Most audiologists’ Web sites were developed to educate the public about the nature and treatment of hearing loss, with many featuring self assessment questionnaires (35%) and information on tinnitus (20%) and ALDs (20%). Half (55%) of respondents spent less than $500 to set up their Web sites, and 40% spend less than $25/month to host the site. Forty percent report monthly revenues from the site of less than $100, while 35% reported revenues from $100-$500. Overall, 60% of respondents reported being satisfied or very satisfied with their Web sites, while 35% reported being either dissatisfied or very dissatisfied.

The development of the World Wide Web as a marketing force cannot be disputed. The number of sites on the Internet relating to hearing loss have increased significantly in the last few years. Several articles in professional audiology journals have detailed how to build a Web site,1 how to determine the necessity of having a Web site,2 and how to develop an online image.3 However, the question remains: Is it practical for a small office to try to compete in this medium? Building a Web site is time consuming and can be expensive.

The purpose of this study was to obtain information about Web site design and maintenance from private practice audiologists and to use this information as a guide in determining whether to proceed with developing a Web site. This was accomplished in the present study by using an email survey to investigate private practice audiologists’ experiences with developing and maintaining Web sites. The survey requested information from the audiologists regarding their length of time in private practice, length of time hosting a Web site, types of services offered through their Web site, costs of establishing and maintaining their sites both in terms of time and money, and whether or not they were satisfied with their Web site.

Survey Method
Subjects: Twenty responses were obtained from an email survey sent to the contact person at 117 Web sites that were identified using publicly available search engines. The surveys were sent a total of three times. A decrease in responses was noted after each mailing, and it was determined that further mailings would not likely result in any further responses.

Subjects: Web sites were identified using publicly available search engines, such as Yahoo, Searchwave, and Altavista. To be considered for inclusion, it was essential that the Web site have an email address as the surveys were being sent by email. It was the intent of this project to send and receive the surveys by email; however, subjects were given the additional options of returning the survey by fax or the postal service. In total, 255 private practice audiology Web sites were identified, but only 117 provided an email address for individuals to contact them directly. Therefore, surveys were emailed to the Web sites which provided an email address and met the other criteria identified above. (Author’s Note: Although the survey is not included here due to space limitations, a copy of the survey is included in the Web site version of this article found at www.hearingreview.com.) Responses for each completed survey were tabulated and the aggregate results are detailed in this report.

 Survey Results
Survey Participants and Their Websites: The first question in the survey inquired about the number of employees in the categories of audiologists, hearing aid dispensers, physicians, audiology aides, and “other.” Only 10% (n=2) of offices reported having more than 10 total employees. Seventy percent (n=14) of the respondents reported 3 or fewer employees. The respondents were primarily small private practice audiology offices employing 1-3 audiologists. Few of the respondents reported employees in the other categories listed, such as physicians, hearing instrument specialists, or audiology aides. Small private practices were the group of primary interest in this investigation; therefore, the results are felt to be an accurate representation of Web site design and maintenance in offices where there are fewer than 3 audiologists.

Two questions focused on the length of time the individuals had been in private practice and how long they had been hosting a Web site. Of particular interest was whether those pursuing Web sites were new to private practice or whether those who had been in private practice for many years were more likely to have developed Web sites and maintained them for a longer period of time. Forty-five percent (n=9) of the respondents reported being in private practice for 15 years or more, while a smaller number (15%, n=3) indicated that they had been in private practice for less than 5 years. Almost all of the respondents (95%) reported hosting their Web sites for more than a year, with only 20% having an Internet presence for more than 4 years. Of those who had been in private practice for more than 15 years, slightly more than half (55%) had been hosting their Web sites for more than 2 years. Only 3 respondents (15%) reported being in private practice for less than 5 years. Due to the small sample size, broad conclusions cannot be drawn from these results.

Web Site Purpose: Overwhelmingly, the respondents reported using their Web sites to educate the public and their patients about the nature and cause of hearing loss. Several also indicated that they posted self assessment questionnaires (35%) and listed information about tinnitus (20%) and assistive listening devices (20%). The category of “other” elicited a variety of interesting uses. These included practice and staff information, hearing conservation, auditory processing disorders, vestibular information, testimonials, and links to manufacturers providing hearing aid information.

Original or Re-Design? Respondents were asked to indicate whether their current Web site was their first attempt or if the site had been redesigned. The majority (85%) indicated that their current Web site was their first attempt, while the remaining respondents (15%) reported having restarted their Web sites at least once. In reviewing many private-practice Web sites prior to sending out the surveys, it was noted that some sites were very elaborate with graphics and animation while others were very basic. The approach taken by some was to fill in a template provided by the Web site host which gave them a more generic look. One respondent commented that the Web site should be unique and interesting and that “cookie cutter” designs should be avoided.

