Unilateral Hearing Loss: Listening Ability, Social Participation and Adaptive Strategies to Challenges in the Real World

Background: Unilateral hearing loss (UHL) is associated with speech-in-noise difficulties, impaired spatial hearing, and reduced social participation, yet conventional audiological assessments may not capture these real-world consequences. This study characterised the multidimensional functional impact of UHL using an ecologically oriented test battery and explored whether accessible behavioural and self-reported measures accounted for individual differences in speech-in-noise comprehension. Methods: Fifteen adults with moderate to profound sensorineural UHL and sixteen adults with normal hearing completed standardised questionnaires assessing hearing disability and social participation, an auditory reaction-time task in quiet and noise, the National Acoustic Laboratories Dynamic Conversations Test, head-orientation tracking, and post-task self-reports. Group differences were assessed using mixed-effects models and independent-samples t-tests. An exploratory regression examined speech-in-noise performance within the UHL group. Results: Participants with UHL reported greater hearing difficulties and social participation restrictions, and showed modestly poorer speech-in-noise comprehension although the UHL–NH difference in speech-in-noise comprehension was no longer statistically significant after adjustment for age. Reaction times were significantly longer in noise than in quiet but did not differ significantly between hearing groups. The UHL group also showed a significantly more pronounced head orientation towards the poorer-hearing side and greater within-participant head-orientation variability. An exploratory model combining reaction time in noise with three post-task self-report items showed strong apparent in-sample fit (adjusted R2 = 0.71). However, internal cross-validation of the complete model-selection procedure yielded substantially lower predictive performance (RCV2 = 0.19). Conclusions: UHL is associated with differences across complementary perceptual, behavioural, and self-reported dimensions of everyday communication. Multimodal functional assessment may provide information beyond conventional audiometry, although the exploratory model requires validation in larger, age-matched independent cohorts.