Best Fitting Practices for Hearing Aids

Core Fitting Principles

The American Academy of Pediatrics recommends that hearing aid fitting should be based on a prescriptive procedure that incorporates individual real-ear measures accounting for each patient's ear-canal acoustics and hearing loss, with verification that amplified speech is comfortably above sensory threshold but below discomfort level across the speech frequency range 1, 2, 3
The primary objective is to provide maximum access to all acoustic features of speech within an intensity range that is safe and comfortable, as recommended by the American Academy of Pediatrics 1, 2, 3
Amplified speech must be comfortably above the patient's sensory threshold but below the level of discomfort across the entire speech frequency range for both ears, according to the American Academy of Pediatrics 1, 2, 3

Hearing aid fitting proceeds optimally when results of physiologic audiological assessment including diagnostic ABR, OAE, and tympanometry are in accord with medical examination, as stated by the American Academy of Pediatrics 1, 2, 3
For infants below developmental age of 6 months, hearing aid selection must be based on physiologic measures alone, as recommended by the American Academy of Pediatrics 1, 2, 3
Behavioral threshold assessment with visual reinforcement audiometry should be obtained as soon as possible to cross-check and augment physiologic findings, according to the American Academy of Pediatrics 1, 2, 3

Amplification-device selection, fitting, and verification must be based on a prescriptive procedure that incorporates individual real-ear measures, as recommended by the American Academy of Pediatrics 1, 2, 3
Real-ear (microphone verification) measures determine if hearing aids are meeting actual prescriptive targets and can identify under-amplification as a cause of patient dissatisfaction, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
Validation of amplification benefits, particularly for speech perception, should be examined in both the clinical setting and the child's typical listening environments, as stated by the American Academy of Pediatrics 1, 2, 3
Self-assessment measurement tools such as the Hearing Handicap Inventory for the Elderly (HHIE) or Hearing Handicap Inventory for Adults (HHIA) should be used to determine impact on quality of life, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 5

Monitoring of amplification requires ongoing audiological assessment along with electroacoustic, real-ear, and functional checks of the hearing instruments, as stated by the American Academy of Pediatrics 1, 2, 3
Periodic evaluations of hearing to monitor stability and evaluation of amplification/assistive listening devices should occur at least annually for adults and children aged >5 years, according to the American Academy of Otolaryngology-Head and Neck Surgery 6
More frequent monitoring may be warranted in individuals with fluctuating hearing loss, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6
For infants and young children, developmental monitoring should occur at regular 6-month intervals, as stated by the American Academy of Pediatrics 1, 2, 3

Patients should be referred for cochlear implant evaluation when they have appropriately fit amplification and persistent hearing difficulty with poor speech understanding, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
The "60/60" guideline (pure tone average thresholds ≥60 dB and word recognition ≤60%) has 96% sensitivity for identifying cochlear implant candidates, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4

Do not rely on patient self-report alone for determining adequacy of hearing aid fitting, as patients cannot accurately differentiate degree of hearing loss or identify losses requiring intervention, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 6
Avoid under-amplification by confirming prescriptive targets are met through real-ear measurements, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
Do not assume infants and young children with well-fit amplification devices will automatically develop auditory skills—ongoing validation is essential, as recommended by the American Academy of Pediatrics 1, 2, 3