By: Ashley Tilahun, Au.D., CCC-A, FAAA

Abstract

This case study presents Mr. Dennis*, a 55-year-old male with bilateral hearing loss, including congenital profound deafness in the right ear and normal to moderate high-frequency sensorineural hearing loss in the left ear. Over a nine-year period, Mr. Dennis sought care for his left ear hearing loss, trying different hearing aids, including the Starkey Halo 2 i2400 RIC, Widex Evoke Fusion 2 440 RIC, and finally, the Widex SmartRIC 440. Although he was a candidate for a BiCROS hearing aid system, Mr. Dennis preferred to amplify only his left ear. His hearing condition remained stable from 2015 to 2024, with a slight decline in high frequencies detected in 2020. His shift in hearing technology was motivated by the need for better sound clarity and speech comprehension in noisy environments. This case explores Mr. Dennis's hearing aid journey and his resistance to bi-cross devices, highlighting the importance of personalized hearing care plans.

Introduction

Understanding Single-Sided Deafness with Restricted Hearing on the Contralateral Side:

Single-sided deafness (SSD) occurs when a person has severe to profound (or total) hearing loss in one ear while the other ear has normal or near-normal hearing. Sometimes, though, the ear with better hearing (the contralateral ear) may also have some level of hearing loss, such as high-frequency hearing loss. This can create extra challenges since the better ear might not fully make up or compensate for the deaf ear (Kay-Rivest et al., 2022; Katiri et al., 2020).

People with SSD often struggle with sound localization or figuring out where sound sources originate. They rely very much on their good ear, which becomes harder in noisy environments or group conversations, where the brain struggles to process sound from only one ear. If the better ear has any hearing loss, it adds to the difficulty in understanding speech in the presence of noise (Agterberg et al., 2014).

For SSD with hearing loss in the contralateral ear, options might include a hearing aid for the partially hearing ear or special devices like a Bi-cross system. Managing SSD and hearing loss in the better ear usually requires a customized approach to improve speech understanding and sound clarity.

Incidence and Prevalence of Single-Sided Deafness (SSD) in the U.S.

Approximately 60,000 new cases of SSD are diagnosed each year in the United States. Around 7.2% of the U.S. population experiences unilateral hearing loss. SSD can occur across all age groups, but its impact can vary depending on the degree of hearing loss and the age at onset (Kay-Rivest et al., 2022).

Mr. Dennis’ Case History

Mr. Dennis, a 55-year-old man, was born with profound right-sided deafness of unknown etiology. His left ear, however, exhibited normal to moderate high-frequency hearing loss. Mr. Dennis first visited the clinic in the Summer of 2015, where his hearing test revealed a profound (unaidable) sensorineural hearing loss in the right ear and normal to moderate high-frequency sensorineural hearing loss in the left ear.

   Mr. Dennis’  2015 Decibel Chart

**Right ear, no response to the beeps at themaximum loudness level of the hearing test equipment**

At the time of his appointment, Mr. Dennis expressed initial interest in using a hearing aid for his left ear only due to some difficulty understanding speech in quiet and noisy situations and localizing various sound sources. It was suggested at that time that Mr. Dennis try a hearing aid in the left ear. It was also suggested that he try a BiCROS (bi-contralateral routing of sound) hearing aid system to determine if he would benefit more compared to a single hearing aid device. It was also suggested to Mr. Dennis that the BiCROS system may help him better localize sounds and enhance his speech understanding in various listening situations. However,  Mr. Dennis expressed that he had tried a BiCROS hearing system in the past and indicated that the Bi-cross system was not beneficial. He described the BiCROS hearing system as “confusing to his brain” as he had been used to relying only on his left ear since birth. Despite the audiologist suggesting a BiCROS hearing aid system and trying a single hearing device for his left ear, Mr. Dennis chose not to pursue hearing aids at that time. He decided at that time he would consider hearing amplification but would return in one year for an updated hearing test and to determine if and when he is ready to try a hearing aid for his left ear.

Mr. Dennis’ Return and Hearing Aid Consideration:

In the Summer of 2016, Mr. Dennis returned to the clinic with no changes in his hearing since the 2015 evaluation.

