Understanding asymmetrical hearing loss: causes and solutions
Here’s why people may experience one-sided hearing loss and what to do about it
Medically reviewed by
Updated:
October 17, 2025
Binaural hearing, or the ability to hear with both ears, helps us orient ourselves in space, detect where sounds come from, and separate speech from background noise. When one ear functions significantly worse than the other, this balance is disrupted, making it harder to communicate and stay aware of your surroundings.
Asymmetrical hearing loss (AHL) is defined as a 10 decibel or greater difference in the hearing ability of one ear versus another. It can have many different causes and may be temporary or permanent. A CROS hearing aid may be most beneficial for patients experiencing permanent hearing loss.
key takeaways
- Asymmetrical hearing loss affects one ear more than the other — A person is said to have AHL if their audiogram registers a difference of 10 decibels or greater between their left and right ear.
- Visit a doctor as soon as possible to reduce the risk of permanent damage — Some causes, like impacted earwax or infections, are temporary but need prompt care to avoid long-term damage.
- Most underlying causes are curable — Many possible AHL causes, such as ear infections, may be easily cured. Other conditions like Ménière’s disease may not have a known cure but can be managed through medication or other medical treatments.
What is asymmetrical hearing loss?
Asymmetrical hearing loss occurs when one ear hears significantly better than the other. While both ears may experience some level of hearing difficulty, there’s a noticeable difference—typically 10 decibels (dB) or more—between the two. This imbalance can make it harder to localize sounds, follow conversations in noisy environments, and maintain overall sound clarity.
Someone with asymmetrical hearing loss may also have bilateral hearing loss, meaning both ears are affected but to different degrees.
AHL can develop for many reasons, including sudden loud noise exposure, ear infections, Ménière’s disease, or repeated gun use. Identifying the underlying cause early is key to preventing permanent damage and improving treatment outcomes.
Asymmetrical hearing loss symptoms
Asymmetrical hearing loss symptoms are unique to this type of hearing loss. In addition to a general diminished ability to hear, and a significant difference in hearing ability in one ear versus the other, people with asymmetrical hearing loss may also experience these symptoms:
- Difficulty determining direction of sounds. Since one ear doesn’t function as well as the other, some sounds may be missed or misinterpreted.
- Trouble with volume. Noises may seem amplified in your “good” ear because of the contrast of hearing. This can make adjusting the volume on music or TV difficult since you don’t want to hurt your good ear but still struggle to hear out of the one experiencing loss.
- Problems with speech recognition. Realizing someone is talking or determining who is speaking may become difficult as voices often become background noise with this type of hearing loss.
- Difficulty with balance. Asymmetrical hearing loss may cause vertigo and related symptoms such as dizziness, nausea, headaches, and trouble standing.
Causes of asymmetrical hearing loss
Asymmetrical hearing loss can develop for a variety of reasons, ranging from damage inside the ear to blockages in the ear canal. Understanding whether the cause is sensorineural or conductive helps your audiologist determine the most effective treatment or management plan.
Unilateral sensorineural hearing loss
Damage to the inner ear (cochlea) or auditory nerve may result in unilateral sensorineural hearing loss. This type of hearing loss is likely permanent since it usually involves nerve damage. Common causes of unilateral sensorineural hearing loss include:
- Acoustic neuroma. Also known as a vestibular schwannoma, an acoustic neuroma refers to a benign tumor growing on the auditory nerve. While these tumors aren’t cancerous, acoustic neuromas can still be dangerous since they form in between the neck and the head. They are usually caused by genetic factors or exposure to radiation.
- Ménière’s disease. Ménière’s disease is a chronic inner ear disorder causing hearing loss, vertigo, tinnitus, and congestion in the ears. Autoimmune reactions and allergies may contribute, but there isn’t an exact cure. If you are diagnosed with Ménière’s disease, talk to your audiologist about treatment options.
- Sudden sensorineural hearing loss. This type of hearing loss occurs when someone experiences a sharp decline in hearing within a 72-hour period. With sudden hearing loss, the cause is usually idiopathic, or unknown. Current treatments typically include steroids, and prognosis is usually good with prompt medical care.
Conductive asymmetrical hearing loss
Usually temporary, this type of hearing loss occurs when something blocks or inhibits the passage from the middle or outer ear. Some examples include excessive ear wax or eardrum perforations.
- Otosclerosis. Bone tissue regeneration is a lifelong continual process. However, sometimes the bones in the middle ear experience abnormal regeneration or stress fractures, preventing them from working properly. This condition is called otosclerosis.
- Ear infections. Common in children, ear infections can also affect adults suffering from allergies or even respiratory viruses. When treated with antibiotics, ear infections usually go away within a couple weeks.
- Eardrum perforations. Injuries, ear infections, and sudden loud noises may all cause eardrum perforations. Injuries to the affected side are most likely to cause asymmetrical hearing loss.
