Article

Lace and Single-Sided Deafness

Here we discuss why patients with SSD are great candidates for LACE and what type of benefits they should experience as a result of training.

July 17, 2026

Written by:

Neurotone

Scientifically reviewed by:

Prescribing LACE is typically limited to individuals with symmetrical hearing loss, which is expected given that the majority of hearing aid wearers have bilateral impairment. However, this leaves patients with more complex hearing profiles, such as single-sided deafness (SSD), significantly underserved when it comes to auditory training. Here we discuss why patients with SSD are great candidates for LACE and what type of benefits they should experience as a result of training.

Single-sided deafness (SSD) affects about 1 in every 1,000 babies and hundreds of thousands of adults (Kay-Rivest, et al 2022). Although CROS hearing aids have been the main option for those with SSD, as Table 1 shows, BAHA and CIs have supplanted CROS as the option of choice for managing this condition.

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Device type	Mechanism (how it works)	Key adoption and preference trends
CROS Hearing Aids(Contralateral Routing of Signals)	Non-surgical. Re-routes sound from the bad ear to the good ear wirelessly.	Highly trialed due to zero surgical risk, but suffers from low ultimate device purchase rates. Of the 11% of patients actively opting for a CROS trial, only 4% of those trialing the device chose to buy it due to high costs and lack of true directional hearing.
BAHA(Bone-Anchored Hearing Systems)	Surgical or headband. Transmits sound vibrations through skull bone to the better ear.	Preferred by patients over CROS for physical comfort, but historically limited by surgical hesitation. Given a choice between treatments, roughly 27% of seeking patients opted for bone-anchored surgery.
Cochlear Implants (CI)	Surgical. Directly stimulates the auditory nerve of the deaf ear to restore true binaural hearing.	This is the fastest-growing segment and the most preferred surgical solution. In comparative clinical settings, 51% of patients chose a CI over BAHA (27%) or CROS (22%) because it is the only device capable of restoring sound localization and speech clarity in noise.

Table 1. A breakdown of available management options for SSD from Jakob et al (2022).

Unique challenges associated with unilateral hearing loss

If you haven’t thought about unilateral hearing loss in a while, remember that individuals with SSD have unique communication challenges associated with their condition.

The Head-Shadow Effect

The head acts as a physical barrier that blocks high-frequency speech sounds (like "s," "f," and "t") traveling from the deaf side to the hearing ear. This reduces speech clarity by up to 6 dB , making speech sound muffled.

Loss of Sound Localization

The brain determines where a sound is coming from by comparing the timing and volume differences between both ears. With SSD, you cannot tell where a speaker is located or notice if someone is approaching from your deaf side.

Trouble in Background Noise & Fatigue

Similar to individuals with mild to moderate symmetrical hearing loss, those with SSD are likely to have added difficulty understanding conversations in noise and feeling fatigued after straining to listen for prolonged periods of time.

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How Lace helps with unilateral hearing loss

When properly fitted or mapped, any of the three management options listed in Table 1 can effectively reduce the unique communication challenges associated with SSD.

Regardless of the management option chosen, however, patients with SSD are excellent candidates to use Lace auditory training exercises for the same reasons as individuals fitted with bilateral hearing aids:

a single dose of Lace is likely to result in improved listening ability

Therefore, when you fit a CROS hearing aid or map a CI or BAHA, encouraging these patients to do Lace exercises is beneficial.

Although Lace will still provide benefits because the training targets listening skills, it is important to set realistic expectations. For patients with SSD who use a CROS, BAHA, or CI, Lace is an effective adjunct to their device. Lace cannot restore binaural advantages that are lost due to SSD. Sound localization and reduction of the head-shadow effect rely on properly fitted or mapped devices.

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REFERENCES

Jakob, T. F., Speck, I., Rauch, A. K., Hassepass, F., Ketterer, M. C., Beck, R., Aschendorff, A., Wesarg, T., & Arndt, S. (2022). Bone-anchored hearing system, contralateral routing of signals hearing aid or cochlear implant: what is best in single-sided deafness? European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 279(1), 149–158. https://doi.org/10.1007/s00405-021-06634-7

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://doi.org/10.1002/lary.29941