Becoming a computer technician is a great point of entry into the IT field. In addition, computer hardware certifications can help demonstrate your knowledge and competency in maintaining computers, mobile devices, printers and more. Below, you’ll find our pick of six computer hardware certifications to help you get your IT career off the ground.

Although we cover our favorite hardware certifications here, the idea that hardware can operate independently of software (or vice versa) isn’t true. If you dig into the curriculum for any specific hardware-related certs in any depth, you’ll quickly realize that software is in control of hardware.

Software comes into play for installation, configuration, maintenance, troubleshooting and just about any other activity you can undertake with hardware. The hardware label simply indicates that devices are involved, not that hardware is all that’s involved.

Job board search results (in alphabetical order, by certification)

Differing factors, such as specific job role, locality and experience level, may impact salary potential. In general, hardware professionals can expect to earn somewhere in the mid-$60,000s. SimplyHired reports average earnings at $71,946 for IT technicians, with highs reported at almost $116,000. The average national salary for computer hardware technicians ranges from about $31,000 to more than $53,000. However, some certifications command higher salaries. Certification Magazine’s “Annual Salary Survey” (Salary Survey 2018) average salaries for CompTIA Server+ at $98,060 and the A+ credential at $97,730.

CompTIA A+

The CompTIA A+ certification is the granddaddy and best known of all hardware credentials. For anyone serious about working with PCs, laptops, mobile devices, printers or operating systems, the A+ should at least be on their radar, if not in their game plan.

Since the first A+ credential was awarded in March 1993, the program continues to draw active interest and participation. With more than 1 million IT professionals now possessing the A+ credential, it is something of a checkbox item for PC technicians and support professionals. It also appears in a great many job postings or advertisements.

A+ is also ISO 17024 compliant and accredited by ANSI. Thus, this credential must be renewed every three years in keeping with concomitant requirements for continuing education or regular examinations to maintain certification currency. Some 20 continuing education units (CEUs) are required for renewal.

Earning an A+ from CompTIA involves passing two exams: 220-901 and 220-902. test 220-901 focuses on hardware, networking, mobile devices, connectivity and troubleshooting. test 220-902 draws on knowledge of installing and configuring common operating systems (Windows, Linux, OS X, Android and iOS). It also covers issues related to cloud computing, security and operational procedures. Candidates will find a variety of question formats, including standard multiple-choice, drag-and-drop and performance-based questions on these exams.

Candidates who earn the A+ often find themselves in job roles that include technical support specialist, field service technician, IT support technician, IT support administrator or IT support specialist. The A+ is recognized by the U.S. Department of Defense (in DoD Directive 8140/8570.01-M). Also, technology companies, such as Ricoh, Nissan, Blue Cross Blue Shield, Dell, HP and Intel, require staff to earn the A+ certification to fill certain positions.

The A+ certification encompasses broad coverage of PC hardware and software, networking and security in its overall technical scope.

A+ Facts and Figures

ACMT: Apple Certified Macintosh Technician

Given the popularity of Apple products and platforms, and widespread use of Macintosh computers in homes and businesses of all sizes, there’s demand galore for Mac-savvy technicians.

The AppleCare Mac Technician (ACMT) 2018 credential is Apple’s latest hardware-related ACMT certification. (The credential was formerly called the Apple Certified Macintosh Technician or Apple Certified Mac Technician.) Per Apple, the ACMT 2018 “qualifies a technician to repair all the Mac products that were covered by prior ACMT certifications, plus all other Mac products that were produced before April 2018.” Technicians with the ACMT certification who work at an Apple-authorized service facility are allowed to perform service and repairs.

The ACMT’s two required exams are the Apple Service Fundamentals and the ACMT 2018 Mac Service Certification. Service Fundamentals focuses on customer experience skills, ESD and safety, troubleshooting and deductive reasoning, and product knowledge. The Mac Service test covers troubleshooting and repair of Mac hardware (mainly Apple iMac and MacBook Pro systems). Note that the Apple Service Fundamentals test is also required for the Apple Certified iOS Technician (ACiT) 2018 certification.

The ACMT 2018 is a permanent credential and does not require annual recertification. However, as new products are added to the Apple portfolio, AppleCare will make associated courses available through Apple Technical Learning Administration System (ATLAS). You must complete these courses to service new products.

ACMT Facts and Figures

BICSI Technician and Registered Communications Distribution Designer

BICSI is a professional association that supports the information and communications technology (ICT) industry, mainly in the areas of voice, data, audio and video, electronic safety and security, and project management. BICSI offers training, certification and education to its 23,000-plus members, many of who are designers, installers and technicians.

BICSI offers several certifications aimed at ICT professionals, who mainly deal with cabling and related technologies. Two credentials, the BICSI Technician and the BICSI Registered Communications Distribution Designer (RCDD) are pertinent (and popular) in this story.

The BICSI Technician recognizes individuals who lead an installation group or team, perform advanced testing and troubleshooting of cable installations, evaluate cabling requirements, recommend solutions based on standards and best practices, and roll out new and retrofit projects. Technicians must be well versed in both copper and fiber cabling.

Candidates need a good deal of knowledge about the hardware, networking devices and communications equipment to which they connect cables.

To earn the credential, candidates must pass a single two-part test consisting of a hands-on practical evaluation and a written exam. In addition, candidates must possess at least three years of verifiable ICT industry installation experience within the past five years. Credentials are valid for three years. Certification holders must earn 18 hours of continuing education credits (CECs) in each three-year credentialing cycle and pay the current renewal fees to maintain this credential.

Interested candidates should also check out other BICSI certifications, such as the Installer 1 (INST1), Installer 2 Copper (INSTC) and Installer 2 Optical Fiber (INSTF).

An advanced credential, the Registered Communications Distribution Designer (RCDD) is so well respected that the Department of Defense Unified Facilities requires RCDD for all telecom-related design projects. The RCDD is geared toward experienced ICT practitioners with at least five years of ICT design experience. Alternatively, candidates who do not have the requisite experience but who possess at least two years of design experience plus three years of knowledge “equivalents” (combination of approved education, certifications or education), may also sit for the exam. All experience must have been within the preceding 10 years.

RCDD candidates should be able to create and prepare system design specifications and plans, as well as recommended best practices for security design requirements, for business automation systems. RCDDs are also well versed in data center, cabling systems and design for wireless, network, and electronic security systems.

To earn the credential, candidates must meet the experience requirements, submit the application plus credentialing fees, along with a current resume. In addition, candidates must submit four letters of reference two of which much be from current or former clients. One reference may be personal while the remaining references must come from the candidate’s employer.

