What Happens at a Hearing Evaluation and Hearing Aid Fitting
A step-by-step look at hearing tests, the audiogram, real-ear measurement, trial periods and follow-up care so you know what to expect and what to ask.
Before your appointment
A first visit to an audiologist or hearing instrument specialist usually has two goals: finding out how well you hear, and deciding what, if anything, would help. It is useful to come prepared. Consider bringing:
- A list of your medications and any past ear problems, surgeries or noise exposure
- Notes on situations where you struggle, such as restaurants, meetings, TV or phone calls
- Any earlier hearing test results
- A family member or friend, whose voice can be used in testing and who can help remember what is discussed
The hearing evaluation
A visit typically starts with a case history, questions about your hearing, health and daily listening needs, followed by a look into your ear canals with an otoscope to check for wax, infection or other problems. The standard tests, described in detail by an ASHA-supported consumer guide, include:
- Pure-tone testing. You wear earphones and signal when you hear beeps at different pitches, typically from 250 to 8,000 Hz. The results are plotted on an audiogram, a chart of the softest sounds you can hear at each pitch in each ear.
- Bone conduction testing. A small vibrating device behind the ear sends sound directly to the inner ear. Comparing these results with the earphone results shows whether hearing loss is conductive (outer or middle ear), sensorineural (inner ear or nerve) or mixed.
- Speech testing. You repeat words at different volumes, and sometimes with background noise, to measure how well you understand speech, not just whether you hear it.
- Tympanometry. A soft probe changes air pressure in the ear canal to check how the eardrum moves, which can reveal fluid, a hole in the eardrum or other middle ear issues.
Afterward, the provider should walk you through your audiogram in plain language: the type and degree of loss, whether both ears are similar, and whether anything suggests you should see a physician. Ask for a copy of your results. You have a right to one, and you can take it to another provider.
Who pays for the test, and getting your records
Medicare Part B covers diagnostic hearing exams when a doctor or other provider orders them to find out whether you need medical treatment, and lets you see an audiologist once every 12 months without an order for non-acute hearing problems, as Medicare.gov explains. It does not cover exams for fitting hearing aids. Ask before the test how it will be billed. Our guide to paying for hearing aids covers Medicare Advantage, Medicaid and VA benefits.
The FDA notes that you can request your hearing evaluation records and buy hearing aids somewhere other than the clinic that tested you. Providers that send health information electronically for transactions such as insurance claims are covered by HIPAA, and its right of access, in 45 CFR 164.524, sets the rules:
- The provider may ask you to put the request in writing.
- It must act within 30 days, with one extension of up to 30 more days if it tells you in writing why and when.
- Any fee must be reasonable and cost-based, covering only copying labor, supplies, postage and, if you agree to one, a summary.
Choosing hearing aids
If hearing aids are recommended, the conversation turns to style and features. The NIDCD describes the main styles: behind-the-ear, in-the-ear and smaller canal styles, each suited to different degrees of loss and different needs. Your provider should consider your hearing results, the shape of your ears, how easily you handle small devices, whether you prefer rechargeable batteries, and features such as phone streaming or programs for noisy places. Good questions to ask include what the total cost is, what the warranty covers and whether there is a trial period.
The FDA does not require a medical exam or hearing test before you buy prescription hearing aids, but your state may require a visit to an audiologist or other licensed professional first. For anyone under 18, hearing aids must be bought by prescription, and the FDA advises a medical evaluation, preferably by an ENT doctor, beforehand.
The fitting appointment and real-ear measurement
At the fitting, the hearing aids are placed in your ears, checked for comfort and programmed on a computer. Hearing aid software offers a starting point based on your audiogram, but every ear canal is shaped differently, which changes how much sound actually reaches your eardrum.
That is why the American Speech-Language-Hearing Association calls real-ear measurement (REM) the gold standard for verifying a hearing aid fitting. A thin, soft tube connected to a microphone is placed in your ear canal next to the hearing aid while calibrated speech is played. The provider can then see on screen how loud the sound is at your eardrum and adjust the hearing aid to match research-based targets for your hearing loss. The test is quick and painless. Not every clinic does it routinely, so it is a fair question to ask when choosing a provider.
The fitting visit should also cover how to insert and remove the aids, change or charge batteries, clean them, use any phone app, and what to do if they whistle or feel uncomfortable.
The trial period
According to the NIDCD, most manufacturers allow a trial period, commonly 30 to 60 days, during which hearing aids can be returned for a refund. Trial terms are set by the seller and manufacturer and sometimes by state law, so get them in writing. Ask specifically:
- How many days is the trial, and when does it start?
- Which fees, if any, are nonrefundable if I return the aids?
- Can I try a different model or brand within the trial?
Use the trial actively. Wear the hearing aids every day in the places that matter to you and keep notes on what works and what does not to bring to follow-up visits.
Follow-up visits and adjustment
Adjusting to hearing aids takes time. The FDA notes that the adjustment period can last several months, and that your own voice and everyday sounds may seem too loud at first. Expect one or more follow-up visits in the first weeks to fine-tune settings based on your experience. Many providers also use questionnaires or aided speech tests to confirm the hearing aids are meeting your goals.
Over the longer term, plan on periodic cleanings and checks, repeat hearing tests to catch changes, and repairs when needed. Ask at the start which of these are included in your purchase price and for how long. A good fitting is not a single appointment; it is an ongoing relationship with a provider you trust.
If a problem with the provider cannot be resolved, the state board that licenses audiologists or hearing aid dispensers handles complaints about licensees. Injuries or malfunctions caused by the device itself can be reported to the FDA through MedWatch or by calling 1-800-FDA-1088.
General information only, current as of the date above. The information on Hearing Clinic Finder is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.