Binaural Fittings…….Is the Practice the Same Everywhere?

Audiologists in the United States have gradually, over the past 30 years, moved from a culture that fits mostly monaural (23% in 1983) to a culture that fits mostly binaural (75% in 2010).  Many of us fit almost all of our bilaterally hearing-impaired patients binaurally, unless there are financial issues or hearing impairment characteristics that contraindicate this type of a fitting.  The benefits of binaural fittings have become very obvious to most American audiologists based upon patient experience and proof by the literature time after time.  Sergei Kochkin (2000) summarized these benefits some years ago based upon surveys of hearing-impaired individuals and documented studies of patient success.

15 Reasons To Use Binaural Hearing Aids for Bilateral Losses (Kochkin, 2000)

1. Better understanding of speech.  By wearing two hearing instruments rather than one selective listening is more easily achieved.  This means your brain can focus on the conversation you want to hear.  Research shows that people wearing two hearing aids routinely understand speech and conversation significantly better than people wearing one hearing aid.

2. Better understanding in group & even noisy situations. Speech intelligibility is improved in difficult listening situations when wearing two hearing aids.

3. Better ability to tell the direction or localize sound.  In a social gathering, for example, localization allows hearing from the direction someone is speaking. Also, localization helps determine from which direction traffic is coming or where children or grandchildren are playing.  Simply put, with binaural hearing, people better detect where sounds are coming from in every situation.

4. Better sound quality.   When listening to a stereo system, both speakers are incorporated to get the smoothest, sharpest, most natural sound quality.  The same can be said of two hearing instruments that increase hearing range from 180 degrees reception, with just one instrument, to 360 degrees.  This greater range provides a better sense of balance and sound quality.

5. Smoother tone quality.   Wearing two hearing instruments generally requires less volume than using  one device.  The result is less distortion and better reproduction of amplified sound.

6. Wider hearing range.  People can hear sounds from a further distance with two ears. A voice that’s barely heard at 10 feet with one ear can be heard up to 40 feet with two ears.

7. Better sound identification.   Often, with just one hearing instrument, many noises and words sound alike, whereas with two hearing instruments, as with two ears, sounds are more easily distinguishable.

8. Keeps both ears active resulting in less hearing loss deterioration. Researchers have demonstrated that when only one hearing instrument is worn, the unaided ear tends, over time, to lose its ability to hear and understand. This is clinically called the auditory deprivation effect.  Those wearing two hearing instruments keep both ears active.

9. Hearing is less tiring and listening more pleasant.  More binaural hearing aid users report that listening and participating in conversation is more enjoyable with two instruments as they do not have to strain to hear with the better ear.  Thus, binaural hearing can make life more relaxing.

10. Feeling of balanced hearing. Hearing in both ears results in a feeling of balanced reception of sound, also known as the stereo effect; whereas monaural hearing creates an unusual feeling of sounds being heard in one ear.

11. Greater comfort when loud noises occur.   A lower volume control setting is required with each of two hearing instruments than with just one hearing instrument, resulting in better tolerance of loud sounds.

12. Reduced feedback and whistling.  With a lower volume control setting the chances of hearing aid feedback is reduced.

13. Tinnitus Masking.   About 50% of people with ringing in their ears report improvement when wearing hearing aids.  If the patient has a hearing aid in only one ear, there will still be ringing in the ear which does not have a hearing aid.

14. Consumer preference.   When given the choice and allowed to hear binaurally, the overwhelming majority of consumers choose two hearing aids over one, when they have a hearing loss in both ears.

15. Customer satisfaction research with more than 5,000 consumers with hearing loss in both ears demonstrated that binaurally fit subjects are more satisfied than people fit with one hearing aid.

If fitting both ears with amplification is so successful in the United States, what are the figures in other countries?  Neilsen (2010) indicates that the general binaural fitting rates in Europe are about 50% but in some parts of Europe, such as the UK and Spain, they are 15%-20%.  A major question then lingers; Why are binaural fittings so minimal in other parts of the world?  Does it have to do with the socalized healthcare systems in Europe and the criteria for binaural fittings?  Is it the philosophy of the physicians, researchers, audiologists, and akustikers in Europe?

Hopefully, one of our readers can shed some light on this issue and assist Hearing International in answering this lingering question.



Kochkin, S. Binaural Hearing Aids: The Fitting of Choice for Bilateral Loss Subjects. Knowles Electronics: Itasca, Ill (2000).  A tutorial for Audiologists, dispensers and physicians; includes 15 reasons why binaural hearing aids are effective.  Retrieved January 2, 2012:

Neilsen, S., Dynamics of the hearing aid market.  Oticon/William Demant Holding.  Retrieved January 2, 2012:


About Robert Traynor

Robert M. Traynor is a board certified audiologist with 45 years of clinical practice in audiology. He is a hearing industry consultant, trainer, professor, conference speaker, practice manager, and author. He has 45 years experience teaching courses and training clinicians within the field of audiology with specific emphasis in hearing and tinnitus rehabilitation. Currently, he is an adjunct professor in various university audiology programs.