Web Site Establishment and Costs: Four questions queried the respondents regarding who designed their Web site and the costs associated with set up and maintenance of the site. A variety of Web site designers were reported. Slightly less than half (45%) designed their own Web sites, 30% indicated that they used the services of a Web site design company, and 10% utilized the services of a friend with computer skills.

The cost of setting up the Web site varied across all categories with 15% of respondents setting up their sites at no cost, 40% spending less than $500, 15% spending $500-$1000, 20% spending $1000-$3000, and 10% spending more than $3000 to set up their sites (Figure 1). The cost of hosting a Web site also varied across several categories with nearly half of the respondents (40%) spending less than $25 per month on Web hosting fees (Figure 2). No respondents indicated a monthly web hosting fee of more than $75. For the majority of respondents, the cost of maintaining the Web site was either included in the Web hosting fee (35%) or included in an employee’s salary (30%). One-quarter of respondents (25%) reported paying separately for Web site maintenance; however, nearly half of these did not know the actual cost.

f03-fig1-2.gif (23379 bytes)

Revenue Generation: The amount of revenue generated by audiologists’ Web sites is generally less than $500 per month, according to the survey (Figure 3). Forty percent of respondents indicated monthly revenue of less than $100, and 35% indicated revenue in the $100-$500 category. One respondent (5%) reported revenue of over $1000 per month. Interestingly, 20% of respondents did not track the revenue generated by their Web sites.

f03-fig3.gif (12368 bytes)

Responsibility for Maintenance: Who is responsible for maintaining the Web site in a typical practice? Website maintenance was delegated to the Web site host in 35% of responses and to various others in 30% of the responses (Figure 4). The “other” category included the marketing director, a Web site consultant, a marketing company, and an audiologist’s spouse. It was less likely for the audiologist to maintain the Web site personally, as this occurred in only 15% of responses.

Website maintenance consumes surprisingly little time, according to the survey respondents. Nearly unanimously, the respondents indicated less than 1 hour per week in Web site maintenance. The minimal amount of time spent in maintaining the Web site could also be considered to be a problem as will be discussed later.

f03-fig4-5.gif (21471 bytes)

Two questions in the survey focused on who responded to emails addressed to the Web site and the amount of time per week that this task required. In 55% of offices, the audiologist responded to emails personally. Other individuals to whom this task was delegated included the marketing director, office manager, a combination of audiologist and staff, and the practice owner. As with Web site maintenance, the amount of time per week required for this task was in the range of less than 1 hour per week in the majority of offices. Only one individual reported needing more than 4 hours per week to respond to email.

Advertising and the Web Site: Advertising and drawing new visitors to a Web site can be an important goal that is also an associated expense. However, the cost of advertising an audiology Web site was minimal for the majority of respondents, as 55% reported spending less than $50 per month. On the other end of the spectrum, 25% reported spending $500 or more per month advertising their Web sites. The remaining respondents were fairly evenly distributed over the other categories.

We also asked where audiologists advertised their Web sites. The responses were fairly consistent across categories. Business cards, stationery, newspaper, and telephone books were the most frequently cited venues for advertising. Most respondents used all four of the above listed responses, with several also mentioning creative ideas such as being listed on search engine registries, advertising the site on pens and refrigerator magnets, and putting the Web site address on brochures. A small number of respondents (15%) also indicated that they had used web banner ads and television commercials to advertise their Web sites.

Hosting Banner Ads from Other Businesses: In many cases, a local business will exchange banners or charge for hosting the banner of a reputable company. However, nearly all of the survey respondents (90%) indicated that they did not use advertising in this way. In visiting Web sites prior to beginning this project, banner ads were noted on several Web sites, so it was surprising that so few of those responding were availing themselves of this opportunity.

Online Purchasing Options: Two questions assessed the availability of direct purchase at the Web site and how these purchases were processed. The question of whether direct purchase was available at the Web site was met with a resounding no. Very few respondents (n=3, 15%) indicated that they provided direct purchase; however, those who did generally provided a secure site or used a telephone, a third party, or e-mail to process the orders. Of those allowing direct purchase, the products generally available were assistive listening devices, batteries, stock ear plugs, and other accessories.

Overall Satisfaction with Web Site: The final question on the survey asked about the individuals’ satisfaction with the marketing and market expansion results obtained with their Web sites. The level of satisfaction with Web sites was distributed fairly evenly across the categories provided, with the exception of the category “extremely satisfied” which was not selected by any of the respondents (Figure 5). The majority of respondents reported themselves to be satisfied with their Web site. Overall, 60% of respondents reported being either satisfied or very satisfied with their Web sites, while 35% reported being either dissatisfied or very dissatisfied. One respondent chose not to answer this question.

