Optimal Management of Single-Sided Deafness

This article was originally published in The Laryngoscope. 2013;123:304-305.

Background

Current trends in auditory rehabilitation for single-sided deafness (SSD) reflect a renewed interest in the functional impact of unilateral hearing loss and also in the advances in technologies for SSD that make interventions more effective and more appealing to patients. Clinicians are now equipped with an array of therapeutic options ranging from Bluetooth contralateral routing of signal (CROS) devices to in-the-ear TransEar hearing aids (Ear Technology Corp., Johnson City, Tenn.), as well as bone-anchored hearing aids (BAHA). Even unilateral cochlear implantation represents a current investigational intervention that may offer yet another option to patients in the future.

A prominent deficiency in this field is the absence of concise and evidence-based guidelines for patient and intervention selection. Factors to consider when recommending the best treatment include functional handicapping due to SSD, speech understanding in noise, localization, ease of use, the need for surgery and cost. This article seeks to review the pertinent literature on this topic and offer a best-practice framework.

Best Practice

As a best practice, it is reasonable to consider a sequential interventional approach for SSD patients that takes into consideration the degree of invasiveness or risk associated with each intervention. For example, an initial trial of a CROS or TransEar type hearing aid can be recommended as a nominal risk, noninvasive option for patients with SSD. If those trials prove unsatisfactory, the patient might then be considered an appropriate candidate for an implantable bone conduction device (e.g., BAHA or Sophono). Extensive counseling about peri- and postoperative care as well as complication rates for the BAHA need to be discussed with the patient preoperatively. Those patients likely to require magnetic resonance imaging (MRI) should also be counseled against Sophono implantation due to MRI incompatibility. Finally, patients should understand the realistic benefits offered by hearing interventions (whether CROS, TransEar, BAHA, or Sophono). There is no cost-effectiveness analysis comparing the use of the BAHA versus other modalities.