Quick Answer
Audiologists use a process called Real-Ear Measurement (REM) to verify that hearing aids are delivering the correct amount of sound for your specific ears and hearing loss. This quick in office test measures how sound actually behaves inside your ear canal while you wear your hearing aids. By using REM, providers can fine-tune your hearing aids for clearer speech, natural sound quality, and greater comfort.
A Personalized Approach to Hearing Aid Fittings
Today’s hearing aids are incredibly advanced. They are essentially small computers that analyze and adjust sound thousands of times each second.
But even the best hearing technology still needs to be customized to your unique ears and hearing needs. Just like eyeglasses must be tailored to your prescription, hearing aids work best when they are precisely adjusted for how sound travels inside your ear canal.
That’s why many audiologists use Real-Ear Measurement (REM) during hearing aid fittings. This verification process helps ensure that your hearing aids are delivering sound exactly as intended.
What Is Real-Ear Measurement?
Answer
Real-Ear Measurement (REM) is a clinical test that measures how much sound your hearing aids are delivering directly inside your ear canal. A tiny microphone is placed comfortably in your ear while speech-like sounds are played through your hearing aids. This allows your audiologist to see how sound is amplified in your specific ear and make precise adjustments if needed.
Definition
Real-Ear Measurement (REM) is a verification method used by audiologists to measure hearing aid performance inside the ear canal while the device is being worn.
Because every ear canal has a unique shape and size, sound can behave differently from person to person. REM helps confirm that your hearing aids are delivering the right amount of sound across different pitches for your individual hearing profile.
Why Aren’t Default Hearing Aid Settings Always Perfect?
Answer
Most hearing aids start with manufacturer “first-fit” settings that are designed to work for many people. While these settings are a useful starting point, they are based on averages rather than your exact ear acoustics. Real-Ear Measurement allows audiologists to refine those settings so sound is balanced, clear, and comfortable for you.
Think of first-fit settings like the default settings on a new smartphone. They work well for many people, but they are not personalized yet. Without verification, some individuals may experience:
- speech that sounds slightly unclear
- sound that feels too sharp or too soft
- difficulty hearing certain pitches
REM allows providers to move beyond trial-and-error and make adjustments based on measured data from your ear.
How Does Real-Ear Measurement Work?
Answer
During REM testing, a very small microphone is placed inside your ear canal while you wear your hearing aids. Speech-like sounds are played through speakers, and specialized equipment measures how those sounds are amplified in your ear. Your audiologist then compares the results to recommended targets for your hearing loss and adjusts the hearing aids if needed.
Step-by-Step: What Happens During an REM Appointment
Review your hearing test and listening goals
Your audiologist will review your hearing evaluation results and talk about situations where you want better hearing, such as conversations, restaurants, or meetings.
Place a small measurement microphone in the ear canal
A thin, flexible tube with a microphone is gently placed into the ear canal. Most patients say they barely notice it.
Play speech-like sounds through the hearing aids
The system plays sounds that simulate speech to evaluate how the hearing aids amplify different frequencies.
Measure sound levels inside the ear
The equipment measures the sound reaching your eardrum and compares it to recommended amplification targets.
Fine-tune the hearing aids for clarity and comfort
If adjustments are needed, the audiologist modifies the hearing aid programming to match your hearing needs more precisely.
The entire process is typically quick, comfortable, and painless.
Why Is Real-Ear Measurement Considered the Gold Standard?
Answer
Real-Ear Measurement is widely considered the gold standard in hearing aid verification because it confirms that hearing aids are delivering the correct sound levels for the wearer. Instead of relying on estimated settings, REM allows audiologists to verify performance using real measurements inside the ear.
Some clinics rely only on default programming because it is faster. However, verification testing provides additional precision and often leads to better long-term hearing outcomes.
Many patients notice benefits such as:
- clearer speech understanding
- more natural sound quality
- reduced listening fatigue
- fewer misunderstandings in conversation
- greater confidence wearing hearing aids
When hearing aids are carefully verified, patients often feel more comfortable adapting to them and using them consistently.
How Much Does Real-Ear Measurement Cost?
The cost of Real-Ear Measurement (REM) can vary depending on the clinic and whether the service is part of a hearing aid fitting.
