WSA’s Sound Preference: Why Hearing Aid Sound Personalization Matters

Why do some people with nearly identical hearing loss prefer very different hearing aids and sound settings? That question is at the heart of Sound Preference, a new research initiative and clinical tool from WS Audiology (WSA) that explores how individual listening preferences may influence hearing aid satisfaction, selection, and long-term use.

Previewed for members of the media on March 24 at WSA headquarters in Lynge, Denmark, the initiative focuses on a reality familiar to experienced hearing care professionals: a fitting can meet prescriptive targets but still leave a wearer dissatisfied even after counseling and acclimation. WSA, the parent group of Widex and Signia, argues that personal preference may be a key missing piece, helping explain why some patients thrive while others struggle, return their devices, or abandon them in a drawer.

For decades, hearing aid fitting has operated in two worlds. One is the formal, evidence-based side of the profession: prescriptive targets, probe-mic verification, speech-in-noise testing, validation, and other established best practices. The other is the more subjective “art” of fitting: the clinician’s judgment about what will sound right to an individual patient in daily life. WSA’s Sound Preference initiative seeks to bring more structure to that second dimension, not by replacing best practices, but by adding a more deliberate focus on how different listeners respond to different sound designs.

The 20-60-20 Split in Sound Preference

At WSA’s headquarters, CEO Jan Makela succinctly summarized the company’s evidence: when users are double-blind tested, roughly 20% show a strong preference for low-delay, more natural sound; 20% show a strong preference for highly processed sound optimized for clarity; and about 60% can do well with either. “You don’t know which one they are when they come in,” he said, arguing that better identification of those preferences could improve retention, conversion, and reduce follow-up visits.

This corresponds with WSA’s official research summary, which says that in both a large online study and a real-life study, up to 40% of listeners showed a strong preference for one of the company’s two sound designs, while the remainder had weaker or no clear overall preference.¹

As Widex VP of Innovation Adam Westermann points out, about 85% of hearing care professionals agree that no single technology can satisfy all users. This is particularly interesting to WSA because they are uniquely positioned to study sound preferences within their company. WSA has two successful but intentionally different signal-processing traditions under one roof:

• Widex’s time-domain architecture, built around extremely low delay and a “less is more” natural hearing philosophy, and
• Signia’s frequency-domain architecture, built around stronger processing, directional real-time conversation enhancement (RTCE), and contrast in noisy settings.

Some listeners favor a sound design that maintains more of the original character of the environment, allowing speech and surrounding sounds to remain in relatively natural proportion. Others prefer a more assertive processing style that increases speech contrast and manages background sound to improve communication in tougher real-world situations. Both sound philosophies can work well, but people don't always react to them in the same way.

Lise Henningsen, WSA’s manager of audiological research and communication, cited studies indicating that only about half of those who start their journey to better hearing successfully complete it, and only 62% of adult users actually wear their hearing aids regularly.^2,3 The industry has often assumed that if audibility, intelligibility, and fit-to-target are good, the hard part of the job is mostly done. However, the remaining differences that are sometimes lumped into “acclimatization” or “you’ll get used to it” — as well as adjustments that might be thought of as the “art” or subjective side of hearing aid fitting—may be exactly where satisfaction or dissatisfaction live.

In other words, it’s not always about whether a device works or is fit to target, but how it works, what artifacts it introduces, and how that aligns with the patient in front of you. Henningsen’s presentation offered one of the clearest explanations of why preference may matter. She described preference formation as resting on four pillars:

• Sensory comfort. How sound is perceived and processed.
• Emotional reward. How the sound “feels.”
• Social meaning. How sound connects you to people and your environment.
• Cognitive ease. How sound fits into experience and meaning, while increasing confidence.

Taken together, these pillars suggest that a hearing aid does more than just restore audibility and access to sound, says Henningsen. It changes how familiar environments feel, whether daily sounds are rewarding or irritating, how smoothly people navigate social interactions, and how much mental friction and cognitive effort they experience.

“Preference formation is about ensuring comfort, reward, ease, and meaning throughout life,” she said. “That language may sound softer than traditional hearing aid fitting science, but it speaks directly to the real reasons some users accept amplification and others resist it.”

Research in Sound Preference

In-depth research on Sound Preference was mainly presented by Laura Winther Balling, PhD, WSA senior evidence and research specialist. Balling explained that the company began with three questions:

• Can people be grouped by sound preference?
• Do they describe these preferences differently? and
• Can clinicians predict preference based on profile data such as hearing loss, age, lifestyle, or experience?

They found the answers to be clearly yes to the first question, partly yes to the second question, and essentially no to the third.

Balling described two initial studies involving a total of 276 participants: a large-scale online “recording study” with 248 listeners and a real-world “guided-walk” study with 28 experienced hearing aid users. In the recording study, participants listened to paired sound scenes representing two sound philosophies (frequency versus time domain) and then chose which they preferred across 10 listening situations. In the guided-walk study, wearers experienced both sound designs in real-world environments, including music, transit, café, street, and park settings. Across both studies, the overall split was nearly 50/50, but the key finding was in the strength of preference: about 15% to just over 20% showed a strong preference for each sound design, leaving roughly 60% in the middle.

Just as interesting was what WSA didn’t find. Balling said the researchers looked at hearing loss, age, gender, hearing aid experience, auditory-lifestyle questionnaires, and what mattered to participants in hearing aids. There were hints of relationships, she said, but nothing strong enough to build a clinically useful profile. “We can’t really group people based on profiling. We need to expose them to the sounds,” Balling said. In other words, preference may be real, but it’s not easily predicted from an intake form or a few demographic questions.

