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Unilateral hearing loss

unilateral hearing loss, unilateral hearing loss in children
Unilateral hearing loss UHL or single-sided deafness SSD is a type of hearing impairment where there is normal hearing in one ear and impaired hearing in the other ear


  • 1 Signs and symptoms
  • 2 Causes
  • 3 Prevalence
  • 4 Profound unilateral hearing loss
  • 5 Management
    • 51 Evaluation
  • 6 Hearing issues
  • 7 See also
  • 8 References
  • 9 External links

Signs and symptomsedit

Patients with unilateral hearing loss have difficulty in

  • hearing conversation on their impaired side
  • localizing sound
  • understanding speech in the presence of background noise
  • interpersonal and social relations

In quiet conditions, speech discrimination is no worse than normal hearing in those with partial deafness;1 however, in noisy environments speech discrimination is almost always severe12


Known causes include physical trauma, acoustic neuroma, measles, labyrinthitis, microtia, meningitis, Ménière's disease, Waardenburg syndrome, mumps epidemic parotitis, and mastoiditis


A 1998 study of schoolchildren found that per thousand, 6-12 had some form of unilateral hearing loss and 0-5 had moderate to profound unilateral hearing loss It was estimated that in 1998 some 391,000 school-aged children in the United States had unilateral hearing loss3

Profound unilateral hearing lossedit

Profound unilateral hearing loss is a specific type of hearing loss when one ear has no functional hearing ability 91 dB or greater hearing loss People with profound unilateral hearing loss can only hear in monaural mono

Profound unilateral hearing loss or single-sided deafness, SSD, makes hearing comprehension very difficult With speech and background noise presented at the same level, persons with unilateral deafness were found to hear only about 30-35% of the conversation4 A person with SSD needs to make more effort when communicating with others5 When a patient can hear from only one ear, and there are limited possibilities to compensate for the handicap, eg, changing listening position, group discussions and dynamic listening situations become difficult Individuals with profound unilateral hearing loss are often perceived as socially awkward due to constant attempts to maximize hearing leading to socially unique body language and mannerisms6

SSD also negatively affects hearing and comprehension by making it impossible for the patient to determine the direction, distance and movement of sound sources6 In an evaluation using the Speech, Spatial and Qualities of Hearing Scale SSQ questionnaire, SSD results in a greater handicap than subjects with a hearing loss in both ears

Profound SSD is often confused with Sensory Discrimination Disorder SDD, a type of Sensory Processing Disorder, and can lead to incorrect processing of sensory information or auditory input during interpersonal communications

SSD is known to cause:

  • Irritability
  • Sound aversion: any presence of noise, no matter how low
  • Body language and mannerisms which appear socially awkward or unusual, like staring at others mouths or tilt the head frequently
  • Frequent headaches, stress
  • Social isolation
  • Chronic interpersonal communication difficulties due to inability of brain to isolate or beam form sounds and voices of other individuals
  • Appearance of anxiousness even in low noise situations
  • Jumpiness
  • Trouble figuring out where sounds are coming from
  • Variable light dizziness
  • Trouble paying attention to what people are saying: "evasive" behaviour
  • Misdiagnoses as ADHD
  • Seeming lack of awareness of other people's personal space and moods since brain is hyper-focused on deciphering auditory information in lieu of non-verbal social cues
  • Lack of sound depth: any background noise in the room, in the car is flat and wrongly interpreted by the brain The effect is similar to what happens when trying to hear someone speaking in a noisy crowd on a mono TV The effect is also similar to talking on the phone to someone who is in a noisy environment see also: King-Kopetzky syndrome
  • Inability to filter out background noise or selectively listen to only the important portion of the noise in the environment
  • For sensorineural hearing loss, the lack of input coming from the damaged sensory apparatus can cause "ghost beeps" or ringing/tinnitus as the brain attempts to interpret the now missing sensory data The frequency and the volume of the noise can increase according to one's physical condition stress, fatigue, etc This can aggravate social problems and increase the difficulty of speech comprehension
  • Talking loudly or "broadcasting": the affected person cannot perceive the volume of his or her voice relative to other people in the same room or close company, resulting in being characterized by others who may be located beyond normal auditory range as domineering or boorish


Learning of the central nervous system by "plasticity" or biological maturation over time does not improve the performance of monaural listening2 In addition to conventional methods for improving the performance of the impaired ear, there are also hearing aids adapted to unilateral hearing loss which are of very limited effectiveness due to the fact that they don't restore the stereo hearing ability

  • Contralateral Routing of Signals CROS hearing aids are hearing aids that take sound from the ear with poorer hearing and transmit to the ear with better hearing There are several types of CROS hearing aid:7
    • conventional CROS comprises a microphone placed near the impaired ear and an amplifier hearing aid near the normal ear The two units are connected either by a wire behind the neck or by wireless transmission The aid appears as two behind-the-ear hearing aids and is sometimes incorporated into eyeglasses
    • CIC transcranial CROS comprises a bone conduction hearing aid completely in the ear canal CIC A high-power conventional air conduction hearing aid fits deeply into the patient’s deaf ear Vibration of the bony walls of the ear canal and middle ear stimulates the normal ear by means of bone conduction through the skull
    • BAHA transcranial CROS Bone Anchored Hearing Aid BAHA: a surgically implanted abutment transmits sound from the deaf ear by direct bone conduction and stimulates the cochlea of the normal hearing ear
    • SoundBite Intraoral bone conduction which uses bone conduction via the teeth One component resembles a conventional behind-the-ear hearing aid that wirelessly connects to a second component worn in the mouth that resembles a conventional dental appliance8

In Germany and Canada, cochlear implants have been used with great success to mostly restore the stereo hearing ability, minimizing the impacts of the SSD and the quality of life of the patient 9