Other advanced BICSI certifications include the  Outside Plant (OSP) Designer, Data Center Design Consultant (DCDC) and Registered Telecommunication Project Manager (RTPM).

BICSI Technician Facts and Figures

BICSI Registered Communications Distribution Designer (RCDD) Facts and Figures

CTT Routing & Switching: Cisco Certified Technician Routing & Switching

Cisco certifications are valued throughout the tech industry. The Cisco Certified Technician, or CCT, certification is an entry-level credential that demonstrates a person’s ability to support and maintain Cisco networking devices at a customer site.

The Routing & Switching credential best fits our list of best computer hardware certifications, and it serves as an essential foundation for supporting Cisco devices and systems in general.

The CCT requires passing a single exam. Topics include identification of Cisco equipment and related hardware, such as switches and routers, general networking and service knowledge, working with the Cisco Technical Assistance Center (TAC), and describing Cisco IOS software operating modes. Candidates should also have a working knowledge of Cisco command-line interface (CLI) commands for connecting to and remotely servicing Cisco products.

CCT Routing & Switching Facts and Figures

CompTIA Server+

CompTIA also offers a server-related certification, which steps up from basic PC hardware, software, and networking Topics to the more demanding, powerful, and expensive capabilities in the same vein usually associated with server systems.

The CompTIA Server+ credential goes beyond basic Topics to include coverage of more advanced storage systems, IT environments, virtualization, and disaster recovery and business continuity topics. It also puts a strong emphasis on best practices and procedures for server problem diagnosis and troubleshooting. Although Server+ is vendor-neutral in coverage, organizations such as HP, Dell, Intel, Microsoft, Xerox, Lenovo and HP use Server+ credentialed technicians.

Those who work or want to work in server rooms or data centers, with and around servers on a regular basis, will find the Server+ credential worth studying for and earning. It can also be a steppingstone into vendor-specific server technician training programs at such companies as those mentioned above, or with their authorized resellers and support partners.

Note that the CompTIA Server+ test is still listed on that organization’s website as “good for life,” meaning it does not impose a renewal or continuing education requirement on its holders. The SK0-004 launched on July 31, 2015. Typically, exams are available for at least two years. If CompTIA’s revision history for Server+ is any guide to future updates and revisions, then it’s likely that we’ll see a new test making an appearance sometime before the end of 2019.

Server+ Facts and Figures

Beyond the Top 5: More hardware certifications

There are many more hardware-oriented certifications available that you might want to consider. As you get into IT and start to develop a sense of your own interests and observe the hardware systems and solutions around, you’ll be able to dig deeper into this arena.

You can investigate all the major system vendors (including HP, Dell, IBM, and other PC and server makers) as well as networking and infrastructures companies (such as Juniper and Fortinet) to find hardware-related training and certification to occupy you throughout a long and successful career.

Although ExpertRating offers many credentials, we rejected them after viewing several complaints regarding the general quality of the courses. Obviously, such complaints are from disgruntled customers but were enough to make us proceed with caution.

This is also an area where constant change in tools and technology is the norm. That means a course of lifelong learning will be essential to help you stay current on what’s in your working world today and likely to show up on the job soon.

The launch of Apple’s iPhone 14 range has not gone to plan, with sales of non-Pro models underwhelming and an unusually high number of bugs. And now Apple has confirmed yet another problem impacting the range.

In a memo sent to authorized retailers, first seen by MacRumors and which I have subsequently seen and Tested via an Apple partner, Apple has acknowledged a widely reported bug with SIMs. Affected iPhone 14 models display a “SIM Not Supported” error message, then the phones freeze, rendering them unusable until they are hard reset. But there is some good news.

In the memo, Apple states it is investigating the problem, and while a fix still awaits, the company did confirm the issue is not hardware-related. This means it can be fixed by software, so a recall of impacted iPhone 14 models will not be required. Until a fix arrives, Apple recommends that iPhone 14 owners try waiting because, in some cases, the error message will disappear, and the phones become responsive again.

That said, Apple does warn against hard resetting your new phone, which has been the most popular course of action. Instead, you should take your iPhone 14, iPhone 14 Plus, iPhone 14 Pro or iPhone 14 Pro Max to an Apple Store or authorized retailer for assistance.

For now, confusion surrounds the problem because iPhone models sold in the US do not have a physical SIM card slot. Consequently, it is unclear whether the issue is limited to eSIM or simply a software bug that has nothing to do with the SIM/eSIM malfunctioning.

Either way, this is just the latest in a long line of problems to hit the iPhone 14 range, including iMessage and FaceTime authentication errors, CarPlay and data migration bugs, random reboots, glitches with the Dynamic Island, Lockscreen and high battery drain — the latter of which appears to be impacting a lot of older iPhones as well after updating to iOS 16.

So if you plan to upgrade to an iPhone 14 model, my advice is to wait until Apple has resolved more of these issues. The first market is iOS 16.1, which launches in late October and should come with a lot of fixes. Until then, Apple has its work cut out.

___

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We may be thankful our government takes on the never-ending and thankless task of trying to get the citizens of this formerly great nation (only extremists want it great again) to do what we are supposed to do.

Green New Deals and electric cars get the bulk of the attention, but nothing evades the gimlet eye of our contemporary nannies. I refer to a conference on “hunger, nutrition and health” coming up at the White House. As part of this affair, the continuing problem with food labeling once again comes to the fore.

Faithful readers might remember, about 18 months ago, I commented on the great advances in food labeling taking place since I was a kid in the dark unenlightened days of the ’50s. As any of you who go shopping are aware, there is no end of helpful stuff printed on the sides and backs of about anything you buy not found in the fresh foods aisles. This has all been mandated, with ever increasing stringency, over the decades. We label applesauce, apple pie filling, apple juice — when do we finally mandate a label on the apple?

Alas, as the president for the delightfully yclept “Center for Science in the Public Interest points out, “…it’s clear that it’s not having the desired impact to advance the public health.” When all this labeling info was mandated, it was asserted the consumer, being health and safety conscious, would adjust his diet to conform to the latest (latest is important because they keep changing) suggestions.

Unfortunately, that hasn’t happened. We just keep eating more and getting fatter and dying from COVID as a result, not to mention a host of other problems. Spearheaded by Democrats in Congress, legislation is proposed requiring warnings about certain ingredients, and to cause those warnings to migrate from the side of the can to the front. One suggestion is to make icons in the shape of a stop sign, and put red, yellow and green backgrounds to make  apparent the severity of the risk.

