Impact of Prescribed and Self-Selected Music Interventions on Stress, Sleep, Heart Rate Variability, and Brain Connectivity in Surgeons Using 7-Tesla Functional Magnetic Resonance Imaging and Wearable Actigraphy: Multimodal Feasibility Randomized Controlled Trial

<strong>Background:</strong> Stress, sleep deprivation, and burnout are significant safety risks for acute care surgeons, negatively impacting performance, well-being, and clinical outcomes. <strong>Objective:</strong> This pilot randomized controlled trial aimed to measure neurophysiological effects of prescribed music (PM) and self-selected music (SSM) on surgeon stress, burnout, and neurophysiological responses using a multimodal protocol that integrated functional magnetic resonance imaging (fMRI), wearable biosensor monitoring, and psychological self-assessments. <strong>Methods:</strong> Full-time attending surgeons at a quaternary care hospital were invited to participate in a 3-armed trial (1:1:1 block allocation). Intervention groups were instructed to listen to 30 minutes (minimum 15 minutes) of either PM or SSM daily at bedtime for 6 weeks, reflecting real-world conditions. PM comprised original compositions based on elements promoting perceived relaxation from a prior study. The control arm avoided music in the 30 minutes before bed. Allocation was concealed from the recruiting investigator; the fMRI technicians, the statistician, and lead investigators were blinded until analyses were completed. Functional connectivity patterns were measured using fMRI at baseline and 6 weeks while participants listened to simulated intensive care unit noise, PM, and SSM. Secondary outcomes included continuous actigraphy for sleep quality and self-reported anxiety, sleep quality, and burnout using validated scales (State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and Maslach Burnout Inventory). <strong>Results:</strong> A total of 22 surgeons were assessed; demands of fMRI and data collection schedule led 3 to decline and 2 (allocated to PM) not to finish baseline measures; 6 PM, 5 SSM, and 6 controls received allocated intervention; 2 PM participants were withdrawn for nonadherence and missing follow-up data and 1 control missed follow-up collection due to scheduling (final analysis set after missing data: PM: n=4, SSM: n=5, control: n=5). One control participant experienced transient vertigo in fMRI. Trends in fMRI data indicated that both intervention groups experienced less negative emotional arousal and anxiety, with physical tension reduced in the PM group. The PM group exhibited reduced stress response in the frontal lobes when exposed to intensive care unit alarms, suggesting diminished attentional response to the high-stress auditory environment, compared to control. However, lack of statistical significance and baseline variability entail cautious interpretation. Observations of sleep quality were mixed, and no statistically significant differences in stress surveys were observed. <strong>Conclusions:</strong> Both music interventions trended toward positive changes in neurophysiological responses, suggesting potential benefits in reducing surgeon stress. However, due to the small sample, mixed or nonsignificant results, and the exploratory nature of this study, findings should be considered preliminary. Further research with larger, diverse cohorts is required to confirm trends, refine both the intervention approach and recruitment strategies, and determine whether objective compositional elements or personally selected music drive the mechanisms of potential positive effects. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT05980429; https://clinicaltrials.gov/study/NCT05980429

Effect of low-intensity focused ultrasound on hippocampus of alcohol addicted mice: a preliminary study

Alcohol addiction is a chronic relapsing brain disorder characterized by significant neurobiological changes, particularly within the hippocampus, which mediates emotional regulation and reward-seeking behavior. Previous studies have shown that alcohol-induced neuronal injury contributes to withdrawal-associated anxiety and persistent alcohol preference. This study investigated the therapeutic effects of low-intensity focused ultrasound (LIFU) on the hippocampus in a mouse model of alcohol addiction. Twenty-six male C57BL/6 mice were allocated to an alcohol-exposed group (n = 20) and a control group (n = 6). Following a 28-day modeling period, the alcohol group was randomly subdivided into a therapy group and a sham group. The therapy group received LIFU treatment, while the sham group underwent an identical procedure with the ultrasound transducer powered off. After seven days of treatment, the therapy group exhibited less severe anxiety symptoms upon alcohol withdrawal and a reduced preference for alcohol compared to the sham group. The brain-derived neurotrophic factor (BDNF) concentration was significantly lower in the therapy group than in the sham group, but did not differ significantly from the control group. Hippocampal HE staining revealed more pronounced degeneration and apoptosis of granule cells in the dentate gyrus (DG) region in the sham group relative to the therapy group. These preliminary findings suggest that LIFU may modulate alcohol addiction by mitigating hippocampal neuronal injury.