In some situations, the test may be billable to insurance when it is performed as part of a diagnostic or verification service.
Coverage varies depending on your insurance plan.
Why Is REM Worth It?
Real-Ear Measurement provides something that programming software alone cannot: objective verification of what your hearing aids are actually doing inside your ear.
Without REM, hearing aids are often programmed based on estimates. With REM, your audiologist can measure the exact sound levels reaching your eardrum and adjust the devices to match evidence-based targets for your hearing loss.
This precision often leads to:
- clearer speech understanding
- better balance between soft and loud sounds
- improved comfort
- less listening fatigue
- better long-term satisfaction with hearing aids
In other words, REM helps ensure that the technology you invested in is truly optimized for your ears.
Helpful Tips for Getting the Best Hearing Aid Performance
Ask your audiologist whether Real-Ear Measurement is part of your hearing aid fitting process.
Give yourself time to adjust gradually to new hearing aids. Schedule follow-up visits if something does not sound quite right. Pay attention to situations where hearing feels easier or more challenging. Keep your hearing aids clean and well maintained for optimal performance.
Small adjustments can make a big difference in everyday listening.
Common Questions About Real-Ear Measurement
Is Real-Ear Measurement uncomfortable?
No. The microphone used during REM testing is very small and flexible. Most people find the test quick and comfortable.
Do all hearing aid fittings include REM?
Not always. Some clinics use manufacturer default settings only. Clinics that focus on verification testing often include REM because it helps ensure accurate programming. If you buy online, those can be fine-tuned, but not with REM.
How long does Real-Ear Measurement take?
The measurement portion usually takes only a few minutes and is often completed during the hearing aid fitting appointment.
Can REM improve hearing aid clarity?
Yes. Because the test measures sound directly inside the ear, it allows providers to make precise adjustments that can improve speech clarity and listening comfort.
Should REM be done for existing hearing aids?
It can be helpful if you feel your hearing aids are not performing as well as expected. The measurement may reveal adjustments that improve performance. If you buy online or buy an Over-The-Counter (OTC) hearing aid, schedule an appointment with your local audiologist to get an exact adjustment.
Hearing Care Expertise at Eastside Audiology
At Eastside Audiology, our providers focus on delivering personalized hearing care that matches each patient’s hearing needs and lifestyle. Verification methods such as Real-Ear Measurement allow us to ensure hearing aids are working as effectively as possible for the individual wearing them. Our team serves patients throughout Mill Creek, Woodinville, Issaquah, Renton, and surrounding communities, helping people improve communication and stay connected to the moments that matter most.
Ready to Make Sure Your Hearing Aids Are Optimized?
If you are considering hearing aids or already wearing them and want to make sure they are fully optimized, Real-Ear Measurement can help ensure they are delivering the best possible sound.
Schedule a visit with Eastside Audiology to learn more about personalized hearing solutions and hearing aid verification.
About the Author: Dr. Nichole Kingham, AuD, ABA, F-AAA
Doctor of Audiology, Eastside Audiology
Dr. Nichole Kingham is a Doctor of Audiology (AuD), licensed in the State of Washington and board-certified by the American Board of Audiology (ABA). She is also a Fellow of the American Academy of Audiology (F-AAA). As the owner and clinical leader of Eastside Audiology, Dr. Kingham is committed to delivering evidence-based, patient-centered hearing healthcare to individuals and families throughout the greater Seattle area, including Woodinville, Everett, Mill Creek, Renton, and Issaquah.
Expertise and Experience
- Clinical Focus: Dr. Kingham specializes in comprehensive diagnostic hearing evaluations, complex hearing aid fittings, and the integration of advanced hearing technology to support real-world communication success.
- Practice Leadership: As a private practice owner, she brings a unique perspective that combines clinical excellence with a commitment to long-term patient outcomes and ethical care delivery.
- Community Commitment: Dr. Kingham serves patients across King and Snohomish Counties and is dedicated to improving access to high-quality audiologic care in the communities she serves.
- Credentials: Dr. Kingham earned her Doctorate in Audiology (AuD) and maintains active board certification through the American Board of Audiology, reflecting her commitment to the highest standards of clinical care.
Disclaimer: The information presented in this article is for general informational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions regarding your hearing health.