Single sided deafness (SSD) is characterized by significant sensorineural hearing loss, severe or profound, in only one ear. SSD adversely affects various aspects of auditory perception, including causing impairment in sound localization, difficulties with speech comprehension in noisy environments, and decreased spatial awareness, resulting in a significant decline in overall quality of life (QoL). Several treatment options are available for SSD, including cochlear implants (CI), contralateral routing of signal (CROS), and bone conduction devices (BCD). The lack of consensus on outcome domains and measurement tools complicates treatment comparisons and decision-making. This narrative overview aims to summarize the treatment options available for SSD in adult and pediatric populations, discussing their respective advantages and disadvantages. Rerouting devices (CROS and BCD) attenuate the effects of head shadow and improve sound awareness and signal-to-noise ratio in the affected ear; however, they cannot restore binaural hearing. CROS devices, being non-implantable, are the least invasive option. Cochlear implantation is the only strategy that can restore binaural hearing, delivering significant improvements in speech perception, spatial localization, tinnitus control, and overall QoL. Comprehensive preoperative counseling, including a discussion of alternative technologies, implications of no treatment, expectations, and auditory training, is critical to optimizing therapeutic outcomes.

Aim: The aim of this study was to assess the subjective experiences of adults with different cochlear implant (CI) configurations—unilateral cochlear implant (UCI), bilateral cochlear implant (BCI), and bimodal stimulation (BM)—focusing on their perception of speech in quiet and noisy environments, music, environmental sounds, people’s voices and tinnitus. Methods: A cross-sectional survey of 130 adults who had undergone UCI, BCI, or BM was conducted. Participants completed a six-item online questionnaire, assessing difficulty levels and psychological impact across auditory domains, with responses measured on a 10-point scale. Statistical analyses were performed to compare the subjective experiences of the three groups. Results: Patients reported that understanding speech in noise and tinnitus perception were their main concerns. BCI users experienced fewer difficulties with understanding speech in both quiet (p < 0.001) and noisy (p = 0.008) environments and with perceiving non-vocal sounds (p = 0.038) compared to UCI and BM users; no significant differences were found for music perception (p = 0.099), tinnitus perception (p = 0.397), or voice naturalness (p = 0.157). BCI users also reported less annoyance in quiet (p = 0.004) and noisy (p = 0.047) environments, and in the perception of voices (p = 0.009) and non-vocal sounds (p = 0.019). Tinnitus-related psychological impact showed no significant differences between groups (p = 0.090). Conclusions: Although speech perception in noise and tinnitus remain major problems for CI users, the results of our study suggest that bilateral cochlear implantation offers significant subjective advantages over unilateral implantation and bimodal stimulation in adults, particularly in difficult listening environments.

Objectives: This cross-sectional study evaluates emotional prosody recognition in adults with unilateral cochlear implants (UCI, n = 22), bilateral cochlear implants (BCI, n = 15), and typical hearing, defined as normal hearing sensitivity confirmed by standard audiometric assessment (TH, n = 21), using the Montreal Affective Voices (MAV). Secondary aims assess demographic and clinical factors influencing performance. Materials and Methods: Participants underwent audiological testing (PTA5, speech-in-noise at SNR +5 dB), cognitive screening (MoCA), visual emotion recognition, and MAV assessment for emotion identification (happiness, sadness, fear, anger, surprise, pleasure, pain, disgust, neutral), and subjective valence ratings. Mean age ± SD was 56.2 ± 8.1 years in UCI participants, 46.1 ± 19.7 years in BCI participants, and 35.5 ± 11.5 years in TH participants. Group comparisons were performed using non-parametric tests (Kruskal–Wallis, Mann–Whitney U), and multivariable linear regression models adjusted for study group, age, and education, with corresponding visual emotion-recognition scores and speech-in-noise performance at +5 dB SNR evaluated as additional covariates. Results: Both CI groups showed profound deficits in auditory emotion recognition (unadjusted total scores: UCI 30.4 ± 10.6, BCI 30.1 ± 8.7 vs. TH 61.9 ± 7.4; p < 0.001). After FDR correction, significant overall group effects were observed for eight of the nine emotion-specific outcomes; Sadness did not remain significant after correction. No Bonferroni-adjusted UCI-versus-BCI comparison was significant. Older age and lower education level were associated with poorer performance for selected outcomes. Visual emotion-recognition scores were positively associated with auditory performance for Anger and Neutral. Global cognition and disability (WHODAS 2.0) were comparable across groups. Conclusions: Cochlear implant users showed substantially poorer recognition of emotional prosody than typical-hearing participants, with no consistent statistically significant difference between unilateral and bilateral users. Technological improvements and targeted rehabilitation may help to enhance socioemotional communication in CI users.