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This entry was posted in Helpful Information and tagged BBC health, single sided deafness, SSD, Unilateral Hearing Loss on May 1, 2013 by oticonmedical. Enter your email address to follow this blog and receive notifications of new posts by email. Unilateral hearing loss (UHL) is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties. This indicates that the majority of people today who are fit monaurally with hearing aids are those with unilateral hearing loss (UHL).  UHL is defined as a loss in one ear of any degree (mild to profound) regardless of the type of hearing loss. Recent research indicates school-aged children with UHL demonstrate worse oral language scores (worse language comprehension, oral expression, and oral composite) compared with siblings and normal-hearing age peers.5 Academically, children with UHL have been found to perform more poorly than their normal-hearing counterparts. Although the choice to fit infants with moderate or greater degrees of bilateral hearing loss has become standard practice, the decision of whether to fit amplification to children with UHL is less clear. With the introduction of universal newborn hearing screening, UHL can be diagnosed within the first 3 months of life.
The treatment of UHL can include sound field systems, FM systems, traditional hearing aids, CROS hearing aids, bone-anchored hearing aids (BAHA), and even a cochlear implant depending on the type, configuration, and degree of hearing loss. The benefits of hearing aids include increased audibility, minimizing of auditory deprivation, as well as ease of listening in both quiet and noisy listening conditions. Johnstone and her colleagues10 investigated the sound localization acuity of children with mild-to-severe UHL ages 6 to 14 years who wore a hearing aid in the impaired ear. Fitting of hearing aid amplification is indicated for some people with unilateral hearing losses. Regarding timing, older children and adults with UHL who are identified as candidates should be fit with amplification as soon as possible. Should hearing aids be fit differently for patients with UHL than for those with bilateral hearing losses? It should be noted that current prescriptive methods are specifically studied and designed for people with bilateral hearing loss. When doing the initial fitting, be aware that some software will default to a monaural fitting prescription when only one hearing aid is connected if the fitting rule incorporates a binaural correction.
As mentioned, the literature on fitting of asymmetric hearing loss can inform how to fit UHL. One technique12 to achieve the goal of binaural fusion or balance for fitting an asymmetric hearing loss can easily be applied to fitting UHL. Whether hearing aids should be fit differently for those with UHL also extends beyond the gain-frequency response prescription to features of the hearing aids. Children’s limited experience with receptive speech and the importance of overhearing will limit the use of directional microphones.
One important consideration when using wireless accessories is that the fitting should be considered open regardless of how the impaired ear is fit.
Frequency lowering (frequency compression, frequency translation, or frequency transposition) algorithms are another common feature in hearing aids today. UHL is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties.
Would you like some practical help and guidance on how you can support your child's language development? We provide a support group at our Hampshire Family Centre for babies and pre-school children with persistent 'glue ear' or unilateral (one-sided) hearing loss and their families..
The monthly sessions are friendly and supportive, providing you and your child with lots of expert advice and practical support.
Glue ear (or conductive hearing loss) is a very common condition in young children, and can have a major impact on their speech and language development. Unilateral hearing loss (or hearing loss on one side) can also impact on speech and language development. At The Elizabeth Foundation, we have over 30 years of experience of supporting babies and preschool children with hearing loss to develop their listening skills, natural speech and language. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. 1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St.
2Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Objective: Language acquisition was assumed to proceed normally in children with unilateral hearing loss (UHL) since they have one functioning ear. Results: Lower FA of left lateral lemniscus was observed for children with UHL compared to their NH siblings, as well as trends toward differences in other auditory and non-auditory regions. A few studies have used DTI to investigate the neuroanatomic properties of auditory processing regions in patients with hearing loss. This study protocol was approved by the Human Research Protections Office (HRPO) at the Washington University School of Medicine. Cognitive ability was assessed by the Wechsler Abbreviated Scale of Intelligence (WASI) (Wechsler, 1999). The images were preprocessed and transformed into modified (Talairach and Tournoux, 1988) space using the following methods. The 15 regions of interest selected for analysis are listed in Table 1 and fall into two groups.
Regions were located and sampled after the MPRAGE scans were transformed into Tailarach space over three to four slices each by one independent rater under the supervision of an experienced neuroradiologist. Because multiple variables can predict outcomes, we used multiple linear or logistic regression modeling to evaluate the role of age and UHL simultaneously with the specific DTI parameters which were statistically significant or trending toward significance in bivariate analysis on the educational outcomes of interest. Though NH subjects performed better on all aspects of the cognitive testing, these differences were not all statistically significant (Table 3).