How is asymmetrical hearing loss diagnosed?
Diagnosing asymmetrical hearing loss starts with a visit to an audiologist. Because one-sided hearing loss can result from a range of causes—some temporary and others more serious—the provider will take a detailed medical history and use both listening tests and imaging tools to pinpoint the source.
Initial assessment
The assessment begins with a conversation about your symptoms, medical history, and any recent noise exposure or ear infections. The audiologist will visually examine your ears to check for obstructions, inflammation, or damage to the eardrum. Based on these findings, they may recommend specific hearing tests to measure how well each ear responds to sound.
Audiological tests
The most common diagnostic tool is an audiogram, which measures your hearing ability across different pitches and volumes. During this test, you’ll wear headphones and signal when you hear tones or words at varying frequencies. The results are charted as two lines, one for each ear. Normally, the lines are similar, but if one dips 10 dB or more below the other, it indicates asymmetrical hearing loss. This helps determine the level and type of hearing loss.
Imaging and additional tests
If the audiogram suggests an underlying medical condition, your provider may perform or order further testing. An otoscope exam, for example, allows the audiologist to view the ear canal and eardrum for signs of infection, fluid, or perforation. In some cases, MRI or CT imaging may be used to rule out more complex issues.
Management and treatment options
Treatment depends on the cause and severity of the hearing loss. Some cases resolve on their own or respond well to medication, while others require surgical correction or hearing devices to restore clarity and balance. Below are the most common medical and technological approaches audiologists use to help patients manage asymmetrical hearing loss.
Medical treatments
Most causes of asymmetrical hearing loss are treatable. For example, ear infections usually go away within a couple of weeks with antibiotics and eardrum perforations usually heal on their own. Unfortunately, some possible underlying factors aren’t easily treatable, such as Ménière’s disease, which doesn’t have a known cure.
Surgical interventions
Occasionally, asymmetrical hearing loss may require surgery for successful treatment. One example is otosclerosis, which often requires a stapedectomy, or removal of the stapes bone in the middle ear. 90% of cases result in complete recovery.
Hearing aids and assistive devices
When the cause of asymmetrical hearing loss is permanent, an audiologist will likely recommend hearing aids to assist patients accomplish their daily tasks.
CROS hearing aids. CROS or “contralateral routing of signal” hearing aids may be an option for severe cases of asymmetrical hearing loss. This device reroutes sounds from the worse ear to a hearing aid in the better ear.
Cochlear implants. For severe cases when the patient is almost deaf, a cochlear implant may be the best choice. This medical device consists of two parts: one that’s worn externally and one that’s surgically inserted under the skin. A cochlear implant bypasses the damaged auditory nerve and transmits sounds directly to the brain. Patients with one-sided deafness are typically the best candidates for cochlear implants.
Tips for living with asymmetrical hearing loss
If you suspect you are experiencing asymmetrical hearing loss, you should visit an audiologist as soon as possible. Some types of hearing loss may become permanent if left untreated. A prompt diagnosis gives you the best prognosis.
Support and resources
Hearing loss can feel isolating. Finding a hearing loss support group through the Hearing Loss Association of America directory may help you feel connected to a community while offering additional support around how to manage your symptoms. Additionally, educating loved ones on the effects of hearing loss can foster understanding and empathy as they understand how to better communicate with you—and you with them.
Above all, it’s imperative to assess and treat cases of sudden hearing loss quickly. “Sudden losses should be addressed within 36 hours for best treatment outcomes,” Dr. Hinson says. “Intratympanic injections can be done for sudden loss if diagnosed early. These injections are given through the ear drum into the middle ear space and can result in reversal of hearing loss in some cases.”
You can use our trusted online directory to find a qualified hearing specialist near you and take the first step toward better hearing today.
Frequently asked questions
Should I make a doctor’s appointment for asymmetrical hearing loss?
Yes. Determining and promptly treating the underlying cause of asymmetrical hearing loss can improve your chances of making a full recovery.
What are some possible reasons for asymmetrical hearing loss?
Asymmetrical hearing loss often arises from ear infections, acoustic neuromas, and injuries. The problem may be sensorineural in origin, referring to the inner ear or auditory nerve, or conductive, involving the middle or outer ear.
What’s the difference between asymmetrical hearing loss and unilateral hearing loss?
A patient with unilateral hearing loss only experiences hearing loss in one ear and usually has near-normal hearing in their other ear. Unlike unilateral hearing loss, asymmetrical hearing loss may affect both ears, but always one more than the other by a difference of at least 10 decibels.
What’s the most common cause of asymmetrical hearing loss?
AHL is most commonly caused by uneven noise exposure. Individuals engaged in loud hobbies, such as shooting, face a higher risk compared to the general population. Additionally, military service members often experience asymmetrical hearing loss due to trauma.