Anxiety among Chinese primary school teachers under the “double reduction” policy: prevalence and associated factors

ObjectivesThe implementation of the “Double Reduction” Policy in China has raised concerns about increased anxiety levels among primary school teachers. However, the prevalence of anxiety symptoms and the factors associated with them remain unclear. This study aims to investigate the prevalence and correlates of anxiety among primary school teachers under this policy.MethodsA cross-sectional survey was conducted from September to October 2022 among primary school teachers in 15 cities across China. Participants completed a series of questionnaires administered via WeChat to assess anxiety symptoms and potential related factors, including perceived stress, sociodemographic characteristics, and job-related variables. Anxiety and perceived stress were measured using the Generalized Anxiety Disorder-7 (GAD-7) and 10-item Perceived Stress Scale (PSS-10), respectively.ResultsOverall, 44.5% (1,423/3,199) of teachers reported at least mild anxiety symptoms. Among them, 56.43%, 25.30% and 18.27% had mild, moderate, and severe anxiety, respectively. In the final logistic regression model, five variables remained independently associated with anxiety: education level (master’s degree or above: OR = 2.781, 95% CI: 1.858–4.163), income dissatisfaction (OR = 1.487, 95% CI: 1.205–1.834), intermediate professional title (OR = 1.372, 95% CI: 1.084–1.738), younger age (OR = 0.979, 95% CI: 0.966–0.993), and perceived stress (OR = 1.489, 95% CI: 1.443–1.538).ConclusionAnxiety was prevalent among primary school teachers during the implementation of the “Double Reduction” Policy. Higher education level, income dissatisfaction, intermediate professional title, younger age, and elevated perceived stress were significant risk factors for anxiety. Therefore, interventions focusing on stress management and occupational support may help improve teachers’ mental well-being.

Psychometric validation of the revised Chinese version of the Dimensional Anhedonia Rating Scale in psychiatric outpatients

ObjectiveTo refine the Chinese version of the Dimensional Anhedonia Rating Scale (DARS) and evaluate the psychometric properties of the Revised Chinese DARS (RC-DARS) in a large sample of first-visit psychiatric outpatients.MethodsThe study was conducted in two sequential phases at a specialized psychiatric hospital. In Phase I (n = 277), the existing Chinese DARS underwent semantic and cultural refinement in accordance with ISPOR and TRAPD guidelines, incorporating cognitive interviews and back-translation procedures. In Phase II (n = 788), the RC-DARS was administered alongside the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), and the MMPI Suicide Ideation Subscale (MMPI-SI). Exploratory and confirmatory factor analyses were conducted using common-factor extraction and the WLSMV estimator for ordinal indicators. Internal consistency, gender-based measurement invariance, and convergent validity were evaluated.ResultsExploratory analyses supported a four-factor domain structure. Confirmatory factor analysis demonstrated good model fit for the domain-based model (χ²/df = 3.81, CFI = 0.98, TLI = 0.97, RMSEA = 0.08, SRMR = 0.05), with substantially superior fit relative to an alternative reward-processing model. Internal consistency was excellent (Cronbach’s α = 0.95; McDonald’s ω = 0.96). Multi-group analyses supported configural, metric, and scalar invariance across gender (ΔCFI < 0.01). RC-DARS total scores were significantly negatively correlated with depressive symptoms (r = −0.443), anxiety (r = −0.317), sleep disturbance (r = −0.494), and suicide risk (r = −0.312) (all p <.001). Individuals with severe depressive symptoms exhibited significantly lower RC-DARS scores than those below the clinical threshold.ConclusionsThe RC-DARS demonstrates robust psychometric properties in a first-visit outpatient sample. The revision primarily enhances semantic precision and structural differentiation without materially altering score distributions. The scale may serve as a refined instrument for dimensional assessment of anhedonia in similar clinical contexts, pending longitudinal and multi-site validation.

