Unilateral hearing loss (UHL) means that hearing is normal in one ear but there is hearing loss in the other ear. The hearing loss can range from mild to very severe. Approximately one out of 1000 children is born with UHL. Unilateral hearing loss can occur in both adults and children. Nearly 3% of school-aged children have UHL.Children with UHL are at higher risk for having academic, speech/language and social/emotional difficulties than their normal hearing peers. Some children with UHL experience these difficulties but others do not.

Many times we do not know the cause of hearing loss. Below are some possible causes of UHL:

• Hearing loss that runs in the family (genetic or hereditary)
• An outer, middle or inner ear abnormality
• Specific syndromes
• Specific illnesses or infections
• Skull (temporal bone) fractures
• Excessive or extreme noise exposure
• Traumatic brain injury

Unilateral Hearing Loss in Children

Unilateral hearing loss (UHL) means that hearing is normal in one ear but there is hearing loss in the other ear.

Many children with UHL are identified at birth through newborn hearing screening programs. We know that early identification and intervention of hearing loss results in extremely favorable outcomes, and we now have an opportunity to intervene earlier for children with UHL.

Although hearing sometimes gets worse, often it does not. Hearing that worsens over time is sometimes referred to as progressive hearing loss. The otolaryngologist (ear, nose, and throat [ENT] doctor) can order tests that may be able to determine whether your child is at risk of progressive hearing loss. It is important for an audiologist (hearing specialist) to closely monitor your child's hearing in both ears. If there are any changes, your audiologist will suggest ways to help your child.

What types of evaluations will my child need?

• Hearing: An audiologist will conduct a complete hearing test for your child. This will include tests of his or her middle ear function. The audiologist may also do special hearing tests if they are needed and make referrals to other professionals who can help your child.
• Ear, Nose, and Throat (ENT): Any child with hearing loss should be seen by an ENT doctor. The ENT will examine your child's ears. He or she will want to make sure that conditions such as wax and middle ear conditions such as fluid are not causing your child's hearing loss. The ENT may order some special tests to see whether the cause of the hearing loss can be determined.
• Eye and Vision: An ophthalmologist (eye doctor) will examine your child's eyes and vision. Since your child has a hearing loss, it is important to check that his or her vision is normal. Disorders that affect both vision and hearing are more commonly seen in children with bilateral hearing loss.
• Genetics: Most children with permanent hearing loss are referred to a geneticist. This doctor may be able to determine a possible cause of the hearing loss and tell you whether it runs in the family. He or she may ask other family members to have their hearing tested. The geneticist will also check your child for other medical problems.
• Speech/Language: A speech-language pathologist will evaluate and monitor your child's speech and language development. If your child's speech or language is delayed, the speech-language pathologist may suggest activities to do at home or may recommend speech therapy.
• Early Intervention: If your child is under 3 years of age, he or she should be evaluated by your county's early intervention program. This program is available to your child in your community. Program personnel may test your child and recommend that he or she receive services to stimulate speech and language, or they may simply want to monitor your child and track his or her development.
  

What are some treatment options for children with UHL?

A hearing aid might be an option for your child. Some children with UHL benefit from using a hearing aid. Factors to consider include your child's age and the amount of hearing loss. Your audiologist will help you to decide what will best meet your child's needs.

