How we ran it
Fourteen towns, chosen for size and spread rather than for anything about their hearing clinics: Tyler, Texas; Joplin, Missouri; Bowling Green, Kentucky; Grand Junction, Colorado; Dothan, Alabama; Hattiesburg, Mississippi; Bend, Oregon; Muncie, Indiana; Yakima, Washington; Lafayette, Louisiana; Johnson City, Tennessee; Rapid City, South Dakota; Florence, South Carolina; and Sioux City, Iowa. For each we searched "hearing aids [town] [state]" on google.com from a desktop browser 1,366 pixels wide, with English and United States settings, signed out, from Austin, Texas, with the search location left to Google.
We recorded whether an AI Overview appeared, how many businesses the map pack listed, how many organic web results sat on the first page, and what kind of site held each web result. We sorted the sites into five kinds: an independent clinic's own website; a manufacturer-owned chain, a manufacturer's brand network or a manufacturer's store locator; a big-box retailer; a review or directory site; and a hospital, health system, ENT physician group or civic site. ENT groups are medical practices that sell hearing aids, so we kept them out of the clinic count to be fair to it. Our data file counts 47 local business sites; six of those are ENT physician groups, which we show separately here.
We did not count ads. Google shows ads unevenly to a signed-out browser with no history, so an absence of ads in this method means nothing. Our earlier four-town sample, run a different way, saw national hearing aid brands advertising in all four towns; that is below.
Chains, manufacturers and a big-box club held 56 of the 122 web results.
Across the 14 first pages there were 122 organic web results, eight or nine per town. Manufacturer-owned chains, brand networks and store locators held 48 of them; a big-box warehouse club held another 8. Together that is 56 of 122, between two and six results in every town, an average of four. One manufacturer-owned chain's site appeared on page one in 13 of the 14 towns; a second in 7; a third in 7; a manufacturer's store locator in 6.
Independent clinics' own websites held 41 of the 122, an average of about three per town, from one (Tyler) to five (Johnson City and Sioux City). Review and directory sites held 12 (one review site in 12 of the 14 towns), and hospitals, ENT groups and civic sites held 13.
- An independent clinic's own site: 41 of 122 results
- A manufacturer-owned chain, brand network or store locator: 48 of 122 results
- A big-box warehouse club: 8 of 122 results
- A review or directory site: 12 of 122 results
- A hospital, ENT physician group or civic site: 13 of 122 results
Each row is one search. The count at the right is chain, manufacturer and big-box results out of the web results on that page.
Chain, manufacturer and club pages averaged four of the eight or nine web results per town, and appeared in all 14 towns. The reason is in the ownership of the industry, set out on the manufacturer stores guide: the five largest manufacturers all operate US retail networks, and each location page of each network carries the authority of a national site.
Chain locations held 5 of the 41 map spots.
Google showed a map pack on all 14 pages, with three businesses in 13 towns and two in one. Of the 41 businesses listed, five were chain locations by name, in four towns. In 12 of the 14 towns at least two of the three were not chain locations, and in 10 towns none of the three was.
That is the part of the page a national site cannot take from outside the county. Google's own help page says local results rest mainly on relevance, distance and prominence, and that no one can pay for a better local ranking. Distance is yours by definition. Relevance is the profile: category, services, hours, description, and whether the practitioner is listed. Prominence, in Google's words, is partly "how many websites link to your business and how many reviews you have".
An AI Overview appeared once in 14 searches.
Sioux City was the only town where Google put an AI Overview above the results. That matches the pattern Whitespark found in May 2025 across 540 searches in Houston, Phoenix and Denver: AI Overviews on 15% of local-intent searches (a service plus a place) and on 92% of informational questions. A search for "hearing aids Joplin" is local intent. A search for "do I need a hearing test" is informational, and on those searches a clinic's articles compete with an AI answer and with the manufacturers' content. Whitespark's study did not include hearing clinics, so we quote its figures for local searches in general, and our one-in-fourteen is a single snapshot.
Every town
| Town | AI Overview | Map pack | Web results | Clinic sites | Chain, maker, big-box | Review sites | Hospital, ENT, civic |
|---|---|---|---|---|---|---|---|
| Tyler, TX | no | 3 | 9 | 1 | 5 | 1 | 2 |
| Joplin, MO | no | 3 | 9 | 3 | 5 | 1 | 0 |
| Bowling Green, KY | no | 3 | 8 | 2 | 3 | 1 | 2 |
| Grand Junction, CO | no | 3 | 9 | 4 | 3 | 1 | 1 |
| Dothan, AL | no | 3 | 8 | 2 | 4 | 1 | 1 |
| Hattiesburg, MS | no | 3 | 9 | 2 | 5 | 0 | 2 |
| Bend, OR | no | 3 | 9 | 3 | 3 | 1 | 2 |
| Muncie, IN | no | 3 | 9 | 3 | 6 | 0 | 0 |
| Yakima, WA | no | 3 | 8 | 3 | 4 | 1 | 0 |
| Lafayette, LA | no | 3 | 9 | 2 | 4 | 1 | 2 |
| Johnson City, TN | no | 3 | 9 | 5 | 3 | 1 | 0 |
| Rapid City, SD | no | 3 | 9 | 3 | 4 | 1 | 1 |
| Florence, SC | no | 2 | 9 | 3 | 5 | 1 | 0 |
| Sioux City, IA | yes | 3 | 8 | 5 | 2 | 1 | 0 |
| All 14 | 1 | 41 | 122 | 41 | 56 | 12 | 13 |
The earlier four-town sample
Earlier in October 2026 we looked at independent businesses in four of the same towns (Tyler, Joplin, Bowling Green and Grand Junction) with a different method: third-party estimates of how many searches each business ranked for, today against five years ago. We counted a business as declining when a third or more of those rankings were gone. Of eight independent hearing clinics, three were declining. National hearing aid brands were running Google ads in all four towns. Eight clinics is a small sample, and third-party ranking estimates are estimates; we report it only because it prompted this snapshot.
What we take from it, for now
First, the map pack is the part of the page the chains held least: in 12 of the 14 towns, at least two of the three spots went to businesses that were not chain locations. Work on it on purpose: the right primary category, every service listed, real photos, hours that match the door, a review every patient is asked for the same way, and a practitioner listing for the audiologist under their own name.
Second, in these 14 searches the web results under the map were where the chains sat, on "hearing aids [town]". A clinic will not outrank a manufacturer for its brand name and should not try. It has a fair chance at "hearing test [town]", "audiologist [town]", "hearing aid repair [town]", "real ear measurement [town]" and "tinnitus [town]", because location pages are not built for those and a clinic's own pages, once they exist, are more relevant and closer.
Third, the informational searches are the only place AI Overviews showed up often in Whitespark's data, and they are where a clinic's articles meet the manufacturers' content libraries. Write the articles the front desk gets asked, with the provider's name on them.
Caveats
One search per town is one search. Results change by the hour, by device, and by exactly where the searcher stands; a person in Joplin sees a map pack weighted to where they stand. We searched from Austin with the location left to Google, so every town got the same treatment. We did not count ads, for the reason given above. The sorting of sites into kinds involved judgment in a few cases, which we explain in the method. We plan to rerun the snapshot; when we do, the new tables go here and the old ones stay.
Sources for the claims above: Google Business Profile Help, "Tips to improve your local ranking on Google", support.google.com; Whitespark, "The Prevalence of AI Overviews in Local Search", May 12, 2025, whitespark.ca; The Capitol Forum, June 5, 2026, thecapitolforum.com. Our own data is in the table.