Rehabilitation strategies for pediatric single-sided deafness, including children with asymmetric hearing loss: a systematic review

Abstract Objectives: This study aimed to analyze in a comprehensive systematic review the hearing rehabilitation strategies for single-sided deafness (SSD) and asymmetric hearing loss (AHL) in children. Current rehabilitative options include contralateral routing of signal (CROS) devices, bone conduction devices, and cochlear implantation (CI). Methods: A systematic review of PubMed/MEDLINE was performed to identify studies on pediatric SSD and AHL rehabilitation published up to 7 July 2025. Reviews, meta-analyses, case reports, and animal studies were excluded. Eligible studies included pediatric populations treated with rehabilitative devices, with outcomes focused on speech perception, auditory performance, binaural hearing, quality of life, and questionnaire-based measures. Study selection followed PRISMA principles. Results: A total of 1527 records were identified by three authors through PubMed/MEDLINE (2003-July 2025) after duplicate removal. Title screening retained 581 studies, and abstract screening retained 267 studies. Fifty-eight full-text papers were assessed for eligibility; 10 were excluded due to overlapping patient cohorts, leaving 48 papers for the qualitative synthesis. Overall, 1622 children were analyzed; 43 studies focused on SSD and five on AHL. Conclusions: Available evidence supports rehabilitation in pediatric SSD and AHL. CROS systems offer a non-surgical and reversible option with benefits in selected listening situations but limited effects on localization. Bone conduction devices may improve hearing in noise and some functional outcomes, especially in conductive indications. CI appears to provide the greatest opportunity to restore bilateral auditory input, particularly when performed early in congenital SSD