• Conventional Hearing Aid: A hearing aid may be appropriate for some children with UHL. It is recommended if there is some usable hearing in the impaired ear. The goal is for your child to be able to hear and understand speech in the ear with hearing loss. It may also allow your child to have a perception of more "balanced" hearing. A conventional hearing aid is not recommended if your child has severe or profound UHL. Most young children are fit with a behind-the-ear (BTE) type of hearing aid.When a child's ear canal growth slows (at approximately 12 years of age), he or she may be a candidate for an in-the-ear (ITE) hearing aid. The choice will depend on a variety of factors such as degree of hearing loss, chronic external or middle ear pathology, and maturity level. Any child under the age of 18 years requires medical clearance by a physician prior to the fitting of a hearing aid.
• Frequency Modulating (FM) System: At some point, your audiologist may recommend an FM system for your child. An FM system can provide a great deal of benefit to children with any degree of UHL. With this device, the speaker (teacher or parent) wears a small microphone and the child has a receiver. The receiver may be a headset, an attachment to the child's hearing aid, an ear bud style earphone, a desktop speaker, or room speakers. An FM system allows the speaker's voice to be heard at a listening level that is louder than the existing background noise. An FM system can be used in different situations, such as school, church, scouts, and the car. It is important to note that in group situations, young children should be able to hear all who are contributing to a conversation. In other words, a young child learns not only from a parent or teacher but also from other children.
• Osseointegrated Auditory Device: This device, called a Baha, is placed surgically in the bone behind the ear. It is intended for individuals with primarily conductive hearing loss (outer or middle ear abnormality). It has recently been marketed for individuals with "single sided deafness" or profound UHL. The Baha is approved for children over 5 years of age, but little is known about its effectiveness in children with UHL at this time.
• Contralateral Routing of Signal (CROS) Aid: This hearing aid is for individuals with a severe or profound UHL. It picks up sound on the impaired side and delivers it to the good ear. This system may be useful in quiet listening situations. It is not recommended in situations where noise could enter on the impaired side and be sent to the "normal" side. This could actually make it more difficult for your child to understand what is being said. A CROS aid is not a good choice unless your child can determine when it helps and when it does not. For this reason, it is not recommended for young children.
• Cochlear Implant: A cochlear implant is not an option for children with UHL. This device, which is placed surgically in the inner ear, is only for children with severe or profound hearing loss in both ears.
  

What else do I need to know?

• If your child seems to be having more difficulty hearing, see your audiologist as soon as possible. Signs of difficulty may include:
• ignoring sounds to which he or she used to respond
• saying "huh?" more often
• needing the TV turned up
• seeming unusually frustrated
• having trouble with attention
• having uncharacteristic behavioral problems
• reporting that his or her hearing aid is not working
• Remember that your child will have difficulty localizing sounds. This is important for safety. He or she may not be able to tell from where someone is calling him or her or from which direction a horn is honking.
• If your child starts to show signs of an ear infection, take him or her to your doctor as soon as possible. Such signs may include: tugging on the ear(s), increased irritability, difficulty sleeping, and/or fever. If your child has an ear infection or fluid in his or her ear, it could cause temporary hearing loss. Middle ear fluid may cause hearing loss in your child's "good" ear and/or increased hearing loss in his or her "impaired" ear. Although middle ear problems are common in young children, it can be more detrimental to your child than to a child with normal hearing in both ears.
• Make sure your child's ears do not get plugged by earwax. Although earwax is normal, it can cause temporary hearing loss. If you notice that your child has excessive earwax, take him or her to the doctor.
• Has your child been diagnosed with large vestibular aqueduct syndrome (LVA)? This is a particular formation of the inner ear that can be seen on a CT scan or MRI ordered by your ENT. If your child has LVA, you may be instructed to try to avoid situations where your child could get bumped in the head. Sometimes a blow to the head or sudden changes in pressure (as experienced with scuba diving) can cause the hearing to worsen. If your child has LVA and you have any concern about a change in hearing, you should schedule an appointment with your audiologist.
• Start to think about "hearing conservation." This refers to protecting the hearing that you have. Have your child use earplugs when he or she is going to be at loud events (fireworks, concerts). Extremely loud sounds can cause additional hearing loss. If your child is using an iPod or MP3 player, make sure to keep the volume at a reasonable level. As your child grows, teach him or her about hearing conservation. It should become a habit. A fun and informative Web site for you and your child to visit is Dangerous Decibels. Your child might enjoy going to the "Virtual Exhibit" part of the site.