What Audiologists Wish Every Patient Knew Before Buying Hearing Aids
We spoke with five practicing audiologists across the United States — from private practices, hospital-based clinics, and university audiology programs — and asked them the same set of questions. Their answers were candid, sometimes surprising, and consistently useful.
Here's what they want you to know.
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Meet the Experts
Dr. Sandra Okafor, Au.D. — Private practice audiologist, Houston, TX. 18 years in clinical practice, specializing in adult hearing rehabilitation.
Dr. Marcus Trevino, Au.D., Ph.D. — Associate professor of audiology, University of Arizona. Researcher in hearing aid outcomes and patient adherence.
Dr. Priya Nair, Au.D. — Hospital-based audiologist, Northwestern Medicine, Chicago. Focuses on complex hearing loss cases and cochlear implant candidacy.
Dr. James Whitfield, Au.D. — Veteran audiologist, VA Medical Center, Atlanta. Works primarily with veterans experiencing noise-induced and age-related hearing loss.
Dr. Leah Sorensen, Au.D. — Pediatric and adult audiologist, Minneapolis. Runs a hybrid practice offering both prescription and OTC hearing aid guidance.
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"The Biggest Mistake Patients Make"
We started with the most direct question we could ask.
Dr. Okafor: "They wait too long. The average person waits seven years from the time they first notice hearing difficulty to the time they seek help. Seven years. That's seven years of strained relationships, missed conversations, and — we now know — increased cognitive load that may contribute to cognitive decline. The hearing loss doesn't get better while you wait. It usually gets worse."
Dr. Trevino: "From a research standpoint, the biggest mistake is treating hearing aids as a last resort rather than a first-line intervention. We have strong evidence that early amplification leads to better outcomes — better speech understanding, better quality of life, better adherence to wearing the devices. People who wait until their hearing loss is severe often struggle more with the adjustment period."
Dr. Whitfield: "For my veteran population, it's not seeking help at all. There's still a stigma — hearing aids are seen as a sign of weakness or old age. But I'll tell you what I tell my patients: the strongest thing you can do is take care of yourself. These are tools, like glasses. Nobody thinks twice about wearing glasses."
Dr. Sorensen: "I see a lot of people who bought OTC hearing aids without getting a proper hearing test first. They're amplifying sound, but they don't actually know what frequencies they're missing. It's like getting reading glasses without knowing your prescription — you might get lucky, but you might make things worse."
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What a Hearing Test Actually Tells You
Many patients don't fully understand what happens during an audiological evaluation — or why it matters.
Dr. Nair: "A comprehensive audiological evaluation is much more than the beep test. We're looking at the full picture: pure-tone thresholds across frequencies, speech discrimination scores, middle ear function, and sometimes more specialized testing depending on the patient's history. The audiogram tells us what you're not hearing. The speech testing tells us how well you're processing what you do hear. Those are very different things, and both matter enormously for hearing aid fitting."
Dr. Trevino: "Speech discrimination scores are particularly underappreciated by patients. Two people can have identical audiograms — the same degree of hearing loss at the same frequencies — but one person might score 90% on speech discrimination and the other might score 60%. The person with 60% is going to have a much harder time with hearing aids, not because the devices aren't working, but because the auditory nerve isn't processing speech as cleanly. That's something we need to counsel patients about before they have unrealistic expectations."
Dr. Okafor: "I always explain the audiogram to my patients in plain language. I show them where their hearing falls on the chart, I explain what sounds they're missing — typically high-frequency consonants like 's,' 'f,' 'th,' 'sh' — and I connect that to the specific complaints they came in with. When someone understands why they can hear that someone is talking but can't understand the words, it changes everything. They become much more motivated to address it."
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On Choosing Between Prescription and OTC Hearing Aids
The FDA's 2022 OTC hearing aid ruling opened the market to direct-to-consumer devices. We asked our experts how they counsel patients navigating this choice.
Dr. Sorensen: "I'm genuinely supportive of OTC hearing aids for the right patient. If someone has mild to moderate hearing loss, is tech-savvy, is motivated to self-fit and adjust, and has realistic expectations — OTC can be a great entry point. The price difference is real. But I always recommend getting a hearing test first, even if you're going OTC. Know what you're working with."
Dr. Okafor: "The patients I worry about with OTC are the ones who have more significant hearing loss than they realize, or who have an underlying medical condition — asymmetric hearing loss, sudden hearing loss, drainage, pain — that needs to be evaluated before they start amplifying. OTC devices aren't appropriate for everyone, and the FDA guidelines say as much. The problem is that not everyone reads the guidelines."
Dr. Whitfield: "For my veterans, I almost always recommend prescription devices, and not just because the VA covers them. These are patients with complex histories — noise exposure, blast exposure, sometimes tinnitus, sometimes central auditory processing issues. They need professional fitting, real ear measurement, and ongoing follow-up. OTC isn't designed for that level of complexity."
Dr. Nair: "I think the OTC category has done something important: it's normalized the conversation about hearing aids. People are seeing them at Walgreens and Best Buy. That visibility reduces stigma. Even if a patient ultimately needs prescription devices, the fact that they walked into my office because they were curious about OTC options is a win."
Dr. Trevino: "The research on OTC outcomes is still developing, but early data is promising for mild-to-moderate loss. The key variable seems to be patient engagement — people who actively use the companion app, adjust their settings, and seek out information do significantly better than passive users. That's actually true of prescription hearing aids too."
