Skip to main content


Log in

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

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others



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


  1. Abdala C (2000) Distortion product otoacoustic emission (2f1-f2) amplitude growth in human adults and neonates. J Acoust Soc Am 107:446–456

    Article  CAS  PubMed  Google Scholar 

  2. American Academy of Audiology Pediatric Amplification (2013) Updated clinical practice guidelines for unilateral hearing loss.

  3. American Speech-Language-Hearing Association.

  4. American Speech-Language-Hearing Association. (

  5. Arndt S, Aschendorff A, Laszig R, Beck R, Schild C, Kroeger S, Ihorst G, Wesarg T (2011) Comparison of pseudo-binaural hearing to real binaural hearing rehabilitation after cochlear implantation in patients with unilateral deafness and tinnitus. Otol Neurotol 32:39–47. doi:10.1097/MAO.0b013e3181fcf271

    Article  PubMed  Google Scholar 

  6. AWMF (2013) Diagnostik von Sprachentwicklungsstörungen (SES), unter Berücksichtigung umschriebener Sprachentwicklungsstörungen (USES) (Synonym: Spezifische Sprachentwicklungsstörungen (SSES)).

  7. Bamiou DE, Savy L, O’Mahoney C, Phelps P, Sirimanna T (1999) Unilateral sensorineural hearing loss and its aetiology in childhood: the contribution of computerised tomography in aetiological diagnosis and management. Int J Pediatr Otorhinolaryngol 51:91–99

    Article  CAS  PubMed  Google Scholar 

  8. Bess FH, Dodd-Murphy JD, Parker RA (1998) Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional health status. Ear Hear 17:1–11

    Google Scholar 

  9. Bess FH (1986) The unilaterally hearing-impaired child: a final comment. Ear Hear 7:52–54

    Article  CAS  PubMed  Google Scholar 

  10. Bess FH, Tharpe AM (1986) An introduction to unilateral sensorineural hearing loss in children. Ear Hear 7:3–13

    Article  CAS  PubMed  Google Scholar 

  11. Bess FH, Tharpe AM (1984) Unilateral hearing impairment in children. Pediatrics 74:206–216

    CAS  PubMed  Google Scholar 

  12. Birbaumer N, Schmidt RF (1991) Biologische Psychologie, 2nd edn. Springer, Berlin, p. 482

    Book  Google Scholar 

  13. Borg E, Risberg A, McAllister B, Undemar BM, Edquist G, Reinholdson AC, Wiking-Johnsson A, Willstedt-Svensson U (2002) Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol 65:15–26

    Article  PubMed  Google Scholar 

  14. Brookhouser PE, Worthington DW, Kelly WJ (1991) Unilateral hearing loss in children. Laryngoscope 101:1264–1272

    Article  CAS  PubMed  Google Scholar 

  15. Bullinger M (1997) Gesundheitsbezogene Lebensqualität und subjektive Gesundheit. Ein Überblick über den Stand der Forschung zu einem neuen Evaluationskriterium in der Medizin. Psychother Psychosom Med Psychol 47:76–91

    CAS  PubMed  Google Scholar 

  16. Chantiluke K, Barrett N, Giampietro V, Brammer M, Simmons A, Rubia K (2015) Disorder-dissociated effects of fluoxetine on brain function of working memory in attention deficit hyperactivity disorder and autism spectrum disorder. Psychol Med 45:1195–1205. doi:10.1017/S0033291714002232

    Article  CAS  PubMed  Google Scholar 

  17. Cherry EC (1953) Some experiments on the recognition of speech, with one and two ears. J Acoust Soc Am 25:975–979

    Article  Google Scholar 

  18. Dancer J, Burl NT, Waters S (1995) Effects of unilateral hearing loss on teacher responses to the SIFTER. Screening Instrument for Targeting Educational Risk. Am Ann Deaf 140:291–294

    Article  CAS  PubMed  Google Scholar 

  19. de Wolf MJ, Hol MK, Mylanus EA, Snik AF, Cremers CW (2011) Benefit and quality of life after bone-anchored hearing aid fitting in children with unilateral or bilateral hearing impairment. Arch Otolaryngol Head Neck Surg 137:130–138. doi:10.1001/archoto.2010.252

    Article  PubMed  Google Scholar 

  20. Deutsche Gesellschaft für Phoniatrie und Pädaudiologie.

  21. Doyle-Thomas KA, Lee W, Foster NE, Tryfon A, Ouimet T, Hyde KL, Evans AC, Lewis J, Zwaigenbaum L, Anagnostou E, NeuroDevNet ASD Imaging Group (2015) Atypical functional brain connectivity during rest in autism spectrum disorders. Ann Neurol 77:866–876. doi:10.1002/ana.24391

