Personalizing Cochlear Implant Care in Single-Sided Deafness: A Distinct Paradigm from Bilateral Hearing Loss

Abstract

Background: Cochlear implants (CIs) serve diverse populations with hearing loss, but patients with single-sided deafness (SSD) often show lower post-implantation usage and satisfaction than bilateral CI users. This disparity may stem from their normal contralateral ear providing sufficient auditory input for many daily situations, reducing the perceived need for consistent CI use. Consequently, uniform screening and evaluations, typically designed for bilateral hearing loss, often fail to address SSD's unique needs. Methods: This narrative review synthesizes the current literature to explore patient and device factors shaping CI integration, outcomes, and experience in SSD. It highlights implications for developing personalized care strategies distinct from those used in bilateral hearing loss. Results: SSD patients face unique challenges: reliance on compensatory behaviors and significant auditory processing difficulties like acoustic-electric mismatch and place-pitch discrepancy. Anatomical factors and deafness of duration also impact outcomes. Traditional measures are often insufficient due to ceiling effects. Music perception offers a sensitive metric and rehabilitation tool, while big data and machine learning show promise for predicting outcomes and tailoring interventions. Conclusions: Optimizing CI care for SSD necessitates a personalized approach across candidacy, counseling, and rehabilitation. Tailored strategies, including individualized frequency mapping, adaptive auditory training, advanced outcome metrics like music perception, and leveraging big data for precise, data-driven predictions, are crucial for improving consistent CI usage and overall patient satisfaction.

Keywords: big data; cochlear implant; hearing loss; machine learning; music perception; precision medicine; single-sided deafness.

Figure 1

Cochlear Implants (CI) as treatment for single-sided deafness (SSD), and how a personalized medicine approach can be integrated to optimize the patient experience, maximizing CI use and minimizing dissatisfaction. CT = computed tomography. EP = electrophysiological. NH = normal hearing.

Figure 2

Factors contributing to reduced cochlear implant (CI) use and perceived benefit among individuals with SSD, recognizing that there is also significant intrapopulation variability in individual patient experiences and challenges. Special etiological considerations include duration of deafness, as well as contraindications such as vestibular schwannoma, and cochlear nerve deficiency. NH = normal hearing.

Figure 3

Example workflow of big data and machine learning (ML) applications in optimizing cochlear implant (CI) utility and satisfaction among patients with single-sided deafness (SSD). By organizing and extracting data from large datasets consisting of SSD-only cases, clinicians and their patients can make more accurate and informed predictions regarding treatment strategies, device design, and performance outcomes. Text with gray backgrounds indicate patient-interfacing steps.