By the Division of Professional Licensure

Board of Registration of Hearing Instrument Specialists

The Board of Registration of Hearing Instrument Specialists is one of 33 professional and occupational licensing boards within the Division of Professional Licensure. The Board oversees the examination and licensing of those professionals who are in the practice of fitting and dispensing hearing aids by measuring human hearing solely for the purpose of making selections, adaptations or sales of hearing aids intended to compensate for impaired hearing.

Hearing Instrument Specialists are individuals who engage in the practice of dispensing in or fitting hearing aids. The practice of fitting and dispensing hearing aids means the measurement of human hearing solely for the purpose of making selections, adaptations or sales of hearing aids intended to compensate for impaired hearing. The Board of Registration of Hearing Instrument Specialists protects the public through regulation of the practice and the title of Hearing Instrument Specialist in the Commonwealth of Massachusetts in accordance with the statutes.


Signs of a Hearing Loss

  • You strain to hear normal conversation
  • You misinterpret or misunderstand what others say
  • Other people sound as if they are mumbling
  • You are told that you constantly have the radio or television turned up too loud
  • You constantly ask people to repeat themselves
  • Your ears ring or you experience episodes of dizziness

Consumer Tips

Thinking about purchasing a hearing aid? Here are some suggestions:

Consider getting an ear examination

The Food and Drug Administration (FDA) recommends that you have your ears examined by a licensed physician. Ear examinations are universally recommended by the medical community to ensure there are no underlying diseases or medical problems causing the hearing loss. A hearing loss may be a symptom of another medical problem that needs a doctor's attention. Also, the cause and severity of a hearing loss vary widely from person to person. However, The American Academy of Otolaryngologists, Head and Neck Surgeons (AAO-HNS) has developed a list of 8 guidelines. A licensed professional should recognize these signs and if they are present suggest that you see a physician.

  1. Visible or congenital deformity of the ear.
  2. A blockage of cerumen or other foreign matter that completely occludes the ear canal.
  3. Fluid or drainage from the ears.
  4. Sudden onset of hearing loss within the past 90 days.
  5. A unilateral hearing loss (occurring on only one side) that either happened or worsened within the previous 90 days.
  6. Spells of acute or chronic dizziness.
  7. Pain or discomfort in your ears.
  8. A difference in testing resulting in an air-bone gaps at 500Hz, 1,000Hz, and 2,000Hz of at least 15 decibels.

At present, a person who is 18 years of age or older may according to Food and Drug Administration regulations sign a medical waiver stating that they do not wish to see a physician. Examples of why a person might sign a waver are: symptoms listed are not present, they already know that they have a hearing loss, or for religious reasons. There must be a statement on the purchase agreement stating that this is not in your best health interest.

Get a hearing evaluation from a hearing instrument specialist or an audiologist. Have your hearing tested to assess your ability to hear with and without hearing aids. This test will enable a hearing instrument specialist or audiologist to select and fit a hearing aid to your individual needs.

Check out the dispenser

( The term "dispenser" refers to anyone dispensing hearing aids, whether the person is a hearing instrument specialist or an audiologist.)

Before you buy, check the reliability of local hearing aid dispensers with your local Better Business Bureau (BBB), consumer protection agency, licensing board, or state attorney general. Ask if there are any complaints on file, and how the company or professional has responded to the complaint.

Ask the hearing instrument specialist about a trial period. Many manufacturers, hearing specialists, and consumer groups recommend, that consumers be given a 30-day trial period with only a service fee (varying from 5-20% of the purchase price) if the consumers return the product. This fee covers the evaluation of your hearing, the hearing instrument, fitting the instruments and adjustments that have been made.

If you purchase hearing instruments in your home, you have the right under the FTC's Sales Rule to cancel within three business days of any sale for $25 or more. The sale may take place in your home, or at a location that is not the seller's regular place of business.