 Mr. Dennis’ 2016 Decibel Chart

  **Did not test the right ear due to known profound (unaidable) hearing loss**

Mr. Dennis was finally interested in trying a hearing aid for his left ear. It was recommended he consult with his ENT physician to obtain medical clearance for the hearing aid and to rule out any medical pathologies or involvement relating to his hearing loss. After Mr. Dennis was medically cleared, hearing aid options were discussed, and he became interested in trying a receiver-in-the-canal (RIC) device. He was fitted with a Starkey Halo 2 i2400 RIC hearing aid for his left ear. The device used a 312 battery, and Mr. Dennis was pleased with the results.

Mr. Dennis’ Starkey Halo 2 i2400 RIC 312 Hearing aid

Continued Challenges and Progress

Mr. Dennis returned to the hearing clinic in the Summer of 2020, reporting that he had lost his hearing aid and could not replace it due to the expired loss and damage warranty. He expressed that although the Starkey hearing aid was helpful, he was eager to learn if other hearing devices just may help him hear speech a little more clearly.

During the Summer of 2020 follow-up, a hearing test revealed a slight decrease in high-frequency hearing in the left ear from 2000-8000 Hertz (Hz), possibly related to aging, according to his ENT physician.

Mr. Dennis 2020 Decibel Chart

**Did not test the right ear due to known profound (unaidable) hearing loss**

After obtaining medical clearance from his ENT physician and hearing aid evaluation, Mr. Dennis decided to try the Widex Evoke Fusion 2 440 RIC, also with a 312 battery. He noted an improved sound quality, describing it as cleaner and crisper than his previous Starkey hearing aid.

            Mr. Dennis’ Widex Evoke Fusion 2 440 RIC hearing aid

By the summer of 2024, Mr. Dennis returned to the hearing clinic, expressing interest in upgrading his hearing device. Hearing test results showed no significant change since 2020.

Mr. Dennis 2024 Decibel Chart

**Did not test the right ear due to known profound (unaidable) hearing loss**

After obtaining medical clearance for hearing aids and considering his hearing aid options, Mr. Dennis opted for the Widex SmartRIC 440 rechargeable hearing aid. He reported that the sound quality was clearer, more robust, and more natural compared to his Widex Evoke. Additionally, during his one-month hearing aid follow-up appointment, he noticed improved speech comprehension in noisy environments. Mr. Dennis was highly satisfied with his decision and agreed to return for an annual hearing test and hearing aid check-up.

     Mr. Dennis’ Widex SmartRIC Rechargeable Hearing Aid and charger

Positive Impact with New Hearing Aid Technology

Introducing the Widex SmartRIC hearing aid has greatly improved Mr. Dennis' hearing experience. The advanced technology in these devices helped him understand speech better, especially in noisy situations. Mr. Dennis found the sound quality to be clearer and more natural when compared to his previous hearing aids, highlighting how important new developments in hearing aid design are for improving his quality of life.

While he still encounters some difficulties in loud environments and localizing sound sources,  Mr. Dennis understood the significant advantages these new hearing aids offer. He was consistent with his hearing check with his audiologist to ensure that any changes in his hearing were addressed in a quick yet timely fashion. This proactive approach to his hearing care is crucial for effectively managing his hearing loss and allowing Mr. Dennis to gain the most benefit from the use of his hearing aid.

Conclusion

In conclusion, Mr. Dennis's experience with hearing aids shows the powerful impact that advances in audiology technology can have on people with hearing loss. From his early use of the Starkey Halo to the improvements he found with the Widex Evoke and, ultimately, the Widex SmartRIC, each new device met his changing needs and preferences. His positive feedback highlights the importance of staying updated with new technology, which greatly improved his communication ability, especially in difficult listening situations.

Mr. Dennis’s commitment to hearing check-ups and open communication with his audiologist has been key to maximizing his hearing outcomes. While he still encounters some challenges, the benefits of his new hearing aid have clearly improved his quality of life. This case underscores the value of personalized hearing solutions and how new technology can help individuals with hearing loss live more fulfilling, connected lives. Ongoing follow-ups and a strong healthcare support system are vital for maintaining long-term hearing health.

Audiology Curiosity:

What’s a BiCROS Hearing Device, and Why Did Mr. Dennis refuse to try it?

