Graduate Studies, UNL

 

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

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First Advisor

Michelle Hughes

Degree Name

Doctor of Philosophy (Ph.D.)

Committee Members

John Maag, Timothy Guetterman, Wayne Babchuk, Yingying Wang

Department

Communication Disorders

Date of this Version

4-29-2026

Document Type

Dissertation

Citation

A dissertation presented to the faculty of the Graduate College at the University of Nebraska in partial fulfillment of requirements for the degree Doctor of Philosophy

Major: Communication Disorders

Under the supervision of Professor Michelle Hughes

Lincoln, Nebraska, May 2026

Comments

Copyright 2026, Priya Karimuddanahalli Premkumar. Used by permission

Abstract

Individuals with single-sided deafness (SSD) encounter challenges such as difficulty localizing sounds, understanding speech in noisy environments, heightened auditory fatigue, and a diminished quality of life. The available treatment options for SSD are diverse, ranging from contralateral routing of signal (CROS) devices and bone conduction devices (BCD) to osseointegrated auditory implants (OAI), cochlear implants (CI), or even opting for no device at all. However, each of these treatment choices comes with its own set of advantages and disadvantages. Navigating the decision-making process for SSD treatment can be challenging due to each option's unique pros and cons. Furthermore, there remains a significant gap in understanding the factors influencing this decision-making process and in easing the process of decision-making. The current study aimed to address these gaps by developing and validating the decision aid (DA) using a mixed methods approach that pursued the following three objectives. Firstly, this study aimed to qualitatively examine the factors influencing patients' decision-making process for SSD treatment. We conducted semi-structured interviews with 15 adults with SSD. This Phase involved four participants using CI, three using CROS, two using OAI, and five participants who had decided not to use any rehabilitative options. Qualitative responses from each participant were analyzed using a grounded theory approach. We identified eight themes that influenced the decision-making process. These themes included: 1) perception of surgery, 2) affordability or insurance coverage, 3) quick or easy option, 4) accustomed to hearing in one ear, 5) cosmetic appeal, 6) professional recommendations, 7) limited information about non-invasive treatment option and 8) etiology of hearing loss.

Secondly, the study aimed to develop a DA by building on the qualitative findings from the first Phase. We developed the DA, which consists of brief information on what SSD is, the challenges it poses, different options, how these options work, and research evidence on the advantages and disadvantages of each. To provide the research evidence, we have reported the percentages of improvement, no improvement or worsening for each outcome measure (advantages and disadvantages) across each treatment option. Finally, the study assessed the effectiveness of DA using quantitative methods. The DA was validated on four professionals and 19 adults with SSD. Professionals completed the acceptability questionnaire (feedback) post-reading DA. Adults with SSD completed the knowledge, and decisional conflict scale questionnaire before and after reading the DA. Further, adults with SSD completed the acceptability questionnaire after reading the DA. Our results indicate that the developed DA was acceptable to adults with SSD and professionals, and that it also increased knowledge and reduced decision conflict among adults with SSD.

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