Semin Hear 2010; 31(4): 275-289
DOI: 10.1055/s-0030-1268030
© Thieme Medical Publishers

Children with Unilateral Hearing Loss

Judith E.C Lieu1
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Further Information

Publication History

Publication Date:
07 December 2010 (online)


In the United States alone, unilateral hearing loss (UHL) affects 0.1 to 5% of school-aged children and 0.04 to 3.4% of infants at birth. Several studies from the 1980s and 1990s raised the specter that UHL in children was not as benign as common wisdom suggested. In children 6 to 12 years old, UHL is associated with significantly poorer oral language skills and vocabulary intelligence quotient scores. Children with UHL are at higher risk of receiving individualized educational plans in school and speech therapy. Quality of life in children also may be negatively affected by UHL, similar to children with bilateral hearing loss. Although a growing number of audiologists, deaf educators, and otolaryngologists acknowledge the problems that many children with UHL experience, the larger medical and educational communities still tend to discount UHL as a problem for children. Further research is necessary to identify the children with UHL who may benefit from interventions and to determine which interventions are most effective in children with UHL.


  • 1 Oyler R F, Oyler A L, Matkin N D. Warning: a unilateral hearing loss may be detrimental to a child's academic career.  The Hearing Journal. 1987;  40(9) 18-22
  • 2 Bess F H. Children with unilateral hearing loss.  J Acad Rehab Audiol. 1982;  15 131-144
  • 3 Mild and Unilateral Hearing Loss: National Workshop. Beaver Run Resort, Breckenridge, CO; Centers for Disease Control and Prevention July 26–27, 2005
  • 4 Wazen J J, Spitzer J B, Ghossaini S N et al. Transcranial contralateral cochlear stimulation in unilateral deafness.  Otolaryngol Head Neck Surg. 2003;  129(3) 248-254
  • 5 Barsky-Firkser L, Sun S. Universal newborn hearing screenings: a three-year experience.  Pediatrics. 1997;  99(6) E4
  • 6 Finitzo T, Albright K, O'Neal J. The newborn with hearing loss: detection in the nursery.  Pediatrics. 1998;  102(6) 1452-1460
  • 7 Everberg G. Etiology of unilateral total deafness studied in a series of children and young adults.  Ann Otol Rhinol Laryngol. 1960;  69 711-730
  • 8 Mehra S, Eavey R D, Keamy Jr D G. The epidemiology of hearing impairment in the United States: newborns, children, and adolescents.  Otolaryngol Head Neck Surg. 2009;  140(4) 461-472
  • 9 Niskar A S, Kieszak S M, Holmes A, Esteban E, Rubin C, Brody D J. Prevalence of hearing loss among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey.  JAMA. 1998;  279(14) 1071-1075
  • 10 Ross D S, Visser S N, Holstrum W J, Qin T, Kenneson A. Highly variable population-based prevalence rates of unilateral hearing loss after the application of common case definitions.  Ear Hear. 2010;  31(1) 126-133
  • 11 Martínez-Cruz C F, Poblano A, Conde-Reyes M P. Cognitive performance of school children with unilateral sensorineural hearing loss.  Arch Med Res. 2009;  40(5) 374-379
  • 12 American Academy of Pediatrics, Joint Committee on Infant Hearing . Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs.  Pediatrics. 2007;  120(4) 898-921
  • 13 Kenna M A, Wu B L, Cotanche D A, Korf B R, Rehm H L. Connexin 26 studies in patients with sensorineural hearing loss.  Arch Otolaryngol Head Neck Surg. 2001;  127(9) 1037-1042
