How We Evaluate, Fit & Verify Hearing Aids

Quick answer: A successful hearing-aid fitting is more than choosing a brand and accepting the manufacturer’s default settings. At Hearing Aid Factory Outlet, the process combines hearing and speech testing, the patient’s real-world communication goals, individualized programming, objective verification such as Real Ear Measurement when appropriate, and follow-up based on what the patient actually experiences in daily life.

Gwen Cantrell, BC-HIS, a Georgia-licensed Hearing Aid Dispenser, has fit hearing aids since 2013. Her approach is simple: the fitting is not finished merely because the hearing aids work in a quiet office. The goal is better communication with the people and in the places that matter to the patient.

1. We Start With the Patient, Not a Product Catalog

The process begins with case history, otoscopic examination, hearing testing, speech understanding, and discussion of the situations where hearing is breaking down. An audiogram is essential, but it does not tell the entire story. Two people with similar hearing thresholds can have very different difficulty understanding speech, especially in competing noise.

When appropriate, speech-in-noise testing helps quantify how much difficulty a patient has understanding speech when background sound is present. That information can influence counseling, technology selection, microphone strategies, and whether accessories such as remote microphones should be considered. See our speech-in-noise testing information.

We also watch for findings that warrant medical evaluation rather than simply fitting amplification. When appropriate, we help patients obtain an ENT or medical referral.

2. We Identify the Listening Situations That Actually Matter

“I want to hear better” is a starting point, not a complete treatment goal. We want to know what better hearing means in the patient’s life: understanding a spouse, following conversation at lunch, hearing customers at work, participating in meetings, hearing a teacher, following church services, watching television comfortably, or keeping up with grandchildren.

This patient-centered approach is consistent with established hearing-care outcome frameworks that focus on specific communication goals rather than the audiogram alone. Those goals help guide hearing-aid style, physical coupling, features, accessories, and later follow-up.

3. We Match the Hearing Aid to Hearing, Lifestyle and Usability

Technology selection considers the degree and configuration of hearing loss, speech-understanding ability, difficult listening environments, ear anatomy, dexterity, vision, smartphone use, prior hearing-aid experience, cosmetic preferences, budget, and the amount of professional support likely to be needed.

We work with prescription technology from Starkey, Phonak, and Signia. We are not paid more to recommend one manufacturer over another. The purpose of carrying multiple major manufacturers is to let the recommendation follow the patient rather than forcing every patient into one product line.

4. Physical Fit Matters as Much as Electronics

The hearing aid style, receiver strength, dome or custom earmold, retention, and venting all affect comfort and acoustic performance. A fitting that is technically sophisticated but uncomfortable, difficult to insert, or overly occluding will not succeed in real life.

For example, a patient who says their own voice sounds boomy or as if they are “talking in a barrel” may be experiencing an occlusion problem. The solution is not automatically more or less volume. Physical coupling, venting, low-frequency gain, feedback risk, and the patient’s hearing loss have to be considered together.

5. Evidence-Based Programming Provides the Starting Targets

Modern prescription hearing aids can be programmed using validated prescriptive fitting approaches such as NAL-NL2 or DSL. These approaches establish frequency-specific targets based on the patient’s hearing information rather than relying solely on a manufacturer’s proprietary default fitting.

Manufacturer first-fit software is useful as a starting point, but it cannot fully predict the acoustics of an individual ear canal. That is why objective verification is such an important part of a high-quality fitting.

6. Real Ear Measurement: Measure What the Hearing Aid Delivers in the Ear

Real Ear Measurement (REM), also called probe-microphone measurement, allows the actual amplified sound in the patient’s ear canal to be measured while the hearing aid is being worn. A thin probe tube is positioned in the ear canal, and calibrated signals are presented while the system measures the hearing aid’s response.

This allows the fitting to be compared with evidence-based prescriptive targets across speech input levels and adjusted when necessary. Professional standards and best-practice guidance from organizations including the Audiology Practice Standards Organization, American Academy of Audiology, and American Speech-Language-Hearing Association support objective verification rather than relying only on software predictions.

7. Verification and Validation Are Not the Same Thing

Verification asks: Is the hearing aid delivering the intended acoustic output?

Validation asks: Is the patient experiencing meaningful improvement in the communication situations that matter?

Both matter. A technically accurate fitting still has to work for the human being wearing it.

