First Steps After Noticing Hearing Loss

You've been turning up the TV volume for months. Your partner has stopped bothering to repeat themselves—they just give you "the look." At restaurants, you've perfected the art of nodding at the right moments even when you can't quite catch what people are saying. You tell yourself it's just background noise, or maybe everyone else mumbles these days.

But somewhere in the back of your mind, you know. The moment might have been when your grandchild whispered "I love you" and you had to ask them to repeat it. Or when you missed an important detail in a work meeting. Or when you realized you've been avoiding phone calls because they're just too hard. Whatever the moment was, you've crossed a threshold: you can't pretend anymore that your hearing is fine.

Now what? The uncertainty feels overwhelming. Do you see your regular doctor? Go straight to a hearing specialist? How much will it cost? What if it's bad news? What if hearing aids are too expensive? What if it's not even fixable? These questions can feel paralyzing—but here's what many people discover: taking that first step is often much simpler than the weeks or months of worry that preceded it.

Who Should You See First?

The good news: you have options, and there's no single "right" path. The best starting point depends on your insurance, symptoms, and personal preferences.

Option 1: See an Audiologist Directly (Most Common Path)

Most people can schedule directly with an audiologist without needing a referral from their doctor. Audiologists are doctoral-level hearing healthcare professionals who specialize in diagnosing and treating hearing loss. They can perform comprehensive evaluations, explain your results, and discuss treatment options—all in one visit.

This path makes sense if:

• You've gradually noticed hearing difficulties over time (not sudden)
• You don't have ear pain, drainage, or other medical symptoms
• Your insurance doesn't require referrals for specialists
• You want a comprehensive evaluation and are open to discussing treatment options

What you'll get: A complete hearing assessment, explanation of results, discussion of options (which might include hearing aids, assistive technology, or medical referral if needed), and a plan moving forward.

Option 2: Start with Your Primary Care Physician

Some people prefer starting with their regular doctor, especially if they have other health concerns or if their insurance requires a referral.

This path makes sense if:

• Your insurance requires PCP referrals for specialists
• You have other symptoms (ear pain, dizziness, drainage)
• You want simple issues ruled out first (like earwax buildup)
• You prefer your trusted doctor to guide next steps

What you'll get: Your PCP can examine your ears, check for simple issues like wax buildup or infection, and provide referrals to audiology or ENT specialists as needed. They typically won't perform comprehensive hearing testing in the office but can identify obvious problems.

Option 3: See an ENT (Ear, Nose, and Throat Doctor)

ENTs are physicians who specialize in medical and surgical treatment of ear conditions. While audiologists focus on diagnosing hearing loss and providing treatment like hearing aids, ENTs address medical issues that might be causing hearing problems.

This path makes sense if:

• You experienced sudden hearing loss (over hours or days—this is an emergency)
• You have significant ear pain, drainage, or bleeding
• Your hearing loss is only in one ear (asymmetric)
• You have a history of chronic ear infections or ear surgery

What you'll get: Medical evaluation to determine if your hearing loss has a treatable medical cause. ENTs often work with audiologists in their practice or refer to them for hearing testing.

What Happens at a Hearing Evaluation?

Understanding what to expect can help reduce anxiety about that first appointment. Here's what typically happens during a comprehensive hearing evaluation with an audiologist.

The Conversation (15-20 minutes)

Your audiologist will start by asking about your hearing concerns. They'll want to know:

• When you first noticed changes
• Specific situations where you struggle (restaurants, phone calls, TV)
• Whether one ear seems worse than the other
• Your medical history and medications
• Exposure to loud noise (work, hobbies, military service)
• Family history of hearing loss
• Impact on your daily life and relationships

This isn't an interrogation—it's a conversation to help your audiologist understand your unique situation and what matters most to you.

Physical Examination (5-10 minutes)

Your audiologist will look inside your ears using an otoscope (a lighted magnifying tool) to check for obvious issues like earwax buildup, infection, or structural problems. This is completely painless—like looking in your ears with a small flashlight.

The Hearing Tests (30-40 minutes)

All hearing tests are non-invasive and painless. You'll typically sit in a sound-treated booth wearing headphones.

Pure tone testing: You'll hear tones at different pitches and volumes, raising your hand or pressing a button when you hear them. This creates your audiogram—a chart showing which sounds you can and can't hear.

Speech testing: You'll repeat words or sentences to test how well you understand speech, not just whether you can hear sounds.

Middle ear testing (tympanometry): A soft probe is placed in your ear canal to measure how your eardrum responds to pressure changes. This takes about 30 seconds per ear and helps identify middle ear problems.

Review of Results (15-20 minutes)

Most audiologists explain your results during the same appointment. They'll show you your audiogram, explain what it means in practical terms (not just technical jargon), and discuss options. This might include:

• No treatment needed—monitoring only
• Hearing aids or other assistive technology
• Referral to an ENT if medical treatment might help
• Communication strategies and accommodations

Total time: Expect to spend 60-90 minutes for a comprehensive evaluation. Some clinics offer same-day hearing aid trials; others schedule a follow-up appointment.

What Will It Cost?

Cost concerns prevent many people from seeking evaluation—but the diagnostic appointment itself is usually more affordable than people expect.

