When you get hearing aids, you expect them to help you hear clearly-especially in noisy rooms, during conversations, or while watching TV. But what if your hearing aids aren’t actually delivering the sound they’re supposed to? Many people leave the clinic thinking their new devices are working fine, only to return weeks later complaining they still can’t understand speech. The problem isn’t always the hearing aid itself. It’s the fitting. And the single most important step that separates good fittings from great ones is real-ear measurement.
What Real-Ear Measurement Actually Does
Real-ear measurement (REM) is a simple, non-invasive test that checks exactly how much sound is reaching your eardrum when your hearing aids are in place. It’s not a guess. It’s not an estimate. It’s a direct measurement of the actual sound pressure levels inside your ear canal, using a tiny microphone probe placed near your eardrum. This probe picks up the sound coming from your hearing aid and compares it to what your hearing loss requires. Why does this matter? Because every ear is different. The shape, length, and width of your ear canal change how sound travels. Two people with identical hearing loss can get the same hearing aid model, but one might hear perfectly while the other struggles-because one had REM, and the other didn’t. Research shows ear canal resonance can vary by up to 20 decibels between individuals. That’s like turning the volume up or down by half on your TV-just because of your ear’s shape. REM ensures your hearing aid is amplifying speech at the right levels across all frequencies, especially the high-pitched sounds like “s,” “f,” and “th” that are critical for understanding words. Without REM, you’re relying on a generic formula built for an average ear. That’s like wearing shoes sized for someone else’s feet. It might fit, but it won’t feel right-and it won’t work well.How REM Works: Step by Step
The process takes about 15 to 25 minutes and happens right in the audiologist’s office. Here’s what you can expect:- Ear exam: The audiologist checks your ear canal with an otoscope to make sure there’s no wax, infection, or damage that could interfere with the test.
- Probe tube placement: A thin, flexible tube (less than 1 mm wide) is gently inserted into your ear canal, about 5 millimeters from your eardrum. You might feel a slight tickle, but it’s not painful.
- Hearing aid insertion: Your hearing aid is placed in your ear, with the probe tube still in place. It stays there for the rest of the test.
- Sound testing: The audiologist plays speech sounds at different volumes-typically 50 dB (soft), 65 dB (normal conversation), and 80 dB (loud). The probe microphone records exactly how much amplification your hearing aid is delivering at each frequency.
- Comparison to targets: The system compares the measured output to your personal prescription targets, like NAL-NL2 or DSL v5.0. These aren’t random numbers-they’re based on decades of research into what hearing loss needs to understand speech.
- Adjustments: If the hearing aid isn’t hitting the target, the audiologist fine-tunes it on the spot. This might mean changing gain, compression, or frequency response settings.
Why Manufacturer Settings Alone Aren’t Enough
Most hearing aids come with a “first fit” setting-a default program based on your audiogram and the manufacturer’s algorithm. It’s a starting point, not a final answer. Studies show these default settings match the target amplification only about 52% of the time. That means nearly half the time, your hearing aid is either too quiet, too loud, or boosting the wrong frequencies. Why? Because manufacturers design their algorithms using data from standardized test boxes (2cc couplers), which simulate an “average” ear. But there’s no such thing as an average ear. Your ear canal has a unique acoustic signature. The real-ear-to-coupler difference (RECD) can vary by up to 15 dB. That’s why two people with the same hearing loss can get the same hearing aid and have completely different results. One 2019 study found that patients fitted with REM had 35% better speech understanding in noisy environments than those fitted without it. That’s not a small improvement. That’s the difference between following a conversation in a restaurant and giving up and nodding along.
REM vs. OTC Hearing Aids
The rise of over-the-counter (OTC) hearing aids has made it easier-and cheaper-to buy devices without professional help. But OTC devices are designed for mild hearing loss and don’t include REM. The FDA itself acknowledges this in its 2022 rule: OTC hearing aids “cannot replace the need for professional evaluation and fitting.” Without REM, you’re left guessing. You might adjust the volume yourself, but you can’t know if you’re boosting the right frequencies. Many users report whistling (feedback), muffled speech, or discomfort because the device isn’t calibrated to their ear. One Trustpilot review from April 2023 said: “Bought OTC aids online, saved $1,000 but they whistle constantly.” That’s the cost of skipping verification. Professional fittings with REM cost more upfront, but they reduce the need for follow-up visits. A 2021 study found that patients who had REM needed 43% fewer adjustments later. That saves time, money, and frustration.What the Experts Say
The American Speech-Language-Hearing Association (ASHA), the American Academy of Audiology (AAA), and the American Medical Association (AMA) all agree: REM is the gold standard. ASHA’s 2020 Practice Portal says: “Probe microphone measures are the only way to verify that the hearing aid is providing the appropriate gain and output for a client’s hearing loss and ear acoustics.” Dr. H. Gustav Mueller, a leading researcher in the field, put it bluntly: “Without real-ear verification, you’re fitting hearing aids by guesswork-there’s no other way to say it.” Even critics, like Dr. David Fabry, who notes practical barriers in some clinics, still call REM “the standard to strive for.” And it’s not just theory-it’s reimbursed. Medicare and most private insurers cover REM under CPT code 92597 because it’s recognized as medically necessary.Real Patient Experiences
On HealthyHearing.com’s 2022 survey of over 1,200 hearing aid users, 87% of those who had REM rated their devices as “very effective.” Only 52% of those without REM said the same. One Reddit user, ‘HearingHelp42,’ wrote: “The REM process was slightly uncomfortable but knowing my aids were precisely calibrated made all the difference-I went from struggling in restaurants to understanding 90% of conversations.” Another common theme: reduced listening effort. People report feeling less tired after conversations. That’s because your brain doesn’t have to work as hard to fill in missing sounds. It’s not just about hearing louder-it’s about hearing clearer.
