Man explaining the hearing aid fitting process to his daughter

The Hearing Aid Fitting Process | Aural Rehab

Hearing aid fitting is a different experience for each wearer. A hearing aid is a device that has been designed to restore hearing functionality in persons with hearing loss. The main aim of the hearing aid is to amplify sounds that were not previously audible so as to ensure that the user is exposed to environmental sounds, sounds of alert and danger, and to improve the user’s understanding and perception of speech. Modern hearing aids have evolved to address the different lifestyle needs of the consumer and include features that allow the user to enjoy leisure activities through the attempt to replicate the natural sound.

Prior to using a hearing aid, the compromised auditory system has become accustomed to hearing within a range that is limited as a result of hearing loss. Hence when amplification is introduced through the use of the hearing aid, it can come as a surprise to the auditory system. The surprise to the auditory system is the result of the brain having to rewire its associations with sounds which in turn presents as a symptom of discomfort. The process of adapting to a hearing aid is called auditory rehabilitation.

Hearing aid fitting process

  1. Prescription of amplification 
  2. Selection of amplification 
  3. Verification of fitting 
  4. Orientation and training 
  5. Validation 
  6. Follow-up

Prescription and selection of hearing aid

The audiologist will start the process by providing the user with hearing aid options that are best suited to his/her individual lifestyle requirements and specific to the hearing loss. During this process it is  a crucial step to guide the user in developing realistic expectations of a hearing aid, most importantly that it will not restore his/her hearing ability but aid him/her in hearing better. The decisions of the hearing aid  will be influenced by the user’s manual dexterity, visual abilities, desired advanced features, amplification characteristics, including the style and technology of the hearing aids, and the cost of the hearing aid. The goal in hearing aid selection and fitting is to provide comfortable hearing instruments that will meet the lifestyle needs of the user while easing their communication difficulties and maximizing performance in different listening environments.

Verification of fitting

When fitting a new hearing aid, the audiologist will use a prescription goal to ensure that the audibility of the speech signal is safe and comfortable and to ensure that the amplified speech spectrum closely approximates the prescription goals. Prescription goals are based on scientific and standardized prescriptive methods for fitting a hearing aid. The prescriptions are calculated based on the hearing loss and the ideal amplification required at each frequency in the spectrum. The standardized prescriptive formulas are used as a baseline to determine the optimal amplification required. 

The hearing aid amplification settings are not always set at the highest amplification recommended on the initial fit so that the user can gradually adjust to the sound in a rather comfortable manner.

Orientation and training

The fitting process depends mainly on the user’s participation and the possible difficulties that he/she may find in the initial period. Such a process is gradual and aims at the familiarization with the sounds so that there is no discomfort. Therefore, the audiologist will initially advise that the user uses his or her hearing aid in calm and quiet environments for only a few hours a day. Following that, he or she may use it for longer periods of time with variable sound complexity taking into account the effects of acclimatization and hearing privation in this process. The user will be guided on the physical handling of the hearing aid to allow for ease of use. Counseling and training are intended to enable the individuals to find solutions for their difficulties interfering and influencing from the acceptance of the hearing loss up to the compliance with rehabilitation guidance.


The process of validation is to determine the user’s added benefit from the use of the hearing aid. The validation demonstrates the benefits or limitations of the individual’s aided listening ability to perceive speech and is determined over a period of time, using information derived through the aural rehabilitation process and by directly measuring the individual’s aided auditory performance. Subjective and objective measures are used to obtain information on the validation of the hearing aid. Information is gathered from relatives or close communication partners, the user, as well as the audiologist. 

Follow up

Once the hearing aid has undergone the validation process, this will assist the audiologist in determining the gaps to fine-tune the hearing aid according to the user’s individual preferences.

The hearing aid user is usually seen regularly to monitor the progress and success of the fitting and rehabilitate to the use of the hearing aid. Following the user’s progress is important to measure the adaptation to hearing amplification. Modifications to the initial fit can be made and ongoing counseling can be provided about coping with the hearing aid in everyday life. 

The latest trends in hearing aid technology have gone a step further to aid the user in rehabilitation using smart features installed on the device itself. Some examples of how hearing aids assist the user in adjusting:

  • Hearing aids are now paired with sophisticated software that enables detailed fine-tuning of the hearing aid settings to assist the user in adjusting.
  • The processing abilities of the hearing aid work at incredibly fast speeds which allows the signal to provide a more natural sound quality. More importantly, hearing aids have been designed to automatically activate selected programs based on the analysis of the environment.
  • The software also monitors the user’s preferences and uses artificial intelligence to automatically adjust the settings on the hearing aids to the user’s preferences without having to manually switch programs, etc.
  • Furthermore, the software monitors the user’s usage rate of the hearing aid, thereby encouraging the user to use the hearing aid for longer periods but also providing the audiologist with remote feedback and monitoring.
  • Most modern hearing aids are now controlled by smartphone applications which offer rehabilitation exercises to assist the user in the adjustment process. Most users are familiar with the use of a smartphone which further facilitates easy adaptation to controlling the hearing aid settings as opposed to a remote or toggle on the actual hearing aid.
  • Some hearing aid manufacturers have gone to the extent of offering remote person-centered support through call centers with hearing experts to offer guidance and adjustment to the hearing aid. Lexie Hearing is a prime example of a hearing aid provider that offers remote support and fine-tuning. 

The fitting challenge is to find the perfect balance among desired loudness, good audibility, and sound comfort. This goal is further complicated by the fact that the prescribed gain and output are generally designed for the “average” user and require individualization. All these factors should be addressed by a learning hearing instrument with features for individual preference, so as to achieve the optimum user settings. 

The success of a hearing aid is directly related to the number of situations where it can deliver the desired performance. The addition of multiple adaptive features can unobtrusively provide this performance without requiring constant adjustment by the hearing aid user. However, for these features to provide optimal benefit, the audiologist should be able to provide adequate adjustments based upon the needs of the hearing aid user.

The integration of these adaptive features is designed to provide the user with a flexible responsive device requiring almost no adjustment to maintain optimal performance. However, every hearing loss and physical ear structure is unique which makes fine-tuning necessary to achieve the best possible outcome. Therefore, optimizing hearing aid parameters to the needs of the individual hearing aid user is still an essential component for a successful fitting.

Lexie Hearing

Lexie Hearing is changing the hearing aid market by offering quality hearing aids at an affordable price. One of the biggest advantages Lexie has to offer is their remote support which saves the hearing aid wearer both time and money. Find out more about Lexie Care here.

Image of post writer Nausheen Dawood.

Written by Nausheen Dawood

M. Audiology; B. Communication Pathology in Audiology



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