Single-sided deafness (SSD)—severe or profound hearing loss in one ear with normal or near-normal hearing in the other—can disrupt everyday communication in ways that aren’t always obvious to others. Many people with SSD report difficulty understanding speech in background noise, locating where sounds are coming from, or managing tinnitus. While several treatment options exist, selecting the right intervention often depends on patient goals, expectations, and practical barriers.
A new study from investigators at the University of Miami examined how adults with SSD describe their motivations for seeking treatment, whether those motivations influence the choice of cochlear implantation, and how motivation relates to cochlear implant (CI) outcomes one year after surgery.
How the investigators studied motivation and treatment selection
The investigators retrospectively reviewed 122 adults who completed a structured pre-treatment SSD telehealth consultation between January 2021 and December 2024.
During the visit, patients were guided through education on SSD and options including CROS/BiCROS hearing aids, bone conduction devices, cochlear implants, or choosing no intervention. Patients also identified primary (and often secondary) motivations for seeking help, which were recorded in the chart.
“The three most common primary treatment motivations included improving overall hearing (23.0%), restoring hearing to the deaf side (22.1%), and improving hearing in noise (21.3%).”
Nearly half of patients initially opted for a hearing aid/CROS/BiCROS pathway, and a smaller group chose no treatment. A notable portion initially selected cochlear implantation as their preferred option, but not all went on to receive an implant.
Importantly, the investigators found that motivation did not appear to determine which option a patient selected. Statistical testing did not show a significant relationship between primary motivation and initial treatment choice.
Why some patients didn’t move forward with a cochlear implant
In the cohort, 38.5% of patients initially selected a cochlear implant; however, only 57.4% of those individuals ultimately underwent implantation. The most common reasons for not proceeding were avoidance of surgery and insurance-related limitations. The investigators also noted that some patients did not return to complete the evaluation and/or surgical process even after indicating interest.
“Motivation did not predict treatment choice or CI receipt.”
These findings highlight a real-world gap between choosing a CI in principle and completing all steps needed to receive one. For clinicians, this underscores the importance of addressing barriers early—especially concerns about surgery and coverage—alongside counseling about expected benefits and limitations.
Motivation and outcomes after implantation
Among CI recipients (n = 27), the most common motivations were improving overall hearing and restoring hearing to the deaf side. The investigators evaluated two outcome measures at one year: word recognition scores (WRS) and daily CI use (via datalogging).
Across the group with available data, average one-year word recognition was 43.1%. Average daily use was 10.3 hours per day. However, outcomes were not uniform across motivational subgroups.
Patients whose primary motivation was “restoring hearing” in the deaf ear demonstrated significantly lower word recognition scores at one year compared with the remainder of the group. Their average daily wear time was also lower than several other motivation groups. By comparison, patients motivated by hearing in noise or tinnitus relief tended to show stronger outcomes and higher daily use, often meeting or exceeding evidence-based daily usage recommendations referenced by the investigators.
The investigators interpreted the poorer performance in the “hearing restoration” group as potentially related to expectation mismatch—specifically, the belief that a CI will recreate natural acoustic hearing. Cochlear implants can deliver meaningful access to sound and important functional gains for many SSD patients, but they do not replicate normal hearing in a literal sense.
When goals are framed as “restoration” rather than improved access or function, patients may be at higher risk for disappointment, lower engagement, and reduced wear time.
What this means for clinicians and patients
Overall, the findings suggest that patient motivation—while crucial to discuss—may not reliably predict whether someone proceeds with cochlear implantation. Instead, decisions appear to be shaped by multiple factors, including candidacy considerations, comfort with surgery, insurance access, and what patients understand (and expect) the device to do.
For clinicians, the study supports a counseling approach that explicitly explores motivation and then “tests” expectations against realistic outcomes. The investigators also suggest that structured pre-treatment counseling may help reduce non-use by improving alignment between goals and the lived experience of using a CI.
For consumers, the study offers an important takeaway: it’s normal for the decision to be complex. If a cochlear implant is being considered, asking detailed questions about expected listening in daily life—especially in noise, localization, and tinnitus—may help clarify whether the option fits one’s priorities and tolerance for surgery.
Reference:
Asfour L, Oliva A, Williams E, Holcomb MA. The Role of Patient Motivation in Single-Sided Deafness: Patterns in Treatment Selection and Cochlear Implant Outcomes. Journal of Clinical Medicine. 2025;14:8944. https://doi.org/10.3390/jcm14248944