    Article  PubMed  Google Scholar 

  22. English K, Church G (1999) Unilateral hearing loss in children: an update for the 1990s. Lang Speech Hear Serv Sch 30:26–31

    Article  PubMed  Google Scholar 

  23. Hassepass F, Aschendorff A, Wesarg T, Kröger S, Laszig R, Beck RL, Schild C, Arndt S (2013) Unilateral deafness in children: audiologic and subjective assessment of hearing ability after cochlear implantation. Otol Neurotol 34:53–60. doi:10.1097/MAO.0b013e31827850f0

    Article  PubMed  Google Scholar 

  24. Hintermair M, Wiegand E (2011) Socio-emotional problems in children and adolescents with unilateral hearing loss. Z Audiol 50:130–137

    Google Scholar 

  25. Hoth S, Neumann K (2006) Die diagnostische Aussagekraft der otoakustischen Emissionen. Praktische Arbeitsmedizin 6:18–24

    Google Scholar 

  26. Huber M (2005) Health-related quality of life of Austrian children and adolescents with cochlear implants. Int J Pediatr Otorhinolaryngol 69:1089–1101

    Article  PubMed  Google Scholar 

  27. Husain FT, Schmidt SA (2014) Using resting state functional connectivity to unravel networks of tinnitus. Hear Res 307:153–162. doi:10.1016/j.heares.2013.07.010

    Article  PubMed  Google Scholar 

  28. Irving S, Moore DR (2011) Training sound localization in normal hearing listeners with and without a unilateral ear plug. Hear Res 280:100–108. doi:10.1016/j.heares.2011.04.020

    Article  PubMed  Google Scholar 

  29. Jacob R, Stelzig Y, Nopp P, Schleich P (2011) Audiological results with cochlear implants for single-sided deafness. HNO 59:453–460. doi:10.1007/s00106-011-2321-0

    Article  CAS  PubMed  Google Scholar 

  30. Johnson CE (2000) Children’s phoneme identification in reverberation and noise. J Speech Lang Hear Res 43:144–157

    Article  CAS  PubMed  Google Scholar 

  31. Johnstone PM, Nabelek AK, Robertson VS (2010) Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. J Am Acad Audiol 21:522–534. doi:10.3766/jaaa.21.8.4

    Article  PubMed  Google Scholar 

  32. José MR, Mondelli MF, Feniman MR, Lopes-Herrera SA (2014) Language disorders in children with unilateral hearing loss: a systematic review. Int Arch Otorhinolaryngol 18:198–203. doi:10.1055/s-0033-1358580

    Article  PubMed  Google Scholar 

  33. Kamal SM, Robinson AD, Diaz RC (2012) Cochlear implantation in single-sided deafness for enhancement of sound localization and speech perception. Curr Opin Otolaryngol Head Neck Surg 20:393–397. doi:10.1097/MOO.0b013e328357a613

    Article  PubMed  Google Scholar 

  34. Kiese-Himmel C (2002) Unilateral sensorineural hearing impairment in childhood: analysis of 31 consecutive cases. Int J Audiol 41:57–63

    Article  PubMed  Google Scholar 

  35. Kiese-Himmel C, Kruse E (2001) Unilateral hearing loss in childhood. An empirical analysis comparing bilateral hearing loss. Laryngorhinootologie 80:18–22

    Article  CAS  PubMed  Google Scholar 

  36. Kiese-Himmel C, Ohlwein S, Kruse E (2000) Acceptance of wearing hearing aids by children: a longitudinal analysis. HNO 48:758–764

    Article  CAS  PubMed  Google Scholar 

  37. Kitterick PT, Lucas L, Smith SN (2015) Improving health-related quality of life in single-sided deafness: a systematic review and meta-analysis. Audiol Neurootol 20(Suppl 1):79–86. doi:10.1159/000380753

    Article  PubMed  Google Scholar 

  38. Klatte M, Wegner M, Hellbrück J (2006) Lärm in der schulischen Umwelt und kognitive Leistungen bei Grundschulkindern. Teil B: Kognitionspsychologische Untersuchungen. Zwischenbericht zum Status Seminar des Programms "Lebensgrundlage Umwelt und ihre Sicherung" des Landes Baden-Württemberg (BWplus). ; Link: Publikationen

