Importance of Real Ear Measures in Hearing Aid Fittings

Yonah Orlofsky, AuD • September 10, 2020

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Real ear measurement (REM) is the process of evaluating if a hearing aid is delivering the

correct amount of amplification, by frequency, relative to a prescriptive target. Today, it is

considered the gold standard for verification and provides an objective measurement of the

performance of a hearing device. Digital hearing aids can be programmed specifically based on

a patient’s audiogram using a manufacturer’s algorithm. Although this method of fitting will

most likely provide some subjective benefit to the user, it does not consider the details of the

patient’s ear canal and may lead to fittings which may be under or over target. Every ear canal is

different in length and diameter and may have a different natural resonance. By inserting a thin

probe microphone into the ear canal, REM can take these variables into account and measure

the actual sound energy at the level of the tympanic membrane or ear drum. The other day I

saw a patient from another clinic who has not worn her hearing aids in quite some time due to

poor sound quality. After performing REM it was obvious why. Despite a relatively mild fit in the

manufacturer’s software, all the input levels were measured above target prescription during

Real Ear Measures. After the appropriate modifications, the patient noticed a more natural

sound quality immediately. She did not need new hearing aids; she just needed a more accurate

fitting. This example illustrates how important best practices are in hearing aid fittings. A patient

can have the top of the line hearing device but if it is not fit and measured properly, you may

not be getting the best results. If you are considering getting help with your hearing, make sure

your provider conducts real ear measurements.

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