Two methods of fine tuning the initial settings of hearing aids were compared: An audiologist-driven approach--using real ear measurements and a patient-driven fine-tuning approach--using feedback from real-life situations. The patient-driven fine tuning was conducted by employing the Amplifit(®) II system using audiovideo clips. The audiologist-driven fine tuning was based on the NAL-NL1 prescription rule. Both settings were compared using the same hearing aids in two 6-week trial periods following a randomized blinded cross-over design. After each trial period, the settings were evaluated by insertion-gain measurements. Performance was evaluated by speech tests in quiet, in noise, and in time-reversed speech, presented at 0° and with spatially separated sound sources. Subjective results were evaluated using extensive questionnaires and audiovisual video clips. A total of 73 participants were included. On average, higher gain values were found for the audiologist-driven settings than for the patient-driven settings, especially at 1000 and 2000 Hz. Better objective performance was obtained for the audiologist-driven settings for speech perception in quiet and in time-reversed speech. This was supported by better scores on a number of subjective judgments and in the subjective ratings of video clips. The perception of loud sounds scored higher than when patient-driven, but the overall preference was in favor of the audiologist-driven settings for 67% of the participants.