If you are considering purchasing hearing instruments through the mail, consider the difficulty of getting the right hearing aid for your needs and a proper fit, which can not be done through the mail. Although there is no federal law against the mail order sale of hearing aids, several states have banned hearing aid sales by mail. In states that do allow the sale of aids by mail, the transaction is subject to the FTC's Mail Order Rule. This rule requires companies to ship purchases made by mail when promised or give consumers the option to cancel their order for a refund.

Be aware of sales practices

Avoid being pressured into buying a hearing aid. As with any other medical decision, you should be given the opportunity to seek additional information or a second opinion. Sales personnel using high-pressure approaches demonstrate little concern for your well being.

Purchase Agreements

The hearing aid purchase agreement, or contract, should contain all terms of the transaction in writing, including an explanation of all verbal promises. In reviewing your agreement, remember to consider the following:

  • Is there a written warranty?
  • Is the warranty honored by the manufacturer or by the dispenser? (In some cases warranties by the manufacturer may not be recognized unless the hearing aid is purchased from a seller authorized by the manufacturer.)
  • What services, if any, will be provided free of charge, and how long will they be provided?
  • Will you receive a "loaner" if your hearing aid needs to be repaired?

Do business with a dispenser who will clarify these details and put all verbal commitments into the written contract.


The Hearing Aid

The hearing aid consists of:

  • A microphone which picks up sound waves and converts them into electrical signals;
  • An amplifier which increases the strength of the signal;
  • A battery which provides the energy to operate the hearing aid;
  • A receiver which changes the electrical signals back to sound waves; and
  • A specially fitted ear mold which connects the receiver to the ear canal

Types of Hearing Aids

A hearing aid can be used for only one ear (monaural hearing aid) or two complete hearing aids, one for each ear, can be used (binaural hearing aid system). Today, most dispensers and physicians have realized that there are many more benefits of being fit with binaural instruments when warranted, as this is closer to the natural position. There are many advantages to binaural hearing including but not limited to:

  1. Better ability to discriminate sounds in noise
  2. More restful listening
  3. Better ability to tell direction of sound
  4. Ability to use less power to achieve the same or better results
  5. Less distortion of sound

The basic types of hearing instruments include:

The "in the ear" aid which fits directly into the ear, with part of it extending into the ear canal. These aids have no external wires and are lightweight. The "in the ear" aid is generally effective for very mild to severe hearing loss. There are also types of "in the ear" aids called semi-concha aids, in the canal hearing aids and completely in the canal hearing aids ( which have advantages of their own.). The more severe the loss, generally the larger the instruments need to be. For "in the ear" aids, an ear mold is not required; the aid is shaped to fit the individual's ear canal.

The "behind the ear" aid is a hearing aid of varying sizes that fits snugly behind the ear. The microphone, amplifier and receiver are in one unit connected to the earmold by a short plastic tube. This type of aid is suitable for hearing losses that now range from early losses to profound. Sometimes, they can be more cosmetic as they often can be matched to hair color.

The "eyeglass" and "body aid" types, though still in use for some circumstances have generally gone out of use and account for less than 1% of all instruments currently dispensed.

The "completely in the canal (CIC)" type of in the ear aid. As the name implies, this type of instrument sits much further into the ear canal. The advantages of this type of hearing instrument include that they are cosmetically nearly invisible, have a reduction of feedback or whistling sounds, better directionality of sound and a reduction of wind noise. You also can achieve more power for some losses as they sit closer to the eardrum. These devices are also not correct for all types of hearing losses or individuals.

All types of hearing aids can also be improved by the addition of more advanced technologies including: multiple memories, to allow for specific listening situations; multiple channels, for better processing of sound; multiple microphones, to aid in better perception of sound in noise or at a distance; telecoils for better performance on the telephone and other options. Digital technology is also available today in all styles of instruments, which will generally give the clearest reproduction of sound, can be completely automatic and make millions of calculations/second.