Two faces of police stress: Spanish validation of operational and organizational PSQ scales

IntroductionPolice officers face multiple psychosocial risks stemming from operational and organizational aspects of their work. The Police Stress Questionnaire (PSQ) includes operational (PSQ-Op) and organizational (PSQ-Org) versions to assess these stressors. This study aimed to validate both versions in a sample of Mossos d’Esquadra, examining their factorial structure, reliability, and convergent and discriminant validity.MethodsExploratory and confirmatory factor analyses were conducted to examine the internal structure of the PSQ-Op and PSQ-Org. Internal consistency was evaluated using reliability indices. Convergent and discriminant validity were assessed through correlations with measures of anxiety, depression, and coping strategies.ResultsBoth PSQ-Op and PSQ-Org showed an essentially unidimensional structure, indicating that each scale measures a coherent latent construct. Operational and organizational stress remained distinct domains. Both scales exhibited high reliability and adequate psychometric properties. Subtle gender differences were noted in the perception of specific stressors.DiscussionThese findings support the validity and reliability of the PSQ-Op and PSQ-Org for assessing psychosocial risks among Spanish police officers. The scales can inform interventions targeting workplace stress prevention and the promotion of organizational well-being, emphasizing the need to address operational and organizational stressors separately.

The case for fixing everything

The handsome new book Maintenance: Of Everything, Part One, by the tech industry legend Stewart Brand, promises to be the first in a series offering “a comprehensive overview of the civilizational importance of maintenance.” One of Brand’s several biographers described him as a mainstay of both counterculture and cyberculture, and with Maintenance, Brand wants us to understand that the upkeep and repair of tools and systems has profound impact on daily life. As he puts it, “Taking responsibility for maintaining something—whether a motorcycle, a monument, or our planet—can be a radical act.”

Radical how? This volume doesn’t say. In an outline for the overall work, Brand says his goal is to “end with the nature of maintainers and the honor owed them.”

The idea that maintainers are owed anything, much less honor, might surprise some readers. Actually, maintenance and repair have been hot topics in academia since the mid-2010s. I played some role in that movement as a cofounder of the Maintainers, a global, interdisciplinary network dedicated to the study of maintenance, repair, care, and all the work that goes into keeping the world going.

Brand is right, too, that maintainers haven’t gotten the laurels they deserve. Over the past few decades, scholars have shown that work from oiling tools to replacing worn parts to updating code bases all tends to be lower in status than “innovation.” Maintenance gets neglected in many organizational and social settings. (Just look at some American infrastructure!) And as the right-to-­repair movement has shown, companies in pursuit of greater profits have frequently locked us out of being able to do repairs or greatly reduced the maintainable life of their products. It’s hard to think of any other reason to put a computer in the door of a refrigerator.

Some of Brand’s earlier work helped inspire those insights. But his new book makes me think he doesn’t see things that way. For Brand, maintenance seems to be a solitary act, profound but more about personal success and fulfillment than tending to a shared world or making it better.


Born in 1938, Brand is 87 years old. A sense hangs over the book—with its battles against corrosion, rust, and decay, with its attempts to keep things going even as they inevitably falter—of someone looking over life and pondering its end. Maintenance: Of Everything connects to every stage of Brand’s life. It’s worth reviewing where it falls in that arc. Brand has always been interested in tools and fixing things, but rarely has he focused on the systems that need the most care. 

More than a half-century ago, Brand was a member of the Merry Pranksters, a countercultural, LSD-centered hippie collective famously led by Ken Kesey, the author of One Flew Over the Cuckoo’s Nest. In 1966, Brand co-produced the Trips Festival, where bands like the Grateful Dead and Big Brother and the Holding Company performed for thousands amid psychedelic light shows.

Brand’s Whole Earth Catalog had a vision that might feel progressive, but its libertarian, rugged-individualist philosophy of remaking civilization alone stood in contrast to more collective social change movements.

In some ways, the Trips Festival set a paradigm for the rest of his life’s work. Brand’s biographers have described him as a network celebrity—someone who got ahead by bringing people together, building coalitions of influential figures who could boost his signal. As Kesey put it in 1980, “Stewart recognizes power. And cleaves to it.” 

Brand applied this network logic to the undertaking he will always be best remembered for: the Whole Earth Catalog. First published in 1968 and aimed at hippies and members of the nascent back-to-the-land movement, the publication had the motto “Access to tools.” Its pages were full of Quonset huts, geodesic domes, solar panels, well pumps, water filters, and other technologies for life off the grid. It was a vision that might feel progressive or left-leaning, but the libertarian, rugged-individualist philosophy of eschewing corrupt systems and remaking civilization alone stood in contrast to the more collective movements pushing for deep social change at the time—like civil rights, feminism, and environmentalism.