Taken together, the studies suggest that listeners can, in fact, be grouped by sound preference, but those preferences cannot be reliably predicted from profile data alone. Participants often used similar words—such as “clarity,” “naturalness,” and “pleasantness”—to describe different preferred sound qualities. This supports WSA’s broader point that preference is real, clinically relevant, and best understood through direct exposure to sound rather than through questionnaires or demographics alone.

WSA was careful not to present Sound Preference as a shortcut that replaces verification or validation, nor as a personality quiz that tells clinicians what to fit. Instead, it is meant to create structured exposure to different sound processing strategies.

How Sound Preference Works

The new Sound Preference tool creates that structured exposure through paired sound scenes designed to represent “natural” versus “enhanced” sound. Balling described it as both a clinical tool and a conversation starter, while Henningsen framed it more as “a clue finder”: a qualitative tool that can deepen the clinician’s understanding of the client’s sound perception. She also stressed that even a lack of preference is still a meaningful result, as it broadens the field and allows other factors to guide the recommendation.

During the unveiling of Sound Preference at WSA headquarters, the author and four other hearing healthcare media professionals were invited to try it out. We first donned headphones and listened to paired recordings of hearing-aid-amplified sound across a range of listening situations, from music to speech in noise, and rated our preferences (i.e., the natural sound design versus the enhanced sound design). We then went on a guided tour wearing the hearing aids—with the brand logos masked—through several areas of the WSA headquarters, including the large reception hall, outdoor spaces, a meeting room, and a noisy cafeteria, again noting our preferences. The results were revealing: four of the five participants ultimately preferred the time domain / natural sound, while one—okay, that was me—showed a slight preference for frequency domain / enhanced sound.

The point of the exercise was not to declare one hearing aid “better” than another, but to demonstrate that different sound-processing schemes may be better suited to different listeners and listening situations. It also underscored another theme WSA emphasized throughout the presentations: what people think will matter most to them at the outset—music, speech in noise, naturalness, own-voice comfort, etc.—does not always align with what they ultimately value after a direct listening comparison. That disconnect led to some of the more interesting conversations, raising questions about how preferences are formed and what patients may actually prioritize once they hear the differences for themselves.

Sound Preference for Better Hearing Aid Selection and Workflow

WSA’s early clinic pilots suggest that the conversation itself may already have value. In a first pilot study, 20 hearing care professionals in Australia and Canada simply introduced the idea that sound preference is personal and that unhappy patients could return and switch to a different sound approach if needed. Balling said the intervention was modest, but clinicians reported meaningful benefits: 90% said it supported the clinical conversation, 75% said they saw better client outcomes, and 60% reported higher sales and fewer returns. Those were clinician perceptions rather than hard outcomes, and Balling acknowledged that limitation. But when one media member asked whether the gains might be driven mainly by the conversation and the added sense of control it gave users, Balling agreed: “In this specific case, I think it’s all about the conversation.”

A second pilot study integrated the Sound Preference tool into the workflow, typically with front-office staff introducing it before the appointment and the hearing care professional addressing the results during fitting. Here again, WSA emphasized that none of this replaces traditional fitting protocol; fitting formulas, REMs, validated intelligibility measures, etc., remain key. But Henningsen’s challenge to the field is what happens after that: whether the profession has too readily accepted the idea that patients should simply “go home and get used to it.” If a strong sound preference can be identified earlier, WSA believes the acclimatization journey will be easier and that hearing aid use and benefit should increase.

The broader emphasis on well-being also aligns with a recent peer-reviewed paper coauthored by Erin Picou, Balling, and colleagues published this March in Trends in Hearing.⁴  In a crossover study of 30 adults with bilateral hearing loss and hearing aid experience, participants created a preferred “good sound quality” program and a “non-preferred but tolerable” program, wore each at home for about a week, and rated mood and hearing-related experiences daily. The researchers found that sound quality ratings were significantly linked to mood and hearing-related experiences. For participants whose lab and home preferences were consistent, listening-related fatigue and mood were significantly better during the week with the preferred program. Although this was not a direct Sound Preference validation study, it helps explain why the issue may matter beyond mere taste: sound quality and preference appear to be linked to fatigue, confidence, and day-to-day well-being.

Ongoing Sound Preference Research and Implementation

Filip Rønne, PhD, the global head of ORCA Labs at WSA, shared continuing research on the validation of Sound Preference, including preferences in hearing aids, clinical implementation, and what he calls “the science of choice.” An advisory board has been formed that includes Gabrielle Saunders, PhD (University of Manchester, UK), Erin Picou, PhD (Vanderbilt University), Bec Bennett, PhD (NAL), and Helen Henshaw, PhD (University of Nottingham, UK). Research will begin before the end of this year and is expected to be presented sometime in 2027.

Overall, WSA’s Sound Preference initiative aims to formalize a valuable insight long recognized by experienced clinicians. Hearing aid fitting must still begin with setting targets, verification, and evidence-based practices. However, it doesn’t stop there. As Henningsen put it, the goal is to “treat the person in front of you as more than a hearing loss.” If WSA can demonstrate that structured preference assessment improves outcomes and delivers lasting benefits more quickly, it may be a way to bring audiology’s oldest “dark art” a little more into the light.

Beginning April 20, 2026, WSA will launch Sound Preference globally, making its research, educational resources, and clinical tools available to hearing care professionals worldwide. More information can be found at WSA's Sound Preference website.