DTI parameters were compared separately on the left and right side of the brain; for instance, the FA of the right auditory radiation of the UHL group vs.
Paired comparisons between the left and right sides of structures were performed for the UHL and NH groups.
In general, FA correlated positively and MD negatively with test scores for children with UHL (data not shown). Multiple logistic regression analyses were performed similarly for IEP and speech therapy as the dependent variables.
Research shows sound localization test scores were significantly poorer for the children with UHL than for the children with normal hearing. In a study of 60 children with UHL, Bess and Tharpe6 found that 35% of the children had repeated at least one grade in school, and an additional 13.3% required resource assistance, such as academic tutoring.
It has been shown that fitting of aids soon after identification can minimize language delay; however, there can be a delay of up to 7 months in provision of amplification for children with mild and UHL. In this article, we will only discuss the fitting of conventional hearing aid amplification. Their results showed that a hearing aid can provide bilateral localization benefit to some children with UHL.
The decision to fit a patient with unilateral hearing loss should be made on an individual basis, taking into consideration the person’s or family’s preferences, as well as audiologic, developmental, educational, and communication needs.

Those with moderately severe or better UHL are likely to accept the use of a hearing aid, whereas those with a severe or profound UHL may not comply with hearing aid usage at all. For infants, there is still debate whether they should be fit before or after 18 months of age. Although the prescription may provide targets for a monaural versus binaural fitting, it might not specifically address the needs of people with UHL. NAL-NL2 is an example of a prescription that provides binaural correction for both pediatric and adult patients, while DSL 5.0 only has a binaural correction for adults. Directional microphones can be fitted according to the patient’s communication needs for adults with UHL. When a directional microphone is used, it is recommended to keep it in the automatic mode.  There is some evidence that directional microphones in the automatic mode will switch appropriately between a directional and omnidirectional response for the given environment approximately 90% of the time.
But there is only limited literature about hearing aid fitting for patients with UHL; some of the ideas have to borrow from asymmetry hearing loss fitting. Fitting of a hearing aid should be individually based and using your own expertise, taking consideration of patient age, degree of hearing loss, speech development, communication needs, and other morbidities, etc.
Monaural hearing aid fitting considerations for Patients with unilateral hearing loss: Who should receive unilateral fittings, and how should you fit them? Hearing Review. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. However, children with UHL score poorly on speech-language tests and have higher rates of educational problems compared to normal hearing (NH) peers. Twenty nine children with severe-to-profound UHL were compared to 20 siblings with NH using IQ and oral language testing, and MRI with DTI.
Correlation analyses showed associations between several DTI parameters and outcomes in children with UHL. Although children with UHL have performed worse on speech-language tests, it is less clear that the side of hearing impairment influences cognitive abilities. In a prior investigation in this study cohort, differences in resting state functional connectivity MRI (rs-fcMRI) were found in areas associated with auditory processing, executive function and memory formation between children with UHL and NH controls (Tibbetts et al., 2011). Participants with UHL were defined as having severe-to profound sensorineural UHL by pure tone audiometry, with pure tone averages (PTA) ≥70 dB hearing level (HL) in the affected ear. Informed consent was obtained from all parents of subjects and pediatric assent obtained from all minor participants.
Parents also indicated whether children required speech therapy, special educational accommodations or special services at school, or an individualized educational program (IEP).
We used standardized performance IQ, verbal IQ, and full scale IQ scores along with vocabulary T-scores as educational outcomes. A 9-parameter rigid body alignment registered all frames in all runs and was used for motion correction of each subject. Regions of interest (ROIs) used for DTI measurements placed on anatomical T1-weighted MRI scan. Additional regions of interest (ROIs) used for DTI measurements placed on anatomical T1-weighted MRI scan; all are non-auditory ROIs. ROI location was traced on the MPRAGE anatomy, but guided using coregistered T2-weighted images to avoid cerebrospinal fluid, and FA images to capture fiber centers. Educational performance variables were compared with Mann-Whitney U-tests between the UHL and NH groups and between the right and left UHL groups. Paired Wilcoxon signed rank-test of DTI parameters between sides (right and left) were performed within each of the groups. For the regression analyses, a p-value less than 0.05 was considered statistically significant. Demographic characteristics of normal hearing (NH) children and children with unilateral hearing loss (UHL). Comparisons between unilateral hearing loss (UHL) group and the normal hearing group (NH) for educational outcome variables, and right unilateral hearing loss (right UHL) and left unilateral hearing loss (left UHL) groups. The FA of the left lateral lemniscus and the FA of the left subcortical white matter of Heschl's gyrus trended toward being lower in the left UHL group. In all UHL subjects, the right side FA was greater than the left side FA in both auditory and non-auditory regions, with the exception of the superior temporal gyrus, middle cingulate gyrus, anterior limb of the internal capsule, centrum semiovale and the anterior corona radiata (Table 5).
