Prescription hearing aids fit by an audiologist or hearing aid dispenser are programmed according to an individual’s hearing loss using the proprietary software of the hearing aid manufacturer. The software takes into account the type, degree, and configuration of hearing loss in each ear and provides the correct amount of amplification for that individual patient. The initial hearing aid programming and the continual minor adjustments over time are part of the cost of prescription hearing aids: these hearing care professionals have specific training to optimize your experience with hearing aids.

So, can you program your hearing aids at home? No, but you wouldn’t want to. This article will describe what is occurring during a hearing aid programming appointment with a professional and how to make the most out of your time during these sessions.

hearing aid programming
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Initial Evaluation

During a diagnostic audiological evaluation, your hearing thresholds will be determined by playing soft sounds of varying frequency (pitch) in each ear to determine the softest levels at which you can hear. Your discrimination ability will also be tested; you will be presented with words at a comfortable listening level and asked to repeat them back. The audiologist or hearing aid dispenser will review your results with you and discuss hearing aid candidacy, if appropriate. You may need to obtain medical clearance for hearing aids from your primary care physician or from an ear, nose, and throat (ENT) physician.

There are a variety of hearing aid styles and technology levels. Your provider will present you with options that are appropriate for your type and degree of hearing loss, as well as your lifestyle and specific hearing needs. They may or may not have specific preferences for a hearing aid manufacturer based on their personal experience and education, as well as what they feel would work well for you. All prescription hearing aids come with a trial period of anywhere from 30 to 90 days, so you have some peace of mind about the ability to try different types of hearing aids if, for some reason, the first set isn’t a good match.

The most common type of hearing aid fit today is a receiver-in-canal (RIC) style. The microphones and electronics of the hearing aids are housed in a small piece that sits behind the ear, with a thin receiver wire leading to the speaker that fits in the ear canal. These hearing aids are extremely discrete, fit a wide range of hearing losses, and have great directional microphone technology due to the placement of the microphones, which can provide superior performance in noisy environments. Hearing aids in all styles today are available as rechargeable and can be wirelessly programmed, allowing for relaxed and comfortable programming appointments.

Types Of Hearing Aid Programming Available

hearing aid programming
Hearing Aid Manufacturers

There are seven main manufacturers of hearing aids, and all of them have their own proprietary software to program their hearing aids. Think about these like different manufacturers of cars. All cars drive and have features like a radio, cruise control, and a parking brake, but the interface to access these is slightly different based on the brand of vehicle.

The same is true of hearing aids. They are all going to have comparable features and performance, but your audiologist or hearing aid dispenser may have a preference for the interaction of the software for one or two manufacturers.

If you purchase over-the-counter (OTC) hearing aids, they are often self-programmed. This would involve administering a hearing test to yourself, either via the hearing aids themselves or on the Internet. You can then initiate the programming algorithm based on these test results.

These self-fitting hearing aids are not going to have the same flexibility in programming as what is available to an audiologist or hearing aid dispenser with prescription hearing aids, nor is a self-administered hearing test going to be as accurate or thorough as a full diagnostic evaluation. It is also important to note that OTC hearing aids are only appropriate for mild to moderate hearing loss, so it is always a good idea to have a professional hearing test conducted first. 

Many hearing aids now have Bluetooth functionality, meaning you can directly stream phone calls and media to your hearing aids. The manufacturers also offer proprietary apps where users can make some programming adjustments to their hearing aids at home. Your hearing aids will have a baseline set by your audiologist, but you can make some changes depending on the app. For example, you might increase or decrease the volume, change programs, or adjust the balance between treble and bass.

If you happen to find a setting that you would prefer as your new baseline, you can often store this setting in your app and have it set as your new baseline at your next visit. The app will not have the full functionality of the programming software available to your provider.

hearing aid programming

Steps Involved In Programming A Hearing Aid

The first step in a hearing aid programming session is to connect the hearing aids to the computer. As mentioned, most hearing aids are wirelessly programmed these days. Not too long ago, audiologists needed to use clumsy cords and cables to connect; the process is much more seamless now. Typically, a feedback manager is run, meaning that the hearing aids will emit a series of sounds while the patient stays quiet and still. This allows the hearing aids to essentially calibrate themselves to avoid feedback, which is the whistling that is heard when sound escapes from the ear and is re-amplified by the hearing aids. 

Your audiologist will have already entered your hearing test results, also known as your audiogram, into the software. The software will determine the appropriate level of gain to apply at each frequency. Hearing is tested from 250-8000 Hz, which is the range of speech. Likewise, this is the general range that hearing aids can offer amplification. Most hearing losses are poorer in the higher frequency range. Patients may have only a mild hearing loss (or even normal hearing!) in the low frequencies, and then the hearing slopes, becoming poorer with higher frequencies. Thus, hearing aids would apply more gain in the high frequencies to make them audible but comfortable.

