Many people are living with hearing loss in one ear only, this is known as single-sided deafness, unilateral hearing loss, or one-sided hearing loss. It is also called asymmetrical hearing with typically better hearing in the one ear and a severe-to-profound permanent hearing loss in the other ear. You may have been told that you need to live with it as there is still hearing in your good ear, but find that your quality of life is affected as hearing with one ear is hard work!

There is a reason why we are born with two ears and can hear from both sides. If the hearing in one ear is impaired, it can impact our daily lives and affect easy hearing and listening. In order to understand this type of hearing loss and how it could affect your physical functioning, daily activities, social interaction, and the effect on your well-being, let us consider the following points below.

How functioning can be affected

Hearing in both ears helps us to better understand speech in the midst of noise and to follow a conversation in difficult listening situations. Think about a meeting at work, a noisy office where people are talking at once, a party or gathering with a group of people. Often people will talk at the same time and you need to follow the conversation. There may be background noise like office equipment, everyday sounds, or music at a busy restaurant or shopping mall. Those circumstances can make hearing and understanding speech more difficult, and you may have a hard time coping with hearing in one ear only.

Hearing in two ears further helps us to locate the direction of sound. Think about crossing a busy street, waiting for a phone call or alarm, or staying connected with technology. We need to pinpoint where a sound is coming from to respond appropriately or to stay safe. If you cross a street and you think the traffic is on your right because that is your better ear, you may be very confused and distressed when you realize the sound is actually on the left. It may also be hard to tell how loud sound is if you can’t hear from both ears.

Impact on daily activities

People with one-sided hearing often report that they find the following daily activities difficult:

• Listening and hearing in the car, especially if the other person is sitting next to the ear with the bad hearing
• Appreciating music and locating the source of sound
• Sports events with a lot of noise can be overwhelming
• Making out what people are saying when they talk on the side with the bad hearing, especially if there is noise or a group of people
• Communicating with a partner who becomes irritated or frustrated if you ask for repetition or don’t respond
• Experiencing fatigue and getting tired at the end of the day as hearing with one ear is hard work.

Impact on social interaction

Living with one-sided hearing can impact social activities and engaging with other people. As hearing with one ear is more challenging and tiring, you may find that you are limiting activities where you need to hear and talk with groups of people as you are worried that you may not be able to follow and understand them. It is not easy to ask someone to repeat themselves or it could be embarrassing to feel confused and not follow conversations, worrying that important information has been missed. One-sided hearing can then cause you to limit difficult listening situations by withdrawing, reducing participation, or avoiding those places. As hearing loss is hidden, other people or family members may not understand your challenges and why you avoid socializing.

Impact of one-sided hearing on your well-being (psychological effect)

You may be born with hearing in one ear only or maybe you acquired the one-sided hearing loss at a later stage in life. This will have a different impact on your expectations, your well-being, and your response to the hearing loss, and how to manage your one-sided hearing. If it was a sudden loss in the one ear, a medical referral is recommended as it will help you to understand the cause of the hearing loss in the one ear only. To suddenly lose a sense like hearing, even if it is only in the one ear, can cause you to be worried and stressed. Anxiety over possibly losing the remaining hearing in the good ear can be experienced.

You may feel more isolated, frustrated, and not be confident about your ability to participate and contribute at work or social gatherings. It may also affect your relationship with friends or loved ones when you become more dependent on them or when you can’t connect with them as before. Feeling vulnerable can be expected, especially if the cause of the hearing loss was sudden. Any loss causes us to seek a new identity and role. Confidence links with communication and if you can’t perform as you used to, it may affect your self-esteem.

In cases where one-sided hearing loss was there from birth, coping strategies could have developed already and it is part of your identity. It could then have less of an effect on self–esteem. 

Solutions, support, and strategies

Like most challenges in life, there are many solutions, strategies, and support that form part of an action plan. The impact of one-sided hearing loss will vary amongst individuals and how it affects their social life and well-being. It is therefore important to tailor a plan according to your needs and expectations. We will talk about technology solutions, support, and listening strategies that are available.

Technology Solutions:

Devices or hearing aid technology that can help for single-sided deafness include the following:

• CROS (Contralateral Routing of Signals) or BiCROS hearing aid: A CROSS hearing aid takes the sound from the ear with poor hearing and sends it to the ear with the better hearing.
• Bone Anchored Hearing Aid: Sound vibrations of the device travel across the bones of the head from the deafened side to the hearing side.
• Cochlear Implant: Although not routinely done, cochlear implants are approved for people 5 years and older with one-sided hearing loss who have a profound permanent (sensorineural) hearing loss in one ear and normal or mild hearing in the other ear.
• FM (frequency modulated) system: This solution is often used by children with one-sided hearing loss where the FM device is placed in the better ear to overcome difficult listening situations like hearing in noise or over a distance.

Support:

• Counseling to understand the social, emotional, and functional impact of one-sided hearing loss
• Expectations should be addressed
• Quality of life can be improved when you take action to overcome hearing challenges
• Additional management should be explored in some cases e.g. bothersome tinnitus or balance problems
• Referral to other professionals e.g. ENT (especially in the case of a sudden loss or to investigate the cause); counselor, hearing health professional
• Loved ones/conversation partners/family and friends/those who work, live, and socialize with us – hearing does not only affect you but also those you are in contact with and need to communicate with
• Professionals should understand the challenges so that they can refer rather than dismiss the problem.

Listening Strategies:

• Placement and preferential seating – the better ear needs to face the person that you are talking to in a group situation or when hearing is difficult
• Remember to depend on all senses when you need to be alert like crossing a street or driving, as you can’t rely on hearing only
• Lip-reading skills can be developed and some therapists provide training
• Knowing the topic of conversation and communication strategies can help to ease listening. Therapy can help to teach and train such strategies and more communication tips are available on this site.
• Awareness and understanding of the problem will help a person to stay motivated, participate and proactively manage the problem.

There is more to one-sided hearing loss than learning to live with it. Take the first step to explore and learn about the options available to you as you work to understand, connect and hear everything that surrounds you – on both sides!