That vision also led straight to the empowerment that came with new digital tools, and to Silicon Valley. In 1985, Brand published the Whole Earth Software Catalog, the last of the series, and also cofounded the WELL—the Whole Earth ’Lectronic Link, a pioneering online community famous for, among other things, facilitating the trade of Grateful Dead bootlegs. He also wrote a hagiographic book about the MIT Media Lab, known for its corporate-sponsored research into new communications tech. “The Lab would cure the pathologies of technology not with economics or politics but with technology,” Brand wrote. Again, not collective action, not policymaking: tools. And Brand then cofounded the Global Business Network, a group of pricey consulting futurists that further connected him to MIT, Stanford, and the Valley. Brand had literally helped bring about the modern digital revolution.

His attention then turned toward its upkeep. Brand’s 1994 book, How Buildings Learn: What Happens After They’re Built, argued against high-modernist architectural ideas. Nearly all buildings eventually get remade, he argued, but he especially favored cheap, simple structures that inhabitants could easily retool to suit changing needs. In some ways, Brand was recapitulating the liberated—or libertarian—philosophy of the Whole Earth Catalog: People can remake their world, if they have access to tools. In a chapter titled “The Romance of Maintenance,” he asked readers to see the beauty, value, and occasional pleasures of fixer-uppers of all kinds.

This chapter was a touchstone for many of us in the academic subfield of maintenance studies. Researchers in disciplines like history, sociology, and anthropology, as well as artists and practitioners in fields like libraries, IT, and engineering, all started trying to understand the realities and, yes, romance of maintenance and repair. Brand joined and contributed to Listservs, attended conferences, chatted with intellectual leaders. So it’s a bit uncharitable when he writes that his new book is “the first to look at maintenance in general.” He knows better. The real question, though, is what his work has to teach us that others have not said before. In this first volume, the answer is unclear.


Maintenance: Of Everything, Part One is an odd book. If so much of Brand’s thinking has been about access to tools, he now asks, in a more extended way: How are our tools maintained? But where Brand began his career with a catalogue, in this volume we get … what? A digest? An almanac? An encyclopedia? Its form and riotous variety fit no genre easily. 

The book has two chapters. The first, “The Maintenance Race,” recounts the story of three men who took part in the Golden Globe, a round-the-world race for solo sailors held in 1968. Each of the sailors, Brand explains, had a different philosophy of maintenance. One neglected it and hoped for the best. He died. Another thought of and prepared for everything in advance, and while he didn’t win the race, he completed it and once held the record for the “world’s longest recorded nonstop solo sailing voyage.” The final sailor won and did so through heroic acts of perseverance; his style was “Whatever comes, deal with it,” Brand explains. Structured like a fairy tale and unremittingly romantic, the story—like most of the anecdotes in the book—focuses on the derring-do of vigorous white guys. The strategy is no secret. Brand’s outline explains: “Start with a dramatic contest of maintenance styles under life-critical conditions—a true story told as a fable.” This myth is meant to inspire. 

The second chapter, “Vehicles (and Weapons),” is over 150 pages long. It has five sections, multiple subsections, five subsections designated “digressions,” one called a “subdigression,” two “postscripts,” and several “footnotes” that are not footnotes in a formal sense but, rather, further addenda. At times, it all feels like notes for a future work. Brand makes no apology for the book’s woolliness. “All I can offer here,” he writes, “is to muse across a representative of maintenance domains and see what emerges.” Perhaps the most charitable reading of the potpourri is that it represents the return of a Merry Prankster, offering us a riotous varied light show. It’s a good book to leave on a table and occasionally open to a random page for entertainment. But it often seems as if it does not know what it wants to say or be. 

“Vehicles (and Weapons)” begins by paraphrasing two famous works of maintenance philosophy, Robert M. Pirsig’s Zen and the Art of Motorcycle Maintenance and Matthew B. Crawford’s Shop Class as Soulcraft. Maintenance involves both “problem finding” and “problem solving.” While much repair work is marked by anxiety, impatience, and boredom, it also offers positive values and outcomes. “Motorcycle maintainers take heart from what they repair for—the glory of the ride,” Brand writes. 

The beauty and triumph of cheapness is a running theme throughout the work, harking back to How Buildings Learn. Henry Ford’s Model T won out over early electric vehicles and hugely expensive luxury vehicles like Rolls-Royce’s Silver Ghost because it was cheap and easier to maintain. The three most popular cars in human history—the Ford Model T, the Volkswagen Bug, and the Lada “Classic” from Russia—all privileged cheapness, “retained their basic design for decades, and … invited repair by the owner.” Or, to be fair, maybe demanded it? For every hobbyist who delighted in being able to self-reliantly keep a VW running, there must have been thousands who appreciated how cheap it was and hated that it broke a lot. Brand never points to social research, like surveys, that might help us know people’s feelings on such matters.