Story continues

Inevitably, manufacturers don’t want to clutter up their labels with stop signs. Those darn manufacturers just don’t care about “public interest” do they? They even have the temerity to suggest that since, admittedly, hardly anyone pays any attention now, why will cluttering up the carefully designed label make any difference?

They are of course, even though for selfish reasons, correct. We consumers just continue to go on our merry way, drinking sugar, eating fat, sprinkling salt and heaven knows what else in defiance of what our betters are quite sure is proper for us. Why? I, for example, LIKE sugar and fat. It tastes good. So I’m 15 pounds overweight? So what! I might live another two or three years, into my 90s, with Alzheimer's in the home. I’ll pass, thank you. The destination is always the same, so I prefer, in moderation, to enjoy the journey.

As the folks at the “Center” surely know, front of label will be as ignored as side or back.

Fortunately, years ago when I took a stab at a futuristic novel, I had come up with the solution. By 2060 (when I set the novel) every transaction will be done electronically. Cash will be banned. Therefore, every time a shopper goes to the store, everything the shopper buys will be recorded. Also, every health metric for the shopper will  be in the massive data banks then, as now, routinely maintained. So, let us say you are a 40-year-old female, for which exists a profile of the proper diet. At the beginning of each month, said female will be given a list of what she may — or may not — buy. Anything not on the list, or in quantities greater than permitted, simply cannot be purchased. Rationing during World War II was a crude version of this.

Mandatory physical exams monitor results, with modifications made as necessary. See how simple this is? We supply tickets for failing to wear seat belts. Why not tickets for failing to eat right?

Charles Milliken is a professor emeritus after 22 years of teaching economics and related subjects at Siena Heights University. He can be reached at milliken.charles@gmail.com.

This article originally appeared on The Daily Telegram: Charles Milliken: Food labeling guidelines are not enough

People with mild to moderate hearing loss can now obtain medical-grade hearing aids without a prescription or a specialist's help, slashing the cost by hundreds or thousands of dollars.

A new Food and Drug Administration rule went into effect Monday, vastly expanding the market for over-the-counter hearing aids. Dozens of previously approved devices will now be available without a prescription or a professional consultation. (If you're under 18 or suffer severe hearing loss, you will still need to see an otolaryngologist or audiologist.)

The move is expected to bring hearing aids to more retail outlets where consumer electronics are sold, as well as drawing more mainstream manufacturers into the field. One of the first to jump in is Sony Electronics, which announced its first two hearing aid models last week.

By making it easier and less expensive to obtain hearing aids, experts say, many of the millions of Americans with untreated hearing loss may finally take action.

"Everybody loses hearing as you get older. That’s just a fact of life," said Dr. John Oghalai, an otolaryngologist with Keck Medicine of USC. It's worse for some people than others, he added, noting that certain forms of hearing loss are hereditary.

The National Institute on Deafness and Other Communication Disorders estimates that 1 in 8 Americans age 12 or older — about 30 million people — has lost some hearing in both ears. But people who've been told they need hearing aids typically wait five to seven years to get them, said Barbara Kelley, executive director of the Hearing Loss Assn. of America.

Here's one other thing to consider. Equipping yourself with a hearing aid isn't as simple as buying practicing glasses. It will require more tech savvy, more patience and — even in the new era of over-the-counter devices — more money.

The devices aren't cheap — prices start around $800 — and insurance plans may not cover them. Medicare, for example, doesn't pay for hearing aids or exams, although some Medicare Advantage plans might.

Nevertheless, the cost should be far lower with an over-the-counter sale than it would be to buy the same hearing aid through a specialist.

The Times talked to medical experts, consumer advocates and industry insiders for tips on what to expect.

How do I know if I need a hearing aid?

Sound waves traveling through your ear canal cause your eardrum to vibrate. Those vibrations send signals through the tiny bones in your inner ear to the fluid-filled cochlea, where they're transformed into electrical signals that stimulate your auditory nerves. A variety of factors — age, disease, injury, hygiene — can interfere with that signal chain, dimming or even obliterating sounds you once heard clearly.

Typical symptoms of mild to moderate hearing loss include having trouble hearing people on the phone, turning up the TV volume so much that other people complain, becoming tired from listening and hearing but not being able to understand conversations when there's background noise. Often, Kelley said, your companions will notice your hearing issues before you do.

Oghalai said that if you don't find yourself in many group settings — you don't eat out often or don't get called into many meetings — then you may not need hearing aids. Not everyone needs the same level of hearing functionality.

Further, some hearing problems aren't the kind you can resolve with over-the-counter gadgets. The FDA says that if you can't make out voices even when the room is quiet, or if you can't hear loud music, power tools or other high-volume noises, your hearing loss is too severe for nonprescription devices to address.

Plus, the FDA says, some issues — including blood or fluid leaking from the ears, a sudden change in hearing, problems in one ear but not the other, vertigo or hearing loss that worsens and then gets better — are a sign of medical problems that need professional attention.

So how can you tell if your ears aren't delivering the goods? An audiologist will typically put you in a soundproof booth, then determine how loud a sound has to be at a number of frequencies (that is, pitches) before you can detect it. That will produce a graph showing the frequencies in which you've suffered loss, as well as how significant the loss is.

As hearing aids move to over-the-counter sales, those tests will shift to the web and smartphone apps. You can see an example of a self-administered hearing test at Soundly.com, a Los Angeles-based site that sells hearing aids. The result is a graph showing how your left and right ear should detect sound at various frequencies and how well they actually do.

Be sure to take the test in a quiet room — the whoosh of air conditioning and the rumble of traffic could throw off your results.

Everyone's ears are unique, as are their hearing issues. But if you're an older person experiencing presbycusis (age-related hearing loss), it's probably increasing as the sound frequency rises, said Dr. Nina L. Shapiro, an otolaryngologist at UCLA's David Geffen School of Medicine.

Shapiro illustrated this point with a fun fact: "Older individuals tend to have a harder time hearing female voices, because they're higher pitched." (Insert your aging married couple joke here.)

I've tested my hearing. What else will I have to do?

The other main service you would get if you went to a hearing professional is a custom "fit." That refers to how well the hearing aid matches your hearing loss, not to how good it feels in your ear (which we'll get to in a minute).

Most hearing aids work by cranking the volume on the sounds reaching the eardrums. They have one or two miniature microphones and an amplifier that feed a tiny speaker wedged into your ear canal.

High-end hearing aids can be adjusted to provide more amplification in the specific frequency bands where you need it and less in the ones you don't. The lower-end models aren't as programmable; instead, they tend to offer a few optional settings to adapt the amplification to various environments, such as to help you understand speech in a noisy room.