Though there were many trends toward significance in the NH group, there were no significant correlations.
Spearman rho correlation values between educational outcomes and DTI parameters (fractional anisotropy, FA; mean diffusivity, MD) in auditory and non-auditory regions of interest (ROI) in participants with normal hearing (NH), unilateral hearing loss (UHL), right UHL or left UHL. As with the correlation analyses, FAs were generally positively related to test scores while MDs were negatively associated with test scores (Table 7). The FAs of the bilateral middle cerebellar peduncles were negatively related to the need for speech therapy (Table 8). In the ensuing years, as the benefits of binaural hearing aid fittings became apparent, the proportion of monaural-to-binaural fittings did a dramatic flip-flop.
Localization acuity in younger children with UHL was significantly improved, but not in the group of older children; time of intervention is also a main factor affecting the localization benefit. On the one hand, it is unknown what degree of UHL may result in auditory deprivation and what is the critical time to provide amplification thereby avoiding these effects.
That is, we do not yet know if people with UHL prefer the gain generated by a prescriptive method designed for monaural fitting of a bilateral hearing loss.7 But we can get some inspiration from fitting experiences with asymmetrical hearing loss.
While a program button to access multiple listening programs may be of little relevance for patients with UHL, a volume control is a must. WDRC will automatically adjust the gain of the hearing aid based on the input sound level to ensure natural perception of loudness. For children, the use of directional microphone may be beneficial in some listening situations, such as when the target signal is located in front of the listener; however, decreased performance with directional response has been noted when the target signal was located to the side or behind the listener. Such hearing aids can receive an audio signal from a remote location to improve signal-to-noise ratio (SNR) and can be of particular benefit when listening in noisy environments.
The time of arrival of the streamed wireless signal to the impaired ear should not be delayed too much relative to the good ear receiving the signal acoustically to avoid disturbing perceptual effects. Noise reduction has not been found to improve or degrade speech understanding in adults or school-aged children, but it can improve comfort and ease-of-listening in realistic listening situations.
Since the good ear will receive undistorted normal sound, the frequency lowered sound may interfere with binaural processing. The role of aided ear is to provide more useful information to help understand speech and for binaural processing.
The relevance of other treatment options than conventional hearing aids, such as FM, CROS, BAHA, and a cochlear implant, also should be considered and communicated to the patient. Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss.
Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear.
An evidence-based systematic review of amplitude compression in hearing aids for school-age children with hearing loss. Fewer wires, less complexity, and more connections: The new challenge for wireless hearing instruments.

Diffusion tensor imaging (DTI) is an imaging modality used to measure microstructural integrity of brain white matter. Regression analyses revealed relationships between educational outcome variables and several DTI parameters, which may provide clinically useful information for guidance of speech therapy. It was previously assumed that because children with UHL had one functioning ear, speech acquisition and language comprehension skills developed normally.
According to the REA hypothesis, children with right UHL should have greater difficulties with language skills than those with left UHL. In light of DTI changes reported in prior studies of hearing loss, the goal of this study was to determine how UHL influences the development of white matter tracts in the brain. All scores were standardized to a mean of 100 with a standard deviation (SD) of 15, except for the vocabulary T-score, which is standardized to a mean of 50 and SD of 10. Resampling was done by a 3-dimensional cubic spline interpolation and transformed to a Talairach atlas space using a single common atlas derived from adult and child brains via a warping mechanism (Burgund et al., 2002).
The second group are non-auditory regions that are considered important white matter areas that are commonly sampled in DTI studies of the brain. The FA and MD values in the ROIs were measured and averaged over consecutive slices for a more accurate measurement than a single slice would give, thus minimizing the risk of type I error.
Correlations between educational variables and DTI parameters were explored using Spearman's rho coefficient. There were no significant differences in gender, age, racial composition, handedness or rates of prematurity between the NH and UHL groups. However, NH individuals trended toward higher scores on the verbal component of the cognitive tests (Table 3).