A BiCROS (bilateral contralateral routing of signals) hearing aid system is a specialized solution designed for people with single-sided deafness. It involves two devices: one is worn on the deaf ear, which captures sound and transmits it wirelessly to the hearing aid in the better ear. This helps improve sound localization and hearing in situations where the sound originates from the side of the non-hearing ear (Stewart & Woodward, 2021).

While Mr. Dennis was a candidate for this technology, he managed his hearing loss with a hearing aid only for his left ear. His reason was due to being “used to hearing” only from the left ear. He indicated he had tried a BiCROS device in the past but was not intrigued. He described the BiCROS experience as confusing and chose not to try the system again. This shows how each individual with single-side deafness with restricted hearing on the contralateral side has different experiences with various hearing devices, systems, and technology.

Audiologist's Takeaway

Mr. Dennis’s case study showcases the evolving nature of hearing healthcare. Over nearly a decade, he took a practical approach to managing his hearing loss, seeking gradual improvements and being open to trying new hearing aid technologies as they become available. His journey highlights how some patients, especially those with single-sided deafness, may prioritize one ear over the other and choose not to use a BiCROS system despite its potential benefits.

His progression—from using the Starkey Halo to the Widex Evoke and eventually upgrading to the Widex SmartRIC—demonstrates his growing expectations for sound quality, especially in challenging environments like background noise. Each new device brought clear improvements, and Mr. Dennis reported noticeable gains in hearing with every upgrade. His choice to amplify only one ear, while unconventional for some with SSD, suited his personal needs and lifestyle.

The success of Mr. Dennis’s most recent fitting was encouraging. The improvements in his quality of life from these technological upgrades, particularly his positive experience with the Widex SmartRIC in noisy settings, are promising. Regular follow-ups are essential, especially in cases of progressive hearing loss, to ensure ongoing satisfaction and optimal hearing aid performance. It is recommended that Mr. Dennis continue with annual hearing tests and hearing aid check-ups to maintain his hearing health and device function.

References:

1. Katiri, R., Hall, D. A., Buggy, N., et al. (2020). Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study: Protocol for an international consensus on outcome measures for single-sided deafness interventions using a modified Delphi survey. Trials, 21, 238. https://doi.org/10.1186/s13063-020-4094-9

2. Stewart, E., & Woodward, J. (2021). Out of the [head] shadow: A systematic review of CROS/BiCROS literature. Hearing Review, 28(8), 22-25. https://hearingreview.com/inside-hearing/research/head

3. Agterberg, M. J., Hol, M. K., Van Wanrooij, M. M., Van Opstal, A. J., & Snik, A. F. (2014). Single-sided deafness and directional hearing: contribution of spectral cues and high-frequency hearing loss in the hearing ear. Frontiers in neuroscience, 8, 188. https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2014.00188/full

4. Kay‐Rivest, E., Irace, A. L., Golub, J. S., & Svirsky, M. A. (2022). Prevalence of single‐sided deafness in the United States. The Laryngoscope, 132(8), 1652-1656. https://onlinelibrary.wiley.com/doi/full/10.1002/lary.29941

5. Coburn, C., & Seitz, K. (2017). *Music streaming with Halo 2: Fitting tips for patient success*. Starkey Hearing Technologies. https://order.starkeypro.com/pdfs/technical-papers/Music_Streaming_with_Halo_2.pdf

6. Widex. (2018; 2019). Evoke Fusion 2 440 hearing aid.  Retrieved from:  https://www.widex.com/en-us/hearing-aids/evoke/

7. Widex. (2024). SmartRIC 440 hearing aid. Retrieved from:   https://www.widex.com/en-us/hearing-aids/smartric/
8. Other case studies from Dr.Ashley

***Please Note: To safeguard the individual's privacy, the name has been changed in this article.

***Disclaimer: The content presented here serves general informational purposes and is not intended as professional advice or a replacement for medical consultation. It is essential to seek personalized guidance and assistance from a qualified physician or hearing healthcare provider for any specific questions, concerns, or individual health conditions related to hearing. A professional in the field can offer a comprehensive evaluation and suitable recommendations based on your unique circumstances. Ignoring or postponing seeking medical or professional help may have negative impacts on your health. Always consult with a healthcare professional for precise diagnosis, appropriate treatment, and personalized advice concerning your hearing health.***