Background: Bilateral hearing aids are desirable to restore hearing in the most effective and natural way. The aim of the present study was to identify which type of hearing rehabilitation was preferred by our patients and which factors drove their choice. Methods: One hundred eight patients with moderate-to-severe asymmetrical hearing loss before and after a 1-month trial with bilateral hearing aids were considered. Results: As high as 58.3% of patients decided to continue with bilateral hearing aids (group BI), while 41.7% chose unilateral hearing aid (UNI group) in the best ear. Patients in the UNI group were significantly older than those in the BI group ( P = .04); age > 77 years was an independent prognostic factor of unilateral hearing aid choice (odds ratio = 6.26; P = .04). Matrix test scored significantly worse with a single hearing aid than with 2 hearing aids in both groups (UNI P = .03; BI P = .01). Conclusion: Patients with asymmetric hearing loss often prefer unilateral hearing aid, almost half in our experience. Nonetheless, bilateral hearing aids are desirable as unilateral hearing aid was associated with significantly poorer performance at a speech in noise hearing tests. Age at fitting could play a relevant role and is thus important in early diagnosis. Further studies are needed to confirm our results and investigate strategies to promote bilateral rehabilitation.