Other sections recount how Americans created interchangeable parts (enabling not only cheap mass production but also easy maintenance), examine how maintenance works with assault rifles and in war, and track the history of technical manuals from the early modern period to the age of YouTube. These stories are solid, but they’re also well known to students of technology, and nearly all are recycled from the work of others, featuring many large block quotes. The volume breaks little new ground. 

Brand treats maintenance as an unalloyed good. But the field of maintenance studies has moved on, burrowing into the domain’s ironies, complexities, and difficulties. A simple example: In most cases, it is environmentally far better to retire and recycle an internal-combustion vehicle and buy an electric one than to keep the polluting beast going forever. Maintaining a gas-guzzler or a coal-­burning power plant isn’t a radical act but a regressive one. Also, maintenance can become a life-breaking burden on the poor, and it falls inequitably on the shoulders of women and people of color. Keeping existing systems going can be a way of avoiding tough, necessary change—like making technological systems more accessible for people with disabilities. In this volume, Brand is uninterested in such difficult trade-offs. He avoids any question of how politics shapes these issues, or how they shape politics.

This avoidance comes out most clearly in a section of “Vehicles (and Weapons)” that talks about Elon Musk—a character of “unique mastery,” Brand informs us. He tells us that Bill Gates once shorted Tesla’s stock, only to lose $1.5 billion. The lesson is clear: Elon won. 

In what political and social vision is money the best way to keep the score? Brand rightly points out that electric vehicles have fewer moving parts and, in that sense, are more maintainable than internal-combustion vehicles. He celebrates Musk most of all because his products “have all proven to be game changers in part because they combine ingenious design with surprisingly low cost.” Again, it’s Brand’s “cheap, available tools” hypothesis. But there’s a real superficiality and lack of follow-through in thinking here: Teslas remain luxury vehicles whose sales have slumped since federal tax subsidies disappeared. The company has faced several right-to-repair lawsuits; there’s even a law review article on the topic. Musk is in no sense a maintenance hero. Yet Brand writes that with his companies, “Musk may have done more practical world saving than any other business leader of his time.” By the time Brand was writing this book, the controversies surrounding Musk for at least flirting with antisemitism, racism, sexism, authoritarianism, and more were quite clear. About this, the book says not a word.

book cover
Maintenance: Of Everything, Part One
Stewart Brand
STRIPE PRESS, 2026

For sure, Brand needn’t agree with Musk’s critics, but failing to even broach the subject is tone deaf and out of touch. Others have argued that Silicon Valley’s “Move fast and break things” mentality undermines healthy maintenance. Brand doesn’t raise the idea—even to dismiss it. 

It could be that with Maintenance: Of Everything, Part One Brand is just getting going; that in subsequent volumes he’ll have something more coherent to say; that he’ll raise really hard questions and try to answer them. But given his track record, we might reasonably doubt it. Kesey said Brand cleaves to power; he certainly doesn’t question it. 

Lee Vinsel is an associate professor of science, technology, and society at Virginia Tech and host of Peoples & Things, a podcast about human life with technology.

Role of TRPC1 in the pathogenesis of depression induced by traumatic brain injury

BackgroundTraumatic brain injury (TBI) is one of the leading causes of mortality and disability, with many patients developing long-term sequelae. Depression is among the most common psychiatric complications following TBI, yet its underlying mechanisms remain unclear. Transient receptor potential canonical 1 (TRPC1) has been implicated in neurological disorders, but its role in post-TBI depression is not well understood.MethodsA controlled cortical impact (CCI) model was used to induce moderate TBI in mice. At 4 weeks post-injury, depressive-like behaviors were assessed using the tail suspension test (TST), forced swim test (FST), and sucrose preference test (SPT). Subsequently, reactive astrocytes and microglia were quantified, along with the expression of inflammatory cytokines, in the ipsilateral hippocampus. Synaptic function was also evaluated.ResultsBehavioral tests revealed that TBI mice exhibited significant depressive- and anxiety-like behaviors at 4 weeks post-injury. Concurrently, TRPC1 expression was downregulated in the ipsilateral hippocampus, accompanied by reduced levels of synaptic-associated proteins, elevated pro-inflammatory cytokines, and increased reactive astrocytes and microglia. Further experiments demonstrated that TRPC1 overexpression attenuated neuroinflammation, restored synaptic function, and ameliorated depressive-like behaviors in TBI mice.ConclusionThis study suggests that TBI may trigger depression by downregulating TRPC1, thereby promoting neuroinflammation and synaptic dysfunction. Conversely, TRPC1 overexpression mitigates these effects, highlighting its potential as a therapeutic target for post-TBI depression.

