(a)

1. (1) Evaluation of hearing aids must be performed with the hearing aids on the patient.

2. (2) This shall be accomplished either:

   1. (A) In sound field; or
   2. (B) With instruments that objectively measure hearing aid performance with appropriate prescriptive techniques to account for the different means of programming the hearing aid.

3. (3) The preferred verification method of fitting is to use probe microphone measures in conjunction with the patient’s:

   1. (A) Ear;
   2. (B) Ear mold; and
   3. (C) Personal amplification system.
4. (4) A real-ear-to-coupler difference (RECD) can be obtained and probe tube measurement performed in a coupler if a patient is unwilling to tolerate probe microphone measurement in the ear.
5. (5) A prescriptive measure addressing gain should be in place to address the possibility of overestimating or underestimating gain until the patient is five (5) years of age.

(b)

1. (1) First-time hearing aid users under the age of eighteen (18) years must receive medical evaluation and clearance from an otolaryngologist within six (6) months prior to being fitted with a hearing aid.
2. (2) First-time hearing aid users eighteen (18) years or older must be advised of the desirability of a medical evaluation.

3. (3) First-time hearing aid users eighteen (18) years or older should be referred to a physician, preferably one specializing in disorders of the ear if any of the following conditions are present:

   1. (A) Visible deformities of the ear since birth or from injury;
   2. (B) Fluid, pus, or blood coming out of the ear within the previous three (3) months;
   3. (C) Sudden, quickly worsening, or fluctuating hearing loss within the previous three (3) months;
   4. (D) Dizziness;
   5. (E) Hearing loss in only one (1) ear or a large difference in hearing between ears;
   6. (F) Ear wax build up or feeling that something is in the ear canal;
   7. (G) Pain or discomfort in the ear; or
   8. (H) Tinnitus or ringing in one (1) or both ears.