(a) Prior to audiometric testing, the hearing aid dispenser shall:

1. (1) conduct a direct otoscopic observation of the client's ear canals;

2. (2) inquire and/or make general observations regarding any of the following conditions:

   1. (i) visible congenital or traumatic deformity of the ear;
   2. (ii) history of or presence of active drainage from the ear within the previous 90 days;
   3. (iii) history of sudden or rapidly progressive hearing loss within the previous 90 days;
   4. (iv) acute or chronic dizziness;
   5. (v) unilateral hearing loss of sudden or recent onset within the previous 90 days;
   6. (vi) visible evidence of bleeding, significant cerumen accumulation, or presence of a foreign body in the ear canal;
   7. (vii) pain or discomfort in the ear; and
3. (3) inquire as to any additional medical conditions, physical considerations or surgical history with reference to the client's hearing and potential hearing aid use.

(b) Appropriate testing procedures shall include:

1. (1) determination of pure-tone thresholds for each ear, in accordance with prevailing hearing related industry standards, including:

   1. (i) pure-tone air conduction thresholds for each ear;
   2. (ii) masked pure-tone air conduction thresholds if there is a difference of 40dB or more between the air conduction thresholds of the two ears or the air conduction threshold of the poorer ear and the bone conduction threshold of the better ear;
   3. (iii) pure-tone bone conduction thresholds for each ear; and
   4. (iv) masked pure-tone bone conduction thresholds if there is a difference of 15dB or greater between the bone conduction threshold of the better ear and the air conduction threshold of the poorer ear;

2. (2) determination of speech audiometry for each ear including:

   1. (i) the speech recognition threshold (SRT) for each ear (or, if undeterminable, the speech awareness threshold) utilizing appropriate spondaic word lists or other acceptable methods;
   2. (ii) the most comfortable loudness (MCL) for speech for each ear;
   3. (iii) the threshold of discomfort (TD) or uncomfortable level (UCL) for speech for each ear; and
   4. (iv) speech recognition scores for each ear and/or binaurally (as appropriate) utilizing appropriate phonetically balanced word lists or other acceptable methods.