical therapy for a fall-risk assessment and rehabilitation. Others are given a home-based vestibular rehabilitation therapy (VRT) program for one month. McClung reports a 90% success rate with VRT.

Long COVID 

Long COVID (the most often used term in the literature) is defined as short- and long-term health effects associated with COVID-19 with symptoms that can last for weeks or months after recovery (CDC, 2024). These symptoms include “brain fog,” cognitive issues, and memory loss (Wu, 2022). The Wu study followed 8,000 adults and found 23% still had COVID symptoms at 12 weeks post-diagnosis. 

The American Academy of Physical Medicine and Rehabilitation estimated 1 in 5 COVID-19 survivors will experience Long COVID (AAPM&R, 2024). The National Center for Health Statistics put the number at 17% (NCHS, 2024).

The average age for experiencing Long COVID (n = 27,651) for adults is between 35 and 64 years, with women more at risk than men (8.5% and 5.2%, respectively) (Adjaye-Gbewonyo, 2023). In children, the numbers were less (1.3% n = 7,463). Hispanic children were at 1.9% compared to Asian and Black children (0.2% and 0.6%, respectively)

In a study following 1,502 pregnant women, it was estimated that 10% who had COVID-19 while pregnant will develop Long COVID (Robertson, 2024).

Brain Fog

Brain fog is a non-medical term that has found its way into the professional literature when describing a patient with the following symptoms: reduced mental acuity, reduced cognition, inability to concentrate, inability to multi-task, and loss of short- and long-term memory. 

Also, when looking at these behaviors in detail, we see a very similar pattern of behavior consistent with an auditory processing disorder (APD): delays before responding, asking people to repeat what they’ve said, mishearing spoken questions, saying “Huh?” or “What?” or “What did you say?” and becoming easily fatigued while listening (DiSogra, 2022).

Brain Shrinkage, APD, and Brain Fog

In 2021, a significant observation was made by researchers at England’s Biobank Research Center. A group of patients (n = 394) who were identified as having a normal MRI study pre-pandemic were later diagnosed with COVID-19 (with hospitalization for high fever and a course of intervention that included oxygen therapy). 

Patients needing oxygen therapy had reduced gray matter volume in the frontal lobe. Patients who experienced fever also had reduced gray matter volume in the temporal lobe. (Duoaud, 2021)

A repeat MRI showed several areas of the brain that play a role in auditory processing had shrunk in some patients after being diagnosed with COVID-19. (See Table 2).

Table 2:

Anatomical Structure                            Role in Auditory Processing                  

Cingulate Cortex                                        Dichotic Listening, Attentional Focus, Working Memory

Amygdala                                                  Rhythm/Music, Startle Response

Hippocampus and Limbic/Cortical Area                     Informational Processing

__________________________________________________________________

Table 2. Neural structures that were found to be smaller post-pandemic based on two MRI studies

Other structures that are involved with auditory processing that were not looked at specifically (and are in close proximity to the structures that appear in Table 2) are listed in Table 3.

Table 3:

Anatomical Structure                            Role in Auditory Processing                  

Corpus Callosum                                        Dichotic listening, Localization

Insula                                                        Dichotic listening, Rhythm/Music, Speech in Noise

Brainstem Nuclei                                        Localization

Planum Temporale                                     Sound Decoding

Heschl’s Gyrus                                           Audition, Auditory Processing

Table 3. Other neural structures that could affect auditory processing not measured in the Duoaud study (2022).

Auditory Processing

The Duoaud study shed new light on why “brain fog” exists. A case study was published in 2023 (Alexander, 2023) that successfully demonstrated that the traditional auditory processing test battery known as the “Buffalo Battery” (Katz, 2007) is an excellent measure for a post-COVID adult patient whose symptoms align with a diagnosis of “brain fog.”

The recommended rehabilitation was followed for three months. Repeat testing (including a post-therapy Hearing Handicap Inventory for Adults – HHIA) showed scores in the normal range for all subtests and a “No handicap” rating on the HHIA.

A new screening battery has since been proposed from the University of Pittsburgh that includes the following tests: Words-In-Noise (WIN), Random Dichotic Digits Task (RDDT), and the Quick Speech in Noise (QuickSIN) tests (Cancel, 2023).

