What is the recommended treatment for unilateral hearing loss?

Treatment Recommendations for Unilateral Hearing Loss

For patients with unilateral hearing loss, a hearing aid fitting should be considered based on the degree of residual hearing, but contralateral routing of signals (CROS) amplification is not recommended for children. 1

Assessment and Diagnosis

• Initial evaluation should include comprehensive audiologic assessment to determine the type, degree, and characteristics of the unilateral hearing loss 1
• For sudden unilateral sensorineural hearing loss (SSNHL), prompt audiometric testing is essential for diagnosis and treatment planning 1
• Magnetic resonance imaging (MRI) should be considered to rule out vestibular schwannomas or other retrocochlear pathologies in cases of unilateral sensorineural hearing loss 1, 2

Treatment Options

Hearing Aids

• For children with unilateral hearing loss, appropriateness of hearing aid fitting should be assessed individually based on degree of residual hearing 1
• Traditional contralateral routing of signals (CROS) amplification is NOT recommended for children with unilateral hearing loss 1
• For adults with persistent unilateral hearing loss following SSNHL, conventional hearing aids may be beneficial if there is usable residual hearing 1

Amplification Options for Adults

• Monaural hearing aid options should be considered for those who can benefit from amplification in the poorer ear without crossover 1
• For adults with single-sided deafness, options include:
  • CROS hearing aids (microphone on affected ear transmits to better ear) 1
  • Bilateral CROS (BiCROS) for those with pre-existing hearing loss in the better ear 1
  • Osseointegrated bone conduction devices that transfer sound from affected side to better cochlea 1

Medical Management

• For unilateral SSNHL, corticosteroids (oral or intratympanic) may be offered as initial therapy to improve hearing recovery 1
• Prompt treatment of otitis media with effusion (OME) is indicated in patients with sensorineural hearing loss, as it can compound hearing difficulties 1
• Surgical options such as cochlear implantation may be considered in specific cases of profound unilateral hearing loss 1

Special Considerations

• The impact of unilateral hearing loss on quality of life should not be underestimated; 86% of adults with unilateral SSNHL report significant hearing handicap 1
• Patients with unilateral hearing loss experience difficulties with:
  • Conversation on the affected side 1
  • Overall hearing in noisy environments 1
  • Sound localization, which can pose safety concerns 1

Follow-up and Monitoring

• Regular audiologic follow-up is essential to monitor hearing status and effectiveness of interventions 1
• For children, language evaluation should be performed at regular intervals to ensure development is commensurate with age and cognitive abilities 1
• For patients with SSNHL, audiometric assessment should be obtained within 6 months of initial diagnosis to document recovery or permanent loss 1

Rehabilitation Approaches

• Audiologic rehabilitation should be addressed as soon as hearing loss is identified 1
• Hearing assistive technology systems can provide improved communication in specific listening situations and may be useful during initial treatment phases 1
• Counseling about the impact of unilateral hearing loss and available management options is essential for patient adjustment and quality of life improvement 1