  • 14 Lee K H, Larson D A, Shott G et al.. Audiologic and temporal bone imaging findings in patients with sensorineural hearing loss and GJB2 mutations.  Laryngoscope. 2009;  119(3) 554-558
  • 15 Morton C C, Nance W E. Newborn hearing screening—a silent revolution.  N Engl J Med. 2006;  354(20) 2151-2164
  • 16 Rødningen O K, Prescott T, Eriksson A S, Røsby O. 1.4Mb recurrent 22q11.2 distal deletion syndrome, two new cases expand the phenotype.  Eur J Med Genet. 2008;  51(6) 646-650
  • 17 Dikkers F G, Verheij J B, van Mechelen M. Hereditary congenital unilateral deafness: a new disorder?.  Ann Otol Rhinol Laryngol. 2005;  114(4) 332-337
  • 18 Dodson K M, Kamei T, Sismanis A, Nance W E. Familial unilateral deafness and delayed endolymphatic hydrops.  Am J Med Genet A. 2007;  143A(14) 1661-1665
  • 19 Patel N, Oghalai J S. Familial unilateral cochlear nerve aplasia.  Otol Neurotol. 2006;  27(3) 443-444
  • 20 Smith A B. Unilateral hereditary deafness.  Lancet. 1939;  2 1172-1173
  • 21 Bamiou D E, Savy L, O'Mahoney C, Phelps P, Sirimanna T. Unilateral sensorineural hearing loss and its aetiology in childhood: the contribution of computerised tomography in aetiological diagnosis and management.  Int J Pediatr Otorhinolaryngol. 1999;  51(2) 91-99
  • 22 Laury A M, Casey S, McKay S, Germiller J A. Etiology of unilateral neural hearing loss in children.  Int J Pediatr Otorhinolaryngol. 2009;  73(3) 417-427
  • 23 McClay J E, Booth T N, Parry D A, Johnson R, Roland P. Evaluation of pediatric sensorineural hearing loss with magnetic resonance imaging.  Arch Otolaryngol Head Neck Surg. 2008;  134(9) 945-952
  • 24 Simons J P, Mandell D L, Arjmand E M. Computed tomography and magnetic resonance imaging in pediatric unilateral and asymmetric sensorineural hearing loss.  Arch Otolaryngol Head Neck Surg. 2006;  132(2) 186-192
  • 25 Song J J, Choi H G, Oh S H, Chang S O, Kim C S, Lee J H. Unilateral sensorineural hearing loss in children: the importance of temporal bone computed tomography and audiometric follow-up.  Otol Neurotol. 2009;  30(5) 604-608
  • 26 Simons J P, Ruscetta M N, Chi D H. Sensorineural hearing impairment in children with Chiari I malformation.  Ann Otol Rhinol Laryngol. 2008;  117(6) 443-447
  • 27 Tharpe A M, Sladen D P. Causation of permanent unilateral and mild bilateral hearing loss in children.  Trends Amplif. 2008;  12(1) 17-25
  • 28 Gedlicka C, Formanek M, Ehrenberger K. Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss.  Am J Otolaryngol. 2009;  30(3) 157-161
  • 29 Hashimoto H, Fujioka M, Kinumaki H. Kinki Ambulatory Pediatrics Study Group . An office-based prospective study of deafness in mumps.  Pediatr Infect Dis J. 2009;  28(3) 173-175
  • 30 Vartiainen E, Karjalainen S. Prevalence and etiology of unilateral sensorineural hearing impairment in a Finnish childhood population.  Int J Pediatr Otorhinolaryngol. 1998;  43(3) 253-259
  • 31 Lieu J E, Tye-Murray N, Karzon R K, Piccirillo J F. Speech-language scores in children with unilateral hearing loss.  Pediatrics. 2010;  125 e1348-e1355
  • 32 Uwiera T C, DeAlarcon A, Meinzen-Derr J et al. Hearing loss progression and contralateral involvement in children with unilateral sensorineural hearing loss.  Ann Otol Rhinol Laryngol. 2009;  118(11) 781-785
  • 33 Kakigi A, Nakatani H, Takeda T. Hearing changes in the contralateral ear with juvenile unilateral profound hearing loss of unknown origin.  Int J Pediatr Otorhinolaryngol Extra. 2006;  1(3) 192-195
  • 34 Fowler K B, Boppana S B. Congenital cytomegalovirus (CMV) infection and hearing deficit.  J Clin Virol. 2006;  35(2) 226-231