COVID-19 Additional Tests

Knowing that brain shrinkage is a concern that could be causing “brain fog,” the Middle Latency Response Test (see Cochlear Hearing Loss – Objective Testing “C”) in addition to the Time Compressed Sentences test (Dias, 2018) would be able to objectively and subjectively identify any conduction defect along the auditory pathway. Although the rehabilitation plan is individualized based on APD test results, the findings solidify the APD diagnosis (DiSogra, 2024, Alexander, 2023).

Cognitive Impairment

A cognitive impairment can be defined as having one or more deficits in global cognition, working memory, executive function, verbal fluency, verbal learning, and memory (Miskowiak, 2023).

Cognitive problems occurin 1 of 5 COVID patients with symptoms lasting more than three months (sometimes referred to as “long-haulers”). Cognitive problems may resolve over 18-24 months. COVID-19 is also capable of eliciting “persistent measurable neurocognitive alterations” especially in the areas of attention and working memory (Lauria, 2023).

COVID-19 cognitive impairment prognosis: 70% recover by 9 months; 30% may not ever recover (Gupta, 2021).

Cognitive Screening

Cognitive complaints associated with “brain fog” can be screened via cognitive screening tests by audiologists. Beck (2024) reports that when an audiologist performs a cognitive screening, the result helps determine whether the patient’s communication problem is primarily an audiologic issue, or whether a medical referral (based on a positive cognitive screening) is the more prudent recommendation.

According to the American Academy of Audiology Scope of Practice, Principle 2, Rule 2b (American Academy of Audiology, 2024), “Individuals shall use available resources, including referrals to other specialists…”

Pharmaceutical Management for Cognitive Impairments

There are no FDA-approved pharmaceuticals or dietary supplements for cognitive impairments (Mayo Clinic, 2021).

Diagnosis Codes for Billing

The following ICD-10 Codes can be used for billing. However, payment is not guaranteed by the carrier unless the testing is a covered service.

G31.84: Mild Cognitive Impairment

H93.25: (Central) Auditory Processing Disorder

R41.9: Unspecified symptoms involving cognitive functions and awareness (i.e., “Brain Fog”)

U09.9: Post-COVID-19 condition, unspecified

Summary

For patients who have contracted COVID-19, viral hearing losses (usually high frequency and bilateral) can be confined to the cochlea and auditory pathways, although sometimes middle ear pathology may be present.

Vaccine-related auditory/vestibular/cognitive impairments can occur. However, the incidence is very low. Despite this low incidence, the data serves as an excellent counseling tool for both short- and long-term management.

There is objective, clinical evidence that the virus affects the size of several brain structures along the auditory pathway (including brainstem and cortical regions) from pre-COVID normal MRI findings and post-COVID abnormal MRI findings on the same patients. “Shrinkage” sheds light on the inaccurate use of the term “brain fog” when the behaviors associated with this subjective, non-medical term fall in direct line with the behaviors associated with an auditory processing disorder.

Objective test results (DPOAE, ABR, and MLR) in conjunction with an APD battery of tests will support the diagnosis of an auditory processing disorder/mild cognitive impairment (or as it is sometimes referred to, ‘brain fog’). 

Acknowledgements

Special thanks to the following audiologists who contributed information for this manuscript: Angela Loucks-Alexander, AuD, Auditory Processing Institute, Queensland, Australia; Samuael Atcherson, PhD, University of Arkansas Medical School; Douglas L. Beck, AuD, audiology consultant, San Antonio, TX. Bobby McClung, Valleydale Hearing and Balance Center, Birmingham, AL.

Robert M. DiSogra, AuD, is an audiology consultant in Millstone, NJ. He is a board member of The Audiology Project, a non-profit organization that promotes audiology-based diagnosis and treatment for patients with diabetes or other chronic illness (www.theaudiologyproject.com). He was the 2020 recipient of the Clinical Excellence in Audiology Award from the American Academy of Audiology. 