Metacognitive beliefs about biased thinking condition the role of anxiety sensitivity in the somatic symptom–health anxiety pathway

BackgroundSomatic symptoms are closely linked to health anxiety, and anxiety sensitivity is often described as a trait-like amplifier of responses to bodily sensations. Metacognitive beliefs operate at a higher-order level and may influence the conditions under which this amplification is observed.MethodsA cross-sectional survey was completed by 564 university students, who reported on somatic symptom burden (PHQ-15), anxiety sensitivity focused on physical concerns (ASI-3 Physical), metacognitive beliefs about biased thinking (MCQ-HA Biased Thinking), and health anxiety (SHAI). Pearson correlations and regression-based conditional process analyses were used to estimate a two-way moderation model and a three-way moderated moderation model (PROCESS Models 1 and 3) with 5,000 bootstrap samples and Johnson-Neyman probing. ResultsSomatic symptoms, anxiety sensitivity, and biased-thinking beliefs were all positively associated with health anxiety. The two-way interaction between somatic symptoms and anxiety sensitivity was not clearly supported. A small but statistically significant three-way interaction indicated that anxiety sensitivity strengthened the somatic symptom to health anxiety association only at higher levels of biased-thinking beliefs, a range that applied to roughly one quarter of the sample. ConclusionThese findings provide preliminary support for the idea that anxiety sensitivity may act as a conditional vulnerability, increasing the impact of somatic symptoms on health anxiety primarily when metacognitive beliefs about biased thinking are high.

Early tinnitus burden and subjective hearing are candidate markers of 2-year quality of life after cochlear implantation in single-sided deafness

BackgroundCochlear implantation is a common treatment for adults with single-sided deafness (SSD), but patient-reported benefits vary. The relationships among tinnitus burden, perceived hearing ability, psychological distress, disease-specific health-related quality of life, and whether early postoperative outcomes predict later results are not well understood.ObjectiveThis study explores how disease-specific quality of life relates to tinnitus burden, hearing, stress, depression, and anxiety after cochlear implantation in SSD. It also seeks early markers linked to 2-year outcomes.MethodsThis secondary complete-case analysis was based on a previously reported prospective longitudinal SSD cohort. Of 70 adults with postlingual SSD, 36 (51.4%) had complete Nijmegen Cochlear Implant Questionnaire (NCIQ) data at baseline and at 6 months, 1 year, and 2 years after unilateral cochlear implantation and were included. Additional measures included the Tinnitus Questionnaire (TQ), Oldenburg Inventory (OI), PerceivFed Stress Questionnaire (PSQ), General Depression Scale (ADS-L), Generalized Anxiety Disorder 7-item scale (GAD-7), and Freiburg Monosyllable Test (FMT) at 65 dB. Timepoint-specific correlations with the NCIQ were analyzed using Spearman’s rank correlations. Exploratory multivariable analyses employed linear regression on rank-transformed variables to assess whether baseline and 6-month patient-reported profiles were associated with 2-year NCIQ outcomes. Longitudinal within-patient comparisons were conducted as a secondary descriptive analysis.ResultsHigher NCIQ scores were linked to lower tinnitus burden and better hearing across all assessments. Associations with depression and anxiety persisted, while connections with perceived stress emerged after surgery. At baseline, higher tinnitus burden was associated with lower 2-year NCIQ scores. At 6 months, higher tinnitus is still associated with lower 2-year NCIQ scores, whereas better hearing is associated with higher 2-year NCIQ scores. Early postoperative improvement was followed by stabilization over 2 years.ConclusionImprovement in health-related quality of life after cochlear implantation in adults with SSD is complex and extends beyond hearing alone. Tinnitus was the most consistent negative factor, while improved subjective hearing at 6 months was associated with better outcomes at 2 years. These results support a structured, multidimensional approach to patient-reported follow-up after cochlear implantation in SSD and suggest that early postoperative patient-reported status may serve as an early candidate marker for later quality-of-life outcomes.