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OBJECTIVE: We have shown that the acoustic change complex (ACC) can be elicited by changing the horizontal sound location in young individuals. In this study, we aimed to evaluate the application of ACC within the elderly and its relationship with behavioural results. DESIGN: The minimum audible angle (MAA), as well as onset cortical auditory evoked potentials (onset-CAEPs) and ACC elicited by the stimuli of location-change white noise (±45 to ±2 degrees) were recorded. Latencies and amplitudes were analysed using repeated-measures ANOVA. Pearson correlation analysis was conducted to examine the relationship between ACC and MAA. STUDY SAMPLE: Ten older adults with normal hearing (NH) and twenty with presbycusis. RESULTS: The ACC was effectively elicited with angular variations in elderly participants. The onset-CAEP N1 latency, ACC N1'-P2' amplitude, and N1' latency were all associated with the angle shifts, with the N1' latency being the most predictive factor for angle discrimination. The consistency between MAA and ACC made them complementary for the clinical evaluation of sound localisation. CONCLUSIONS: The utilisation of ACC, evoked by location-change sounds, presented a promising clinical objective measure for evaluating sound localisation abilities in the elderly.

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OBJECTIVE: One proposed method to improve sound localisation for bilateral cochlear implant (BiCI) users is to synchronise the automatic gain control (AGC) of both audio processors. In this study we tested whether AGC synchronisation in a dual-loop front-end processing scheme with a 3:1 compression ratio improves sound localisation acuity. DESIGN: Source identification in the frontal hemifield was tested in in an anechoic chamber as a function of (roving) presentation level. Three different methods of AGC synchronisation were compared to the standard unsynchronised approach. Both root mean square error (RMSE) and signed bias were calculated to evaluate sound localisation in the horizontal plane. STUDY SAMPLE: Six BiCI users. RESULTS: None of the three AGC synchronisation methods yielded significant improvements in either localisation error or bias, neither across presentation levels nor for individual presentation levels. For synchronised AGC, the pooled mean (standard deviation) localisation error of the three synchronisation methods was 24.7 (5.8) degrees RMSE, for unsynchronised AGC it was 27.4 (7.5) degrees. The localisation bias was 5.1 (5.5) degrees for synchronised AGC and 5.0 (3.8) for unsynchronised. CONCLUSIONS: These findings do not support the hypothesis that the tested AGC synchronisation configurations improves localisation acuity in bilateral users of MED-EL cochlear implants.

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The auditory gaze cueing effect (auditory-GCE) is a faster response to auditory targets at an eye-gaze cue location than at a non-cue location. Previous research has found that auditory-GCE can be influenced by the integration of both gaze direction and emotion conveyed through facial expressions. However, it is unclear whether the emotional information of auditory targets can be cross-modally integrated with gaze direction to affect auditory-GCE. Here, we set neutral faces with different gaze directions as cues and three emotional sounds (fearful, happy, and neutral) as targets to investigate how the emotion of sound target modulates the auditory-GCE. Moreover, we conducted a controlled experiment using arrow cues. The results show that the emotional content of sound targets influences the auditory-GCE but only for those induced by facial cues. Specifically, fearful sounds elicit a significantly larger auditory-GCE compared to happy and neutral sounds, indicating that the emotional content of auditory targets plays a modulating role in the auditory-GCE. Furthermore, this modulation appears to occur only at a higher level of social meaning, involving the integration of emotional information from a sound with social gaze direction, rather than at a lower level, which involves the integration of direction and auditory emotion.