Discussion
This study was designed to determine how the typical, small, private practice audiologist manages the use of his/her Web site. The Web sites surveyed were not selected based on the size of the office; however, the majority of offices responding indicated that they employed 1-3 audiologists and some level of support personnel. A few large offices also responded, as well as offices employing physicians and hearing aid dispensers.

The costs of designing and maintaining a Web site appear to be reasonable, as the respondents in this study reported a wide range of costs associated with the development of their Web sites, ranging from no cost to in excess of $3000. The costs of maintaining the site include Web hosting fees, Web site maintenance fees, and advertising costs. Half of the respondents indicated that they spent less than $25 per month in Web hosting fees, and 65% indicated that the cost of maintaining the site was included in the Web hosting fee. Advertising costs were also reasonable in that 55% of respondents indicated spending less than $50 per month advertising the Web site.

Overall, the respondents in this survey indicated that the amount of time required for responding to email and updating the Web site was less 2 hours per week. It should be noted that 83% of those selected to receive this survey by email did not respond, and this may suggest that many private practice audiologists who have Web sites may not have the time to respond to queries from the field and/or are inundated with email.

Most of the sites visited prior to beginning this project had a date listed when they were last updated, and for many of these sites, this date was over a year old. If generating interest in the Web site is important for a particular practice, more regular updates and changes in the Web site may result in more patients visiting the site regularly. One idea that could be used is an “Ask the Audiologist” segment where the audiologist could answer common questions about hearing loss, tinnitus, balance, hearing aids, etc. This could be updated monthly and patients could be encouraged to visit the site each month to view the latest information. Another idea is a “technology corner” where new developments in surgery, hearing aids, assistive listening devices, etc, could be profiled and updated each month. It may be more productive to treat the Web site as an active brochure for the practice, rather than as a static newspaper advertisement. Changes should be made regularly and the Web host should provide tracking information that indicates how many individuals have visited the site monthly. However, implementing these types of ideas will likely result in more time being needed to maintain the Web site and this may offset any perceived or real financial benefit.

It appears that the majority of audiologists are not using Web sites as a marketing tool to bring more patients into their offices, but rather as an educational tool to help empower individuals with hearing impairment and provide them with information that they can use when they visit their hearing care professional. This may be the best approach to take at this time, since hearing testing and hearing aid fitting continue to require a visit to the office and transactions such as this cannot be completed online.

However, the fast pace of our society should not be ignored. Many patients are looking for ways to streamline their office visits—if not to eliminate them entirely. The necessity for counseling in the patient’s acceptance of the hearing loss and the use of the hearing aid, along with aural rehabilitation, requires personal time with the patient, but it may be possible to incorporate some of the counseling information and hearing aid information on the practice Web site. Many practices are making this information available on their Web sites, and there are further possibilities in this area. For example, real-time messaging is a technology that is already widely available on the Internet, but its availability for small private practices is likely limited at this time due to cost. As technology improves, the ability to provide real-time messaging in a group format could open up possibilities for many hearing care professionals who want to provide aural rehabilitation classes but have difficulty getting their patients to commit or do not feel that they have the time in their schedules.

Similarly, a “chat room” could be posted on the Web site where the audiologist would be available at a designated time to provide educational information and problem-solving techniques. A topic could be designated in advance and any patients with questions or problems regarding the topic could log on and participate in the discussion. This may be a way to provide better follow-up care to those patients who may have difficulty coming to the office, but have access to the Internet and are willing to try a different approach. Similarly, newly fitted patients could be scheduled to visit the chat room and participate in a discussion with other newly fitted individuals, with the hearing care professional serving as the moderator. w

Acknowledgment
This article was adapted from a paper submitted by the first co-author (CFP) in partial fulfillment of the AuD degree at Central Michigan University.

Correspondence can be addressed to HR or Cynthia F. Parker, AuD, Seaford Audiology, Seaford Professional Center, Ste 4, 24488 Sussex Hwy, Seaford, DE 19973; email: [email protected].

 Cynthia F. Parker, AuD, (left) is president of Seaford Audiology Inc, Seaford, Del; Michael Stewart, PhD, is a professor at Central Michigan University; Kris English, PhD, (not pictured) is an assistant professor at Duquesne University; and Patricia McCarthy, PhD, is a professor at Rush University.

References
1. Adkins C. How to build a Web site. Advance for Speech-Language Pathol & Audiol. 2001;11(7): 20-21.
2. Burney P. Websites: A necessity for today’s dispensing professional? Hearing Review. 2001 8(5): 32-36.
3. Ingrao B. Investing in your online image. Advance for Audiol. 2001; 3(3):20-22.