If you’re researching hearing aids, you’ve probably come across endless comparisons between brands, features, and prices. While these differences matter, they’re not the most important factor in your success with hearing aids.
The truth is, how your hearing aids are fitted and the quality of professional support makes more of a difference than the device itself.
For more than a decade, studies have shown that people consistently get better performance and satisfaction from their hearing aids when those devices are fitted using clinical best practices.
What are 'best practices' in hearing aid fitting?
Best-practice care for fitting hearing aids to individuals with hearing loss includes:
- Real-ear measurements (REMs): This is a process where the sound levels produced by your hearing aids are measured from inside your ear canal and fine-tuned to a validated prescriptive target (e.g. NAL-NL2) to ensure they are providing the right amount of amplification for your hearing loss. The size and shape of your ear canals and how the hearing aids fit can drastically alter the real response in your ear, compared to the predicted response that the computer software uses to apply a ‘first fit’.
- Tailored fitting: Hearing aids aren’t one-size-fits-all. With a wide range of styles and feature combinations available, your hearing professional should select and fine-tune your devices to suit your unique hearing profile, personal listening goals, and everyday lifestyle.
- Education and support: Understanding how your hearing aids work, what to expect, and how to get the most out of them is just as important as the technology itself.
- Follow-up care: As your hearing levels and listening needs change, so should your hearing aid settings. Routine follow-up care ensures your devices continue to work optimally for you throughout their lifespan.
What the research says
The evidence is clear and consistent—when audiologists follow best-practice protocols, people hear better, adapt faster, and are more satisfied with their hearing aids. Here’s what some of the research shows:
- A 2018 study by Valente and colleagues found that people who were fitted with hearing aids using real-ear measurements had better speech understanding and were more satisfied overall than those who didn’t receive REM verification.
- In a 2024 report, ASHA confirmed that REM fittings lead to measurably better listening outcomes, even when the hearing aid model is exactly the same.
- Studies like Abrams et al. (2012) and Humes et al. (2017) showed that when people were fit by audiologists using best-practice care, they reported greater benefit and longer-term success than people who used self-fit or retail-style approaches—even when using the same device.
So, what does not-best practice look like?
Unfortunately, not all hearing aid fittings are done to the highest standard. Here are some common shortcuts or oversights that can limit hearing aid benefit:
- Skipping real-ear measurements (REMs): Fitting the hearing aids using default software settings without verifying the actual output in the ear canal—often called a “click-and-fit” approach.
- Relying on proprietary manufacturer algorithms: Allowing the software to use the brand’s default settings, which are typically designed to optimise ‘first-fit’ acceptance for new users, rather than using a validated prescription like NAL-NL2.
- No individualisation beyond the audiogram: Fitting everyone the same way, without considering listening goals, lifestyle needs, or personal comfort and usability.
- Minimal counselling or user education: Handing over the hearing aids without helping the person understand how to use, maintain, and adapt to them.
- No structured follow-up: Failing to schedule follow-up appointments to fine-tune the settings, troubleshoot problems, or assess real-world benefit.
- Treating it as a one-time sale: Viewing hearing aid fitting as a product transaction instead of an ongoing care process.
We have mentioned 'REM' and 'validated prescriptions' a few times: Why does it matter so much?
Despite a strong evidence-base for prescriptive fitting formulas like NAL-NL2, many hearing care professionals (HCPs) still use manufacturer-specific proprietary formulas when programming hearing aids. These settings often reduce amplification—especially in the high pitches— presumably to make the hearing aids sound more pleasant and acceptable at first-fit, but ultimately resulting in poorer audibility compared to NAL-NL2 fittings verified with REM.
Key Findings:
- Under-amplification is common. Studies (e.g. Sanders et al., 2015) show that proprietary fittings reduce amplification across the speech frequency range, often by up to 20 dB at 4000 Hz, leading to poorer speech audibility.
- Speech understanding suffers. In a randomised crossover trial (Valente et al., 2018), participants had significantly better speech recognition (and satisfaction) with verified NAL-NL2 fittings.
- Speech-in-noise performance improves with proper fitting. Leavitt & Flexer (2012) found an average of ~6.5dB improvement in speech-in-noise performance using a verified NAL-NL2 fitting compared to proprietary algorithms from several manufacturers. None of the proprietary settings outperformed NAL.
- Click-and-fit is not enough. Selecting “NAL-NL2” in hearing aid software does not guarantee that the correct sound level reaches the ear. Real-ear testing commonly shows under-amplification by 8–12 dB unless verified. The takeaway? Even when using the right algorithm, only real-ear verification ensures you’re getting the intended benefit.
There is an argument here that a well-fitted basic hearing aid could outperform a poorly-fitted premium device.
Best Practice is the Standard, but not the Rule
In Australia, the use of Real Ear Measurement (REM) during hearing aid fittings is recognized as a component of best practice by professional regulatory bodies such as Audiology Australia (AudA) and the Australian College of Audiology (AcAud). However, specific national statistics on routine use of REM by hearing care professionals are limited.
It’s important to note that not all individuals fitting hearing aids in Australia are members of Audiology Australia or AcAud. Some may be audiometrists or hearing aid dispensers who are not affiliated with these professional organizations. While many of these practitioners provide competent care, their adherence to best practice protocols can vary. Membership in professional bodies often signifies a commitment to ongoing education and adherence to evidence-based clinical guidelines, which should include the use of REM for hearing aid verification.
Choosing the right support makes all the difference
At Evergreen Audiology, we follow best practices at every step. We don’t just hand you hearing aids over the counter – we verify, personalise, and support your journey toward the best hearing outcomes for you.
If you’ve tried hearing aids before and felt disappointed, it’s worth considering that it may not have been the device that failed you, but the process. Perhaps it’s time to retrieve your hearing aids from the drawer and take them for another spin with us?
Valente et al. (2018), Journal of the American Academy of Audiology – link
Abrams et al. (2012), American Journal of Audiology – link
Humes et al. (2017), American Journal of Audiology – link
Mueller & Taylor (2020), Audiology Practices – link
ASHA (2024), REM Value Report – link
De Sousa et al. (2023), Frontiers in Audiology and Otology – link
BMJ Open Protocol (2021), Hearing Aid Fitting Review – link
Sanders et al. (2015) – Discussed in Mueller et al. (2020) [AudiologyOnline QuickTakes] – link
Leavitt & Flexer (2012) – Discussed in Mueller et al. (2020) [AudiologyOnline QuickTakes] – link
Amlani et al. (2017); Pumford & Mueller (2020) – Discussed in Mueller et al. (2020) [AudiologyOnline QuickTakes] – link
