Idiopathic sudden sensorineural hearing loss (iSSNHL) and acute acoustic trauma (AT) are commonly treated with corticosteroids, although evidence for optimal treatment strategies remains limited. Pioglitazone, a peroxisome proliferator-activated receptor-γ agonist with anti-inflammatory and anti-apoptotic properties, has been proposed as a potential adjunctive therapy. In this prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial conducted across five countries, 128 adults with severe to profound unilateral iSSNHL or AT were treated within 96 h of symptom onset. Patients received standard corticosteroid therapy combined with intratympanic and/or oral pioglitazone or placebo. Hearing outcomes were assessed using changes in pure-tone audiometry at the most affected frequencies over 12 weeks. All treatment groups showed significant hearing improvement over time; however, no additional benefit of pioglitazone was observed compared with placebo. Overall hearing thresholds improved substantially, while variations in corticosteroid dose and treatment duration did not influence recovery. These findings indicate that pioglitazone does not enhance hearing recovery when added to corticosteroid therapy, and that higher or prolonged corticosteroid dosing offers no measurable advantage. Further randomized controlled studies are warranted to better define effective treatment strategies for these conditions.

Acquired hearing loss is common among adults, with hearing aids being the primary clinical management option. While hearing aids can improve communication and quality of life, many individuals do not use them consistently or at all. This article presents a protocol for an updated systematic review and meta-analysis of interventions aimed at improving or promoting long-term hearing aid use among adults with hearing loss who are fitted with at least one hearing aid. The review is guided by the Behaviour Change Wheel (BCW) and at its centre the COM-B model (Capability, Opportunity, Motivation - Behaviour), which suggests that the interaction of these three components influences behaviour. The BCW provides a comprehensive framework to understand how interventions target behaviour change and the mechanisms through which they operate. The review objective is to assess the effectiveness of interventions that aim to improve or promote hearing aid use among adults with acquired hearing loss who have at least one hearing aid. Understanding which intervention strategies are effective, and which behavioural functions they target, can help shape future research.

Autoimmune inner ear disease (AIED) represents a rare yet potentially reversible cause of sensorineural hearing loss, characterized by immune-mediated damage to cochlear and vestibular structures. Unlike autoimmunity, which is driven by adaptive immune responses and autoantibodies, autoinflammation stems from innate immune system dysregulation, typically involving inflammasome hyperactivation. This review synthesizes recent advancements in biomarkers for the differential diagnosis of AIED, emphasizing their role in distinguishing it from conditions such as Meniere's disease (MD) and chronic otitis media (COM). Autoantibodies and cytokines, including anti-heat shock protein 70 (HSP70), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), antiphospholipid antibodies, anti-type II collagen, selective immunoglobulin A deficiency (sIgAD), and anti-cochlin antibodies, have a significant role in diagnostic sensitivity, specificity, and correlations with treatment responsiveness. Additionally, we discuss the utility of magnetic resonance imaging (MRI) in identifying inner ear enhancements and propose diagnostic algorithms to facilitate early detection. By integrating serological, immunological, and radiological insights, this work underscores the potential of these biomarkers to guide personalized therapeutic strategies, including corticosteroids and biologics, while addressing diagnostic challenges and the need for standardized criteria. Ultimately, enhanced biomarker utilization may improve outcomes in AIED by enabling timely intervention and reducing misdiagnosis.