Noise Management Preferences During Long-Term Hearing Aid Usage and Their Relation to Audiologic Factors

Preferences for advanced hearing aid (HA) noise management features, such as directionality and noise reduction (DIR + NR), differ significantly among users. Due to the lack of standardized clinical guidelines for fine-tuning these features, audiologists often rely on individual user preferences. However, this approach doesn't always ensure optimal hearing outcomes. The goal of this study was to examine how users respond to these advanced features in everyday acoustic environments, with two main goals: to assess how sensitive users are to changes in DIR + NR settings compared to subtle gain adjustments, and to identify the factors influencing DIR + NR preferences in various situations. A total of 123 individuals using bilateral HAs participated in the study, conducted at two locations in Germany and Japan. Over six testing periods (half a year), participants were provided with two listening programs that differed either in the strength of their DIR + NR settings or in gain levels for high-frequency and soft sounds. Participants documented their preferences via self-initiated questionnaires, reporting experiences with the different settings in real-life listening scenarios. Most participants preferred modest adaptive DIR + NR settings and participants generally expressed higher preference strength for small gain changes than for variations in DIR + NR. Preferences could not be reliably predicted from audiologic or environmental factors, apart from a minor influence of subjective noisiness. These findings suggest that clinicians can guide the initial fitting of DIR + NR settings to optimize speech-in-noise performance, as adaptive DIR + NR configurations are broadly acceptable. User preferences remain important, particularly during gain fine-tuning, as small adjustments can be noticeable.