What is the recommended management for unilateral hearing loss in an older adult?

Management of Unilateral Hearing Loss in Older Adults

For older adults with unilateral hearing loss, management should include audiologic rehabilitation with hearing aids or assistive listening devices, along with counseling about communication strategies to improve quality of life and reduce psychosocial impacts.

Diagnostic Assessment

• Before initiating treatment, hearing loss should be confirmed with a pure-tone audiogram 1
• Screening tests that can identify objective hearing loss include whispered voice test, finger rub test, watch tick test, questionnaires (like HHIE-S), and handheld audiometers 2
• Unilateral hearing loss can significantly impact quality of life - studies show 86% of adults with unilateral sudden sensorineural hearing loss report hearing handicap 2, 3

Treatment Options

Hearing Amplification

• Hearing aids can improve self-reported hearing, communication, and social functioning for adults with age-related hearing loss 2
• For unilateral hearing loss, specific amplification options include:
  • Contralateral routing of signal (CROS) hearing aids - use a microphone on the impaired ear to transmit sound to the better ear 2
  • Bilateral contralateral routing of signals (BiCROS) - for those with pre-existing hearing loss in the better ear 2
  • Monaural hearing aids - for those who can benefit from amplification in the poorer ear without crossover 2

Bone Conduction Devices

• Osseointegrated bone conductive devices transfer sound from the affected side to the better-hearing cochlea 2
• Non-surgical options include headband placement for those who aren't surgical candidates 2
• Deep intracanal devices provide nonsurgical bone conduction sound transmission 2

Assistive Technologies

• Hearing assistive technology (HAT) systems can improve communication in specific listening environments 2
• These technologies typically use headphones and handheld/lapel-worn microphones to transmit sound directly to the listener 2

Counseling and Support

• Patients should be counseled about the possible benefits of audiologic rehabilitation and other supportive measures 2
• Communication strategies for partners and healthcare providers include:
  • Face the person at the same level in good lighting
  • Speak clearly and naturally
  • Minimize background noise
  • Provide important information in writing 1
• Support groups such as Hearing Loss Association of America can help patients adjust to living with unilateral hearing loss 2

Benefits Beyond Hearing Improvement

• Treating hearing loss can provide multiple benefits:
  • Improved communication with family, friends, and healthcare providers
  • Enhanced safety
  • Improved daily functioning
  • Potential reduction in cognitive decline risk
  • Decreased social isolation and improved mental health outcomes 1, 4

Common Pitfalls and Barriers

• Many older adults resist seeking treatment due to:
  • Social stigma
  • Fear of losing independence
  • Financial barriers (hearing aids often not covered by Medicare and many private insurance companies) 1, 5
• Patient adherence to hearing aids may be low if they don't perceive hearing loss or if the initial results are disappointing 2, 5
• Patients may incorrectly believe that hearing loss is a normal part of aging or not amenable to treatment 5

Special Considerations

• Men usually experience greater hearing loss and earlier onset compared to women 5
• Unilateral hearing loss affects women more significantly in terms of perceived handicap (88.5% of women vs. 73.1% overall report handicap) 3
• For sudden unilateral sensorineural hearing loss, urgent assessment is recommended as this may represent a medical emergency 5, 6