Unilateral Hearing Loss and Single-Sided Deafness (Q1 2026)-Unilateral Hearing Loss and Single-Sided Deafness Article

Unilateral Hearing Loss and Single-Sided Deafness Article

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The article reviews unilateral hearing loss (UHL)—aidable hearing loss in one ear—and single-sided deafness (SSD), where the poorer ear is unaidable. Although about 15% of U.S. adults report hearing difficulty, UHL represents roughly 7.2% of adults with hearing loss, and hearing-aid adoption is very low in this group (around 1.4% for mild and 4.2% for moderate UHL/SSD), highlighting unmet needs.<br /><br />Etiologies vary by age. In children, common causes include cochlear nerve deficiency, congenital infections such as cytomegalovirus, and mumps. In adults, over half of cases are idiopathic sensorineural losses, with additional causes including middle ear disease and less common pathologies such as vestibular schwannoma/acoustic neuroma.<br /><br />UHL/SSD has distinctive functional consequences driven by psychoacoustics. Loss of binaural input impairs localization (via head shadow effects and interaural timing differences), reduces the ability to separate speech from noise (spatial release from masking or “cocktail party” listening), and eliminates binaural summation, often increasing listening effort and affecting gain needs in unilateral fittings.<br /><br />The author emphasizes tailored evaluation rather than a unique test protocol: detailed history (including etiology, time since onset, and which ear is affected), consideration of right-ear advantage for speech, communication-needs surveys, and careful audiologic testing with proper masking (preferably using insert earphones). Speech-in-noise testing is strongly recommended alongside word recognition in quiet; additional measures may be needed for tinnitus or loudness intolerance.<br /><br />Management options include: prompt medical referral for sudden sensorineural hearing loss (often steroids orally and/or intratympanic); implantables such as cochlear implants (FDA-approved for SSD in 2019 with specific candidacy criteria) and bone-anchored hearing aids; and non-surgical amplification including traditional hearing aids, CROS/BiCROS systems, and assistive technologies (remote microphones, FM/DM, telecoil/Auracast). Counseling—ideally involving family—is presented as crucial, including setting realistic expectations and recognizing that, for some patients, monitoring rather than treatment may be appropriate.

Keywords

unilateral hearing loss (UHL)

single-sided deafness (SSD)

hearing aid adoption rates

binaural hearing and localization

speech-in-noise testing

head shadow effect

cochlear implant for SSD (FDA 2019)

CROS/BiCROS hearing systems

bone-anchored hearing aids (BAHA)

sudden sensorineural hearing loss steroid treatment