Your audiologist will likely leave the initial fitting by the software alone and see how it sounds to you. It is normal for hearing aids to sound “tinny” or overly bright in the beginning because your brain has become accustomed to hearing without those crisp high-frequency sounds that offer clarity of speech. That said, if the sound quality does not resolve with a few weeks of continuous use, there are adjustments that can be made to soften the quality.

hearing aid programming

Most hearing aids now are also analyzing the environment constantly and making automatic adjustments for comfort and optimization of speech understanding. This is one aspect that can improve with higher technology levels/higher price points. The top-tier hearing aids will have more “scenes” to choose from. In a quiet room at your provider’s office, it can be tricky to hear the difference between these scenes.

It is helpful, when you go for a follow-up appointment, to provide details about any specific scenarios where you felt like you had difficulty hearing. Remember that even people with normal hearing struggle in environments with lots of background noise or over-distance, so set your expectations accordingly. Still, detailed descriptions of your experience can help your provider to make informed adjustments. It may be that you and your provider decide to add a manual program to your hearing aids for a certain situation where the automatic algorithm is not sufficient. 

Can I program my hearing aids at home?

The short answer is no. Hearing aids must be initially dispensed and fit by a trained audiologist or hearing aid dispenser, and continued adjustments are made using the proprietary software. That said, if it is important to you to have some control over your hearing aids, you can talk to your provider about finding a pair that has a corresponding app that will allow you to make some adjustments at home.

Most patients, even the engineers and tech gurus, find that the “set it and forget it” method is preferable. You want your hearing aids to be physically comfortable but also barely noticeable in that you are hearing well as you transition throughout your day, and you aren’t thinking about making constant tweaks and changes. 

Maintenance and Fine-Tuning

Most audiologists have patients come back for at least one or two follow-ups after the initial hearing aid fitting appointment. The fitting usually involves minimal programming, relying on the software algorithm for recommended settings. The provider will spend much of this appointment teaching you about how your hearing aids work, ensuring that you are comfortable inserting and removing them, and discussing care and maintenance.

At the first couple of follow-up appointments, programming adjustments might be made based on your feedback. The audiologist will also be checking the data logging, which is a report of how often you are wearing your hearing aids. That’s right, this is being tracked and monitored! The most important part of finding success with hearing aids is wearing them for all waking hours. Most providers will be hesitant to make any significant changes unless you are first wearing the hearing aids consistently. Your provider also wants to see you back at least once during your trial period to ensure that you are satisfied with your purchase.

After the initial period of the fitting and follow-up, many patients are seen annually or even biannually for a tune-up. Sometimes, this involves repeating the hearing test; if you have noticed a change in your hearing, the hearing aids will need to be recalibrated to prescribe the correct amount of gain. Other times, once patients have become experienced users, they want to experiment with manual programs or add accessories to their hearing aids. Other patients simply like to have a regular check-in with their audiologist to have their hearing aids checked and cleaned.

Unless your hearing has changed or you have noticed difficulty in a particular environment, you shouldn’t feel obligated to have your hearing aids reprogrammed regularly. The ideal scenario is for them to be a “set it and forget it” system where you put them on in the morning and barely notice them throughout the day.

Some of the manufacturers, like Starkey, are now introducing remote programming functionality through their apps. This would be specific to both the manufacturer of the hearing aids and your provider; not all offices have this service available. It won’t replace an in-person appointment but can be useful if you are having an issue and can’t get to the office.

In Summary

Hearing aid programming has come a long way over the years and is now largely automated and easy for you and your provider. That said, audiologists and hearing aid dispensers are specifically trained in psychoacoustics and hearing aid mechanics and can interpret your comments or complaints in a way that allows them to make informed adjustments to your devices. Each hearing aid programming session is individualized to you: your hearing loss, your lifestyle, and the way that your hearing aids can respond to your listening needs.

If you are noticing difficulty hearing, the first step is to schedule a diagnostic hearing evaluation with a trained professional to determine whether you are a good candidate for hearing aids. Your provider will talk you through the whole process, from selecting the best hearing aids for you through the initial fitting and continued follow-up and maintenance.

erin edwards aud
Clinical Audiologist at Towson University | + posts

Erin Edwards received her Doctor of Audiology degree from Towson University in 2015 and her Ph.D. in Education and Leadership from Pacific University in 2022. She has worked with patients of all ages in a variety of settings and has a specific interest in cochlear implants, the relationship of hearing loss and dementia, and interdisciplinary healthcare.

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