With Insurance

Most insurance plans, including Medicare, cover diagnostic hearing evaluations when they're medically necessary. You'll typically pay:

• Medicare: 20% of Medicare-approved amount after meeting your Part B deductible (usually $0-$50)
• Private insurance: Your standard specialist copay ($20-$75 typically) or coinsurance
• Medicaid: Usually fully covered with no out-of-pocket cost

Important: Coverage for hearing aids is separate from coverage for diagnostic evaluations. The evaluation itself is typically covered; hearing aids often are not (though this varies by plan).

Without Insurance

If you don't have insurance or choose to pay out-of-pocket, comprehensive hearing evaluations typically cost $75-$250, depending on location and clinic type. Many audiology practices offer:

• Free hearing screenings (basic tests, less comprehensive)
• Discounted evaluations if you purchase hearing aids from them
• Payment plans for evaluations plus treatment

Call Ahead

Before your appointment, call the clinic and ask:

• "What will my out-of-pocket cost be for a comprehensive hearing evaluation?"
• "Do you accept my insurance?"
• "Do I need a referral or authorization?"

Reputable providers will give you a clear answer. If they can't or won't quote prices, that's a red flag.

Making It Easier: What You Can Do Today

Taking action—even small steps—can help move you forward when you feel stuck. Here are specific things you can do right now.

In the Next 10 Minutes

1. Take a self-screening quiz

The National Institute on Deafness and Other Communication Disorders (NIDCD) offers a quick self-assessment. If you answer "yes" to three or more questions about struggling to hear in various situations, it's worth scheduling an evaluation.

2. Check your insurance coverage

Look at your insurance card or log into your benefits portal to see:

• Do you need a referral to see a specialist?
• What's your specialist copay?
• Are hearing evaluations covered?

3. Make a list of your concerns

Write down specific situations where you struggle: family dinners, work meetings, watching TV, phone conversations. This helps your audiologist understand your real-world challenges.

This Week

1. Find providers near you

Use the American Speech-Language-Hearing Association (ASHA) "Find a Professional" directory to locate certified audiologists in your area. Look for:

• AuD (Doctor of Audiology) credential
• CCC-A (Certificate of Clinical Competence in Audiology)
• Good online reviews from actual patients

2. Call to schedule

When you call, you can ask:

• "How long does a comprehensive hearing evaluation take?"
• "What will it cost with my insurance?"
• "Do I need a referral?"
• "When is your next available appointment?"

3. Tell one person

Share with a trusted friend or family member that you're planning to get your hearing checked. Having someone know about your appointment can provide accountability and support. Many people find it helpful to bring someone to that first visit.

What If You're Still Hesitating?

It's normal to feel uncertain. Many people take time before pursuing hearing care—research shows the average person waits 7-10 years between noticing hearing loss and seeking help. There's no "perfect" time, but there are good reasons not to wait indefinitely:

• Communication challenges don't improve on their own – and they often strain relationships over time
• Earlier intervention supports better outcomes – your brain stays better connected to sounds
• You deserve to stop struggling – exhausting yourself just to follow conversations isn't "managing fine"
• Getting information doesn't commit you to treatment – you can gather facts and decide later

The evaluation itself gives you information. What you do with that information is up to you.

Understanding the Three Common Pathways

Here's a comparison to help you decide which provider to see first:

Provider	Best For	What They Do	Typical Wait Time
Audiologist	Most people with gradual hearing loss	Comprehensive hearing tests, explain results, discuss treatment options including hearing aids	1-3 weeks
Primary Care Physician	Those requiring referrals; ruling out simple issues first	Basic ear exam, remove wax, screen for obvious problems, refer to specialists	Few days to 2 weeks
ENT (Otolaryngologist)	Sudden hearing loss, ear pain, medical issues, asymmetric loss	Medical evaluation, treat infections/medical causes, prescribe medications, perform surgery if needed	1-4 weeks (urgent cases seen sooner)

Common Concerns Addressed

"What if they tell me I need hearing aids and I can't afford them?"

Getting the evaluation gives you information. If hearing aids are recommended, you can:

• Explore insurance coverage (some plans now cover hearing aids)
• Research financing options and payment plans
• Look into assistance programs for low-income individuals
• Consider lower-cost options like Costco hearing aids
• Start with one hearing aid instead of two
• Choose to monitor and revisit treatment later

You're gathering information, not committing to a specific financial decision. See our Financial Assistance Guide for detailed options.

"I'm worried they'll push me into buying something"

Unfortunately, high-pressure sales tactics do exist in hearing healthcare. That's why it's important to choose your provider carefully. Look for:

• Transparent pricing (they tell you costs upfront)
• Trial periods (30-90 days to try hearing aids)
• No same-day pressure (reputable providers expect you to think about major purchases)
• Hospital or university-affiliated clinics (often have less sales pressure)

Learn more in our guide to Choosing an Audiologist.

"What if my hearing is fine and I'm wasting their time?"

If your hearing tests normal, that's excellent news—and not a waste of time. You'll have:

• Peace of mind with concrete data
• A baseline for future comparison
• Information about other possible causes of your symptoms (like auditory processing issues)
• Guidance on protecting your hearing going forward

Healthcare providers see people with varying degrees of hearing loss all the time. Your concerns are valid regardless of test results.