The present study investigated the effects of gain compensation and venting on front-to-back ratios (FBRs), speech understanding in noise, and acceptance of noise in 19 listeners with hearing impairment utilizing directional hearing instruments. The participants were separated into two groups based on degree of low-frequency hearing sensitivity. Subjects were fitted binaurally with Starkey Axent II programmable behind-the-ear hearing aids and full-shell earmolds (select-a-vent). Results demonstrated that gain compensation and venting significantly affected FBRs for both groups; however, acceptance of noise was not significantly affected by gain compensation or venting for either group. Results further demonstrated that speech understanding in noise was unaffected by venting but may be improved with the use of gain compensation for some listeners. Clinical implications are discussed.