FA values trended toward being higher in the NH group than in the UHL group in two auditory regions and two non-auditory regions. In the UHL group, the FA and the MD of several ROIs correlated significantly with several different educational parameters, such as full IQ, verbal IQ, IEP, and speech therapy (Table 6). The children with UHL also had significantly poorer speech-recognition scores than their normal-hearing peers. Children who were fit earlier showed bilateral benefit, whereas children who were fit later showed bilateral interference.
Thus, any binaural correction should be used even though only one hearing aid is being fit to compensate for binaural summation effects. Then, ask the patient about where they perceive your voice to be coming from when you are sitting in front of him or her.
This is because it won’t be known how the poor ear with amplification will interact with the good ear in real-world situations. An example of a wireless accessory that could be used for this purpose is a companion microphone that can be held or worn by a conversational partner or speaker-of-interest. When the poor ear has a severe hearing loss, the aided sound can reach the brain, but it may not be helpful.
Unilateral hearing loss is associated with worse speech-language scores in children: a case-control study. The purpose of this pilot study was to investigate differences in fractional anisotropy (FA) and mean diffusivity (MD) in hearing- and non-hearing-related structures in the brain between children with UHL and their NH siblings. Parents provided demographic data and indicated whether children had a need for an individualized educational program (IEP) or speech therapy (ST). Our aims were to compare the microstructural integrity of white matter tracts using DTI in hearing-related and non-hearing-related brain regions between children with UHL and their NH siblings; and to examine relationships between various educational outcome variables and the DTI parameters (FA and MD) of hearing-related regions. All subjects underwent audiometry, cognitive testing for IQ scores, language testing, and MRI scanning. After the registration steps, the diffusion data was processed with locally written software using a log linear algorithm into DTI parameter data using the commonly used tensor model (Basser et al., 1994). The approximate MNI coordinates for these ROIs are listed in Table 1 (each subject's regions are slightly different). Etiology of hearing loss did not differ significantly between the right UHL and left UHL groups.
In addition, children with UHL had a significantly greater need for IEPs (45%) and speech therapy (41%) than children with NH (5% for both IEPs and speech therapy). The FA of the left uncinate fasciculus was negatively correlated with Performance and Full IQ, the MD of the right posterior limb of the internal capsule was negatively associated with Verbal IQ, while the FA of the left middle cerebellar peduncle was associated with need for speech therapy. And, without hearing aid amplification, localization performance in children with UHL rarely equals that of peers.
Increase or decrease gain accordingly until the patient reports hearing your voice at the front and center of the head.
The patient should have the opportunity to make volume adjustments to match the good ear.11 For young children, the volume control may need to be deactivated for safety concerns. The speaker’s voice will be picked up by the microphone and transmitted wirelessly to the hearing aid. An evidence-based systematic review of directional microphones and digital noise reduction hearing aids in school-age children with hearing loss.
Imaging data from 12 children had to be excluded from analysis, due to movement artifact (n = 1), inability to lie still in the scanner (n = 1), inadequate data acquisition (n = 7) and inadequate data due to the presence of metallic devices (orthodontic appliances, n = 2, and a bone-anchored hearing aid, n = 1). Because both language tests use a standardized scale, they were combined as language outcomes for analysis. The only trends between groups among mean diffusivities were in the MD of the in right subcortical white matter of Heschl's gyrus and left putamen. For both NH and UHL subjects, right sided MD was significantly lower than left sided MD in most structures. For children with right UHL, the MD of the right middle cerebellar peduncle was highly correlated with Verbal IQ, and the FA of both right and left uncinate fasciculus were highly correlated with both Performance and Full IQ.
However, a large case-control study did not find intellectual differences based upon side of hearing impairment (Lieu et al., 2010).
Water in brain tissues diffuses faster parallel to white matter tracts as compared to perpendicular, a property known as anisotropy. Thus, the analysis included 29 children with UHL (13 right UHL, 16 left UHL) and 20 siblings with NH.
In general, FA was greater and MD lower in the NH group than in the UHL group, but this did not reach statistical significance in most regions.
For children with left UHL, both the MD and FA of the left middle cerebellar peduncle were strongly correlated with speech therapy. Anisotropy has been used to investigate the integrity and course of white matter tracts in the brain. Common DTI parameters include fractional anisotropy (FA), which ranges from 0 for equal diffusion in all directions to 1 for diffusion only along 1 axis, and the mean diffusivity (MD), which measures how easily water diffuses averaged over all directions, also ranging from 0 to 1. Restricted diffusion has been identified in several types of disease processes, including acute demyelination, certain brain tumors and acute ischemia (Mukherjee et al., 2008).

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