8. Sometimes the Most Important Voice Is Your Spouse’s Voice

One of Gwen’s favorite ways to personalize a fitting is to involve a spouse or family member when that person’s voice is specifically difficult for the patient to understand. When appropriate, Gwen may bring the spouse into the sound booth or fitting process and have them speak while the patient listens and provides feedback.

The spouse’s voice does not replace standardized speech testing or objective verification. It adds a practical layer of real-world validation. Voices differ in pitch, articulation, intensity, and speaking patterns, and sometimes the complaint that matters most to a patient is very specific: “I can hear people, but I still cannot understand my husband,” or “My wife’s voice is the one I miss.”

9. Sugarloaf Mills Gives Patients an Immediate Real-World Listening Trial

Our location inside Sugarloaf Mills in Lawrenceville provides something unusually useful after a fitting: patients can immediately leave the quiet clinic and experience their hearing aids in a complex real-world environment.

Gwen often encourages a newly fitted patient to walk through the mall, interact with people, or go have lunch and then come back to tell her what they heard. A restaurant or food-court environment introduces competing voices, dishes, reverberation, movement, and changing sound levels that cannot be perfectly recreated by sitting in a quiet fitting room.

The patient can return with specific observations—conversation was clear but dishes were too sharp, the cashier was difficult to understand, a spouse sounded good but surrounding voices were distracting—and those observations can guide additional fine-tuning.

10. When Necessary, Gwen Has Taken the Fitting Into the Patient’s World

Some communication problems are difficult to understand without seeing the environment where they occur. Over the years, Gwen has occasionally gone beyond the clinic when a persistent real-world listening problem justified it.

Examples have included helping a student who was struggling to hear a teacher in the classroom and working with a patient whose job as a retail cashier created a particularly difficult listening environment. The purpose is not to promise an on-site visit for every fitting. It reflects Gwen’s philosophy that difficult listening problems deserve investigation rather than simply telling a patient to “get used to it.”

11. Follow-Up Is Part of the Fitting

The first appointment is not the end of the process. Follow-up allows us to combine objective measurements with what the patient experiences after living in the hearing aids. Adjustments may address speech clarity, background noise, loudness comfort, own-voice quality, physical fit, phone connectivity, programs, or a specific listening environment.

As hearing or lifestyle needs change, periodic retesting and hearing-aid follow-up and adjustments help keep the fitting aligned with the patient.

Our Fitting Philosophy

We do not believe a premium hearing aid automatically produces a premium outcome. Technology matters, but selection, physical fit, programming, verification, patient goals, follow-up, and the skill used to put those pieces together matter too.

Our objective is not simply to make sounds louder. It is to help patients understand speech and participate more fully in the conversations and environments that matter to them.

Clinical Standards and Evidence Behind Our Approach

Our methodology is informed by established hearing-care standards and research, including adult hearing-aid fitting standards from the Audiology Practice Standards Organization, professional guidance on hearing-aid verification and outcome assessment, research on validated prescriptive fitting methods such as NAL-NL2 and DSL, and peer-reviewed evidence comparing manufacturer first-fit programming with fittings verified using probe-microphone Real Ear Measurement.

This page describes how Hearing Aid Factory Outlet applies those principles in everyday patient care. It does not imply that every test, fitting formula, accessory, or validation method is appropriate for every patient.

Frequently Asked Questions

Why is Real Ear Measurement important?
Because fitting software predicts hearing-aid output, while REM measures the amplified sound delivered in the individual patient’s ear canal. It allows the fitting to be compared with evidence-based targets.

Is the manufacturer’s first-fit setting bad?
No. It is a useful starting point. Objective verification helps determine whether that starting point is actually meeting the intended targets in an individual ear.

Why might you ask my spouse to participate?
If understanding a spouse is one of the patient’s main communication problems, listening to that person’s actual voice can provide useful real-world feedback during fine-tuning. It complements rather than replaces standardized testing.

Can I try my hearing aids outside the office?
Yes. Our Sugarloaf Mills location makes it easy to experience a variety of real-world sounds shortly after a fitting and return to discuss what worked and what still needs adjustment.

Will Gwen come to my workplace or another location?
On-site troubleshooting is not a routine promise or necessary for most fittings. Gwen has occasionally evaluated unusually persistent listening problems in the real environment when she believed doing so could help identify the issue.