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Effects of Unilateral Input and Mode of Hearing in the Better Ear: Self-reported Performance Using the Speech, Spatial and Qualities of Hearing Scale

Dwyer, Noël Y.; Firszt, Jill B.; Reeder, Ruth M.

doi: 10.1097/AUD.0b013e3182a3648b
Research Articles

Objective: To evaluate effects of hearing mode (normal hearing, cochlear implant, or hearing aid) on everyday communication among adult unilateral listeners using the Speech, Spatial and Qualities of Hearing Scale (SSQ). Individuals with one good, naturally hearing ear were expected to have higher overall ratings than unilateral listeners dependent on a cochlear implant or hearing aid. The authors anticipated that listening environments reliant on binaural processing for successful communication would be rated most disabling by all unilateral listeners. Regardless of hearing mode, all hearing-impaired participants were expected to have lower ratings than individuals with normal hearing bilaterally. A secondary objective was to compare post-treatment SSQ results of participants who subsequently obtained a cochlear implant for the poorer hearing ear with those of participants with a single normal-hearing ear.

Design: Participants were 87 adults recruited as part of ongoing research investigating asymmetric hearing effects. Sixty-six participants were unilateral listeners who had one unaided/nonimplanted severe to profound hearing-loss ear and were grouped based on hearing mode of the better ear: 30 had one normal-hearing ear (i.e., unilateral hearing-loss participants); 20 had a unilateral cochlear implant; and 16 had a unilateral hearing aid. Data were also collected from 21 normal-hearing individuals, as well as a subset of participants who subsequently received a cochlear implant in the poorer ear and thus became bilateral listeners. Data analysis was completed at the domain and subscale levels.

Results: A significant mode-of-hearing group effect for the hearing-impaired participants (i.e., with unilateral hearing loss, unilateral cochlear implant, or unilateral hearing aid) was identified for two domains (Speech and Qualities) and six subscales (Speech in Quiet, Speech in Noise, Speech in Speech Contexts, Multiple Speech Stream Processing and Switching, Identification of Sound and Objects, and Sound Quality and Naturalness). There was no significant mode-of-hearing group effect for the Spatial domain or the other four subscales (Localization, Distance and Movement, Segregation of Sounds, and Listening Effort). Follow-up analysis indicated the unilateral normal-hearing ear group had significantly higher ratings than the unilateral cochlear implant or hearing aid groups for the Speech domain and four of the ten subscales; neither the cochlear implant nor hearing aid group had subscale ratings significantly higher than each other or the unilateral hearing loss group. Audibility and sound quality imparted by hearing mode were identified as factors related to subjective listening experience. After cochlear implantation to restore bilateral hearing, SSQ ratings for bilateral cochlear implant or cochlear implant plus hearing aid participants were significantly higher than those of the unilateral hearing-loss group for Speech in Quiet, Speech in Noise, Localization, Distance and Movement, Listening Effort, and the Spatial domain. Hearing-impaired individuals had significantly poorer ratings in all areas compared with those with bilateral normal hearing.

Conclusions: Adults reliant on a single ear, irrespective of better ear hearing mode, including those with one normal hearing ear, are at a disadvantage in all aspects of everyday listening and communication. Audibility and hearing mode were shown to differentially contribute to listening experience.

Effects of unilateral input and hearing mode on everyday communication were evaluated with the Speech, Spatial and Qualities of Hearing scale. Participants had one better hearing ear, defined by normal hearing, a cochlear implant or a hearing aid, and one ear with severe to profound hearing loss. Irrespective of hearing mode, adults with unilateral input had significant deficits in all aspects of daily communication. Poorer ear cochlear implantation to restore bilateral input for a subset of participants differentially improved some but not all areas of communication. Self-perceived disability was mediated by hearing mode with respect to audibility and sound quality.

Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO.

This work was supported by R01DC009010 (J.B.F.) and P30DC04665 from the National Institute on Deafness and Other Communication Disorders.

The authors declare no conflict of interest.

Address for correspondence: Jill B. Firszt, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO 63110. E-mail:

© 2014 by Lippincott Williams & Wilkins