Children with Unilateral Hearing Loss (CUHL) study

Why this study?

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Around 1 in every 1,000 babies is born with permanent hearing loss in one ear, known as unilateral hearing loss (UHL). Newborn hearing screening now allows these babies to be identified within weeks of birth. However, there has been little evidence on whether fitting a hearing device early helps their development, leaving families and clinicians to make decisions without clear guidance.

What is CUHL?

The CUHL study began in 2014 and followed 191 children from New South Wales, Queensland and Victoria, from diagnosis to around 5 years of age. Of these, 135 children whose families had not yet decided about a hearing device took part in a randomised controlled trial: they either received a hearing device early or the same hearing care without a device. The families of the other 56 children made their own choice. All children received hearing care through Hearing Australia, and children with typical hearing were also assessed at 3 and 5 years for comparison.

The study looked at children’s hearing and use of hearing devices, speech, language, early reading, everyday listening, social interaction and quality of life. Recordings of everyday conversations at home and questionnaires about family experiences and wellbeing provided further insights into children’s early environments and the impact of hearing loss on families.

Key findings

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1. Most children develop well. At age 3, their language and social skills were within the typical range, although their speech sound production was lower than expected for their age. By the time they started school, children’s language, early reading, behaviour and quality of life were generally similar to those of children with typical hearing.

2. Listening in noise remains a challenge. Children found it harder to understand speech in background noise, and parents reported poorer everyday listening in noisy places and the listening took more effort, similar to children with hearing loss in both ears who use hearing aids. These difficulties continued from age 3 to 5.

3. Early device fitting alone did not improve development. Fitting a hearing device early did not, by itself, lead to measurable improvements in language, speech, listening or social skills at either 3 or 5 years of age. Children who wore their devices regularly understood speech better in some noisy situations. However, regular device use did not reduce the listening effort reported by parents.

4. Hearing can change over time. Hearing in the affected ear worsened in most children during early childhood, often at particular frequencies, and a few children developed hearing loss in both ears.

5. Device needs change as children grow. Families most often reconsidered hearing devices before age 3 and around school entry, when many children began using remote microphone systems. Children who established regular device use early were more likely to keep it up.

6. Everyday conversation matters. Children who had more back-and-forth conversations with their caregivers at 12–15 months had stronger language skills at age 3, whether or not they used a hearing device.

7. Families’ confidence grows over time. Parents described feeling uncertain when their child was first diagnosed and growing more confident as they saw their child developing well. Some uncertainty remained about future hearing changes, device decisions and access to support.

What this means for families and clinicians

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• Make device decisions together and review them. Hearing devices may help in some situations, but there is no single approach that suits every child. Decisions should be made with families and reviewed regularly, especially as children start childcare, preschool and school.

• Pay attention to listening in noise. Whether or not a device is used, remote microphone systems, quieter environments and helpful communication strategies can make everyday listening easier.

• Keep up regular hearing checks. Hearing can change as children grow, so both ears need regular checks at different frequencies, even though reliable hearing tests for each ear can be difficult to obtain in young children.

• Encourage everyday conversation. Talking, playing, reading together and taking turns in conversation support children’s language development.

What next?

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• Continuing to analyse the study data to learn more about how children with UHL develop.

• Sharing the study’s findings through publications, conferences, professional networks and family groups, to help improve care for children with UHL.

• Continuing to follow the CUHL children as they grow, subject to funding.

• Welcoming national and international collaborations to build on the CUHL findings.

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