Audiologist, ENT or hearing aid specialist: who to see first

Start with an audiologist if your hearing has slipped gradually and you have no other ear symptoms. The American Speech-Language-Hearing Association (ASHA) recommends seeing a licensed audiologist first for hearing concerns, even if you plan to buy over-the-counter hearing aids ^[1].

See an ENT (ear, nose and throat) physician first if your hearing changed suddenly or comes and goes, or if you have ear pain, drainage, a plugged feeling, pulsing tinnitus or dizziness ^[1]. A hearing aid specialist is a good choice once medical problems are ruled out and what you need is hearing aids fitted and maintained.

The three professionals at a glance

	Audiologist	ENT physician (otolaryngologist)	Hearing aid specialist
Who they are	Hearing health care expert who helps prevent, diagnose and manage hearing problems for people of all ages [1]	Physician who treats diseases of the ear, nose, throat and related head and neck structures, both medically and surgically [2]	State-licensed professional who evaluates hearing and fits hearing aids [3]
Training	Doctor of audiology (Au.D.), typically 4 years [4]. About 7 to 8 years of education and clinical training in all [5]	College and medical school, then a 5-year otolaryngology residency to be eligible for the specialty board exam [2][6]	Formal education or hands-on apprenticeship, then written and practical exams [3]
License	Required in all states [4]	Physician	Licensed by state authorities. Rules vary [3]
Diagnoses hearing loss	Yes [4]	Yes, including medical causes [2]	Evaluates hearing for fitting. Refers to a physician when medical evaluation is needed [3]
Medicine and surgery	No	Yes [2]	No
Fits hearing aids	Yes [4]	Some audiologists work in ENT physicians' offices [5]	Yes [3]

Start with an audiologist if...

ASHA's referral guide sends these situations to an audiologist ^[1]:

• You're worried about your hearing in general, including if you plan to try OTC hearing aids
• One ear seems to hear differently from the other
• You hear ringing, roaring or beeping in one or both ears
• You've taken medications that can damage hearing
• You've had chemotherapy, or radiation to the head and neck. Chemotherapy-related hearing loss often shows up close to treatment, while radiation-related loss can appear later
• Your hearing loss seems worse than mild to moderate

An audiologist visit usually starts with a full diagnostic hearing test. Here's what happens at a hearing test, step by step.

See an ENT physician first if...

ASHA's referral guide sends these to an ENT ^[1]:

• Sudden or fluctuating hearing loss in one or both ears
• Pulsing tinnitus
• Fluid draining from one or both ears in the past 90 days
• Ear pain or discomfort
• A feeling that your ears are clogged
• A visible ear deformity from birth or injury, or an ear that's been changed by surgery
• Dizziness

Sudden hearing loss is urgent. The ENT specialty's clinical guideline calls hearing loss that develops in three days or less "sudden hearing loss" and estimates about 66,000 new U.S. cases a year. It recommends a hearing test as soon as possible, within 14 days of symptom onset. Doctors may offer steroids as a first treatment within two weeks, and prompt recognition and management may improve recovery ^[7]. Don't wait for a routine appointment weeks out. Read what to do in the first 72 hours.

Pulsing tinnitus, a whooshing or thumping in time with your heartbeat, is on the ENT list rather than the audiologist list ^[1]. See pulsatile tinnitus for what it can mean.

When a hearing aid specialist makes sense

Hearing aid specialists, also called hearing instrument specialists, are licensed by the states. Their training is formal education or a hands-on apprenticeship in hearing instrument sciences, followed by written and practical exams ^[3]. They conduct hearing evaluations and screenings, fit and adjust hearing aids, and provide ongoing support. They refer patients to physicians when medical evaluation is needed ^[3]. Some hold an optional board certification, BC-HIS ^[3].

A specialist is a sensible choice when:

• You've had a full diagnostic hearing test recently
• You have none of the ENT red flags above
• Your main goal is getting hearing aids fitted and serviced

Whoever fits your aids, ask whether they verify the fit with real-ear measurement. See how to choose a hearing aid provider for the full checklist.

Who to see first: common situations

Your situation	First stop
You ask people to repeat themselves more and turn the TV up, with no other symptoms	Audiologist [1]
You woke up with muffled or lost hearing in one ear	ENT, urgently [1][7]
Ringing in one or both ears, nothing else	Audiologist [1]
Whooshing or thumping in time with your heartbeat	ENT [1]
Ear pain or fluid draining from the ear	ENT [1]
Your ear feels plugged and doesn't clear	ENT [1]
Dizziness along with a hearing change	ENT [1]
You finished chemotherapy or head and neck radiation	Audiologist [1]
You had a full hearing test in the past year and want hearing aids	Audiologist or hearing aid specialist

Medicare rules that affect who you see

You can see an audiologist without a doctor's order, with limits. Starting in 2023, Medicare allows one visit to an audiologist without a physician order once every 12 months, per beneficiary. It covers certain diagnostic hearing tests for non-acute hearing conditions. It does not include services related to balance problems, hearing aids, or exams for prescribing, fitting or changing hearing aids ^[8]. Tests that your doctor orders aren't subject to that once-a-year limit ^[8].

Hearing aids and fitting exams aren't covered. Original Medicare doesn't cover hearing aids or exams for fitting hearing aids. Some Medicare Advantage plans include extra hearing benefits ^[9]. If you're on Medicare Advantage, check your plan's referral and network rules before booking. Details are in does Medicare cover hearing aids.

Not sure where to start? Your primary care doctor can look in your ears, review your symptoms and send a referral to the right specialist.

What to bring to your first appointment

Whoever you see first, a little preparation makes the visit more useful:

• A symptom timeline. When you first noticed the problem, whether it came on suddenly or slowly, and whether one ear is worse.
• Your medication list, including any past chemotherapy or radiation, since ASHA flags these for audiology follow-up ^[1].
• Noise history. Jobs, military service, shooting, power tools or loud music.
• Old hearing test results, if you have them, so the new results can be compared.
• Insurance cards and any referral your plan requires.
• A companion. A family member can describe what they've noticed at home and help you remember what was said.

Questions to ask when you call

• Will an audiologist or a hearing aid specialist do my test?
• Is it a full diagnostic hearing test or a screening?
• Do I need a referral for my insurance or Medicare to pay for the test?
• If you find something that needs medical care, who do you refer to?
• Do you also sell hearing aids? Will I get a copy of my results either way?

When you're ready to book, search our directory of audiologists and hearing aid centers by ZIP code or city.