Who fits hearing aids?

Hearing aids are fit by licensed professionals, usually audiologists or hearing instrument specialists. An audiologist has typically completed 6-8 years of higher education and holds a Masters or Doctoral degree in Audiology. A hearing instrument specialist has typically completed licensure requirements as defined by the state in which they practice. Licensure requirements vary state to state and some states require audiologists have a dispensing license in addition to their audiology license, while other states include dispensing under their audiology licensure.

When choosing a professional to work with, it is very important to remember that this is likely to be a relationship you will maintain for many years-much like the relationship with your primary physician. You should be comfortable with your provider, and should feel that you can express concerns to them when you have them. The professional you work with is well versed in the amplification (hearing aid) options they offer, and knows how to address any concerns or issues you have with the instruments. This may take more than one visit, however, so be sure to communicate to them exactly what you like/don’t like about your hearing aids once you are in your trial period.

Sometimes the best way to find a hearing professional is the simplest way - ask your friends with hearing aids who they recommend. Primary care physicians can also have good recommendations, as they often hear the good and bad reviews from other patients.

There are two difference professionals who are qualified to fit hearing aids:  audiologists and hearing instrument specialists.  They have overlapping scopes of practice, but audiologists have significantly additional training in the auditory system beyond just hearing and hearing aids.

The primary differences between an audiologist and a hearing instrument specialist (or "dispensers") is their level of training and scope of practice.  Audiologists have either a masters degree or doctorate in the field of audiology ( total of 6 - 8 years of higher education), and as such have an extensive amount of training in just about everything relating to the ear.  By contrast, hearing instrument specialists have primarily on-the-job training in a less formal manner, although a few community colleges offer 2-year associates degrees in hearing instrument science (but the majority of dispensers do not have this).  Because they relay primarily on on-the-job-training, the dispenser is initially only as good as their trainer, although some excel in the field and actually become better than their trainers.  You could apply a similar logic to audiologists, in that they are only as good as the program they graduated from, but since their training is more formal and involves a greater number of instructors, the quality of training is usually very good for audiologists.

Experience and attitude do count for something, however, so regardless of training the personality of the audiologist or dispenser counts a lot when it comes to a patient's success with hearing aids.  There are many dispensers with a vast amount of experience who can actually run circles around newly-graduated audiologists simply because of their time in the profession.  However, the lengthy training program required for audiologists provides an excellent screening system to find people who are dedicated to the patient; someone who invests as much as eight years into higher education isn't getting into it just for a paycheck, but is looking for a long-term career.  For most hearing instrument specialists, however, this is often a second or even third career for them.

The scope of practice is another consideration, for while both professions work with hearing aids, audiologists have a significantly larger wealth of knowledge.  Dispensers are trained strictly in hearing evaluations for the purpose of fitting hearing aids, while audiologists are trained for full diagnostic evaluations of the patient's entire auditory system, from the outer ear to the brain.  This being the case, audiologists are best suited for diagnosing the actual cause of the hearing loss for determining the best treatment methodology for the patient, which is especially important for patients who are considering hearing aids for the first time and don't know for sure what the cause of their hearing loss is.  Since hearing loss can have many causes, some of which should require medical attention BEFORE getting hearing aids, it's recommended that the first hearing evaluation be conducted by an audiologist for a clinical diagnosis, regardless of whether the person decides to purchase hearing aids from a dispenser or an audiologist.

Their training also isn't limited strictly to hearing, but also to the balance system of the ear.  As much as 70% of our balance system relates to the vestibular portion of the ear, so audiologists have the evaluation of these problems included within their scope of practice.  There are also quite a few other lesser seen aspects to an audiologists scope of practice, such as interoperative monitoring, industrial audiologist (for protecting workers in high noise environments) and forensic audiology (lending their knowledge and expertise to court cases relating to hearing and sound in general).  

To sum it up, if a consumer is concerned about their hearing and has never had a diagnostic evelaution to determine the cause of the hearing loss, it is best that they have a diagnostic evaluation by an audiologist first.  After pther medical problems are ruled out and it is determined that a hearing aid is the best solution for the hearing loss, the consumer could choose to go to either a dispenser or an audiologist.  The experience, reputation and training of the hearing professional matter significantly in the ultimate decision of where to go.