Pediatric Single‐Sided Deafness Workup and Management After Indication Changes for Unilateral Cochlear Implants

Objective In July 2019, the Food and Drug Administration (FDA) approved unilateral cochlear implantation (CI) in children aged 5 years and older with single‐sided deafness (SSD). In this study, we evaluate how the care of children with SSD evolved after this approval. Methods We retrospectively reviewed cases at our center (January 2014 to April 2025) of patients ages 0–21 years with SSD who received magnetic resonance imaging (MRI) and/or CT. We collected data on demographics, diagnostic workup via imaging, and hearing interventions, including CI. Results In our cohort of 184 children with congenital SSD, 108 (58.7%) were imaged before July 2019, and in our cohort of 63 children with acquired SSD, 36 (57.1%) were imaged before July 2019. A greater proportion of children < 5 years were imaged with MRI after July 2019 in both congenital (54.6% before vs. 93.4% after, p < 0.001) and acquired SSD cohorts (42.9% before vs. 100% after, p = 0.02). The prevalence of cochlear nerve deficiency (CND) in the congenital SSD cohort was 70.4% pre‐July 2019 and 63.2% post‐July 2019. The rate of CI did not significantly increase post‐July 2019 (2.8% pre‐July 2019 vs. 3.9% post‐July 2019, p = 0.66) in our cohort of congenital SSD but did increase substantially in children with acquired SSD (2.8% pre‐July 2019 vs. 37% post‐July 2019, p < 0.001). Conclusion Increased workup with MRI was observed after changes in FDA indications for SSD. A high proportion of CND was detected in children with congenital SSD that may affect candidacy of CI relative to children with acquired SSD, who had a significant increase in CI post‐July 2019. Level of Evidence IV.