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What "Real Ear Measurement" Means — and Why You Should Ask for It
This is one of the most important — and least-known — aspects of hearing aid fitting.
Dr. Okafor: "Real ear measurement, or REM, is the gold standard for verifying that a hearing aid is actually delivering the right amount of amplification at the right frequencies for your specific ear canal. Every ear canal is different. The same hearing aid programmed to the same settings will produce different sound pressure levels in different ears. REM lets us measure what's actually happening inside your ear and adjust accordingly. It takes maybe 15 extra minutes and it dramatically improves outcomes."
Dr. Trevino: "Studies consistently show that hearing aids fit with real ear measurement outperform those fit without it — better speech understanding, higher patient satisfaction, better adherence. And yet surveys suggest that fewer than half of audiologists routinely perform REM. That's a problem. Patients should ask: 'Do you perform real ear measurement as part of your fitting process?' If the answer is no, that's worth knowing."
Dr. Sorensen: "I do REM on every patient, every time. It's non-negotiable in my practice. I've had patients come to me from other providers who were struggling with their hearing aids, and when I do REM, I find they were significantly under-amplified in the high frequencies. We adjust, and suddenly they can hear clearly. The devices weren't the problem — the fitting was."
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The Adjustment Period: What Patients Aren't Told
New hearing aid users are often surprised by how challenging the first weeks can be.
Dr. Whitfield: "I spend a lot of time on this in my counseling. When you've had hearing loss for years, your brain has adapted to a quieter world. Suddenly introducing amplification is a shock to the auditory system. Sounds that you haven't heard in years — the refrigerator hum, your own footsteps, paper rustling — are suddenly loud and distracting. That's normal. It takes weeks to months for the brain to recalibrate and learn to filter those sounds again."
Dr. Nair: "The technical term is auditory acclimatization. The brain has to relearn how to process sound. I tell patients to think of it like physical therapy after an injury — it takes consistent effort and time. The patients who do best are the ones who wear their hearing aids consistently, even when it's uncomfortable at first, and who come back for follow-up appointments so we can make adjustments."
Dr. Okafor: "I give every new patient a wear schedule. Start with a few hours a day in quiet environments. Gradually increase wear time and environmental complexity over the first month. Don't try to wear them at a loud restaurant in week one. Build up to it. And call me if something isn't right — that's what the follow-up appointments are for."
Dr. Trevino: "Adherence is the single biggest predictor of outcomes in our research. Patients who wear their hearing aids consistently for the first three months are dramatically more likely to still be wearing them at one year and five years. The ones who give up in the first few weeks because it's hard — they lose out on all the long-term benefits. The adjustment period is real, but it ends."
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Questions Every Patient Should Ask Their Audiologist
We asked each expert for the one question they wish more patients would ask.
Dr. Okafor: "'What does my speech discrimination score mean for my expectations with hearing aids?' That question opens up a really important conversation about realistic outcomes."
Dr. Trevino: "'Do you perform real ear measurement, and will you show me the results?' If they say yes, great. If they look confused, that tells you something."
Dr. Nair: "'What's included in the price — and what happens if I need adjustments or repairs?' Hearing aid pricing is notoriously opaque. Understand what you're buying."
Dr. Whitfield: "'What should I do if I'm struggling in the first few weeks?' Having a plan before you need it makes a huge difference. Know who to call and what to expect."
Dr. Sorensen: "'Are there any medical reasons I should see a physician before getting hearing aids?' Asymmetric hearing loss, sudden hearing loss, ear pain, drainage — these need medical evaluation first. A good audiologist will already screen for this, but it doesn't hurt to ask."
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On the Future of Hearing Care
We closed by asking each expert what they're most excited about in the field.
Dr. Trevino: "The convergence of hearing aids and health monitoring. We're already seeing devices that can detect falls, monitor heart rate, and track activity. The ear is actually an excellent location for biometric sensing. In ten years, your hearing aids may be your primary health monitoring device."
Dr. Nair: "Gene therapy for hearing loss. There are clinical trials underway right now showing real promise for restoring hearing in certain types of genetic hearing loss. We're not there yet for most patients, but the science is moving fast."
Dr. Sorensen: "Honestly? Better access. The OTC category is a start, but we still have millions of people with untreated hearing loss who can't afford prescription devices and don't know OTC options exist. Anything that closes that gap — better insurance coverage, lower prices, telehealth audiology — I'm excited about."
Dr. Okafor: "Artificial intelligence in hearing aids. The devices are getting remarkably good at distinguishing speech from noise, at learning individual preferences, at adapting to environments automatically. My patients who have the latest AI-powered devices are having experiences that would have seemed impossible ten years ago."
Dr. Whitfield: "The destigmatization of hearing loss. It's happening. Younger people are wearing hearing aids and not hiding them. Celebrities are talking about their hearing loss. The conversation is changing. That matters more than any technology, because technology only helps the people who seek it out."
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The Bottom Line
Five audiologists, five different practice settings, five different patient populations — and a remarkable consistency in their core message: seek help early, get a proper evaluation, ask good questions, and give yourself time to adjust.
Hearing loss is one of the most treatable chronic conditions, and yet it remains one of the most undertreated. The gap between those two facts is largely a matter of information, access, and stigma — all of which are changing.
The experts we spoke with aren't just clinicians. They're advocates for a simple idea: that hearing well is worth fighting for, and that the tools to do it have never been better.
If you've been putting off a hearing evaluation, consider this your nudge.
