All direct referrals for hearing aids should meet the following criteria:

History

Patient must be age 60 or older No exceptions.
Symptoms of gradual onset Over years, not over months or weeks.
No fluctuation Other than minor change with colds etc.
No asymmetry Patient reports roughly equal hearing loss in both ears.
No vertigo No recent or recurrent hallucination of movement (unsteadiness of old age does not count).
No earache No recent or recurrent pain.
No tinnitus Occasional tinnitus lasting less than 5 minutes does not count.
No recent discharge None in recent years except slight waxy discharge.

Examination

No canal disease No inflammation or other abnormality.
No perforation Even if old, small or dry.
No drum disorder No inflammation, severe scarring or other significant abnormality on otoscopy (minor scarring or tympanoselerotic patches do not count).
Hearing loss not unilateral Weber central.
Air conduction greater than bone conduction Rinne +ve