As of 2012 there has only been one small-scale study comparing CROS systems7

One study of the BAHA system showed a benefit depending on the patient's transcranial attenuation10 Another study showed that sound localisation was not improved, but the effect of the head shadow was reduced11

Hearing issuesedit

School-age children with unilateral hearing loss tend to have poorer grades and require educational assistance This is not the case with everyone, however They can also be perceived to have behavioral issues12

People afflicted with UHL have great difficulty locating the source of any sound They may be unable to locate an alarm or a ringing telephone The swimming game Marco Polo is generally impossible for them

When wearing stereo headphones, people with unilateral hearing loss can hear only one channel, hence the panning information volume and time differences between channels is lost; some instruments may be heard better than others if they are mixed predominantly to one channel, and in extreme cases of sound production, such as complete stereo separation or stereo-switching, only part of the composition can be heard; in games using 3D audio effects, sound may not be perceived appropriately due to coming to the disabled ear This can be corrected by using settings in the software or hardware—audio player, OS, amplifier or sound source—to adjust balance to one channel only if the setting downmixes sound from both channels to one, or there may be an option to outright downmix both channels to mono Such settings may be available via the device or software's accessibility features1314 As hardware solutions, stereo-to-mono adapters may be available to receive mono sound in stereo headphones from a stereo sound source,15 or some monaural headsets for cellphones and VOIP communication16 may combine stereo sound to mono though headphones for voice communication typically offer lower audio quality than headphones targeted for listening to music From the standpoint of sound fidelity, sound information in downmixed mono channel will, in any case, differ from that in either of the source channels or what is perceived by a normal-hearing person, thus technically some audio quality is lost for example, the same or slightly different sound occurrences in two channels, with time delay between them, will be merged to a sound in the mono channel that unavoidably cannot correspond to the intent of the sound producer; however, such loss is most probably unnoticeable, especially compared to other distortions inherent in sound reproduction, and to the person's problems from hearing loss

See alsoedit

  • Cocktail party effect


  1. ^ a b Sargent EW, Herrmann B, Hollenbeak CS, Bankaitis AE July 2001 "The minimum speech test battery in profound unilateral hearing loss" Otol Neurotol 22 4: 480–6 PMID 11449104 doi:101097/00129492-200107000-00012 
  2. ^ a b Welsh LW, Welsh JJ, Rosen LF, Dragonette JE December 2004 "Functional impairments due to unilateral deafness" Ann Otol Rhinol Laryngol 113 12: 987–93 PMID 15633902 
  3. ^ Lee DJ, Gómez-Marín O, Lee HM August 1998 "Prevalence of unilateral hearing loss in children: the National Health and Nutrition Examination Survey II and the Hispanic Health and Nutrition Examination Survey" Ear Hear 19 4: 329–32 PMID 9728728 doi:101097/00003446-199808000-00008 CS1 maint: Multiple names: authors list link
  4. ^ Christensen L, Richter GT, Dornhoffer JL Feb 2010 "Update on bone-anchored hearing aids in pediatric patients with profound unilateral sensorineural hearing loss" Archives of otolaryngology - head & neck surgery 136 2: 175–7 doi:101001/archoto2009203 
  5. ^ Bess FH, Tharpe AM February 1986 "An introduction to unilateral sensorineural hearing loss in children" Ear Hear 7 1: 3–13 PMID 3512353 doi:101097/00003446-198602000-00003 
  6. ^ a b Noble W, Gatehouse S 2004 "Interaural asymmetry of hearing loss, Speech, Spatial and Qualities of Hearing Scale SSQ disabilities, and handicap" International journal of audiology 43 2: 100–14 PMID 15035562 doi:101080/14992020400050015 
  7. ^ a b Hol, M K S; Kunst, S J W; Snik, A F M; Cremers, C W R J 2009 "Pilot study on the effectiveness of the conventional CROS, the transcranial CROS and the BAHA transcranial CROS in adults with unilateral inner ear deafness" European Archives of Oto-Rhino-Laryngology 267 6: 889–896 PMC 2857795  PMID 19904546 doi:101007/s00405-009-1147-9 
  8. ^ Popelka, G 2010 "SoundBite Hearing System by Sonitus Medical: A New Approach to Single-Sided Deafness" Seminars in Hearing 31 4: 393–409 doi:101055/s-0030-1268037 
  9. ^ "Audiological results with cochlear implants for single-sided deafness" doi:101007/s00106-011-2321-0 
  10. ^ Stenfelt S March 2005 "Bilateral fitting of BAHAs and BAHA fitted in unilateral deaf persons: acoustical aspects" Int J Audiol 44 3: 178–89 PMID 15916119 doi:101080/14992020500031561 
  11. ^ Hol MK, Bosman AJ, Snik AF, Mylanus EA, Cremers CW September 2005 "Bone-anchored hearing aids in unilateral inner ear deafness: an evaluation of audiometric and patient outcome measurements" Otol Neurotol 26 5: 999–1006 PMID 16151349 doi:101097/01mao00001850650483495 
  12. ^ Lieu, J E C 2004 "Speech-Language and Educational Consequences of Unilateral Hearing Loss in Children" Archives of Otolaryngology - Head and Neck Surgery 130 5: 524–530 PMID 15148171 doi:101001/archotol1305524 
  13. ^ OS X Mavericks: Audio pane of Accessibility preferences
  14. ^ Apple - Accessibility - iOS
  15. ^ Making headphones mono - CNET
  16. ^ Google Image Search for "monaural headset"

Mild and Unilateral Hearing Loss: Implications for Early Intervention

External linksedit

  • Profound Unilateral Hearing Loss FAQ's and Flash Animation
  • BoysTownHospitalorg
  • Unilateral Hearing Loss - Notes

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Unilateral hearing loss

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