When you invest in hearing aids, you’re not just purchasing a device—you’re beginning a journey toward better hearing that depends heavily on how well those devices are programmed to match your unique ears. One of the most essential tools audiologists use to ensure your hearing aids are working optimally is Real-Ear Measurement (REM). Yet despite being considered the gold standard in hearing aid verification, many patients have never heard of it, and surprisingly, not all clinics use it consistently.
Understanding what happens during a proper hearing aid fitting and why verification through REM matters can help you become an informed advocate for your hearing health. This article explains what you should expect from a comprehensive hearing aid fitting and why certain clinical procedures make the difference between hearing aids that truly work and those that leave you disappointed.
What Is Real Ear Measurement?
Real Ear Measurement is a verification procedure that measures exactly what’s happening inside your ear canal when you’re wearing your hearing aids. The process involves placing a thin probe microphone tube into your ear canal alongside your hearing aid. This tube contains a tiny microphone that measures the actual sound pressure level reaching your eardrum while various test sounds are played.
The reason REM is so important comes down to basic anatomy: every person’s ear is shaped differently. The size and shape of your ear canal, the resonance characteristics of your outer ear, and even how deeply the hearing aid sits in your ear all affect how sound is delivered. Two people with identical hearing-loss profiles might need quite different hearing aid settings because their ears differ physically. Programming hearing aids based solely on your audiogram assumes an “average” ear, but your ears aren’t average—they’re uniquely yours.
During REM, your audiologist compares the measured output in your ear to prescriptive targets based on your specific hearing loss. These targets, derived from research-validated formulas such as NAL-NL2 or DSL, indicate the amplification you need at different frequencies to restore audibility while maintaining optimal comfort. If the measurements show your hearing aids aren’t meeting these targets, your audiologist can make precise adjustments until the fit is right.
Why Some Clinics Skip This Critical Step
Despite overwhelming evidence supporting REM, surveys suggest that fewer than 40% of hearing aid fittings include verification procedures. There are several reasons clinics might skip this step, though none justify the omission from a best-practice standpoint.
Time constraints are often cited, as REM adds approximately 15-20 minutes to an appointment. Some clinics operate on tight schedules that prioritise volume over thoroughness. Cost can also be a factor, as REM equipment represents a significant investment—typically between $8,000 and $15,000—and requires regular calibration.
Perhaps more concerning is the reliance on manufacturer “first fit” algorithms. Modern hearing aids can generate an initial program based on your audiogram, and in some cases, these automated settings work reasonably well. However, first fit is exactly that—a starting point, not a verified endpoint. Without measurement, there’s no way to know whether your hearing aids are actually providing the amplification you need, particularly in the mid and high frequencies that are crucial for speech clarity.
At The Audiology Place, REM is a standard component of every hearing aid fitting. We consider it non-negotiable because the research is clear: verified fittings result in better outcomes, higher satisfaction, and improved speech understanding in real-world situations.
What to Expect During a Comprehensive Hearing Aid Fitting
A thorough hearing aid fitting involves several interconnected steps, each building on the previous one to ensure optimal outcomes.
Initial Programming and Counselling
Your audiologist begins by programming your hearing aids based on your audiogram and case history. Before any sound is introduced, you’ll receive education about realistic expectations, adjustment timelines, and how to handle your devices. This counselling sets the foundation for success and helps you understand that adaptation counselling is a process, not an instant transformation.
Real Ear Measurement Verification
With your hearing aids initially programmed, the verification process begins. After placing the probe tube in your ear canal (you’ll barely feel it), your audiologist will measure how your ear responds without a hearing aid, then with the hearing aid in place. Test signals—typically speech-shaped noise at different volume levels—are presented while measurements are taken.
The computer screen displays curves showing target amplification and actual output. Your audiologist makes adjustments to bring the two into alignment across frequencies, ensuring soft sounds are audible, calibrating the table, and ensuring loud sounds don’t exceed your tolerance levels.
Functional Verification and Fine-Tuning**
After REM verification, most audiologists conduct functional tests using recorded speech or live voice. You might be asked to repeat sentences presented at different volumes or in the presence of background noise. These speech-in-noise assessments help confirm that the technical measurements translate to real-world benefit.
This is also when you’ll discuss your subjective impressions. Many patients find newly fitted hearing aids sound “tinny” or “sharp” initially, particularly if hearing loss has been present for years. Your brain needs time to reacquaint itself with high-frequency sounds, such as consonants. Your audiologist can make modest adjustments for comfort while preserving the amplification you need, but dramatic reductions to make things “sound normal” often undermine the purpose of amplification.
Beyond the Initial Fitting: The Importance of Follow-Up Care
The first fitting appointment, even with perfect REM verification, is just the beginning. Acclimatisation—your brain’s adjustment to amplified sound—typically takes several weeks to months. Research suggests that patients who return for follow-up adjustments during this period achieve better long-term outcomes than those who don’t.
What Follow-Up Appointments Should Include:
– **Reassessment of your experience** in various listening environments—conversations in quiet, restaurants, television, phone use, and outdoor settings
– **Review of data logging** from your hearing aids, which tracks how many hours you’re wearing them and in what environments
– **Adjustments based on real-world feedback** while staying as close to verification targets as possible
– **Additional REM verification** if significant programming changes are made
– **Troubleshooting** of any physical comfort issues, feedback problems, or handling difficulties
A typical adjustment period involves 2-3 follow-up appointments over the first three months, though your individual needs may vary. