Mrs. Jones came to her hearing-test appointment with her daughter-in-law. She looked more than her 84 years, arriving in a wheelchair with an oxygen tank strapped to the back. She was quiet during most of the intake interview and cooperative during testing. But when the topic of hearing aids was broached, Mrs. Jones looked the audiologist directly in the eyes for the first time, saying in a weakened voice: “I don’t think all that will be necessary. I doubt I’ll be on this earth that much longer. I should’ve gone before Henry those 20 years ago.”

As audiologists are well aware, even the highest levels of hearing aid technology fit to best practice standards (Academy, 2006; ASHA, 2006) fail to meet the daily listening demands of many patients with hearing loss (Lesner, 2003; Laplante-Levesque et al, 2013). Indeed, as Table 1 reveals, the degree of hearing deficit remaining post-hearing aid fitting can be substantial.