References

Adjaye-Gbewonyo D, et al. (2023) Long COVID in adults: United States, 2022. National Center for Health Statistics (NCHS) Data Brief, No. 480

Aedo-Sánchez C, Gutiérrez G, Aguilar-Vidal E. (2023). COVID-19 and vestibular symptoms and assessment: a review. Audiol Neurotol 1–7

Alexander, AL, DiSogra RM, Abbas F, Braund S. Spoles C. (2023). Case study: COVID-19 brain fog or auditory processing disorder. Hear J, 76(4), April

American Academy of Audiology. (2025). COVID-19. (www.audiology.org). Accessed online 1/23/2025

American Academy of Audiology (2024). Scope of practice (www.audiology .org). Search Scope of Practice and clink on Access PDF or https://www.audiology.org/wp-content/uploads/2023/04/Scope-of-Practice_2023.pdf

American Academy of Physical Medicine and Rehabilitation. (2024). Long COVID. Accessed online 1/23/2025

American Tinnitus Association (2020). Tinnitus. Winter edition

Beck, D (2024). Cognition, audition, & repeated cognitive screenings, Hearing Review, May. https://hearingreview.com/hearing-loss/patient-care/evaluation/cognition-audition-repeated-cognitive-screenings. Accessed online 1/25/2025

Cancel VE, et al. (2023). A data-driven approach to identify a rapid screener for auditory processing disorder testing referrals in adults. Sci Rep. 2023 Aug 21;13(1):13636

Cancel VE, McHaney JR, Milne V, Palmer C, Parthasarathy A. (2023). A data-driven approach to identify a rapid screener for auditory processing disorder testing referrals in adults. Sci Rep. Aug 21;13(1):13636

Celik S, Kalcioglu MT, Esen F, Hanege FM, Cag Y, Kocoglu E. (2021). SARS-CoV-2 presence in cerumen. Ear Nose Throat J. Apr;100(2_suppl):158S-159S

Centers for Disease Control and Prevention (CDC). (2024). Long COVID. (www.cdc.gov) 

Dias JW, McClaskey CM, Harris KC. (2019) Time-compressed speech identification is predicted by auditory neural processing, perceptuomotor speed, and executive functioning in younger and older listeners. J Assoc Res Otolaryngol. Feb;20(1):73-88

DiSogra RM. (2021).  COVID-19 and its impact on the auditory and vestibular systems Audiol Today;July. OnLine Feature Article (www.audiology.org)

DiSogra RM. (2021) COVID-19 survey: disposing of cerumen from patients with a positive history of COVID-19. Audiol Today. Available online www.audiology.org/practice-resources/covid-19-resources

DiSogra RM. (2022). Are COVID-19 “brain fog” symptoms and an auditory processing disorder related? Hear Rev, 29(3) March 

DiSogra RM. (2024). COVID-19’s impact on hearing, balance, auditory processing and cognition. Paper presented at the Alabama Acad Audiol annual meeting, September

Douaud G, Lee S, Alfaro-Almagro F, Arthofer C, Wang C, McCarthy P, Lange F, Andersson JLR, Griffanti L, Duff E, Jbabdi S, Taschler B, Keating P, Winkler AM, Collins R, Matthews PM, Allen N, Miller KL, Nichols TE, Smith SM. (2022). SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature 604, pp. 697–707 (https://doi.org/10.1038/s41586-022-04569-5)

Food and Drug Administration (2025). Emergency Use Authorization. (www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization). Accessed online 1/23/2025

Food and Drug Administration. (2025). Coronavirus – COVID-19. (www.fda.gov/drugs/emergency-preparedness-drugs/coronavirus-covid-19-drugs). Accessed online 1/23/2025

Formeister EJ, Wu MJ, Chari DA, Meek R 3rd, Rauch SD, Remenschneider AK, Quesnel AM, de Venecia R, Lee DJ, Chien W, Stewart CM, Galaiya D, Kozin ED, Sun DQ. (2022). Assessment of Sudden sensorineural hearing loss after COVID-19 vaccination. JAMA Otolaryngol Head Neck Surg. Apr 1;148(4):307-315

Frazier KM, Hooper JE, Mostafa HH, Stewart CM. (2020) SARS-CoV-2 virus isolated from the mastoid and middle ear: implications for COVID-19 precautions during ear surgery. JAMA Otolaryngol Head Neck Surg. 146(10):964–966

Frizzo, ACF. (2015). Auditory evoked potential: a proposal for further evaluation in children with learning disabilities. Front. Psychol., 10 June

Gupta S. (2021) Experts: up to one-third of Covid-19 cases become ‘long Covid’. CNN.  Broadcast date: August 13. www.cnn.com/2021/08/15/health/long-haulers-covid-19-year-mystery/index.html