The simpler devices "will be a fine solution for many people who don't even know they have hearing loss," Shapiro said.

Soundly Chief Executive Blake Cadwell predicts that most over-the-counter products will connect via Bluetooth to a smartphone app that will administer a hearing test, then customize the hearing aids to match hearing loss. Some apps will tune the hearing aids automatically in response to the test results; others will require the user to adjust settings in the app.

For example, if you buy the new Jabra Enhance Plus, the first thing you'll do after putting them in your ears is connect them to the app and take a hearing test. The app will use those results to fit the hearing aids to your needs, while allowing you to switch to different presets according to social situation.

Taking the hearing specialist out of the equation is expected to cut more than half the cost of obtaining hearing aids, and it's something consumers welcome, Cadwell said. According to a study by the consumer electronics company Bose, hearing aid customers "were happier with their outcomes when they were in control" of the settings, he said.

Unlike eyeglasses, however, hearing aids don't make an immediate difference in your senses.

"Your brain has to get used to being able to hear again," said Calum MacDougall, a marketing executive at Jabra. "It takes time and adaptation."

In other words, it takes patience and, possibly, fine-tuning and adjustment.

Hearing aids also need to physically fit well to be effective and comfortable. On that front, different styles present different challenges. Some models put most of the electronics behind the ear, then run a wire or tube to a receiver in the ear canal or fit it into the outer ear. Others sit visibly in the ear, like earbuds, and others are inserted completely into the ear canal.

Given these factors, Cadwell said, it's important to recognize how much support consumers will require after they buy over-the-counter devices. When Soundly vets products, he said, it asks manufacturers whether they will have an audiologist on staff and a team of people ready to take customers' calls.

MacDougall said Jabra — whose owner, the Danish company GN, also makes prescription hearing aids sold under the ReSound and Beltone brands — recognizes that over-the-counter devices will require a lot more customer support than the smartphone earbuds it sells. Among other things, the company plans to offer in-person help for Jabra Enhance Plus buyers at its Beltone stores, MacDougall said, adding, "We're going to hold your hand much farther through the process."

Who'll make them, and where will I find them?

Hearing aid manufacturers are allowed to offer at least some of their previously prescription-only devices as over-the-counter products, and Cadwell predicts that a number of them will do so.

"I don't know that we're going to have any large, unexpected players who are not active in this space today," he said.

The hearing aid market is dominated by five companies that sell products under dozens of names; aside from Jabra, none are familiar consumer brands. Consumers who are used to paying $100 to $200 for earbuds also won't recognize the prices: A set of Lexie B1 hearing aids, which the FDA approved for over-the-counter sale, lists for $899.

Before today, the products were sold mainly in places with hearing specialists, such as an audiologist's office or Costco hearing center. But electronics superstore Best Buy and pharmacy chain Walgreens have announced that they will carry over-the-counter hearing aids, and other big-box retailers and pharmacists are expected to follow suit.

One big question is whether Apple will jump in and disrupt the market the way it did with MP3 players and smartphones. It hasn't announced a hearing aid, but it has added technology to its AirPods Pro line to help people with mild to moderate hearing loss.

While Apple's products are designed first and foremost for phone calls and music, they are influencing the hearing aid market, MacDougall said. Apple not only popularized the earbud style, he said, but normalized the sight of people wearing earbuds all the time — even when interacting socially.

Is there a cheaper alternative?

In addition to prescription and over-the-counter hearing aids, there is a third type of hearing device, a personal sound amplification product. While it looks like a hearing aid, it sells for a much lower price — less than $50 in some cases.

Cadwell is not a fan.

"It amplifies sounds without taking into consideration your individual fingerprint of hearing loss," he said.

The devices might come with a few presets to emphasize different frequency bands, he said, but otherwise they just make everything louder.

"You definitely can hear more, because the world just got turned up," he said. But in busy environments, that can make the world more confusing.

Oghalai shared Cadwell's concerns.

"These things are actually kind of dangerous," he said, because they amplify everything and may not block sounds that are loud enough to cause damage.

What features should I look for?

Here are some things to consider when comparing the first crop of devices:

• Physical comfort. Does the device fit comfortably in your ear? How big is it, and how much does it weigh? Is it easy to remove and clean? If you plan to wear it all day, these considerations matter a lot more than if you'll be using it intermittently.
• Battery life. This will also be a priority if you'll be wearing it for long periods. The FDA requires that hearing aid packages indicate the type and number of batteries required, and whether the batteries are rechargeable. You'll also want to know how long the device is expected to work on a single charge; products typically support at least one full day of use, Cadwell said, with rechargeable batteries becoming the norm.
• App features. Can the app program the hearing aids to automatically match your hearing loss? What sort of presets are available to adapt to different environments? Is the app available for your type of phone?
• After-sale support. Does the manufacturer offer the sort of expert guidance a hearing specialist would provide? How, where and for how long is the support available?
• Returns and exchanges. Kelley said you should check whether the manufacturer has a return policy and, if so, what it entails. You don't want to buy a device that doesn't meet your needs, then have no help from the manufacturer to figure out whether a different model or approach would do the trick.
• Connectivity. Some, but not all, hearing aids can connect to your phone and other Bluetooth-capable devices for calls and streaming audio. Also, some have telecoils that can connect directly to the audio feeds at theaters and other public spaces, blocking out background noise.

It's important to remember that the market for these devices is in its infancy. Although millions of Americans might benefit from hearing aids, there's no telling how many will buy over the counter. If the field draws in more consumer electronics companies, Kelley said, all sorts of innovation could ensue.

"Fifteen years ago, who would have thought that we could hold our computer, phone and TV in our hand?" she said. "That's what this new market will allow for as well."

This story originally appeared in Los Angeles Times.

Gregory A. Hood, MD, remembers a patient of his who was perpetually dubious about COVID-19 — and then couldn't be saved.

"I spoke to him on many occasions about the dangers of COVID, but he just didn't believe me," said Hood, an internist in Lexington, Kentucky. "He just didn't supply me enough time to help him. He waited to let me know he was ill with COVID and took days to pick up the medicine. Unfortunately, he then passed away."

The Rise of the Skeptical Patient

It can be extremely frustrating for doctors when patients question or disbelieve their physician's medical advice and explanations. And many physicians resent the amount of time they spend trying to explain or make their case, especially during a busy day. But patients' skepticism about the validity of some treatments seems to be increasing.

"Patients are now more likely to have their own medical explanation for their complaint than they used to, and that can be bad for their health," Hood said.

