Asymmetric Hearing Loss: Causes, Signs, and Treatment

February 22, 2024
Amy Sarow, AuD, CCC-A
Written by
Amy Sarow, AuD, CCC-A
Amy Sarow, AuD, CCC-A

Dr. Amy Sarow is a practicing clinical audiologist and serves as Audiology Lead for Soundly. Her expertise and experience span topics including tinnitus, cochlear implants, hearing aid technology, and hearing testing. She holds a doctoral degree in audiology from the University of Iowa. During her residency at Mayo Clinic, Dr. Sarow was inspired by the three-tiered, patient-centered approach, incorporating clinical work, teaching and research.

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As an experienced audiologist who has diagnosed and treated numerous cases of asymmetric hearing loss, I've witnessed firsthand the challenges that come with it. Hearing loss comes in many forms, and not all are created equal. Whether the hearing loss occurred due to noise exposure, genetics, or a medical condition, it's essential to have a proper diagnosis, so that you can get the most appropriate medical or audiological treatment. As an audiologist with years of experience, I specialize in helping people understand and overcome the challenges associated with hearing loss. In this guide, we'll go through what this type of hearing loss is, common causes, tests, and treatment options.

The Complexity of Asymmetric Hearing Loss

Imagine the struggle to interpret the direction sound is coming from—a scenario where crossing the street becomes a task filled with uncertainty as you can't quite pinpoint the honking of an oncoming car. Social situations, too, become daunting challenges; you're compelled to sit strategically, with your better-hearing ear turned towards your conversation partner. In group settings such as dinner parties, being seated on the wrong side can isolate you, making it difficult to follow discussions when speech and laughter are directed at your less functional ear. This experience gives a small glimpse of what those with asymmetric hearing loss experience.

When there is hearing loss in both ears, but one ear has better hearing than the other, this is known as asymmetric hearing loss. The scenarios described above are some common experiences that individuals with this type of hearing loss experience. While it can be benign, asymmetric hearing loss deserves a proper evaluation to rule out certain medical conditions.

It can present its own unique challenges when it comes to hearing, for example, affecting sound localization, which is the ability to identify the direction and origin of a sound. This can have safety implications and also make it more difficult to tell where voices are coming from.

What Causes Asymmetric Hearing Loss?

Understanding the root of the hearing loss is crucial to personalized treatment. Causes of asymmetric hearing loss can vary and sometimes even remain a mystery. Some common culprits include:

  • Firearms or loud sound exposure:  Exposure to loud noises, such as firearms, can damage the delicate hair cells in the inner ear, leading to hearing loss. Also known as shooter's ear, asymmetry in hearing is a not-so-uncommon occurrence among firearms users.
  • Acoustic Neuroma: A benign growth on the vestibular cochlear nerve, which is responsible for balance and hearing, can also present as an asymmetric hearing loss, which may also be accompanied by unilateral tinnitus and dizziness.
  • Sudden Sensorineural Hearing Loss (SSHL): An unexplained, rapid loss of hearing, sometimes in one ear. It can be associated with an infection or a problem in the ear's blood circulation but the cause is sometimes also unknown.
  • Ménière’s Disease: A condition of the inner ear that causes vertigo, tinnitus, and progressive hearing loss. It often affects only one ear.
  • Otosclerosis:  A condition that causes abnormal bone growth in the middle ear, leading to conductive hearing loss. Otosclerosis may affect one or both ears.

Genetic Factors: Asymmetric hearing loss can also be caused by genetic conditions such as Waardenburg Syndrome or Usher Syndrome.

Signs That Your Hearing May Be Asymmetric

In spotting the signs of asymmetric hearing loss, a crucial aspect is understanding that they might not appear obvious at first, especially if the difference in hearing between your ears is significant. Subtle signs might include:

  • Difficulties in Localization: Struggling to identify the direction from which sound is coming.
  • Difficulty hearing in noise: Understanding speech in background noise becomes more challenging when one ear is worse than the other.
  • The "Good Ear" Effect: Some individuals may find themselves consciously or unconsciously positioning themselves so that their "better hearing" ear is directed toward conversations or sounds of interest, a behavior sometimes referred to as "sitting on the good ear" side.
  • Lack of Comprehensive Awareness: An individual may miss sounds or chunks of conversations when someone is speaking on their "poorer" side.

