Treatment choice in single-sided deafness and asymmetric hearing loss. A prospective, multicentre cohort study on 155 patients

Clin Otolaryngol. 2021 Jul;46(4):736-743. doi: 10.1111/coa.13672. Epub 2021 Mar 26.


Objectives: To describe the treatment choice in a cohort of subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL). To assess the reliability of the treatment trials.

Design: In this national, multicentre, prospective study, the choice of subjects was made after two consecutive trials of Contralateral Routing Of the Signal (CROS) hearing aids and a Bone Conduction Device (BCD) on a headband. Subjects could proceed with one of these two options, opt for cochlear implantation or decline all treatments.

Setting: Seven tertiary university hospitals.

Participants: One hundred fifty-five subjects with SSD or AHL fulfilling the candidacy criteria for cochlear implantation, with or without associated tinnitus.

Main outcome measures: After the two trials, the number of subjects choosing each option was described. Repeated assessments of both generic and auditory-specific quality of life were conducted, as well as hearing assessments (speech recognition in noise and horizontal localization).

Results: CROS was chosen by 75 subjects, followed by cochlear implantation (n = 51), BCD (n = 18) and abstention (n = 11). Patients who opted for cochlear implantation had a poorer quality of life (P = .03). The improvement of quality of life indices after each trial was significantly associated with the final treatment choice (P = .008 for generic indices, P = .002 for auditory-specific indices). The follow-up showed that this improvement had been overestimated in the CROS group, with a long-term retention rate of 52.5%.

Conclusions: More than one third of SSD/AHL subjects are unsatisfied after CROS and BCD trials. Repeated quality of life assessments help counselling the patient for his/her treatment choice.

Keywords: BAHA; CROS hearing aids; asymmetric hearing loss; binaural hearing; cochlear implant; quality of life; single-sided deafness.

Publication types

  • Multicenter Study

MeSH terms

  • Bone Conduction
  • Choice Behavior
  • Cochlear Implants
  • Female
  • France
  • Hearing Aids
  • Hearing Loss, Unilateral / rehabilitation*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality of Life
  • Speech Reception Threshold Test