Simulations of hearing impairment were presented to the normal ears of subjects with moderate to severe unilateral cochlear hearing loss. The intelligibility of speech in quiet and in background sounds was compared with that obtained for the impaired ears using unprocessed stimuli. The results of loudness matches between the two ears were used to tailor a simulation of threshold elevation combined with loudness recruitment individually for each subject. This was assessed either alone, or in combination with a simulation of reduced frequency selectivity, performed by spectral smearing. Finally, we included a simulation of 'dead' regions in the cochlea, where there are assumed to be no functioning inner hair cells and/or neurones, by band-stop filtering over the frequency range corresponding to the dead region. Performance for the impaired ears was markedly worse than for the normal ears using the simulation of threshold elevation and loudness recruitment. The addition of the simulation of reduced frequency selectivity caused performance to worsen, but it remained above that for the impaired ears. The additional simulation of a dead region had little effect, except for one subject, for whom it produced performance comparable to that for the impaired ear in quiet but not when background sounds were present. It is suggested that the relatively poor results for the impaired ears may be caused partly by a form of 'neglect' which is specific to subjects with unilateral or asymmetric loss. This idea was supported by results obtained using bilaterally hearing-impaired subjects, which were markedly better than for the impaired ears of the unilaterally hearing-impaired subjects, and comparable to those for the normal ears listening to the combined simulation of threshold elevation, loudness recruitment and reduced frequency selectivity.