Listening with both ears provides awareness of the direction of sound, ability to hear in noise, and a sense of strong, clear sound. Hearing loss in one ear, called unilateral loss, changes the listening experience. Unilateral hearing loss might be present at birth, develop slowly, happen suddenly or increase over time (showing a progressive loss). A child with unilateral hearing loss can still learn to listen and use spoken language relying on normal hearing in one ear. His responses may seem similar to a child with typical hearing but there are differences. When parents learn about the unique aspects of unilateral hearing loss they can work with service providers to determine needs for information and intervening.
Newborn hearing screening or routine hearing testing at any age can detect unilateral hearing loss. The level of loss can vary from mild to profound. After identification an Ear, Nose and Throat (ENT) specialist might be consulted to determine the reason for the hearing loss. The causes of unilateral hearing loss include mother’s illnesses during pregnancy, viruses in early childhood or incomplete formation of the ear. Obtaining genetic information about possible hereditary conditions or causes can also be explored. It is not always possible to identify the cause of unilateral loss but parents can focus on what to do for their child.
After the initial diagnosis, a child needs regular testing to check for any changes in hearing. Unilateral hearing loss can remain stable permanently. Sometimes individuals develop hearing loss in the other ear later. With unilateral hearing loss the ear with hearing might be described as the “listening” ear or “better” side. The ear with hearing loss could be called the “poor” ear or the “bad’ side. When a child with unilateral hearing has an earache it can make listening harder during that time. If any change in hearing health or listening levels is suspected, parents can obtain care and follow-up from ear specialists and audiologists.
A child with unilateral hearing loss can develop his listening, language and speech through typical early childhood activities including conversing with family, playing games, reading books and singing songs. Parents and teachers can watch to see if communication difficulties arise in certain situations. The child with unilateral hearing loss may have difficulty when there is background noise or several conversations happening at once. How well a child hears all the sounds of speech can impact his own speech skills. Parents can be aware of typical hearing milestones and schedule an evaluation if there are questions about the development of a child’s communication. If there is a delay parents can inquire about speech and language services.
Some children with unilateral hearing loss benefit from a hearing aid but others do not. For some children a hearing aid might provide better access to sound, increase localization, enhance listening in groups or improve hearing in background noise. When a hearing aid is suggested, families can provide it early to help a child develop stronger listening skills. If the classroom is noisy or the teacher is a distance from the child an “FM system” can be requested. FMs amplify a teacher’s voice and carry that sound closer to the child. Parents can also make regular appointments to check devices, document ongoing benefit and review what technology can be useful for the child.
A child with unilateral loss benefits when sounds occur near his hearing ear. Noisy toys can be placed near the baby’s better ear. People can approach a toddler from his stronger side so he hears them coming. A child could sit with his listening side closer to the TV or media speakers. In a conversation he might sit with his listening ear close to one person who is talking, at the head of the table during family meals or at the end of a conversational half circle in school. In noisy and big places, the child can be closer to persons speaking or in quieter areas of the room. Parents can make changes in positioning for easier listening.
Recognizing the direction of sounds (sound localization) can be challenging for a child with unilateral hearing loss. In some situations a child may not know if he is being called or from where. In group games, crowded events, noisy places and areas with traffic a child may have difficulty attending. Families can guide the child to get in the habit of listening closely and looking carefully in noisy or busy areas to be aware of what is going on around him. Whenever a child joins a new classroom, staff can make efforts to lower room sound and seat him away from noisy equipment. Parents can explain to those interacting with a child when it could be helpful to obtain his attention or repeat statements to increase his listening comprehension.
If a child demonstrates difficulty in learning, parents can discuss with teachers ways to enhance listening. The most useful listening distance is within six feet of a speaker. A child usually benefits from sitting so the ear used for hearing is closest to his teacher and classmates. For example, if a child has a left unilateral loss, he should sit so his right ear is closer to those speaking. In a semi-circle he could be seated at one end of the group, with the teacher and children on the side he uses to hear. A child who also relies on vision to supplement what he hears should be allowed to sit where he can see people and materials easily. Sometimes pictorial schedules, written directions or visual cues help a child keep up with the group routine. Parents can ask for accommodations to support a child’s independent participation in play, day care and school settings.
When a child is supported and acknowledged as capable, he can aim to achieve. A child with unilateral hearing loss may appear to be managing but can still have challenges especially in school. Families can keep in close contact with teachers to look for any needs that arise and explore ways to help their child succeed. Protecting the hearing of the “good” ear is also essential. To support their child parents can:
- Create many fun early listening experiences
- Observe how the child interacts and responds
- Look for signs of listening or learning frustrations
- Watch for changes in social and school behaviors
- Realize distraction or disinterest could be listening difficulties
- Discuss strategies with educators to support performance in class
- Ensure when a hearing aid is prescribed that the child uses it full time
- Reduce noise in classrooms (hamster cages, pencil sharpeners, corridor conversations)
- Consider what services or accommodations can help the child achieve
- Keep volume of child’s personal electronic devices at moderate levels
- Obtain effective ear protection for child in noise (earplugs, earmuffs, custom ear molds)
- Intervene across varied settings to create optimal listening experiences for the child
When families take actions for identifying, following up, communicating, amplifying, positioning, attending, accommodating or intervening they become advocates for their child. They can also encourage the child to identify when he can’t hear and what helps him listen better. Even a young child can begin to advocate for himself by saying when he does not hear, suggesting ways he can listen easily or requesting that people speak to his better ear. As a child becomes a self-advocate he learns how to be a successful communicator and stronger learner. A child will take his cues from parents to view unilateral hearing loss as one aspect of his unique, wonderful self.