  39. Kollmeier B (2012)

  40. Konkle D, Schwartz DM (1981) Binaural amplification: a paradox. In: Bess FH, Freeman BA, Sinclair S (eds.) Amplification in education. Alexander Graham Bell Association for the Deaf, Washington, DC, pp 342–357

  41. Kral A, Hubka P, Heid S, Tillein J (2013) Single-sided deafness leads to unilateral aural preference within an early sensitive period. Brain 136:180–193. doi:10.1093/brain/aws305

    Article  PubMed  Google Scholar 

  42. Lieu JE, Tye-Murray N, Fu Q (2012) Longitudinal study of children with unilateral hearing loss. Laryngoscope 122:2088–2095. doi:10.1002/lary.23454

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF (2010) Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics 125:e1348–e1355. doi:10.1542/peds.2009-2448

    Article  PubMed  PubMed Central  Google Scholar 

  44. Martínez-Cruz CF, Poblano A, Conde-Reyes MP (2009) Cognitive performance of school children with unilateral sensorineural hearing loss. Arch Med Res 40:374–379. doi:10.1016/j.arcmed.2009.05.008

    Article  PubMed  Google Scholar 

  45. Mason MF, Norton MI, Van Horn JD, Wegner DM, Grafton ST, Macrae CN (2007) Wandering minds: the default network and stimulus-independent thought. Science 315:393–395

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. MacKay S, Gravel JS, Tharpe AM (2008) Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Trends Amplif 12:43–54

    Article  Google Scholar 

  47. Meis M, Uygun A, Janott C, Hemmer-Schanze C, Hilge C, Kalhlert J, Schick A (2003) Zur Wirkung von aktiven und passiven raumakustischen Maßnahmen auf die Geräuschwahrnehmung und Lebensqualität von Schülern: Ergebnisse aus einer prospektiven Längsschnittstudie. Fortschritte der Akustik DAGA’03. Aachen: DEGA e.V., Oldenburg: 630–631

  48. Neault M (2005) Progression from unilateral to bilateral loss. In: National workshop on mild and unilateral hearing loss: workshop proceedings. Breckenridge, CO. Centers for Disease Control and Prevention, pp 30–31.

  49. Nickisch A, Massinger C, Ertl-Wagner B, von Voss H (2009) Pedaudiologic findings after severe neonatal hyperbilirubinemia. Eur Arch Otorhinolaryngol 266:207–212. doi:10.1007/s00405-008-0737-2

    Article  PubMed  Google Scholar 

  50. Oflaz E (2009) Dissertation zur gesundheitsbezogenen Lebensqualität von schwerhörigen Kindern mit Hörgeräten. Zentrum für Psychosoziale Medizin des Universitätsklinikums Hamburg-Eppendorf Institut und Poliklinik für Medizinische Psychologie Prof. Dr. Dr. Martin Härter.

  51. Otti A, Gündel H, Wohlschläger A, Zimmer C, Sorg C, Noll-Hussong M (2012) Default mode network of the brain. Neurobiology and clinical significance. Nervenarzt 83(16):18–24. doi:10.1007/s00115-011-3307-6

    Google Scholar 

  52. Papso CF, Blood IM (1989) Word recognition skills of children and adults in background noise. Ear Hear 10:235–236

    Article  CAS  PubMed  Google Scholar 

  53. Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Colborn DK, Bernard BS, Rockette HE, Janosky JE, Pitcairn DL, Sabo DL, Kurs-Lasky M, Smith CG (2003) Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels. Pediatr Infect Dis J 22:309–314

    PubMed  Google Scholar 

  54. Patrick DL, Edwards TC, Skalicky AM, Schick B, Topolski TD, Kushalnagar P, Leng M, O’Neill-Kemp AM, Sie KS (2011) Validation of a quality-of-life measure for deaf or hard of hearing youth. Otolaryngol Head Neck Surg 145:137–145. doi:10.1177/0194599810397604

    Article  PubMed  PubMed Central  Google Scholar 

  55. Priwin C, Jönsson R, Magnusson L, Hultcrantz M, Granström G (2007) Audiological evaluation and self-assessed hearing problems in subjects with single-sided congenital external ear malformations and associated conductive hearing loss. Int J Audiol 46:162–171

    Article  PubMed  Google Scholar 

  56. Rohlfs AK, Wiesner T, Drews H, Müller F, Breitfuss A, Schiller R, Hess M (2010) Interdisciplinary approach to design, performance, and quality management in a multicenter newborn hearing screening project: introduction, methods, and results of the newborn hearing screening in Hamburg (part I). Eur J Pediatr 169:1353–1360. doi:10.1007/s00431-010-1228-1