What If Your Clinic Doesn’t Use REM?
If your audiologist doesn’t offer REM, ask why. Most certified audiologists use it routinely-97% of them, according to the Hearing Industries Association. If they don’t, they may be using outdated methods or cutting corners. Ask for a copy of your REM results. You should see a graph showing the target curve and your actual output. If they can’t show you that, it’s a red flag. You can also check if the clinic is affiliated with the American Academy of Audiology or follows ASHA guidelines. These organizations require REM as part of best practices.The Future of Hearing Aid Fitting
New tech is making REM faster and more accurate. Widex’s 2023 MOMENT 2 system uses AI to analyze REM data and suggest adjustments in seconds, cutting fitting time by 30%. The International Organization for Standardization now requires REM for all hearing aids sold in Europe. And the NIH is funding $2.4 million in research to improve verification tools. But here’s the key: no matter how advanced the software or how detailed the 3D ear scans become, we still need to measure what’s happening in your real ear. As Dr. Pamela Souza said in her 2022 keynote: “No matter how advanced our modeling becomes, we’ll always need to verify what’s actually happening in the real ear.”Final Thought: Don’t Settle for Guesswork
Hearing aids are life-changing devices. But they’re only as good as the fitting. If you’re getting hearing aids, insist on real-ear measurement. It’s not an extra service-it’s the standard of care. The difference it makes isn’t subtle. It’s the difference between hearing sounds and understanding words. Between feeling isolated and being part of the conversation. You’ve waited long enough to hear better. Don’t let a bad fit rob you of what’s possible.Is real-ear measurement painful?
No, it’s not painful. A tiny probe tube is placed gently in your ear canal, and you might feel a slight tickling sensation, especially if it’s your first time. About 22% of first-time patients report mild discomfort, but 98% say it’s brief and tolerable. The test lasts only a few minutes per ear.
Do all audiologists use real-ear measurement?
Most do-89% of audiologists use REM routinely, according to the 2022 American Academy of Audiology survey. But not all hearing aid sellers do. Retail specialists and non-audiologist providers often skip it to save time. Always ask: “Will you perform real-ear measurements during my fitting?” If they say no, consider going elsewhere.
Can I skip REM if I have mild hearing loss?
Even with mild hearing loss, REM matters. Studies show that people with mild loss benefit just as much from precise fitting as those with moderate or severe loss. Without verification, you might miss the subtle high-frequency sounds that make speech clear. Skipping REM for mild loss is like ignoring a small leak in your roof-it might seem fine now, but it can cause bigger problems later.
Is REM covered by insurance?
Yes. Medicare and most private insurers cover REM under CPT code 92597. The American Medical Association recognizes it as a medical necessity. If your provider says it’s not covered, ask them to check the code again-or get a second opinion. You’re paying for a service that’s proven to improve outcomes.
How long does a REM test take?
Typically 15 to 25 minutes, depending on how many settings need adjustment. It’s done during your fitting appointment, so you don’t need a separate visit. The time invested upfront reduces the need for follow-ups, which often take longer and cost more.
Can REM be done with hearing aids from any brand?
Yes. REM works with any hearing aid brand-Phonak, Oticon, Widex, Signia, Starkey, and others. The probe microphone system measures the actual sound output, regardless of the manufacturer. What matters is that the audiologist uses a calibrated system and knows how to interpret the results.
What happens if the REM results don’t match the target?
The audiologist adjusts the hearing aid settings on the spot. This could mean increasing gain in certain frequencies, changing compression levels, or adjusting noise reduction settings. The goal is to get the measured output as close as possible to the target curve-within ±5 dB, as required by Medicare guidelines. You’ll see the changes happen in real time on the screen.
Is REM necessary for children?
Absolutely. Children’s ear canals are smaller and more variable than adults’, so using adult-based estimates leads to major errors. The 2023 Joint Committee on Infant Hearing states that REM is essential for all pediatric fittings. Without it, kids may not get the sound clarity they need for speech and language development.
Chris Taylor
I had no idea REM was such a big deal until my audiologist did it last year. I thought my OTC aids were fine until I tried the real-ear test-turns out I was missing half the consonants. Now I can actually hear my kid say 'I love you' without asking her to repeat it. Worth every minute and every penny.