Hanege FM, Kocoglu E, Kalcioglu MT, Celik S, Cag Y, Esen F, Bayindir E, Pence S, Alp Mese E, Agalar C. (2021). SARS-CoV-2 presence in the saliva, tears, and cerumen of COVID-19 patients. Laryngoscope. May;131(5): E1677-E1682

Jafari Z, Kolb BE, Mohajerani MH. (2022). Hearing loss, tinnitus, and dizziness in COVID-19: a systematic review and meta-analysis. Canadian J Neuro Sci, 49(2), 184-195

Katz J. (2007). APD evaluation to therapy: the Buffalo model. Audiol Online, May. (www.audiologyonline.com)

Lauria A, Carfì A, Benvenuto F, Bramato G, Ciciarello F, Rocchi S, Rota E, Salerno A, Stella L, Tritto M, Di Paola A, Pais C, Tosato M, Janiri D, Sani G, Lo Monaco R, Pagano FC, Fantoni M, Bernabei R, Landi F, Bizzarro A, Gemelli Against COVID-19 Post-acute Care Group. (2023). Neuropsychological measures of post-COVID-19 cognitive status. Front Psychol. Jul 10;14:1136667

Mayo Clinic. (2021) Mild cognitive impairment. www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/diagnosis-treatment/drc-20354583

McClung B. (2024). COVID vestibular findings in a private practice. Unpublished research. Personal communication

Mikhail J, Paez A. (2024). COVID-19’s effect on pre-existing hearing loss. Hear Rev; 31(4):20-23

Miskowiak KW, Pedersen JK, Gunnarsson DV, Roikjer TK, Podlekareva D, Hansen H, Dall CH, Johnsen S. (2023). Cognitive impairments among patients in a long-COVID clinic: prevalence, pattern and relation to illness severity, work function and quality of life. J Affect Disord, Mar 1;324:162-169

Mustafa MWM. (2020). Audiological profile of asymptomatic Covid-19 PCR-positive cases. Am J Otolaryngol. May-Jun;41(3)

National Center for Health Statistics. (2024) U.S. Census Bureau, Household Pulse Survey, 2022–2024. Long COVID. (www.cdc.gov/nchs/covid19/pulse/long-covid.htm)

National Institutes of Health (NIH) (2025). Clinical Trials. https://clinicaltrials.gov. Accessed online 1/23/2025

National Institutes of Health (NIH), National Library of Medicine (NLM), National Center for Biotechnology Information (NCBI), PubMed. (2025). https://pubmed.ncbi.nlm.nih.gov. Accessed online 1/23/2025

Robertson R. (2024). One in 10 people with COVID during pregnancy will develop long COVID. MedPage, Feb 13. www.medpagetoday.com

Satar B. (2020). Criteria for establishing an association between Covid-19 and hearing loss. Am J Otolaryngol. Nov-Dec;41(6)

Sriwijitalai W. & Wiwanitkit V. (2020) Hearing loss and COVID-19: A note. Amer J Otolaryngol, 41(3)

US Department of Health and Human Services. (2025), Vaccine Adverse Event Reporting System, (VAERS). https://vaers.hhs.gov

Vaccine Information Center (2024). (www.medalerts.org). Accessed online 1/23/2025

Wu Q, Ailshire JA, Crimmins EM. (2022) Long COVID and symptom trajectory in a representative sample of Americans in the first year of the pandemic. Sci Rep 12. Accessed online 1/23/2025

Key Takeaways:

1. Career Spotlight: IHS aims to spotlight the hearing aid specialist profession, which is in high demand and has been ranked a top job, especially for those seeking a healthcare career without a traditional college degree.
2. Hands-on Engagement: At the HOSA conference, IHS offered interactive experiences like otoscopy demos and earmold impressions to inspire future healthcare professionals.
3. Urgent Need: With hearing loss expected to affect over 700 million people by 2050, IHS is working to expand the workforce by recruiting and training more specialists.

The International Hearing Society (IHS) kicked off its “Help Hearing” campaign while serving as one of 171 exhibitors at the Health Occupations Students of America’s (HOSA’s) International Leadership Conference in Nashville, Tennessee, from June 18-20, 2025. “Help Hearing” is designed to grow awareness of the hearing aid specialist profession, which has been noted as a Top Job by U.S. News and World Report. 

