Unilateral Hearing Loss: Impact and Support

This blog post was written by Deanna Barlow, MAT, TOD, LSLS Cert. AVEd.

Impact of Unilateral Hearing Loss

Unilateral hearing loss has specific impacts on a child’s ability to listen and learn in school. Children with unilateral hearing tend to disproportionately struggle to understand speech in background noise and with localization (telling where a sound is coming from). Students also may struggle to hear a speaker on their poorer hearing side. Students may experience more listening fatigue from the effort of listening through one ear instead of two. Because of this, students have a hard time in noisy situations, including many social situations like lunch and recess. 

These challenges may cause unilateral listeners to appear to be “selectively” listening, or they may appear unattentive. However, it is more likely that classroom noise levels, the position of the speaker, and listening fatigue are contributing to the student’s varying levels of hearing clearly throughout the day. 

Picture this situation:

Katie, a 6th grader with unilateral hearing loss, is sitting in the front row, looking at her teacher. The class is quiet but the air conditioning is on and blowing to Katie’s left, which is her better hearing side. She really has to focus on the teacher to be able to understand the lesson. The teacher asks a question and then points to another student to answer. Katie turns around to see who is answering the question. She needs to lipread in order to understand because of the background noise. However, it’s hard for her to tell exactly who is talking, so she needs to quickly visually scan the room to see who is answering the question. It only takes a couple extra seconds for her to see that James is speaking. She looks at him and focuses…just as he finishes answering the question. Katie missed the entire answer. The teacher continues teaching. It does not matter that Katie has perfect hearing in one ear, background noise and poor localization has caused her to miss all of the auditory information in that moment. 

Supporting Students With Unilateral Hearing Loss

Teachers can support students with hearing loss with various instructional strategies and accommodations. 

• Preferential seating is extremely important. The better hearing ear should face the speaker or the class. Ideally the student should be seated off to one side to allow for visual access to all peers. 

• Background noise should be reduced as much as possible, and students should be seated away from unavoidable sources of noise.

• Use visual supports frequently, including using slides for directions and new vocabulary, referencing pictures, and having important information like homework and test dates written down in a familiar location. 

• Gain student’s attention prior to speaking and check for comprehension. Checking for comprehension should not be a yes or no question (Do you understand?) but rather an open ended question or asking the student to repeat the information back (What did you hear?). 

• When calling on students to answer questions, use the student’s name instead of pointing so the DHH student knows who to look at. 

• Repeat student answers so that everyone can hear them clearly. Students can usually hear the teacher better than peers, especially if the teacher is using a remote microphone system. 

• During groupwork, it is helpful to allow the student’s group to work in the quietest location available. This could be the back table, the hallway, or the library. The middle of the room will likely have the worst acoustics and be the hardest spot for the student to hear in. 

• Provide listening breaks. Listening through hearing devices, but especially listening unilaterally, can be very draining for a student. Listening breaks are short breaks where the student is not required to listen. This can be a short walk to the bathroom, a short break in a quiet area, or just a brief time where the student is able to rest. Listening breaks are valuable because once fatigued, it becomes even more challenging for students to listen and retain what they hear. 

• For young children, do not dismiss hearing devices because the student can hear well out of one ear. Since binaural listening helps with listening in background noise and localization, wearing the hearing device consistently helps a student’s overall language development and incidental learning. Vocabulary, syntax, and pragmatics can be improved with consistent wearing of the hearing device. Language skills are cumulative and it is important for the student to have clear access to spoken language in order to minimize or prevent delays. 

Let’s revisit the situation from above and see how accommodations can help that student:

Katie, a 6th grader with unilateral hearing loss, is sitting on the right side of the classroom, so her better hearing ear is facing the teacher and the class. The air conditioning is on, but it is across the room instead of right next to her better hearing ear. She is watching her teacher give the lesson. The teacher asks a question and then calls on another student by name, James, to answer. Because of Katie’s seat, she can clearly see all the students and she can directly look at James, because she knows he will be answering. Since she is further from the background noise and directly looking at the speaker, she clearly hears and understands his answer. The teacher also clearly repeats his answer, so Katie confirms that she heard the information correctly. Now Katie won’t be confused for the rest of the lesson. 

Resources

This unilateral hearing loss simulator is great for understanding how positioning, background noise, and volume greatly affect a person’s ability to hear unilaterally. https://www.starkey.com/hearing-loss-simulator

This handout on unilateral hearing loss is a quick reference for teachers and SLPs supporting students with unilateral hearing loss. 

For more information on hearing loss, check out listeningfun.com 

Deanna Barlow

MAT TOD

LSLS Cert. AVEd.