This report reviews a consecutive series of 175 children suffering from unilateral hearing loss of 20 dB or more evaluated at the Clocheville Hospital between 1980-1991. We found no numerical preponderance of gender nor of side impairment. The mean age of diagnosis was 6.9 years. Based on speech frequency threshold averages, the loss was profound in 49.7%. 32.8% of the children experienced a deterioration of hearing of 10 dB or more. 40.4% of the children had repeated a grade during primary school (versus 16.3% in normal hearing population, p < 0.001). Monaural deafness especially when more than 40 dB, or delayed identification is significantly associated with a grade failure. A concerted effort aimed at early identification and management strategies in cases of unilateral hearing loss in children is warranted.