Tests for Asymmetric Hearing Loss

In diagnosing asymmetric hearing loss, a comprehensive hearing evaluation is crucial. This typically includes:

  • Puretone Audiometric Testing: This test involves wearing headphones and listening for the softest sounds you can hear at different frequencies to measure the sensitivity of your hearing.
  • Speech Audiometry: A test to measure the ability to both hear and understand speech clearly. Asymmetric hearing loss may show up as a significant difference in word understanding between ears.
  • Acoustic Reflex Testing:  This test assesses the integrity of the auditory and neural pathways. Your audiologist will perform this test by placing a probe in one or both ears while you sit quietly and listen to some tones while monitoring your ear's response to the stimulus. Tone decay testing is another test they may perform, which again monitors the neural response to a stimulus.
  • Auditory Brainstem Response (ABR):  This test measures how well the brain pathways for hearing are working and can be helpful in identifying any underlying neurological conditions.
  • Imaging Studies: Depending on the suspected cause, your doctor may recommend magnetic resonance imaging (MRI) to rule out conditions that may affect the auditory nerve or neurological issues.

Treatment Strategies and Next Steps

As with any medical condition, identifying the cause is key to formulating an effective treatment plan. Not every cause of asymmetric hearing loss has medical treatment options. However, your provider may have recommendations depending on your situation. These may include:

  • Pharmacological Interventions: Treating allergies, reducing inflammation, or addressing circulation problems can have a positive impact, particularly in cases of sudden sensorineural hearing loss.
  • Serial audiograms: This is often a recommended next step to monitor the hearing loss at regular intervals (i.e. annually, every six months, etc.). Once documented stable hearing is documented, follow-up intervals may change to every few years or if a change is noted.

Possible hearing interventions for asymmetric hearing loss include:

  • Hearing Aids: When the asymmetry is medically cleared for hearing aids, these devices can be an effective solution for amplifying sound and improving communication. Depending on the loss, a pair of hearing aids or a CROS device and hearing aid may be most appropriate.
  • Assistive Listening Devices: For those who find difficulty in specialized situations like on the telephone, watching television, or where distance to the sound source is a factor, assistive listening devices can bridge the gap.
  • Cochlear Implants: For moderate to profound sensorineural hearing loss, especially when hearing aids have not provided sufficient benefit, a cochlear implant may be recommended. Unlike hearing aids that amplify sound, cochlear implants directly stimulate the auditory nerve and restore hearing.
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Bridging the Gap for a Balanced Life

Living with asymmetric hearing loss can be challenging, but it doesn't have to limit you. Here are a few strategies to help you adapt and thrive:

  • Communication Strategies: Learn and practice different methods to enhance your ability to communicate. This may include using visual cues, effective repair strategies, reducing background noise (when possible), and managing conversation spaces to ensure you're always within effective hearing range.
  • Stay Educated: Knowing as much as possible about your condition and the available treatments empowers you to make informed decisions about your care.
  • Encourage Understanding and Support: Advocate for yourself and share information about your specific hearing needs with family, friends, and colleagues. The more they understand, the better they can accommodate your needs

The Road Ahead with Asymmetric Hearing Loss

In conclusion, asymmetric hearing loss presents its unique challenges, yet with proper diagnosis and the right treatment approach, many individuals can significantly improve their quality of life. If you suspect you have asymmetric hearing loss or you're currently navigating its complexities, rest assured that help is not only available but also effective.  Consult with your hearing healthcare provider to determine the best path forward for you. Remember, with the right support and strategies in place, you can bridge the gap and live a balanced life. 

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