  • 35 Morzaria S, Westerberg B D, Kozak F K. Evidence-based algorithm for the evaluation of a child with bilateral sensorineural hearing loss.  J Otolaryngol. 2005;  34(5) 297-303
  • 36 Preciado D A, Lawson L, Madden C et al. Improved diagnostic effectiveness with a sequential diagnostic paradigm in idiopathic pediatric sensorineural hearing loss.  Otol Neurotol. 2005;  26(4) 610-615
  • 37 Bess F H, Tharpe A M. An introduction to unilateral sensorineural hearing loss in children.  Ear Hear. 1986;  7(1) 3-13
  • 38 Humes L E, Allen S K, Bess F H. Horizontal sound localization skills of unilaterally hearing-impaired children.  Audiology. 1980;  19(6) 508-518
  • 39 Bess F H, Tharpe A M. Unilateral hearing impairment in children.  Pediatrics. 1984;  74(2) 206-216
  • 40 Bovo R, Martini A, Agnoletto M et al. Auditory and academic performance of children with unilateral hearing loss.  Scand Audiol Suppl. 1988;  30 71-74
  • 41 Bess F H, Tharpe A M, Gibler A M. Auditory performance of children with unilateral sensorineural hearing loss.  Ear Hear. 1986;  7(1) 20-26
  • 42 Hartvig Jensen J, Johansen P A, Børre S. Unilateral sensorineural hearing loss in children and auditory performance with respect to right/left ear differences.  Br J Audiol. 1989;  23(3) 207-213
  • 43 Kiese-Himmel C. Unilateral sensorineural hearing impairment in childhood: analysis of 31 consecutive cases.  Int J Audiol. 2002;  41(1) 57-63
  • 44 Sedey A L, Carpenter K, Stredler-Brown A. Unilateral hearing loss: what do we know, what should we do?. Paper presented at: National Symposium on Hearing in Infants Conference August 1, 2002 Breckenridge, CO;
  • 45 Peckham C S, Sheridan M D. Follow-up? at II years of 46 children with severe unilateral hearing loss at 7 years.  Child Care Health Dev. 1976;  2(2) 107-111
  • 46 Klee T M, Davis-Dansky E. A comparison of unilaterally hearing-impaired children and normal-hearing children on a battery of standardized language tests.  Ear Hear. 1986;  7(1) 27-37
  • 47 Borg E, Risberg A, McAllister B et al. Language development in hearing-impaired children. Establishment of a reference material for a “Language test for hearing-impaired children,” LATHIC.  Int J Pediatr Otorhinolaryngol. 2002;  65(1) 15-26
  • 48 Cozad R L. Speechreading skill and communication difficulty of children and young adults with unilateral hearing loss.  J Aud Res. 1977;  17(1) 25-29
  • 49 Lieu J E, Tye-Murray N, Karzon R K, Piccirillo J F. Unilateral hearing loss is associated with worse speech-language scores in children.  Pediatrics. 2010;  125(6) e1348-e1355
  • 50 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ; Erlbaum 1988
  • 51 Christakis D A, Gilkerson J, Richards J A et al. Audible television and decreased adult words, infant vocalizations, and conversational turns: a population-based study.  Arch Pediatr Adolesc Med. 2009;  163(6) 554-558
  • 52 Geers A E. Predictors of reading skill development in children with early cochlear implantation.  Ear Hear. 2003;  24(1, Suppl) 59S-68S
  • 53 Moeller M P, Tomblin J B, Yoshinaga-Itano C, Connor C M, Jerger S. Current state of knowledge: language and literacy of children with hearing impairment.  Ear Hear. 2007;  28(6) 740-753
  • 54 Zimmerman F J, Gilkerson J, Richards J A et al. Teaching by listening: the importance of adult-child conversations to language development.  Pediatrics. 2009;  124(1) 342-349
  • 55 Hayiou-Thomas M E. Genetic and environmental influences on early speech, language and literacy development.  J Commun Disord. 2008;  41(5) 397-408