Hood sees medical cynicism as part of Americans' growing distrust of experts, leveraged by easy access to the internet. "When people Google, they tend to look for support of their opinions, rather than arrive at a fully educated decision," Hood said.

Only about half of patients believe their physicians "provide fair and accurate treatment information all or most of the time," according to a 2019 survey by the Pew Research Center.

Patients' distrust has become more obvious during the COVID-19 pandemic, said John Schumann, MD, an internist with Oak Street Health, a practice with more than 500 physicians and other providers in 20 states, treating almost exclusively Medicare patients.

"The skeptics became more entrenched during the pandemic," said Schumann, who is based in Tulsa, Oklahoma. "They may think the COVID vaccines were approved too quickly, or believe the pandemic itself is a hoax."

"There's a lot of anti-science rhetoric now," Schumann added. "I'd say about half of my patients are comfortable with science-based decisions and the other half are not."

What Are Patients Mistrustful About?

Patients' suspicions of certain therapies began long before the pandemic. In dermatology, for example, some patients refuse to take topical steroids, said Steven R. Feldman, MD, a dermatologist in Winston-Salem, North Carolina.

"Their distrust is usually based on anecdotal stories they read about," he noted. "Patients in other specialties are dead set against vaccinations."

In addition to refusing treatments and inoculations, some patients ask for questionable regimens mentioned in the news. "Some patients have demanded hydroxychloroquine or Noromectin, drugs that are unproven in the treatment of COVID," Schumann said. "We refuse to prescribe them."

Hood said patients' reluctance to follow medical advice can often be based on cost. "I have a patient who was more willing to save $20 than to save his life," he said. "But when the progression of his test results fit my predictions, he became more willing to take treatments. I had to wait for the opportune moment to convince him."

Many naysayer patients keep their views to themselves, and physicians may be unaware that the patients are stonewalling. A 2006 study estimated that about 10%-16% of primary care patients actively resist medical authority.

Schumann cited patients who don't want to hear an upsetting diagnosis. "Some patients might refuse to take a biopsy to see if they have cancer because they don't want to know," he said. "In many cases, they simply won't get the biopsy and won't tell the doctor that they didn't."

Sometimes Skeptics' Arguments Have Merit

Some patients' concerns can be valid, such as when they refuse to go on statins, said Zain Hakeem, DO, a physician in Austin, Texas.

"In some cases, I feel that statins are not necessary," he said. "The science on statins for primary prevention is not strong, although they should be used for exceedingly high-risk patients."

Certain patients, especially those with chronic conditions, do a great deal of research, using legitimate sources on the Web, and their research is well supported.

However, these patients can be overconfident in their conclusions. Several studies have shown that with just a little experience, people can replace beginners' caution with a false sense of competence.

For example, "Patients may not weigh the risks correctly," Hakeem said. "They can be more concerned about the risk of having their colon perforated during a colonoscopy, while the risk of cancer if they don't have a colonoscopy is much higher."

Some highly successful people may be more likely to trust their own medical instincts. When Steve Jobs, the founder of Apple, was diagnosed with pancreatic cancer in 2003, he put off surgery for 9 months while he tried to cure his disease with a vegan diet, acupuncture, herbs, bowel cleansings, and other remedies he read about. He died in 2011. Some experts believe that delay hastened his death.

Of course, not all physicians' diagnoses or treatments are correct. One study indicated doctors' diagnostic error rate could be as high as 15%. And just as patients can be overconfident in their conclusions, so can doctors. Another study found that physicians' stated confidence in their diagnosis was only slightly affected by the inaccuracy of that diagnosis or the difficulty of the case.

Best Ways to Deal With Cynical Patients

Patients' skepticism can frustrate doctors, reduce the efficiency of care delivery, and interfere with recovery. What can doctors do to deal with these problems?

1. Build the patient's trust in you. "Getting patients to adhere to your advice involves making sure they feel they have a caring doctor whom they trust," Feldman said.

"I want to show patients that I am entirely focused on them," he added. "For example, I may rush to the door of the test room from my last appointment, but I open the door very slowly and deliberately, because I want the patient to see that I won't hurry with them."

2. Spend time with the patient. Familiarity builds trust. Schumann said doctors at Oak Street Health see their patients an average of six to eight times a year, an unusually high number. "The more patients see their physicians, the more likely they are to trust them," he said.

3. Keep up to date. "I make sure I'm up to date with the literature, and I try to present a truthful message," Hood said. "For instance, my research showed that inflammation played a strong role in developing complications from COVID, so I wrote a detailed treatment protocol aimed at the inflammation and the immune response, which has been very effective."

4. Confront patients tactfully. Patients who do research on the Web don't want to be scolded, Feldman said. In fact, he praises them, even if he doesn't agree with their findings. "I might say, 'What a relief to finally find patients who've taken the time to educate themselves before coming here,'" he said.

Feldman is careful not to dispute patients' conclusions. "Debating the issues is not an effective approach to get patients to trust you," he said. "The last thing you want to tell a patient is 'Listen to me! I'm an expert.' People just dig in."

However, it does help to supply patients feedback. "I'm a big fan of patients arguing with me," Hakeem said. "It means you can straighten out misunderstandings and Improve decision-making."

5. Explain your reasoning. "You need to communicate clearly and show them your thinking," Hood said. "For instance, I'll explain why a patient has a strong risk for heart attack."

6. Acknowledge uncertainties . "The doctor may present the science as far more certain than it is," Hakeem said. "If you don't acknowledge the uncertainties, you could break the patient's trust in you."

7. Don't use a lot of numbers. "Data is not a good tool to convince patients," Feldman said. "The human brain isn't designed to work that way."

If you want to use numbers to show clinical risk, Hakeem advises using natural frequencies, such as 10 out of 10,000, which is less confusing to the patient than the equivalent percentage of 0.1%.

It can be helpful to refer to familiar concepts. One way to understand a risk is to compare it with risks in daily life, such as the dangers of driving or falling in the shower, Hakeem added.

Feldman often refers to another person's experience when presenting his medical advice. He explained, "I might say to the patient, 'You remind me of another patient I had. They were sitting in the same chair you're sitting in. They did really well on this drug, and I think it's probably the best choice for you, too.'"

8. Adopt shared decision-making. This approach involves empowering the patient to become an equal partner in medical decisions. The patient is given information through portals and is encouraged to do research. Critics, however, say that most patients don't want this degree of empowerment and would rather depend on the doctor's advice.

Conclusion

It's often impossible to get through to a skeptical patient, which can be disheartening for doctors. "Physicians want to do what is best for the patient, so when the patient doesn't listen, they may take it personally," Hood said. "But you always have to remember, the patient is the one with disease, and it's up to the patient to open the door."

