What to Expect from a High-Quality Hearing Aid Fitting: Best Practices in Hearing Care

Imagine walking into a hearing aid office or clinic and feeling confident you’re in good hands. Hearing healthcare providers who use “best practices” rely on the latest science to offer the highest quality care that results in the best outcomes.^1-6

This article provides a checklist of best practices to help you know if a hearing care office is taking the proper steps to ensure you are receiving top-notch care. By understanding these critical steps in your hearing journey, you can make better decisions to improve your hearing and communication, ensuring your hearing and hearing devices perform at their best.

Prior to our more recent positions in academia, the authors worked in busy audiology clinics that served hundreds of patients. What follows is some practical advice about what to look for in hearing care offices and their services. (Note: Our students have "stood in" for some photos in this article to demonstrate typical best practice procedures in clinics and offices.)

Before you go: Selecting a service provider

If you’re struggling to understand conversations, you’re not alone; over 15% of US adults have a hearing loss, and more than 28 million Americans could benefit from hearing aids.^7,8 If you have difficulty understanding others, it's probably time for a hearing evaluation and to consider a hearing device.

Purpose: To determine the options available in your community.

What to look for: State-licensed audiologists and hearing aid specialists who observe best practices and provide the highest standards of care.

Defining qualities

• Hearing care providers work in various settings, including clinics and hospitals, private practices, retail settings, the Veterans Administration (VA), and wholesale stores like Costco and Sam’s Club, among others.
• Consider finding a provider who is geographically closer to you and available if you need service from them regularly.
• Ask the patient admissions specialist or receptionist if their professional staff adheres to best practices and/or performs real-ear measurements (more on this below).
• Some providers may be affiliated with your established healthcare organization or insurance network. Look for online reviews or feedback from friends or family in your community.
• If you are a veteran registered for Department of Veterans Affairs healthcare, check to see if you're eligible for hearing aids and services through the VA.
• Check your local and state laws regarding hearing aid dispensing regulations. Many states have a minimum required trial period and most states have regulations regarding qualifications for hearing providers.

Keep in mind...

• Ask around. Your friends and family may be the best sources for recommending (or not recommending) a hearing provider.
• Search the Better Business Bureau and other online reviews of local providers.
• Make sure you understand all your payment options when selecting a hearing care provider.
• While not necessarily bad, it's helpful to know if the business is limited to only one or two brands, as is the case with many hearing aid chains and networks (Beltone, Miracle Ear, HearingLife, AudioNova/Connect Hearing, etc.). Additionally, some hearing aid networks "lock” their hearing aid software (e.g., Beltone, Miracle Ear, Sam's Club), meaning only certified network providers can adjust or reprogram the devices.

Best practices during your initial appointment

A good hearing care provider will assess your hearing status and hearing needs. Although, in many cases, the methods and order of the following steps may vary, here's a checklist of what you should expect.

1) Case history

Purpose: To determine the reason you are being seen.

What to look for: Your hearing care provider should interview you during your visit and use a questionnaire to assess your hearing concerns and communication abilities, lifestyle, and health history.

Tips for your initial visit

• Consider writing down questions and then taking notes during your appointment.
• Bring your spouse/partner or family member to ensure you understand any recommendations, ask important questions, and obtain financial consent should you decide to try or purchase a hearing aid.

Keep in mind...

• Your hearing care provider needs to be well-informed about your lifestyle, health problems, and interests.
• Emphasize to the provider why you're there and explain to them the critical listening and communication challenges you're hoping to address (e.g., work, hobbies, friends and family events, sports, games, worship, TV/radio, etc.).
• Although most professionals have a busy schedule, they should ask questions, be caring and empathetic, and be able to devote adequate time so they can understand your unique hearing needs.
• You may not be the only one affected by your hearing loss; let your spouse/partner describe the most pressing situations where they see you struggling to hear.

2) Otoscopy and visual examination of the ear

Purpose: To assess the health of the visible parts of your ear.

What to look for: The provider examines different parts of the ear using a device (otoscope/video-otoscope) to screen for problems. They will then explain the results, including if you need wax removed from your ears (cerumen management).

3) Hearing and communication evaluation in a sound-proof booth

Purpose: To assess your hearing ability.

What to look for: Your hearing should be evaluated in a sound booth using headphones.

What's being tested?

• The softest sounds you can hear (also known as hearing thresholds) should be evaluated across a range of frequencies (pitches).
• Your ability to understand words or sentences should be tested using recorded sounds in quiet and noise that approximate real-world listening conditions.
• The examiner should assess your tolerance for louder sounds and determine your most comfortable listening level.

Gain a clear understanding of your test results

• The hearing care provider should explain the results and address your specific concerns, and a copy of your test results should be made available.
• You should be informed if there is a need to refer you to a medical provider.

4) Needs assessment, hearing device selection, and consultation

Purpose: To select the most appropriate plan of care for your needs.

What to look for: Your hearing provider should ask you questions and provide a questionnaire to identify what is most important to you.

Information guides the path to personalized care

• A questionnaire can help you and your provider understand your hearing needs.
• The hearing provider should also ask about your vision and manual dexterity, which is important for handling and maintaining hearing devices.
• They should discuss ways of managing your hearing needs, including the benefits and limitations of each proposed option.
• They should explain different styles and brands of hearing aids or other options to fit your unique needs. They should also review the pros-and-cons and realistic expectations with you for each solution.