Assistive Listening Devices

These are devices which can also help to make your life easier and are sometimes used in conjunction with hearing aids and sometimes the hearing aids will be removed for certain situations. There are many types of Assistive Listening Devices including:

Infrared or FM systems - which give a better response for areas such as watching TV, theaters, churches and synagogues, and even in some meeting rooms or classrooms.

Light Signaling devices - can be used to alert a person that a phone is ringing, a doorbell is ringing, a baby is crying or even that someone is knocking at a door .

Bed vibrators - are very useful for the hearing impaired who cannot hear an alarm clock , as the hearing aids are taken out at night. These are designed to plug into specially made clocks and will vibrate the bed or pillow when the alarm goes off. The clocks can also be used with a light that will flash, a louder sound, or a combination.

Amplified telephones, portable amplifiers, and handsets - can also be very helpful to the hearing impaired in some situations where the noise level may be too high.

TTY or TDD - These are phones that allow a hearing impaired person to read type on a screen or have it printed out which is sometimes easier than trying to understand on the phone. Both parties must have a TTY or use a relay service. For a relay service an operator will place a call, and after a voice response, type it back to the hearing impaired person's TTY, and then relate a typed message back to the person using voice only.

Amplified ringers for phones- will allow for the sound of the ring to be made louder and in some cases will allow for the tone of the ring sound to be changed.

There are many other types of Assistive Listening Devices and as a hearing impaired individual, you may be entitled to these at your place of business, in hotels and other public places under the Americans with Disabilities Act. However, you must ask for these devices. If you are attempting to help someone who is hearing impaired, it is suggested that you consult with the individual before installation. A properly trained dispenser should be able to provide information for you about these devices and be able to get them for you.


Selecting a Hearing Aid

There is no single hearing aid suitable for all types of hearing loss. The type of aid best for you will depend on the nature and extent of your hearing loss.

In selecting a hearing aid, you should not be overly influenced by the price or the appearance of the aid. An inexpensive hearing aid of poor quality is of no use if it constantly needs to be repaired.

On the other hand, you may find satisfaction with an aid that is moderately priced. A tiny hearing aid that is inconspicuous will have little value if it does not amplify sound adequately to suit your needs. The main goal is to select an aid that will provide you with maximum help.


Do's & Don'ts of Hearing Aids

  • Do wear your hearing aid on a regular basis.
  • Do clean your hearing aid daily.
  • Do store your hearing aid away from small children or pets.
  • Do open your battery door leaving the battery in the door at night.
  • Do remove the battery when storing for extended periods.
  • Do carry spare batteries with you or keep them in various locations, but not where they come into contact with metal objects such as keys or coins. There is no longer a need to keep the batteries in the refrigerator.
  • Do take the time to get used to a hearing instrument, especially if you are a new user. There will be an adjustment period for both you and your family or friends. Even experienced users will have an adjustment period if they purchase instruments of a better technology.
  • Do tell your hearing instrument specialist if there is a problem or if the treatment.
  • Do not let your hearing aid get wet.
  • Do not drop your hearing aid.
  • Do not expose your hearing aid to excessive heat or moisture.
  • Do not continue wearing your hearing aid if irritation or soreness develops.
  • Do not use hairspray while wearing your hearing aid.
  • Do not put off getting a hearing aid if you suspect a hearing loss.

Filing a Complaint

While the majority of hearing instrument specialists conduct themselves as true professionals, the Division of Professional Licensure will take action against those who fail to maintain acceptable standards of competence and integrity.

In many cases, complaints are made by dissatisfied consumers - but, dissatisfaction alone is not proof of incompetence or sufficient grounds for disciplinary action.

If you have a serious complaint against a hearing instrument specialist, call or write the Division's Office of Investigations and ask for a complaint form. Or download a copy of the complaint form pdf format of    Application for Complaint Form  .

Division of Professional Licensure
Office of Investigations
1000 Washington Street, Suite 710
Boston, Mass. 02118
(617) 727-7406