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OBJECTIVES: This study aimed to investigate the effects of an adhesive bone conduction device (aBCD) in children with congenital single-sided deafness (SSD). Specifically, we examined whether the aBCD elicits improvement in the speech perception ability of children with congenital SSD and whether using this device would adversely affect the horizontal localisation abilities of these children. METHODS: Thirteen school-aged children with SSD and seven children with Normal Hearing (NH) were included in this study. Speech perception in noise was measured using the Mandarin Speech Test Materials and sound localisation performance was evaluated using broadband noise stimuli (0.5-20 kHz), randomly played from seven loudspeakers at different stimulus levels (65-, 70-, and 75-dB SPL). RESULTS: All children with SSD showed inferior speech perception and sound localisation performance compared with children with NH. The aBCD use remarkably improved the speech perception abilities of these children under quiet and noise conditions; however, their sound localisation abilities neither improved nor deteriorated. CONCLUSION: This study reveals the effectiveness and safety of a non-surgical aBCD in paediatric patients with SSD. Our results provide a theoretical basis for early hearing intervention with an aBCD in children with congenital SSD who are temporarily unable to undergo ear surgery. LEVEL OF EVIDENCE: Level 3.

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The cochlear implant (CI) as a treatment option for single-sided deafness (SSD) started with a clinical study looking in to the influence of cochlear implantation with a MED-EL device on incapacitating unilateral tinnitus in SSD. The study began in 2003 and was conducted by P. Van de Heyning and his team in Antwerp, Belgium. The first CI in SSD without tinnitus in Germany was implanted by J. Mueller and R. Jacob in Koblenz in 2005. Translational research activities took place since then to evaluate the CI as a treatment option for SSD not only in adults but also in children. They assessed the hearing performance of SSD patients implanted with CI, importance of long electrode arrays in SSD patients, degree of acceptance of CI by SSD children, importance of early CI implantation in SSD children in developing language skills, music enjoyment by hearing with two ears and evidence on spiral ganglion cell body distribution. In 2013, MED-EL was the first CI manufacturer to receive the CE mark for the indication of SSD and asymmetric hearing loss (AHL) in adults and children. In 2019, MED-EL was the first CI manufacturer to get its CI device approved for patients over the age of five with SSD and AHL, by the FDA in the USA. This article covers the milestones of translational research from the first concept to the widespread clinical use of CI in SSD.

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OBJECTIVE: To assess any differences in spatial listening ability of cochlear implant recipients when using both or only one of two bilateral cochlear implants (BCIs) for stimuli originating from behind the subject. DESIGN: Twelve loudspeakers were placed in the rear horizontal plane of the subjects to test the sound localisation performance of BCI users and normal-hearing listeners (NHLs) with or without interfering noise. Stimuli were presented via two rear loudspeakers simultaneously during the speech recognition test. In the tone recognition test, another anechoic chamber was used with stimuli presenting from a loudspeaker behind the participants. STUDY SAMPLE: Twenty-seven NHLs and eleven BCI users. RESULTS: Average root-mean-square (RMS) error for the bilateral condition was significantly lower than that for the right and left cochlear implant (CI) conditions with or without interfering noises (p < 0.05). Average speech or tone recognition scores for the bilateral condition and the right and left CI conditions were not statistically significant (p > 0.05). CONCLUSION: Sound localisation with BCIs was significantly more accurate than with either implant alone. Speech and tone recognition scores were not better with two compared to those of one activated implant. Given the small number of subjects, the results should be considered as preliminary.

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OBJECTIVE: To explore the behavioural and functional performance of a group of children with conductive unilateral hearing loss (UHL) due to congenital aural atresia. METHOD: Twelve children aged 7 to 16 years (Mage 10.0, SD 3.1 years) formed the UHL group and 15 age-matched children (Mage 9.5, SD 3.6 years) with normal hearing formed the control group. Auditory skills were assessed using tests of sound localisation, spatial speech perception in noise, and self-ratings of auditory abilities (Listening Inventory for Education; LIFE and Speech, Spatial and Qualities of Hearing scale; SSQ). RESULTS: When speech was directed to the good ear, performance was poorer than for normal hearing controls. Sound localisation abilities were impaired in children with UHL. Children with UHL reported higher levels of difficulties in classroom settings compared to children with normal hearing, particularly for activities involving listening in noise and focused listening activities. Older children self-report and parents report difficulties for their children across all SSQ scales. CONCLUSIONS: Children with UHL showed a wide range of auditory difficulties. As expected, speech recognition in noise differed from controls. Sound localisation abilities were variable; greater variability was seen for right ear hearing losses suggesting that some of these children may have developed compensatory mechanisms. Younger children identified listening difficulties for school situations where focussed auditory attention was needed. Older children and parents reported greatest difficulty for activities requiring perception of the direction, distance, and movement of sound. Higher levels of effort and inability to ignore sounds were reported as major difficulties.

