Unilateral Hearing Loss: Listening Ability, Social Participation and Adaptive Strategies to Challenges in the Real World

This study examined the challenges associated with unilateral hearing loss (UHL), focusing on speech-in-noise comprehension, spatial hearing, and cognitive effort, and aimed to advance clinical assessments and inform personalized interventions for individuals with UHL. Sixteen adults with UHL and sixteen with normal hearing (NH) completed a mixed-methods assessment, including standardised patient-reported outcome measures, reaction time tasks, speech-in-noise comprehension tests, and head movement tracking. Hearing experiences were evaluated using the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) and the Social Participation Restrictions Questionnaire (SPaRQ). Listening effort was estimated via reaction times during an auditory task, while speech comprehension in noise was assessed using the National Acoustic Laboratories Dynamic Conversation Test (NAL-DCT). Behavioural strategies, such as head movements, were analysed during speech comprehension tasks. Compared to the NH group, participants with UHL showed significantly poorer SSQ12 and SPaRQ scores, longer reaction times in noisy conditions, and moderately reduced speech-in-noise performance, achieved at the expense of greater cognitive exertion. Head movement analysis indicated a compensatory tendency to orient towards the worse ear. A predictive model combining reaction times and self-reported hearing difficulties accounted for 68% of the variance in speech-in-noise comprehension (adjusted R2=0.68, p=0.0002). These findings highlight the impact of UHL on auditory function, cognitive load, and social participation. Ecologically valid measures such as the NAL-DCT and head tracking offer valuable insight into real-world listening challenges. The observed compensatory behaviours suggest the importance of clinical interventions that support spatial orientation strategies to enhance communication and quality of life in individuals with UHL.