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Background: The rate of patients with unilateral hearing impairments (UHI) increase with age and are characterized by asymmetric auditory afferents in which auditory information is asymmetrically transmitted to the brain. Long-term bilateral hearing imbalance can cause abnormal functional changes in the cerebral cortex. However, the relationship between functional alterations in the brain and the severity of the hearing impairment remains unclear., Methods: This study included 33 patients with UHI (left-sided impairment in 17 and right-sided impairment in 16) and 32 healthy patients. All participants underwent resting-state, blood oxygen level dependent functional magnetic resonance imaging. Fractional amplitude of low frequency fluctuation (fALFF) values were calculated after data preprocessing and compared among the left-sided and right-sided impairment groups and the control group. Pure tone audiometry was used to evaluate patients' hearing impairment level. The correlation between fALFF values of abnormal brain regions and the duration and severity of hearing impairment was analyzed., Results: Results provide evidence for altered resting-state functional activities in the brain of patients with left or right long-term UHI, with significantly increased fALFF values in the Heschl's gyrus, superior temporal gyrus, and insula were observed. Moreover, complicated networks reorganization involved in the visual, cognitive, sensorimotor and information transmission functions except for the auditory function and some brain regions exhibited functional changes only in the one-sided impairment group. In addition, the severity of hearing impairment is related with the functional activities in the bilateral Heschl's gyrus, bilateral insula, right superior temporal gyrus, and left middle frontal gyrus., Conclusion: In conclusion, alterations in functional activity are observed in the brains of patients with long-term hearing impairments and multiple brain regions within different functional networks are involved in the brain functional remodeling. The brain reintegration mechanism appears to be asymmetrical and the lateralization pattern in the contralateral brain hemisphere for auditory information processing related with the severity of hearing impairment., (Copyright © 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)