Learning Objectives: - Understanding the importance of binaural hearing – Balancing risk and chances of hearing aids/other supportive technology vs. hearing prosthesis - Involvement of the family and non-medical professions for optimal results

Introduction: Unilateral hearing impairment in children may be the result of several different etiologies including cochlear nerve aplasia, loss of cochlear function and dysplasia of the middle ear or the outer ear canal. All children usually exhibit regular speech development patterns and show unremarkable clinical symptoms or none at all during early development. Nevertheless, the question of hearing rehabilitation needs to be answered in the face of the clinical complex.

Methods: Different strategies of hearing rehabilitation ranging from cochlear implant, conventional hearing aids, implantable hearing aids and supportive measures like FM-transceivers or CROS will be discussed case by case.

Results: As the major factor in child development is signal-to-noise-ratio (SNR), emphasis must be put on true binaural rehabilitation. Addressability out of the direction of the hearing impairment is a secondary problem and has to be weighed carefully against a decrease of SNR resulting from unwanted transmission of noise. This may be one of the reasons why children usually don't go for CROS-systems in the first place. Trans- and epidermal BAHS as well as active implants provide solutions with diverse invasivity and handling – all surpassing a soft-band approach. CI may yield benefits for children with sensorineural hearing loss. Low SNR can be ameliorated in defined circumstances (i.e. educational) by using FM-transceivers.

Conclusions: Binaural rehabilitation is preferred to unilateral or pseudo-binaural hearing - mostly as a consequence of the increase in SNR. Family and the surrounding infrastructure have to be counseled extensively, as the benefit of the hearing system may not be apparent in a young child.