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OBJECTIVE: This study assessed the safety and sound-localisation ability of the Vibrant Soundbridge (VSB) (Med-EL, Innsbruck, Austria) in patients with unilateral microtia and atresia (MA). METHODS: This was a single-centre retrospective research study. Twelve subjects with unilateral conductive hearing loss (UCHL) caused by ipsilateral MA were recruited, each of whom underwent VSB implantation and auricular reconstruction. The bone-conduction (BC) threshold was measured postoperatively, and the accuracy of sound localisation was evaluated at least 6 months after surgery. Horizontal sound-localisation performance was investigated with the VSB activated and inactivated, at varying sound stimuli levels (65, 70 and 75 dB SPL). Localisation benefit was analysed via the mean absolute error (MAE). RESULTS: There was no statistical difference in mean BC threshold of impaired ears measured preoperatively and postoperatively. When compared with VSB-inactivated condition, the MAE increased significantly in unilateral MA patients in the VSB-activated condition. Besides, sound-localisation performance worsened remarkably when sound was presented at 70 dB SPL and 75 dB SPL. Regarding the side of signal location, the average MAE with the VSB device was much higher than that without the VSB when sound was from the normal-hearing ear. However, no significant difference was observed when sound was located from the impaired ear. CONCLUSION: This study demonstrates that in patients with unilateral MA, the VSB device does not affect inner-ear function. Sound-localisation ability is not improved, but deteriorated at follow-up. Our results suggest that the VSB-aided localisation abilities may be related to the thresholds between the ears, plasticity of auditory system and duration of use of VSB.

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When localising sounds in space the brain relies on internal models that specify the correspondence between the auditory input reaching the ears, initial head-position and coordinates in external space. These models can be updated throughout life, setting the basis for re-learning spatial hearing abilities in adulthood. In addition, strategic behavioural adjustments allow people to quickly adapt to atypical listening situations. Until recently, the potential role of dynamic listening, involving head-movements or reaching to sounds, have remained largely overlooked. Here, we exploited visual virtual reality (VR) and real-time kinematic tracking, to study the role of active multisensory-motor interactions when hearing individuals adapt to altered binaural cues (one ear plugged and muffed). Participants were immersed in a VR scenario showing 17 virtual speakers at ear-level. In each trial, they heard a sound delivered from a real speaker aligned with one of the virtual ones and were instructed to either reach-to-touch the perceived sound source (Reaching group), or read the label associated with the speaker (Naming group). Participants were free to move their heads during the task and received audio-visual feedback on their performance. Most importantly, they performed the task under binaural or monaural listening. Results show that both groups adapted rapidly to monaural listening, improving sound localisation performance across trials and changing their head-movement behaviour. Reaching the sounds induced faster and larger sound localisation improvements, compared to just naming its position. This benefit was linked to progressively wider head-movements to explore auditory space, selectively in the Reaching group. In conclusion, reaching to sounds in an immersive visual VR context proved most effective for adapting to altered binaural listening. Head-movements played an important role in adaptation, pointing to the importance of dynamic listening when implementing training protocols for improving spatial hearing.

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OBJECTIVE: Patients with bilateral aural atresia often exhibit poor sound localisation due to bone conduction (BC) features. However, most patients using cartilage conduction (CC) hearing aids reported improvement of sound localisation. DESIGN: CC hearing aids were fitted binaurally. Subsequently, sound localisation was evaluated in three conditions: unaided, aided with previously used hearing aids (air conduction or BC hearing aids), and aided with CC hearing aids. Ears were evaluated with eight loudspeakers positioned in a full-circle at 45-degree interval. Loudspeakers were classified into left and right by midline and front and back by horizontal line. The abilities to distinguish left from right and front from back were compared among three conditions. STUDY SAMPLE: Thirteen patients with bilateral aural atresia participated. RESULTS: The ability to distinguish sounds originating from left or right for participants aided with CC hearing aids was significantly better than that for other conditions (p < 0.05). For distinguishing sounds originating from front or back, unaided ears were significantly better than ears aided with CC hearing aids (p < 0.05). CONCLUSIONS: CC hearing aids provide the ability to distinguish left from right in patients with bilateral aural atresia.