    Article  PubMed  Google Scholar 

  57. Ross DS, Visser SN, Holstrum WJ, Qin T, Kenneson A (2010) Highly variable population-based prevalence rates of unilateral hearing loss after the application of common case definitions. Ear Hear 31:126–133. doi:10.1097/AUD.0b013e3181bb69db

    Article  PubMed  Google Scholar 

  58. Ross DS, Holstrum WJ, Gaffney M, Green D, Oyler RF, Gravel JS (2008) Hearing screening and diagnostic evaluation of children with unilateral and mild bilateral hearing loss. Trends Amplif 12:27–34

    Article  PubMed  PubMed Central  Google Scholar 

  59. Rouger J, Lagleyre S, Démonet JF, Fraysse B, Deguine O, Barone P (2012) Evolution of crossmodal reorganization of the voice area in cochlear-implanted deaf patients. Hum Brain Mapp 33:1929–1940. doi:10.1002/hbm.21331

    Article  PubMed  Google Scholar 

  60. Ruscetta MN, Arjmand EM, Pratt SR (2005) Speech recognition abilities in noise for children with severe-to-profound unilateral hearing impairment. Int J Pediatr Otorhinolaryngol 69:771–779

    Article  PubMed  Google Scholar 

  61. Sarimski K, Hintermair M (2014) Frühförderung hörgeschädigter Kinder: Stand der Forschung, empirische Analysen, pädagogische Konsequenzen. Median, Heidelberg

  62. Schmithorst VJ, Plante E, Holland S (2014) Unilateral deafness in children affects development of multi-modal modulation and default mode networks. Front Hum Neurosci 8(164). doi:10.3389/fnhum.2014.00164

  63. Shargorodsky J, Curhan SG, Curhan GC, Eavey R (2010) Change in prevalence of hearing loss in US adolescents. JAMA 304:772–778. doi:10.1001/jama.2010

    Article  CAS  PubMed  Google Scholar 

  64. Spirakis SE, Hurley RM (2003) Unilateral hearing loss in children with shunt-treated hydrocephalus. J Am Acad Audiol 14:510–517

    Article  PubMed  Google Scholar 

  65. Távora-Vieira D, Marino R, Acharya A, Rajan GP (2015) The impact of cochlear implantation on speech understanding, subjective hearing performance, and tinnitus perception in patients with unilateral severe to profound hearing loss. Otol Neurotol 36:430–436. doi:10.1097/MAO.0000000000000707

    Article  PubMed  Google Scholar 

  66. Tharpe AM (2008) Unilateral and mild bilateral hearing loss in children: past and current perspectives. Trends Amplif 12:7–15. doi:10.1177/1084713807304668

    Article  PubMed  PubMed Central  Google Scholar 

  67. Tieri L, Masi R, Ducci M, Marsella P (1988) Unilateral sensorineural hearing loss in children. Scand Audiol Suppl 30:33–36

    CAS  PubMed  Google Scholar 

  68. Van de Heyning P, Vermeire K, Diebl M, Nopp P, Anderson I, De Ridder D (2008) Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation. Ann Otol Rhinol Laryngol 117:645–652

    Article  PubMed  Google Scholar 

  69. Watier-Launey C, Soin C, Manceau A, Ployet MJ (1998) Necessity of auditory and academic supervision in patients with unilateral hearing disorder. Retrospective study of 175 children. Ann Otolaryngol Chir Cervicofac 115:149–155

    CAS  PubMed  Google Scholar 

  70. Watkin PM, Baldwin M (2011) Identifying deafness in early childhood: requirements after the newborn hearing screen. Arch Dis Child 96:62–66. doi:10.1136/adc.2010.185819

    Article  CAS  PubMed  Google Scholar 

  71. Williamson WD, Demmler GJ, Percy AK, Catlin FI (1992) Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection. Pediatrics 90:862–866

    CAS  PubMed  Google Scholar 

  72. Yang W, Bradley JS (2009) Effects of room acoustics on the intelligibility of speech in classrooms for young children. J Acoust Soc Am 125(2):922–933. doi:10.1121/1.3058900

    Article  CAS  PubMed  Google Scholar 

Download references


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.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Anna-Katharina Rohlfs.

Ethics declarations


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.

Additional information

Communicated by Peter de Winter



Table 6 ᅟ ᅟ

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rohlfs, AK., Friedhoff, J., Bohnert, A. et al. Unilateral hearing loss in children: a retrospective study and a review of the current literature. Eur J Pediatr 176, 475–486 (2017).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: