When you buy a hearing aid, you’re not just buying a device-you’re buying better hearing. But here’s the hard truth: real-ear measurements are the only way to know if that device is actually working for your ears. Not your neighbor’s ears. Not the average ear in a lab. Yours. Skip this step, and you’re guessing. And guessing with hearing aids means missing conversations, straining in noisy rooms, and feeling like the machine doesn’t fit your life.
What Real-Ear Measurements Actually Do
Real-ear measurements (REM) are not fancy marketing. They’re science. A thin probe tube, thinner than a strand of hair, is placed inside your ear canal-just 5 millimeters from your eardrum. Then, while you wear your hearing aid, a speaker plays speech sounds, and the probe measures exactly how much amplification your ears are getting at every frequency. It’s like putting a thermometer inside your ear to see if the hearing aid is delivering the right amount of heat-or sound. This isn’t theoretical. Research from the International Journal of Audiology shows that ear canal shape can change how sound travels by up to 20 decibels between people. That’s like turning up the volume on your TV by half the room’s noise level-just because someone else’s ear is shaped differently. Manufacturer settings? They’re based on average ear canals. Your ear isn’t average. REM fixes that.Why Manufacturer Settings Alone Fail
Most hearing aids come with a "first fit" setting. That’s the default program the device uses when you first turn it on. It’s built by the company based on population averages. And it’s wrong for most people. A 2021 MarkeTrak study found that without verification, those first-fit algorithms only hit the correct amplification target 52% of the time. That means nearly half the time, your hearing aid is either too quiet or too loud in key speech ranges-especially the high frequencies where consonants like "s," "t," and "th" live. If you’re struggling to understand words even with your hearing aid on, this is why. Compare that to REM, which achieves 92% accuracy against target levels. That’s not a small improvement. That’s the difference between hearing someone say "I love you" and hearing "I lo-ve you?"The Science Behind the Process
REM doesn’t just measure volume. It measures sound pressure levels (SPL) from 250 Hz to 8000 Hz-the full range of human speech. It checks how your hearing aid responds to soft, normal, and loud speech (typically 50, 65, and 80 dB SPL). It also accounts for something called RECD-Real-Ear-to-Coupler Difference. That’s the technical term for how your ear canal changes the sound compared to a fake 2cc test box used in labs. RECD varies by up to 15 dB between people. That’s huge. If your audiologist skips measuring your RECD, they’re basically guessing how your ear shapes sound. That’s like tuning a guitar by ear when you’re deaf to certain notes. REM uses prescriptive targets like NAL-NL2 or DSL v5.0. These aren’t random. They’re based on decades of research into how hearing loss affects speech understanding. The goal isn’t to make everything louder. It’s to make speech clearer. REM tells you if the device is hitting those targets-or missing them by 10 dB in the 3000 Hz range, where speech clarity lives.REM vs. Everything Else
You might hear about other methods: software simulations, coupler testing, or even self-fitting OTC hearing aids. Here’s how they stack up:- Manufacturer software (like Oticon Genie or Phonak Target): These simulate what REM would show. But a 2020 study in Trends in Hearing found they only match real-ear performance 65% of the time. They’re a guess, not a measurement.
- Coupler testing (2cc box): This is what manufacturers use to set initial levels. It assumes your ear is average. It’s not. It’s outdated for individual fittings.
- OTC hearing aids: The FDA explicitly says these can’t replace professional fitting. Without REM, you’re flying blind. A Trustpilot review from April 2023 said it best: "Saved $1,000. They whistle constantly."
- REM: Gold standard. Recognized by ASHA, AAA, AMA. Required by ISO 12121:2023 in Europe. Used by 97% of audiologists. 87% of users who had REM rated their hearing aids as "very effective." Those without it? Only 52% did.
What Happens During the Appointment
The process takes 15 to 25 minutes. It’s not complicated, but it’s precise. First, your audiologist checks your ear canal with an otoscope. If you have a perforation, wax blockage, or infection, they’ll delay fitting until it’s safe. About 0.9% of candidates have a contraindication. Then, the probe tube is inserted. It’s tiny. Most people feel a light tickle. A 2021 survey from the Tinnitus and Hearing Center of Arizona found 22% of first-timers felt discomfort-but 98% said it was brief and tolerable. The hearing aid is placed. The probe stays in place. The audiologist plays speech sounds from a speaker placed 1 meter away, at a 45-degree angle, in a sound-treated room. The software shows real-time graphs of what your ear is actually hearing. They adjust the hearing aid-up or down, in specific frequency bands-until the output matches the target curve. You’ll hear the difference immediately. A voice might go from muffled to crisp. Background noise might suddenly feel less overwhelming.Why This Matters for Your Life
This isn’t just about hearing better. It’s about living better. A 2019 study by Kuk et al. showed patients fitted with REM had 35% better speech understanding in noisy environments. That means you can actually follow a conversation at a restaurant. You don’t have to ask people to repeat themselves constantly. You stop feeling exhausted after social events. Reddit user "HearingHelp42" put it simply: "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." And the long-term savings? People who get REM need 43% fewer follow-up visits for adjustments, according to a 2021 study in the International Journal of Audiology. That’s fewer trips, less frustration, and more confidence.Who Doesn’t Use REM-and Why You Should Care
Here’s the dark side: not every provider uses it. 97% of licensed audiologists use REM routinely. But only 12% of retail hearing aid specialists (non-audiologists) do. Why? Time. Training. Profit. REM adds 20 minutes to a fitting. It requires skill. It’s harder to rush. Retail chains often push volume over verification. Medicare and private insurers reimburse for REM under CPT code 92597. That means it’s recognized as a medical necessity. If your provider won’t do REM-or says it’s "optional"-they’re not following standards. You’re being sold a product, not a solution.
What Comes Next
Technology is evolving. Widex’s 2023 MOMENT 2 platform uses AI to analyze REM data faster, cutting fitting time by 30%. 3D ear scanning is getting better-but as Dr. Pamela Souza said in her 2022 AAA keynote: "No matter how advanced our modeling becomes, we’ll always need to verify what’s actually happening in the real ear." The future of hearing care isn’t about smarter algorithms. It’s about smarter verification. REM is not going away. It’s becoming mandatory. Europe requires it. The U.S. medical community demands it. The FDA warns against skipping it.What to Ask Your Provider
Before you buy a hearing aid, ask these questions:- Will you perform real-ear measurements during my fitting?
- What prescriptive targets will you use-NAL-NL2 or DSL v5.0?
- Will you show me the before-and-after graphs?
- Do you use a probe microphone system that meets ANSI S3.46-2013 standards?
- Will you measure my RECD?
Final Thought
Hearing aids aren’t like glasses. You can’t just pick a strength and wear them. Your ears are unique. Your hearing loss is unique. Your brain processes sound uniquely. The only way to match the device to you is to measure what’s happening inside your ear canal-live, in real time. Real-ear measurements aren’t an upgrade. They’re the baseline. Skip them, and you’re not getting a hearing aid. You’re getting a hope.Are real-ear measurements painful?
No. A thin probe tube is gently placed in your ear canal, just before your eardrum. Most people feel a light tickle or pressure, similar to having your ear cleaned. About 22% of first-time patients report mild discomfort, but 98% say it’s brief and tolerable. The process lasts less than 30 minutes.
Can I skip REM if I’m using over-the-counter (OTC) hearing aids?
The FDA explicitly states that OTC hearing aids are not a replacement for professional evaluation and fitting. Without REM, you have no way to know if the device is amplifying the right frequencies at the right levels for your specific hearing loss. Many users report whistling, muffled speech, or discomfort with OTC devices-problems REM can prevent.
Why don’t all hearing aid providers use REM?
It takes time, training, and equipment. A typical fitting without REM can be done in 20 minutes. With REM, it’s 45-60 minutes. Retail chains and non-audiologist providers often prioritize volume and speed over accuracy. Only 12% of retail hearing aid specialists use REM routinely, compared to 97% of licensed audiologists.
Is REM covered by insurance?
Yes. Medicare and most private insurers cover REM under CPT code 92597. It’s listed as a medical necessity by the American Medical Association. If your provider says it’s not covered, ask them to verify the billing code. You’re entitled to this service.
How do I know if my audiologist is doing REM correctly?
Ask to see the real-ear gain or output curves on the screen during the test. They should show your hearing aid’s actual output compared to the NAL-NL2 or DSL v5.0 target line. If the lines match within ±5 dB across speech frequencies, it’s done right. If the graphs are blank or they just say "it’s fine," ask for clarification. Proper REM includes multiple input levels and RECD measurement.
Can REM be done for children or people with dementia?
Yes. REM is essential for pediatric fittings and is required by the 2023 Joint Committee on Infant Hearing. For patients with cognitive challenges, modified protocols exist-like using play audiometry or sedation if needed. The goal is always to verify what the ear actually receives, regardless of age or ability.
What happens if REM shows my hearing aid is too loud or too quiet?
The audiologist adjusts the device’s gain settings in real time-usually in specific frequency bands-until the output matches the target curve. This might mean lowering amplification in high frequencies if it’s too sharp, or boosting mid-range if speech sounds muffled. The adjustment is immediate and based on data, not guesswork.
Do I need REM for every hearing aid I get?
Yes. Even if you’ve had hearing aids before, your ear canal shape, hearing loss, and brain processing can change. Each new device requires new verification. Your hearing isn’t static. Your fitting shouldn’t be either.
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