The HOSA conference attracted more than 14,000 attendees, including teachers and students who are aspiring healthcare professionals. Students engaged in learning and competitions in a bustling expo hall where IHS provided an interactive exhibit experience that included live video otoscopy demonstrations and earmold impression making. Of particular note, Hearing Aid Specialist Blake Cordell, MBA, BC-HIS, and IHS Executive Director Alissa Parady, CAE, delivered a presentation about the hearing aid specialist profession. 

Why should someone consider this career? Parady said, “The opportunities are vast; the demand for professionals is high, and it’s a great option for anyone who wants a meaningful healthcare career without the long college path.” The hearing aid specialist profession has made several U.S. News & World Report Top Jobs lists, including being the number one job without a college degree in 2024. 

While there are over 10,000 hearing aid specialists practicing worldwide, more than 500 million people are expected to have hearing loss requiring rehabilitation by 2030, with those numbers expected to increase to 711 million by 20502. IThrough the “Help Hearing” campaign, IHS is working to increase the accessibility of professionals available for those experiencing hearing loss by growing the pipeline of trainees.

IHS is encouraging aspiring healthcare professionals or those looking for a career change to explore the meaningful work of hearing aid specialists. Their message is that helping people stay connected to their family, friends, and the world around them will not only change patients’ lives, but the lives of hearing aid specialists as well.

For more information about the International Hearing Society, visit IHSinfo.org.  

Featured image: IHS member Blake Cordell, MBA, BC-HIS, demonstrated video otoscopy at the 2025 HOSA Conference in Nashville. Photo: IHS

Key Takeaways:

1. Explainable AI Required: The AMA mandates that clinical AI tools must provide accessible, understandable explanations for their outputs to support physician interpretation and patient care.
2. Independent Oversight: The policy calls for third-party validation—rather than relying on developers—to assess whether AI tools meet explainability standards.
3. Transparency Over IP Claims: While intellectual property should be protected, it must not override patients’ rights to transparency and physicians’ ability to critically assess AI-driven decisions.

As augmented intelligence tools continue to emerge in medical care, the American Medical Association (AMA) adopted policy during the Annual Meeting of its House of Delegates aimed at maximizing trust in and increasing transparency around how these tools arrive at their conclusions. Specifically, the new policy calls for explainable clinical AI tools that include safety and efficacy data. To be considered explainable, these tools should provide explanations behind their outputs that physicians, and other qualified humans, can access to interpret and act on when deciding on the best possible care for their patients.

Furthering the AMA’s support for more oversight and regulation of augmented intelligence (AI) and machine learning (ML) algorithms used in clinical settings, the new policy calls for requiring an independent third party, such as regulatory agencies or medical societies, to determine whether an algorithm is explainable, rather than relying on claims made by its developer. The policy states that explainability should not be used as a substitute for other means of establishing safety and efficacy of AI tools, such as randomized clinical trials. Additionally, the new policy calls on AMA to collaborate with experts and interested parties to develop and disseminate a list of definitions for key concepts related to medical AI and its oversight.

“With the proliferation of augmented intelligence tools in clinical care, we must push for greater transparency and oversight so physicians can feel more confident that the clinical tools they use are safe, based on sound science, and can be discussed appropriately with their patients when making shared decisions about their health care,” says AMA Board Member Alexander Ding, MD, MS, MBA. “The need for explainable AI tools in medicine is clear, as these decisions can have life or death consequences. The AMA will continue to identify opportunities where the physician voice can be used to encourage the development of safe, responsible, and impactful tools used in patient care.”

The AMA Council on Science and Public Health report that served as the basis for this policy noted that when clinical AI algorithms are not explainable, the clinician’s training and expertise is removed from decision-making, and they are presented with information they may feel compelled to act upon without knowing where it came from or being able to assess accuracy of the conclusion. The report also noted that intellectual property concerns, when provided as a rationale for not explaining how an AI device created its output, should not nullify a patient’s right to transparency and autonomy in making medical decisions. To this end, the new policy states that while intellectual property should be afforded a certain level of protection, concerns of infringement should not outweigh the need for explainability for AI with medical applications.

For more information about the AMA, visit ama-assn.org.