Still, some skeptical patients ultimately change their minds. Schumann said patients who initially declined the COVID vaccine eventually decided to get it. "It often took them more than a year," he said, "but it's never too late."

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What Your Feet Can Say About You

They Can Even Flag Health Issues That May Require A Doctor

The Mistake Most People Make Before An Appointment

How To Take Care Of Your Feet Between Appointments

Unity Software's (NYSE:U) stock continues to face headwinds as investors shun unprofitable growth stocks. This has been exacerbated by problems with their monetization business, although these now appear to be largely resolved. Unity continues to invest aggressively in the capabilities of its platform and will need to begin showing returns on these investments going forward. The company's ability to successfully integrate ironSource (IS) and Weta is also crucial. Problems here could drive the stock even lower.

Create

Unity’s Create segment provides tools that allow the creation of engaging and interactive real-time 3D experiences. At the moment, this business is driven by the gaming sector, but in coming years use cases outside of gaming, like digital twins and media, will become increasingly important. The business outside of gaming currently represents 40% of the total Create business and is growing rapidly.

Unity has seen record adoption of their 2021 Long-Term Stable (LTS) version. The LTS version is supported with biweekly fixes for two years and doesn’t introduce feature or API changes, allowing users to lock in production with confidence. Additions and improvements include:

• Visual scripting
• Editor extensibility
• Scene view overlays for artist driven tools and asset ingestion

The Tech Stream version provides earlier access to new features and in 2022 updates include:

• Refined our user input framework
• Improved developer and artist productivity, through features like better spline tooling and better material variant productivity
• Connectivity with other creation tools

Unity have also expanded the capabilities of their Data-Oriented Tech Stack (DOTS). DOTS is a technology stack that is data oriented rather than object oriented and offers 10-100x performance improvements for rich environments that have a lot of content, interactive objects and real-time 3D objects. Unity intend to introduce easy-to-use versions of DOTS into their core technology over the next 2-3 years. DOTS enabled V Rising to scale up the world size and the number of players and was a key factor behind Stunlock choosing Unity.

Unity continues to have the most success in mobile games, but has a growing presence across Console, PC, AR/VR and Web. Unity powers more than 70% of the top mobile games, and nearly half of Steam games for PC were made with Unity in 2021. Those games are also breaking through to the Steam charts, where 13 of the top 20 games in May were made with Unity. Unity games made up 80% of the most popular games on Oculus Quest in July and 72% of the top selling games.

The latest success of the Oculus Quest 2 is a potential indicator that the AR / VR market is reaching an inflection point. The Quest 2 has sold over 14.8 million units since launching in Q4 2020. For perspective, this is more sales than the HTC Vive and Xbox Series X and S, although less than the Nintendo Switch and PlayStation 5.

Meta (META) also has the Oculus Quest 3 and Project Cambria in the pipeline, with the latter supposedly targeted more at metaverse applications than gaming. The Quest 2 is by far the most popular VR headset, making up 78% of all sales in 2021. In comparison, DPVR captured 5.1% of sales and ByteDance’s PicoVR accounted for 4.5% of sales.

Apple (AAPL) is also rumored to be working on an AR/VR headset and AR smart glasses, which could further accelerate the adoption of 3D experiences. Apple reportedly has a research unit with hundreds of employees working on AR and VR, with a product expected in 2023. The headset will reportedly focus on gaming, video streaming and video conferencing and could be priced over 2,000 USD.

In addition to the focus of companies like Meta and Apple on AR / VR hardware, a number of high-profile companies are working on 3D content. Meta views the metaverse as a successor to the mobile internet, and wants to control its own platform so that it is not at the mercy of companies like Apple. Meta have over 10,000 people working on their metaverse ambitions and are committing tens of billions of dollars. Roblox (RBLX), NVIDIA (NVDA) and Microsoft (MSFT) have also been building out virtual worlds.

Another indicator of the growing importance of 3D applications are LiDAR sales, which continue to grow rapidly, driven in large part of transportation use cases. Apple also recently introduced LiDAR to their mobile phones.

Unity’s Create business outside of games includes media and entertainment, e-commerce, industrial and manufacturing, architecture and engineering and construction amongst other industries. The use of digital twins is increasing rapidly and Unity are investing in capabilities to capitalize on this opportunity. One such example in Neural Radiance Field (NeRF), which uses a neural network to create a 3D scene from a series of 2D images, democratizing the creation of digital twins.

The growing importance of Unity’s non-gaming business necessitates a shift in their sales model though. Unity recently partnered with Capgemini to develop sector-specific solutions and services for Unity’s customers. Targeted sectors include consumer goods, retail, telecommunications, energy and utilities. Capgemini is a consulting company that leverages technology to enable digital transformation. 85% of the 200 largest public companies on the Forbes Global 2000 list are Capgemini clients. This type of partnership is generally an important part of the go-to-market strategy for enterprise sales.

In addition to expanding the use of game engines outsides of gaming, Unity’s other focus for the Create business is democratizing the creation of 3D content. Creating 3D content is currently difficult for a number of reasons:

• Complex
• Expensive
• Large file sizes
• Complicated rendering techniques

Unity acquired Weta specifically to make powerful artistic tools more widely available. This has the potential to foster the development of 3D applications and significantly expand Unity’s market opportunity. For the potential of this acquisition to be realized, Weta must be integrated into Unity’s platform. Management believes this process is progressing well, with previews available for customers this year and the first Weta tools released next year, ahead of the initial M&A integration schedule.

Operate

Unity’s Operate business has struggled this year due to the combination of technical issues with their platform and general weakness in the digital advertising market.

Unity had a data quality issue and problems with the accuracy of their audience pinpointer product earlier in the year that impacted the monetization business. Unity have now removed the bad data and improved their monitoring capabilities to try and prevent the same issue from occurring again. Audience Pinpointer accuracy is also improving and Unity plan on introducing features in the second half of the year that will Improve customers' return on ad spend. Revenue has not increased as quickly as expected though due to a combination of macroeconomic headwinds and the difficulty of projecting the trajectory of the monetization business.

Unity Gaming Service

Unity Gaming Service (UGS) allows customers to build their games in a single platform by providing tools for multiplayer services, game operations, user acquisition and monetization. UGS is a suite of tools and services that enable developers to create, host and manage their games in the cloud in a single dashboard experience. UGS is designed to be modular so that creators can select the best tools for their use case, whether the game was built with Unity Unreal or any other game engine.