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Sound localisation is a fundamental attribute of the way that animals perceive their external world. It enables them to locate mates or prey, determine the direction from which a predator is approaching and initiate adaptive behaviours. Evidence from different biological disciplines that has accumulated over the last two decades indicates how small insects with body sizes much smaller than the wavelength of the sound of interest achieve a localisation performance that is similar to that of mammals. This Review starts by describing the distinction between tympanal ears (as in grasshoppers, crickets, cicadas, moths or mantids) and flagellar ears (specifically antennae in mosquitoes and fruit flies). The challenges faced by insects when receiving directional cues differ depending on whether they have tympanal or flagellar years, because the latter respond to the particle velocity component (a vector quantity) of the sound field, whereas the former respond to the pressure component (a scalar quantity). Insects have evolved sophisticated biophysical solutions to meet these challenges, which provide binaural cues for directional hearing. The physiological challenge is to reliably encode these cues in the neuronal activity of the afferent auditory system, a non-trivial problem in particular for those insect systems composed of only few nerve cells which exhibit a considerable amount of intrinsic and extrinsic response variability. To provide an integrative view of directional hearing, I complement the description of these biophysical and physiological solutions by presenting findings on localisation in real-world situations, including evidence for localisation in the vertical plane.

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When asked to identify the position of a sound, listeners can report its perceived location as well as their subjective certainty about this spatial judgement. Yet, research to date focused primarily on measures of perceived location (e.g., accuracy and precision of pointing responses), neglecting instead the phenomenological experience of subjective spatial certainty. The present study aimed to investigate: (1) changes in subjective certainty about sound position induced by listening with one ear plugged (simulated monaural listening), compared to typical binaural listening and (2) the relation between subjective certainty about sound position and localisation accuracy. In two experiments (N = 20 each), participants localised single sounds delivered from one of 60 speakers hidden from view in front space. In each trial, they also provided a subjective rating of their spatial certainty about sound position. No feedback on response was provided. Overall, participants were mostly accurate and certain about sound position in binaural listening, whereas their accuracy and subjective certainty decreased in monaural listening. Interestingly, accuracy and certainty dissociated within single trials during monaural listening: in some trials participants were certain but incorrect, in others they were uncertain but correct. Furthermore, unlike accuracy, subjective certainty rapidly increased as a function of time during the monaural listening block. Finally, subjective certainty changed as a function of perceived location of the sound source. These novel findings reveal that listeners quickly update their subjective confidence on sound position, when they experience an altered listening condition, even in the absence of feedback. Furthermore, they document a dissociation between accuracy and subjective certainty when mapping auditory input to space.

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OBJECTIVE: To perform a long-term evaluation of the localisation capabilities in the horizontal plane of single-sided deaf patients fitted with a BAHA device. DESIGN: Single-centre retrospective study. PARTICIPANTS: Twenty-one adults with single-sided deafness (SSD) with normal hearing in the contralateral ear (pure tone average <20 dB, SDS > 90%) rehabilitated with a Cochlear BAHA device from 2003 to 2012 on the deaf side over a median follow-up of 8 years. OUTCOME MEASURES: The task used in this paper is a sound localisation identification task with a set-up of seven loudspeakers on a semi-circular array at 30-degree intervals performed at three periods: before BAHA, initially and at last follow-up. Our main criterion of judgement was the root-mean-square (RMS) localisation error. In addition, the Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was administered. RESULTS: The mean RMS localisation error was initially estimated at 64° without any rehabilitation (for a chance level RMS estimated at 81°). Initially, with the BAHA device, the RMS localisation error dropped to 51°. At the last follow-up evaluation, a significant decrease at 23° was noted. Concerning the Bern Questionnaire, 19% of the patients (n = 4) did not report any change (score of 0), 33% (n = 7) are satisfied (score of +1 or +2) and 48% (n = 10) are very satisfied with the BAHA device (score better than +3). CONCLUSION: Improvement of sound localisation in the horizontal plane for some SSD patients is likely related to altered processing of monaural spectral cues. The time needed to learn to use the azimuth-dependent spectral cues takes time. Long-term follow-up should be considered for studies investigating sound localisation performance.

