Treatment Recommendations for Unilateral Hearing Loss

Assessment and Diagnosis

The American Academy of Pediatrics recommends that 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, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3, 4
Magnetic resonance imaging (MRI) should be considered to rule out vestibular schwannomas or other retrocochlear pathologies in cases of unilateral sensorineural hearing loss, according to the American Academy of Otolaryngology-Head and Neck Surgery 4

The American Academy of Pediatrics suggests that for children with unilateral hearing loss, appropriateness of hearing aid fitting should be assessed individually based on degree of residual hearing 1, 2
Traditional contralateral routing of signals (CROS) amplification is NOT recommended for children with unilateral hearing loss, as stated by the American Academy of Pediatrics 1, 2
For adults with persistent unilateral hearing loss following SSNHL, conventional hearing aids may be beneficial if there is usable residual hearing, according to the American Academy of Otolaryngology-Head and Neck Surgery 5, 6
Monaural hearing aid options should be considered for those who can benefit from amplification in the poorer ear without crossover, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6
For adults with single-sided deafness, options include CROS hearing aids, Bilateral CROS (BiCROS), and osseointegrated bone conduction devices, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 5, 6

For unilateral SSNHL, corticosteroids (oral or intratympanic) may be offered as initial therapy to improve hearing recovery, according to the American Academy of Otolaryngology-Head and Neck Surgery 4, 6
Prompt treatment of otitis media with effusion (OME) is indicated in patients with sensorineural hearing loss, as recommended by the American Academy of Pediatrics 1, 2
Surgical options such as cochlear implantation may be considered in specific cases of profound unilateral hearing loss, as stated by the American Academy of Pediatrics 7

The American Academy of Otolaryngology-Head and Neck Surgery notes that the impact of unilateral hearing loss on quality of life should not be underestimated, with 86% of adults with unilateral SSNHL reporting significant hearing handicap 5, 6
Patients with unilateral hearing loss experience difficulties with conversation on the affected side, overall hearing in noisy environments, and sound localization, which can pose safety concerns, as reported by the American Academy of Otolaryngology-Head and Neck Surgery 3, 8

Regular audiologic follow-up is essential to monitor hearing status and effectiveness of interventions, as recommended by the American Academy of Pediatrics and the American Academy of Otolaryngology-Head and Neck Surgery 1, 4
For children, language evaluation should be performed at regular intervals to ensure development is commensurate with age and cognitive abilities, according to the American Academy of Pediatrics 1
For patients with SSNHL, audiometric assessment should be obtained within 6 months of initial diagnosis to document recovery or permanent loss, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 4, 6

Audiologic rehabilitation should be addressed as soon as hearing loss is identified, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3, 6
Hearing assistive technology systems can provide improved communication in specific listening situations and may be useful during initial treatment phases, according to the American Academy of Otolaryngology-Head and Neck Surgery 5
Counseling about the impact of unilateral hearing loss and available management options is essential for patient adjustment and quality of life improvement, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 5, 6