UGS was released in beta in October 2021 and became generally available in June 2022, with more than 50,000 game developers signed up and 2,300 new customers added since the launch.

Unity's merger with ironSource is supportive of their monetization strategy as it enables the combination of creation and growth into a single platform to increase creator success.

Gaming Market

The gaming industry is currently undergoing a post-pandemic correction, with US consumer spending on video game hardware, content and accessories in 2022 expected to decline by 8.7% relative to 2021. So far the impact of this decline on Unity's Create business appears to be muted, but there could still be a flow through impact in coming quarters. The Operate business is likely being hit by a combination of reduced consumer screen time and a reduction in advertiser budgets.

Longer term, global entertainment and media revenue is expected to continue outpacing global growth, rising approximately 10% annually through 2026.

The entertainment and media industry is expected to become more digital, more mobile, more dependent on advertising and more evenly distributed globally. These are all generally positive trends for Unity, which has a dominant position in mobile gaming and continues to advance its advertising business. Advertising currently represents 32.2% of total entertainment and media industry revenues and is expected to increase at a 6.6% CAGR through 2026.

Video games revenue is expected to increase at an 8.4% CAGR through 2026, growing into a 321 USD billion industry.

VR revenue is projected to increase at a 24.1% CAGR between 2021 and 2026, growing to reach 7.6 billion USD annually. The global active installed base is expected to increase to 65.9 million by 2026.

AppLovin

AppLovin (APP) made Unity an acquisition offer in August for approximately 59 USD per share. The deal made a lot of sense for AppLovin, from both a strategic and financial perspective, as the company is vulnerable to the combined Unity / ironSource entity, and has a weak balance sheet. Unity's strong position in mobile gaming is obviously attractive to an ad mediation platform. Ad mediation is used by app developers to connect multiple ad networks to their app and serves as an ad network optimizer for developers looking to increase their ad revenue. With Unity combining their ad network with ironSource's ad mediation, the competitive position of AppLovin is significantly undermined.

It is not clear what value AppLovin would provide to Unity though, and it is doubtful the deal was given serious consideration. With the large potential of Unity's Create business, AppLovin having control of the company would be something akin to the tail wagging the dog.

Financial Analysis

Despite making progress with issues in the operate business, Unity lowered full year revenue guidance in the most latest quarter to 1.3-1.35 billion USD. This was attributed to a combination of the weak macroeconomic environment and difficulties projecting the revenue trajectory of their monetization business.

Operate revenue was down 13% YoY in the second quarter, likely in part due to monetization issues, the weak macro environment and the difficult comparable period in 2021. The number of large customers (more than 100,000 USD trailing 12 months revenue) grew 22% YoY in the second quarter and Unity’s net dollar expansion rate was 121%, compared to 142% a year earlier. Both of these figures were lower due to the Operate business.

Over 75% of Unity’s revenue is generated outside of the US, which is likely to be a headwind in coming quarters due to the significant appreciation of the US dollar.

Unity’s cost of revenue consists primarily of hosting expenses, personnel costs for employees associated with product support and professional services, allocated overhead, third-party license fees, and credit card fees, as well as amortization of related capitalized software and depreciation of related property and equipment. Gross margins appear to be trending down over time, although it is not really clear why this is the case. Once monetization issues are resolved, gross margins will bounce back somewhat, but investors should look for a stabilization or improvement in margins as ironSource is integrated and Weta tools are commercialized.

Unity’s operating expenses are extremely high due to the R&D investments they are making in the capabilities of their platform. These are primarily personnel costs and investors will likely want to see the burden of operating expenses fall before the stock moves higher. This should come through a combination of operating leverage and a 100 million USD cost saving program that was announced in the previous quarter.

Unity’s pace of hiring slowed significantly during second quarter of 2022, which was possibly related to macro weakness. Since then, hiring has picked up modestly but it is not clear if this is due to growth reaccelerating or Unity continuing to invest in the long-term capabilities of their platform.

The number of job openings mentioning Unity continues to trend upwards modestly, with no real significant change in trend that would indicate a change in business fundamentals.

Valuation

Unity’s stock is down by over 80% since its peak in November 2021, driven in part by a general pullback in growth stocks and in part by company specific problems. The stock now appears reasonably priced relative to peers and should provide significant upside potential once macroeconomic conditions stabilize and growth reaccelerates. Based on a discounted cash flow analysis I estimate that Unity’s stock is worth approximately 100 USD per share, although the company will likely to make significant progress towards profitability before these types of prices are seen again.

Conclusion

Unity’s heavy investments in R&D, coupled with a weak macro environment, mean the stock may continue to struggle in the short term. If the integration of ironSource can be successfully executed, a rebound in advertising and the commercialization of Weta tools should set Unity up well for the long term. The stock’s current valuation is more than reasonable given the company’s long-term prospects, although this is unlikely to matter in the short term due to Unity’s ongoing losses.

For the first time, you can now buy OTC hearing aids as easily as you can buy practicing glasses. Here's how to figure out if they might work for you.

© Provided by Consumer Reports

By Catherine Roberts

Over-the-counter (OTC) hearing aids are finally here.

As of Oct. 17, you will be able to officially purchase over-the-counter hearing aids in stores and online, without needing to see a doctor, an audiologist, or a licensed hearing aid specialist. For the millions of people with hearing loss who don’t yet use the devices, the new product category is intended to increase access and lower costs.

Over-the-counter hearing aids are only meant for people with self-perceived mild-to-moderate hearing loss, so they’re not right for everybody. Still, if you seem to be having trouble hearing, you may wonder if these devices could be right for you. 

Some tools are already available that can help you figure that out. And keep in mind: The vast majority of people with hearing loss have a mild or moderate amount, according to a 2016 study in the American Journal of Public Health. Researchers estimated that about 36.1 million U.S. residents age 12 or older have either mild or moderate hearing loss, while only about 2.2 million have severe or profound hearing loss. (Note that over-the-counter hearing aids are only intended for adults; children still need to see an audiologist or other hearing specialist for a hearing evaluation.)

Here, we explain some of the existing tools and strategies you can use to figure out if an over-the-counter hearing aid might be right for you.

© Provided by Consumer Reports

An Eargo OTC hearing aid

Photo: Eargo

Start With Simple Questions

The Food and Drug Administration requires that over-the-counter hearing aids be labeled with some of the common signs of mild-to-moderate hearing loss. These include having trouble hearing speech in noisy places or in groups, having a hard time hearing when talking on the phone, or finding that you have to turn up the TV volume to hear it and other people tell you it’s too loud. Another sign: Listening makes you tired. If any of these apply to you, you might want to try an over-the-counter hearing aid. 