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OBJECTIVE: The ability to determine the location of the sound source is often important for effective communication. However, it is not clear how the localisation is affected by background noise. In the current study, localisation in quiet versus noise was evaluated in adults both behaviourally, and using MMN and P3b. DESIGN: The speech token/da/was presented in a multi-deviant oddball paradigm in quiet and in presence of speech babble at +5 dB SNR. The deviants were presented at locations that differed from the standard by 30°, 60° and 90°. STUDY SAMPLE: Sixteen normal hearing adults between the age range of 18-35 years participated in the study. RESULTS: The results showed that participants were significantly faster and more accurate at identifying deviants presented at 60° and 90° as compared to 30°. Neither reaction times nor electrophysiological measures (MMN/P3b) were affected by the background noise. The deviance magnitude (30°, 60° and 90°) did not affect the MMN amplitude, but the smaller deviant (30°) generated P3b with smaller amplitude. CONCLUSIONS: Under the stimulus paradigm and measures employed in this study, localisation ability as effectively sampled appeared resistant to speech babble interference.

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(1) determine if untrained, normal-hearing listeners could learn, with regimented practice trials, to localise a dissonant tonal complex while wearing electronic hearing protectors and achieve equivalent performance to the unoccluded ear, (2) determine if different protector designs affect the localisation learning curve, and (3) determine if a sequential training regimen could be used to determine whether a device is not amenable to training effects. All subjects completed paired training and testing trials, in 12 Learning Units (LU), first with the open ear., then half with device A, a US Army TCAPS (INVISIO® X50), and the other half with device B (a prototype). Both groups then finished with the opposite device. Ten subjects participated, with thresholds below 25 dBHL, bilateral symmetry below 15 dBHL, and naivety with electronic protectors and localisation testing. Subjects eventually approached their open ear capability with device A, but never reached equivalent open ear nor asymptotic performance with device B. Depending upon a protector's sound transduction, frequency response, and other characteristics, different amounts of training are required to adapt. The training protocol has value in determining device acceptability based on the training burden required, especially when mission-related localisation performance is important.

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OBJECTIVE: The objective of this study is to quantify the effect of the Bone Conduction Implant (BCI) on sound localisation accuracy in subjects with conductive hearing loss (CHL). DESIGN: The subjects were tested in a horizontal sound localisation task in which localisation responses were objectively obtained by eye-tracking, in a prospective, cross-sectional design. The tests were performed unaided and unilaterally aided. The stimulus used had a spectrum similar to female speech and was presented at 63 and 73 dB SPL. The main outcome measure was the error index (EI), ranging from 0 to 1 (perfect to random performance). STUDY SAMPLE: Eleven subjects (aged 21-75 years, five females) with BCI participated in the study. Their mixed/conductive hearing loss was either unilateral (n = 5) or bilateral (n = 6). RESULTS: Three of five subjects (60%) with unilateral CHL, and four of six subjects (67%) with bilateral CHL showed significantly improved sound localisation when using a unilateral BCI (p < .05). For the subjects with bilateral CHL, a distinct linear relation between aided sound localisation and hearing thresholds in the non-implant ear existed at 73 dB SPL (18% decrease in the EI per 10 dB decrease in pure-tone average, r = 0.98, p < .001). CONCLUSIONS: Individuals with mixed/conductive hearing loss may benefit from a unilateral BCI in sound localisation.