Make sure you understand your options and the costs

• The cost of the hearing devices should be transparent. A range of prices for hearing aids is available, and the provider should discuss the benefits and limitations of differing technology levels and price categories.
• Some insurance plans may cover hearing devices. Contact your insurance or health plan provider to determine whether you have coverage (note that if using insurance, the provider and hearing aid selection may be dictated or limited by your policy).
• A written contract using language that you understand should be provided.
• Most hearing aids today come with apps and audio streaming (for music, phone calls, videos, etc.), so be sure your smartphone is compatible with the recommended device(s).
• Note: Two classes of hearing devices available today include prescription and over-the-counter (OTC). Prescription hearing aids for individuals of all ages are fitted by a state-licensed hearing care professional and typically include support for the device, including follow-up care. They usually range in cost from $1,500-$7,000. OTC hearing aids are for adults aged 18 and over with perceived mild to moderate hearing loss, and users usually manage them with no professional support or via online support (telecare). They usually cost less than $1,500.

5) Hearing aid fitting and verification (real-ear measurement)

Purpose: To fit and adjust your hearing equipment so that it performs optimally.

What to look for: You should be given clear instructions on how to use your hearing aid, maximize its benefits, and know what to expect during the fitting and trial process.

What you should expect...

• You should receive guidance on how to make the most of your new devices, including instructions on placement, removal, functionality and controls, troubleshooting, care, and maintenance.
• Instructions should be provided in written form or an electronically accessible document.
• You should be informed of loss, damage, and warranty coverage.
• You should know what to do in the event your hearing aids need repair or adjustments.

A CRITICAL STEP: Real-ear measurement / Probe-microphone verification

• A small flexible tube that is connected to a microphone (probe microphone) should be inserted into the ear along with your hearing aid while measurements are made using speech sounds. This is sometimes referred to as “real-ear measurements” (REM).
• REM provides essential information about the amount of amplification (volume/gain) that should be applied to your unique ear canal. This information tells the hearing healthcare provider if the hearing aid is fit for your individual hearing loss. They will use a computer to adjust the volume to make sure you hear the best that you can.
• REM is a critical but underused tool for initial hearing aid fittings. All professional best practice protocols (e.g., audiology and hearing aid specialist organizations) include it in their guidelines. As such, REM can be an indicator of how well the provider adheres to best practices.

6) Validation of benefit

Purpose: To measure how well the selected treatment plan is working.

What to look for: The hearing care provider should evaluate how well your plan of care is improving your hearing and quality of life.

What you should expect...

• You will be asked to complete a questionnaire or survey that measures your satisfaction and perceived benefit from the hearing aids and treatment plan. This may be a follow-up to the initial concerns you mentioned at the initial visit (see above “Needs Assessment”) to see how your agreed-upon goals and expectations match up with your results.
• The provider should measure how well you are hearing with the hearing instruments in place (aided benefit).

Charting your progress; adjusting treatment strategies

• Validation helps you and the hearing professional compare your hearing before treatment to how well you're hearing now.
• Keeping a journal about how things are going with your hearing device can help you when it's time to discuss issues with your provider.
• With this information, the treatment plan and your devices can be tweaked or adjusted, and your provider may recommend further listening and communication strategies.
• If you're in the trial period and you're unhappy with the device or treatment course, you should explore other options and/or another device.

7) Rehabilitation and counseling

Purpose: To provide support in adjusting to living with hearing loss, adapting to a hearing device, and measuring how well the selected treatment plan works.

What to look for: Hearing care professionals should take steps to support your communication during this transition and encourage your continued success beyond the dispensing of hearing devices.

What you should expect...

• Your success with hearing aids goes well beyond simply placing a device in the ear and going about your day. The hearing care provider should educate you regarding self-management, communication strategies, and adapting to a new world of sounds and experiences.
• The provider or their staff should be available to answer questions and, preferably, provide walk-in service if needed.
• You should be informed about using additional accessories such as telecoils, remote microphones, TV streamers, remote controls, and other devices, as appropriate.

Take ownership and advocate for your success!

• Adjusting to hearing aids takes time and effort to succeed. You'll need to do your part in allowing your brain to adapt to the new sounds by sticking to a wearing schedule and following the provider's instructions for aural rehab.
• Stay on top of hearing aid care and maintenance procedures by keeping them clean, dry, and in safe storage when not in use.
• Help your partner, family, and friends understand how they can help you via better communication strategies like facing you when they talk, not speaking from another room, etc. Involving them in the hearing rehab process will allow them to gain a deeper understanding of your needs and goals, resulting in greater success.

Best practices yield better hearing outcomes and quality of life

Many professional organizations provide guidelines for best practices in hearing care.^2-5,9 However, most hearing clinics develop their own methods.¹⁰ Your care can vary significantly depending on the clinic or hearing care practice.

Evidence-based practice in hearing care involves using the best available science, research, and clinical expertise to make informed decisions about your care.^11,12 This approach ensures that treatments and recommendations are proven effective and tailored to your needs, leading to better hearing outcomes and improved quality of life. Unfortunately, not all providers follow these evidence-based best practices.¹³

Hearing is extremely important. We rely on it for enjoyment and staying in touch with the world around us, for safety and navigation, and for gaining important information and maintaining crucial social ties. Untreated hearing loss is associated with many negative factors, including reduced earning potential and quality of life, social withdrawal and depression, cognitive decline and dementia, and several chronic illnesses.

To ensure you receive the best possible care, seek out hearing care providers who embrace evidence-based best practices. Shop around. Ask potential providers about their methods and whether they rely on the latest research and proven techniques in the checklist above. Empower yourself by choosing professionals dedicated to delivering the highest standard of care, leading to a better and improved quality of life.