The agency also provides information about the signs that might suggest that your hearing loss may be too severe for an over-the-counter hearing aid to be of much use. These include not being able to hear speech even if the room is quiet, and not being able to hear loud sounds well (such as engines, power tools, or loud music). If that’s the case for you, then visiting a doctor or an audiologist is a better bet.

You should also think carefully about your hearing needs. Some people—even with milder hearing loss—may want to visit an audiologist simply because they have unusually complex or specific hearing needs, says Sumit Dhar, PhD, a professor in the department of communication sciences and disorders at Northwestern University. This might include someone like an air traffic controller, a litigator who frequently works in a large and echoey courtroom, or a teacher in a large classroom filled with children in all directions.

Rule Out Other Problems

Most hearing loss is irreversible. Still, sometimes changes in hearing can be caused by medical issues such as infections, earwax buildup, or certain types of injuries. In those cases, you’ll need to see a doctor to resolve the problem rather than jumping right to a hearing aid.

The FDA also requires hearing aids to be labeled with a list of “red flags” that indicate you need to see a doctor to get your ears checked out. These include symptoms such as blood, pus, or fluid coming out of your ears recently, ear pain or discomfort, feelings of dizziness or vertigo, and sudden changes in your hearing. 

You can also use an online tool called the Consumer Ear Disease Risk Assessment (CEDRA), developed at Northwestern University, to help rule out any ear problems that warrant a trip to the doctor. 

© Provided by Consumer Reports

A Bose OTC hearing aid

Photo: Lexi

Consider Testing Options

If you think you’re a likely candidate for an over-the-counter hearing aid, you can still decide to get an in-person hearing exam. There’s no need to go it alone.

“For consumers, the gold standard would be go get your hearing tested from a licensed provider, get a copy of that test, and then come home and do your own research on what the best options for you are,” says Kim Cavitt, AuD, a hearing healthcare consultant.

Increasingly, providers are unbundling hearing assessments or consultations from the cost of hearing aids themselves, so you should be able to find a provider who’ll test you even if you don’t want to buy hearing aids from their office. Call ahead to find out how much a test would cost, whether it would be covered by your insurance, and whether you need a referral. Medicare, for example, only covers a hearing test if your doctor refers you for one.

Still, if you’d rather go the DIY route, a number of valid remote or self-test hearing screening options are available that can help you gauge your level of hearing loss without even leaving your house. 

Tone-based testing apps. Typically, in-person hearing examinations include what’s called pure-tone audiometry. This is done with audio tones played in decreasing volumes to determine your specific level of hearing loss. An app-based version can’t totally replicate the in-office experience. Still, certain well-designed apps can produce a measurement called a “pure-tone average” (PTA), or, as some public health experts call it, your “hearing humber.” 

The hearing number reflects how loud speech must be for you to be able to hear it, and provides a simple shorthand for your level of hearing loss. A hearing number of about 25 to 40 means you have mild hearing loss, while 41 to 60 means moderate hearing loss. 

One benefit of the hearing number is that it provides a simple measurement of hearing loss that’s also more concrete than the imprecise labels of “mild” and “moderate,” says Nicholas Reed, AuD, an assistant professor of epidemiology and audiology with the Johns Hopkins Cochlear Center. “For OTCs to succeed, we actually need common language around hearing loss,” Reed says. “We can’t use this vague language.”

The limitation of remote or app-based pure-tone audiometry is that it requires specifically calibrated equipment to work—to ensure the tones are played at the proper volume. This tends to be more achievable within the Apple ecosystem, since the specs for both the devices and the Apple-made headphones are controlled by the same company.

Two iPhone apps will reliably produce a hearing number: Mimi or SonicCloud, according to a group of scientists advocating for more widespread use of the hearing number. Find instructions on how to get the hearing number from these apps here.

If you do get an in-person hearing test, you can also ask the provider who gives you the test for this number.

Digits-in-noise or speech-in-noise tests. In this type of test, your task is to identify spoken numbers or other words while background noise plays. These tests have their own advantages, including that they don’t require any special equipment, which makes them more accessible. And they provide a more real-world test of hearing, says Dewet Swanepoel, DPhil, a professor of audiology at the University of Pretoria in South Africa. “That’s actually what people have difficulty with when they have hearing loss—speech in background noise,” he says. “So this test really gets to the heart of what people have difficulty with.”

The downside: Speech-in-noise tests don’t provide as precise a measure of hearing loss as pure-tone audiometry. Still, they can be a useful screening tool to help you figure out whether you might have at least some degree of hearing loss. 

The World Health Organization’s hearing test app, hearWHO, employs such a testing method, as does an online hearing screening offered by Best Buy. Many other websites also offer to screen your hearing with a digits or speech-in-noise test. Keep in mind, Cavitt advises, that online tests may also be accompanied by marketing pitches from various companies offering hearing aids or hearing care services. 

An evidence-based self-assessment. Another approach for figuring out if an over-the-counter hearing aid is right for you involves assessing how much hearing difficulty you experience in daily life. After all, the FDA’s rules about OTC hearing aids say the devices are meant to address self-perceived hearing loss. 

“The FDA is sending this signal that you can self-determine if you have mild to moderate hearing difficulty,” says Dhar. “Inherent in that claim is that your perception of mild-to-moderate hearing difficulty will be well-correlated” to a professional measurement of hearing loss.

The Hearing Handicap Inventory for the Elderly (HHIE) and its variant, the Hearing Handicap Inventory for Adults (HIAA) are tools that can help you with that self-assessment.

They involve either 10 or 25 questions that are designed to evaluate how much a hearing problem affects your life. The simple questionnaires, developed and validated by audiologists in the 1980s and 1990s, have been used for decades to assess the extent to which hearing loss affects people emotionally and socially. Questions include, “Does a hearing problem cause you to feel embarrassed when meeting new people?” and “Does a hearing problem cause you to have arguments with family members?” This approach can be a good way to figure out if you might get use out of an over-the-counter hearing aid.

“The factor that most likely determines whether somebody will seek hearing aids and use them and benefit from them, is their perceived hearing disability, not what the audiogram says,” says Larry Humes, PhD, a distinguished professor emeritus of speech, language, and hearing sciences at Indiana University. (An audiogram is a graph that shows the results of a hearing test.)

There aren’t a lot of user-friendly online versions of these tests just yet, but you can download a printable copy of the shorter version of the HHIA and the HHIE. If you score in the mild-to-moderate range, that means an over-the-counter hearing aid could be a good fit.

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