The Expected Consequences of Hearing Aid Ownership inventory (ECHO) is a 14-item questionnaire for measuring expectations about hearing aids. The objectives of this study were to evaluate the ECHO questionnaire used in the Danish National Hearing Health Service in terms of reliability and validity; to use the inventory to assess the patients' pre-fitting expectations in different domains, to gain information on possible predictors for the magnitude of expectations, and to evaluate whether first-time users had realistic expectations. The questionnaire was administered to 805 consecutive patients, and responses were received from 47.7%, representative for the population examined in the department. The median age was 74.1 years, with an even distribution of males and females, and a median better-ear pure-tone average (0.5-4 kHz) of 41.3 dB HL. The results showed that the questionnaire had acceptable reliability and validity when the original subscales were rearranged. The pre-fitting expectations with regard to the positive effect of amplification and different aspects related to the hearing aid and service were, overall, very high. Age and hearing status were predictors of the magnitude of expectations related to the hearing aid and the service. In first-time users, unrealistic positive expectations were found with regard to potentially negative features of hearing aids.