Patients with asymmetric or unilateral sensory hearing loss struggle with speech perception in noise and sound source localization due to loss of binaural cues. They may also experience disabling tinnitus and reduced quality of life and quality of hearing. A cochlear implant restores binaural hearing in these patients and can markedly improve sound localization, speech perception in noise, reduce or eliminate tinnitus, and improve quality of life and hearing. Cochlear implantation for single sided deafness is both safe, effective, and not investigational. Since 2019, cochlear implantation for single-sided deafness is an FDA-approved indication. The AAO-HNS endorses cochlear implantation for cases of asymmetric or unilateral sensory hearing loss in adult patients.
Children with unilateral sensorineural hearing loss experience problems with sound localization, speech perception in noise, and increased auditory effort due to loss of binaural cues. This is particularly detrimental as children are still learning language, frequently in noisy classrooms, and their loss is associated with increased risks of failing a grade, behavioral issues, and speech delay. Restoration of true binaural hearing can be accomplished with a cochlear implant, and use of a cochlear implant has demonstrated marked improvements in localization, speech perception in noise and auditory effort in these children. Selected children should undergo cochlear implantation as soon as hearing loss and appropriate anatomy is verified to avoid missing a developmental window that permits integration of binaural cues. It is the position of the AAO-HNS that cochlear implantation is an appropriate management option for rehabilitation of unilateral sensorineural hearing loss in appropriately selected children.
Approved April 2023
Updated May 2026
References:
- Strength of study design (randomized trial): Speech Perception in Noise After Cochlear Implantation for Single-Sided Deafness: A Randomized Clinical Trial. van Heteren JAA, Wendrich AW, Peters JPM, Grolman W, Stokroos RJ, Smit AL. JAMA Otolaryngol Head Neck Surg. 2025 Mar 1;151(3):211-219. doi: 10.1001/jamaoto.2024.4760. PMID: 39820302
- Systematic review/meta-analysis: Cochlear Implantation Outcomes in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis. Daher GS, Kocharyan A, Dillon MT, Carlson ML. Otol Neurotol. 2023 Apr 1;44(4):297-309. doi: 10.1097/MAO.0000000000003833. Epub 2023 Feb 15. PMID: 36791341
- ACIA Guideline: American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness. Dillon MT, Kocharyan A, Daher GS, Carlson ML, Shapiro WH, Snapp HA, Firszt JB. Ear Hear. 2022 Nov-Dec 01;43(6):1605-1619. doi: 10.1097/AUD.0000000000001260. Epub 2022 Aug 22. PMID: 35994570