  • 56 Prathanee B, Thinkhamrop B, Dechongkit S. Factors associated with specific language impairment and later language development during early life: a literature review.  Clin Pediatr (Phila). 2007;  46(1) 22-29
  • 57 Oyler R F, Oyler A L, Matkin N D. Unilateral hearing loss: demographics and educational impact.  Lang Speech Hear Serv Sch. 1988;  19 201-210
  • 58 Dancer J, Burl N T, Waters S. Effects of unilateral hearing loss on teacher responses to the SIFTER. Screening Instrument for Targeting Educational Risk.  Am Ann Deaf. 1995;  140(3) 291-294
  • 59 Most T. The effects of degree and type of hearing loss on children's performance in class.  Deaf Educ Int. 2004;  6(3) 154-166
  • 60 Most T. Assessment of school functioning among Israeli Arab children with hearing loss in the primary grades.  Am Ann Deaf. 2006;  151(3) 327-335
  • 61 Niedzielski A, Humeniuk E, Błaziak P, Gwizda G. Intellectual efficiency of children with unilateral hearing loss.  Int J Pediatr Otorhinolaryngol. 2006;  70(9) 1529-1532
  • 62 Lieu J E. Speech-language and educational consequences of unilateral hearing loss in children.  Arch Otolaryngol Head Neck Surg. 2004;  130(5) 524-530
  • 63 Widen J E, Folsom R C, Cone-Wesson B et al. Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol.  Ear Hear. 2000;  21(5) 471-487
  • 64 Hoffarth K, Lieu J E. Unilateral hearing loss in children: academic implications and recommendations.  Bull Am Aud Soc. 2010;  35(1) 32
  • 65 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion .Health-related quality of life. Available at: Accessed: December 22, 2009
  • 66 Wake M, Hughes E K, Collins C M, Poulakis Z. Parent-reported health-related quality of life in children with congenital hearing loss: a population study.  Ambul Pediatr. 2004;  4(5) 411-417
  • 67 Petrou S, McCann D, Law C M, Watkin P M, Worsfold S, Kennedy C R. Health status and health-related quality of life preference-based outcomes of children who are aged 7 to 9 years and have bilateral permanent childhood hearing impairment.  Pediatrics. 2007;  120(5) 1044-1052
  • 68 Giolas T G, Wark D J. Communication problems associated with unilateral hearing loss.  J Speech Hear Disord. 1967;  32(4) 336-343
  • 69 Newman C W, Jacobson G P, Hug G A, Sandridge S A. Perceived hearing handicap of patients with unilateral or mild hearing loss.  Ann Otol Rhinol Laryngol. 1997;  106(3) 210-214
  • 70 Borton S A, Mauze E, Lieu J E. Quality of life in children with unilateral hearing loss: a pilot study.  Am J Audiol. 2010;  19(1) 61-72
  • 71 Fortnum H M, Summerfield A Q, Marshall D H, Davis A C, Bamford J M. Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study.  BMJ. 2001;  323(7312) 536-540
  • 72 Kennedy C, McCann D, Campbell M J, Kimm L, Thornton R. Universal newborn screening for permanent childhood hearing impairment: an 8-year follow-up of a controlled trial.  Lancet. 2005;  366(9486) 660-662
  • 73 National Center for Hearing Assessment and Management (NCHAM) .State EHDI/UNHS Mandates. Summary Table. 1998. Available at: Accessed: May 24, 2009
  • 74 Holstrum W J, Gaffney M, Gravel J S, Oyler R F, Ross D S. Early intervention for children with unilateral and mild bilateral degrees of hearing loss.  Trends Amplif. 2008;  12(1) 35-41
  • 75 American Academy of Audiology. Pediatric amplification protocol .2003 Available at: Accessed: September 15, 2009
  • 76 McKay S. Management of young children with unilateral hearing loss.  Volta Review. 2007;  106(3) 299-319

Judith E.C LieuM.D. 

660 S. Euclid Avenue, Campus Box 8115

St. Louis, MO 63110