European Journal of Pediatrics

, Volume 176, Issue 4, pp 475–486 | Cite as

Unilateral hearing loss in children: a retrospective study and a review of the current literature

  • Anna-Katharina RohlfsEmail author
  • Johannes Friedhoff
  • Andrea Bohnert
  • Achim Breitfuss
  • Markus Hess
  • Frank Müller
  • Anke Strauch
  • Marianne Röhrs
  • Thomas Wiesner
Original Article


Despite the introduction of universal newborn hearing screening (UNHS), unilateral hearing loss (UHL) is sometimes recognized late. This diagnostic delay has adverse repercussions, given the importance of binaural hearing for the development of normal auditory processing. It is incorrect to maintain that unilateral hearing is the minimum requirement for adequate speech development and that hearing aid provision is consequently unnecessary. In our retrospective study, hearing aid provision resulted in improved directional and selective hearing (quiet and noisy environments) and, compared with their chronically ill counterparts, the children in our study displayed superior health-related quality of life (HRQoL) scores in all areas. On the basis of the results, the authors conclude that even mild hearing losses (from an auditory threshold of 30 to 40 dB) should have the opportunity for hearing aid provision. A selective literature review was conducted in PubMed and textbooks and with reference to national and international guidelines. Early diagnosis and treatment of UHL have a positive effect on verbal-cognitive, linguistic, communicative, and socio-emotional development, as demonstrated by neurophysiological studies. Among the treatment modalities with differing effects on the quality of binaural hearing, cochlear implants are now used increasingly in children with hearing loss bordering on deafness.

Conclusion: Published evidence and clinical experience support early diagnosis and treatment. Wherever feasible, hearing aid provision before or at the end of the first year of life is recommended for children with UHL.

What is Known:

Almost 30 years ago, poor academic performance was reported in children with unilateral hearing loss (UHL).

Despite improvements in treatment options, it is traditionally held that unilateral hearing is the minimum requirement for adequate speech development and hearing aid provision is unnecessary.

What is New:

Academic and behavioral deficits in children with UHL may be mediated by deficiencies in the default mode network.

Published evidence supports the recommendation for hearing aid provision before or at the end of the first year of life in children with UHL.


Unilateral hearing loss (UHL) Binaural hearing Auditory processing Speech development Hearing aid provision Health-related quality of life 



Bone-anchored hearing aids


Brainstem evoked response audiometry


Behind-the-ear (hearing aids)


Cochlear implant(s)




Contralateral routing of signal


Computed tomography


German Society of Phoniatrics and Pediatric Audiology


Default mode network


Frequency Animal Sound Test


Frequency modulation (systems)


Health-related quality of life


Multi-Frequency Animal Sound Test


Otoacoustic emission(s)


Sensorineural hearing loss


Signal-to-noise ratio


Transient evoked otoacoustic emission(s)


Universal newborn hearing screening



We would like to thank all the families for their time in participating in the retrospective study. We also owe a debt of gratitude to the DISABKIDS Project, in particular for the support of the Coordination Center in Hamburg (project partners: Professor Dr. Monika Bullinger, Professor Dr. Silke Schmidt, and Dr. habil. Corinna Petersen-Ewert) in providing the DISABKIDS software.

Authors’ contributions

A-KR and JF are joint principal authors who contributed equally to the retrospective study and to the literature review presented here. A-KR, JF, FM, and TW participated in the concept, design, and interpretation of the manuscript. JF and A-KR coordinated the study centers and patient inclusion, and JF was responsible for the practical conduct of the retrospective study. MH, TW, and MR provided the patients for the study, and ABr and AS were responsible for diagnostic testing. JF, FM, A-KR, and TW conceptualized the data analysis. JF, ABo, and TW developed the questionnaires for the retrospective study. A-KR, FM, TW, and JF drafted the manuscript, and all the listed authors have reviewed and approved the final version of the manuscript as submitted.

Compliance with ethical standards


This study was not funded.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the Hamburg regional medical board. All procedures performed in this study involving human participants were in accordance with the ethical standards of the ethics committee of the Hamburg regional medical board.

Informed consent

Informed consent was obtained from all individual participants included in the study or their parents/legal guardians.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Anna-Katharina Rohlfs
    • 1
    Email author
  • Johannes Friedhoff
    • 1
  • Andrea Bohnert
    • 2
  • Achim Breitfuss
    • 1
  • Markus Hess
    • 1
  • Frank Müller
    • 1
  • Anke Strauch
    • 3
  • Marianne Röhrs
    • 4
  • Thomas Wiesner
    • 5
  1. 1.Department of Voice, Speech and Hearing DisordersUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department for ENT and Communication DisordersUniversity Medical Center of the Johannes Gutenberg University, MainzMainzGermany
  3. 3.KIND HörgeräteHamburgGermany
  4. 4.Community Practice for Otorhinolaryngology, Phoniatrics and Pediatric AudiologyHamburgGermany
  5. 5.Department of Phoniatrics and Pediatric AudiologyWerner Otto InstitutHamburgGermany

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