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Biological motion-sensitive neural circuits are quite adept in perceiving the relative motion of a relevant stimulus. Motion perception is a fundamental ability in neural sensory processing and crucial in target tracking tasks. Tracking a stimulus entails the ability to perceive its motion, i.e., extracting information about its direction and velocity. Here we focus on auditory motion perception of sound stimuli, which is poorly understood as compared to its visual counterpart. In earlier work we have developed a bio-inspired neural learning mechanism for acoustic motion perception. The mechanism extracts directional information via a model of the peripheral auditory system of lizards. The mechanism uses only this directional information obtained via specific motor behaviour to learn the angular velocity of unoccluded sound stimuli in motion. In nature however the stimulus being tracked may be occluded by artefacts in the environment, such as an escaping prey momentarily disappearing behind a cover of trees. This article extends the earlier work by presenting a comparative investigation of auditory motion perception for unoccluded and occluded tonal sound stimuli with a frequency of 2.2 kHz in both simulation and practice. Three instances of each stimulus are employed, differing in their movement velocities-0.5°/time step, 1.0°/time step and 1.5°/time step. To validate the approach in practice, we implement the proposed neural mechanism on a wheeled mobile robot and evaluate its performance in auditory tracking.

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The peripheral auditory system of lizards has been extensively studied, because of its remarkable directionality. In this paper, we review the research that has been performed on this system using a biorobotic approach. The various robotic implementations developed to date, both wheeled and legged, of the auditory model exhibit strong phonotactic performance for two types of steering mechanisms-a simple threshold decision model and Braitenberg sensorimotor cross-couplings. The Braitenberg approach removed the need for a decision model, but produced relatively inefficient robot trajectories. Introducing various asymmetries in the auditory model reduced the efficiency of the robot trajectories, but successful phonotaxis was maintained. Relatively loud noise distractors degraded the trajectory efficiency and above-threshold noise resulted in unsuccessful phonotaxis. Machine learning techniques were applied to successfully compensate for asymmetries as well as noise distractors. Such techniques were also successfully used to construct a representation of auditory space, which is crucial for sound localisation while remaining stationary as opposed to phonotaxis-based localisation. The peripheral auditory model was furthermore found to adhere to an auditory scaling law governing the variation in frequency response with respect to physical ear separation. Overall, the research to date paves the way towards investigating the more fundamental topic of auditory metres versus auditory maps, and the existing robotic implementations can act as tools to compare the two approaches.

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BACKGROUND: Individuals with single-sided deafness (SSD) have problems with speech perception in noise, localisation of sounds and with communication and social interaction in their daily life. Current treatment modalities (Contralateral Routing of Sound systems [CROS] and Bone Conduction Devices [BCD]) do not restore binaural hearing. Based on low level of evidence studies, CROS and BCD do not improve speech perception in noise or sound localisation. In contrast, cochlear implantation (CI) may overcome the limitations of CROS and BCD, as binaural input can be restored. Promising results have previously been achieved on speech perception in noise, sound localisation, tinnitus and quality of life. METHODS AND DESIGN: A single-center Randomised Controlled Trial (RCT) was designed to compare all treatment strategies for SSD. One hundred and twenty adult single-sided deaf patients (duration of deafness >3 months and maximum 10 years; pure tone average at 0.5, 1, 2, 4 kHz, deaf ear: threshold equal to or more than 70 dB, better ear: threshold of maximum 30 dB) will be included in this trial and randomised to CI, 'first BCD, then CROS' or 'first CROS, then BCD'-groups. After the trial period, patients in the two latter groups may choose with which treatment option they continue. Outcomes of interest are speech perception in noise, sound localization, tinnitus and quality of life. These outcomes will be measured during a baseline visit and at follow up visits, which will take place at 6, 12, 18, 24, 36, 48 and 60 months after onset of treatment. Furthermore, an economic evaluation will be performed and adverse events will be monitored. DISCUSSION: This RCT allows for a comparison between the two current treatment modalities for single-sided deafness and a new promising treatment strategy, CI, on a range of health outcomes: speech perception in noise, sound localization, tinnitus and quality of life. Additionally, we will be able to answer the question if the additional costs of CI are justified by increased benefits, when compared to current treatment strategies. This study will inform health policy makers with regard to reimbursement of CI. TRIAL REGISTRATION: Netherlands Trial Register (www.trialregister.nl): NTR4580.