Treatment Options for Unilateral Low-Frequency Hearing Loss
For unilateral low-frequency hearing loss, the primary treatment options include corticosteroids as initial therapy, followed by amplification devices such as hearing aids, CROS/BICROS systems, or osseointegrated bone conductive devices if hearing does not recover. 1
Initial Medical Management
Corticosteroid Therapy
- Offer corticosteroids as initial therapy within 14 days of symptom onset
- Options include:
- Oral steroids (first-line)
- Intratympanic steroid injections (for patients with contraindications to oral steroids)
- Monitor blood pressure during treatment
- Follow-up with repeat audiometry within 2-6 months of treatment
Important Considerations
- One-third to two-thirds of patients may recover some hearing within 2 weeks
- Patients who recover half their hearing in first 2 weeks have better prognosis
- Patients with minimal change within first 2 weeks are unlikely to show significant recovery
- Presence of dizziness at onset indicates poorer prognosis 1
Diagnostic Evaluation
- Pure-tone audiometry to confirm low-frequency hearing loss pattern
- MRI of brain and internal auditory canals to rule out vestibular schwannoma (especially important in unilateral cases)
- Auditory Brainstem Response (ABR) may be used as a less expensive alternative screening tool if MRI is contraindicated 1
- Consider evaluation for Menière's disease, as low-frequency hearing loss is characteristic (though typically accompanied by vertigo) 2
Rehabilitation Options for Persistent Hearing Loss
Hearing Aids
- Monaural hearing aid for the affected ear if residual hearing is sufficient
- Modern digital devices offer improved cosmetic appearance and better sound quality 1
CROS/BICROS Systems
- Contralateral Routing of Signal (CROS) hearing aids: microphone on impaired ear transmits sound to better ear
- BICROS systems for patients with pre-existing hearing loss in the better ear 1
Osseointegrated Bone Conduction Devices
- Transfers sound from affected side to better hearing cochlea
- Available as surgical option or with headband placement for non-surgical candidates 1
Other Options
- Deep intracanal devices
- Dental bridges with ear-level devices
- Hearing assistive technology (HAT) systems for specific listening situations 1
Counseling and Support
- Address psychosocial impact of unilateral hearing loss
- 86% of patients with unilateral sudden hearing loss report hearing handicap
- Provide information about:
- Treatment options and possible outcomes
- Risk of hearing loss in the other ear (very low)
- Amplification and rehabilitation options
- Consider referral to support groups such as Hearing Loss Association of America 1
Follow-up Care
- Audiometric evaluation at the end of treatment
- Follow-up audiometry within 6 months of initial diagnosis
- Regular monitoring of hearing and amplification devices at least annually
- Assess improvement in hearing-related quality of life 1, 3
Special Considerations
- Rule out psychogenic hearing loss, particularly in young adult women with acute-onset unilateral hearing loss 4
- Low-frequency hearing loss without vertigo may be a distinct condition and not necessarily a prodromal sign of Menière's disease 5
- Unilateral hearing loss can significantly impact quality of life despite having normal hearing in the other ear 1, 3
By following this treatment approach, patients with unilateral low-frequency hearing loss can expect improved hearing-specific quality of life, enhanced communication, and better overall quality of life.