When you get hearing aids, you want them to work-really work. Not just turn up the volume, but make speech clear in a noisy room, reduce the effort of listening, and let you hear your grandchild’s laugh without straining. Too many people leave the clinic disappointed, wondering why their new hearing aids don’t sound right. The problem isn’t the device. It’s the fitting. And the single most important step most clinics skip? Real-ear measurements.
What Real-Ear Measurements Actually Do
Real-ear measurements (REM) are the only way to know exactly how much amplification your hearing aid is delivering inside your own ear canal. Think of it like this: your ear canal isn’t a standard tube. It’s shaped uniquely-like a fingerprint. That shape affects how sound moves through it. A hearing aid programmed using a generic model might deliver 15 dB too much or too little at key speech frequencies. That’s the difference between hearing clearly and hearing muffled, distorted noise.
REM uses a tiny probe microphone placed inside your ear, next to your eardrum, while you wear the hearing aid. A speaker plays speech sounds, and the system measures the actual sound pressure levels reaching your eardrum. It then compares that to a scientifically proven target-like NAL-NL2 or DSL v5.0-that’s calculated based on your hearing test results. If the output doesn’t match, the audiologist adjusts the hearing aid until it does.
This isn’t guesswork. It’s science. Studies show that when REM is used, patients understand speech in noise 35% better than those fitted without it. That’s not a small improvement. That’s going from missing half the conversation at dinner to catching every word.
Why Manufacturer Settings Aren’t Enough
Most hearing aids come with a “first fit” setting. That’s the default program the manufacturer suggests based on average ear anatomy. But here’s the problem: there’s no such thing as an “average” ear. Research shows individual ear canal acoustics can vary by up to 20 dB between people. That means if your audiologist just uses the manufacturer’s preset, your hearing aid might be delivering the wrong amount of amplification-especially in the high frequencies where speech clarity lives.
One study found that without REM, only 52% of hearing aids hit their target gain. With REM, that jumps to 92%. That’s not a slight upgrade. That’s going from barely adequate to precisely calibrated.
Even the fancy software simulations from brands like Oticon or Phonak-tools that try to predict real-ear performance-only match actual measurements about 65% of the time. Why? Because they’re still guessing. REM doesn’t guess. It measures.
The Process: What Happens During REM
The procedure is quick, safe, and non-invasive. Here’s what you can expect:
- Your audiologist will do a quick check of your ear canal with an otoscope to make sure there’s no wax blockage or damage.
- A thin, flexible probe tube (about the width of a human hair) is gently inserted into your ear canal, placed within 5 mm of your eardrum. This is the same tube used to measure your ear’s natural resonance (called the RECD).
- You’ll wear your hearing aid as usual, and the probe stays in place.
- Soft speech sounds are played through a calibrated speaker positioned in front of you.
- The system records how much amplification your hearing aid is actually providing at every frequency-from low rumbles to high-pitched voices.
- The audiologist compares the results to your target curve and makes fine adjustments until the two lines match.
The whole process adds about 15 to 25 minutes to your appointment. But here’s the kicker: patients who get REM have 43% fewer follow-up visits for adjustments. That means less time back in the clinic, less frustration, and better outcomes from day one.
What Happens If You Skip REM
Over-the-counter (OTC) hearing aids are now widely available. They’re cheaper. And they don’t require a professional fitting. But the FDA itself says these devices “cannot replace the need for professional evaluation and fitting.” Why? Because without REM, you’re flying blind.
People who buy OTC aids online often report whistling (feedback), distorted speech, or that the devices “just don’t sound natural.” One Trustpilot review from April 2023 summed it up: “Saved $1,000. They whistle constantly. I had to return them.”
Even in professional settings, clinics that skip REM are taking a gamble. A 2021 survey showed only 12% of non-audiologist hearing aid specialists consistently use verification. Meanwhile, 97% of board-certified audiologists use REM every time. The difference? Training, standards, and accountability.
Real Stories: What Patients Say
On HealthyHearing.com’s 2022 survey of over 1,200 hearing aid users, 87% of those who had REM said their hearing aids were “very effective.” Only 52% of those without REM felt 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. Nearly 70% of patients who had REM reported feeling less mentally drained after conversations. That’s huge. Hearing shouldn’t be exhausting.
The only complaint? The probe tube can feel a little tickly. About 22% of first-time users report mild discomfort. But 98% say it’s brief and totally worth it.
Why Professionals Demand REM
It’s not just audiologists who agree. The American Speech-Language-Hearing Association (ASHA), the American Academy of Audiology (AAA), and even the American Medical Association all call REM the gold standard. ASHA’s Practice Portal says bluntly: “Probe microphone measures are the only way to verify that the hearing aid is providing the appropriate gain.”
Dr. H. Gustav Mueller, a pioneer in the field and co-author of The Hearing Aid Handbook, put it simply: “Without real-ear verification, you’re fitting hearing aids by guesswork-there’s no other way to say it.”
And it’s not just opinion. Medicare and most private insurers now reimburse for REM under CPT code 92597. That’s because it’s been proven to be medically necessary. If your audiologist doesn’t offer it, they’re not meeting the standard of care.
What’s Next for REM
Technology is making REM even better. New systems like Widex’s MOMENT 2 use AI to analyze results faster, cutting fitting time by 30%. In Europe, ISO 12121:2023 now requires REM for all hearing aids sold. The NIH is investing $2.4 million to improve REM tools, and pediatric guidelines now state it’s “essential” for children.
Some are exploring 3D ear scans to predict real-ear responses. But 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.”
REM isn’t going away. It’s becoming the baseline. And if you’re getting hearing aids, you deserve nothing less.
Questions You Might Have
Is real-ear measurement painful?
No, it’s not painful. A thin probe tube is gently placed in your ear canal, next to your eardrum. Most people feel a slight tickle or pressure, but it’s brief and tolerable. Around 22% of first-time users report mild discomfort, but 98% say it’s worth it.
How long does REM take?
It adds about 15 to 25 minutes to your fitting appointment. While that might seem like extra time, it prevents most follow-up visits. Patients who get REM have 43% fewer adjustments needed later.
Can I skip REM if I’m getting OTC hearing aids?
The FDA explicitly states that over-the-counter hearing aids cannot replace professional evaluation and fitting. Without REM, you’re relying on generic settings that don’t account for your unique ear shape or hearing loss. Many users report feedback, poor speech clarity, or discomfort-problems REM would have prevented.
Does insurance cover real-ear measurements?
Yes. Medicare and most private insurers cover REM under CPT code 92597. It’s recognized as a medical necessity because it directly impacts treatment outcomes. If your provider says it’s not covered, ask them to check the code.
Why do some clinics not use REM?
Some clinics skip it to save time or because they lack the equipment or training. Non-audiologist providers are far less likely to use it-only 12% do consistently. Board-certified audiologists, however, use REM in nearly all fittings because it’s the standard of care. If your provider doesn’t offer it, ask why.
Can REM help with tinnitus or other hearing issues?
REM is specifically designed to verify hearing aid output, not treat tinnitus. But if you have tinnitus and use hearing aids, properly fitted aids can reduce the perception of ringing by restoring natural sound levels. REM ensures your aids are delivering the right amplification to help with that.
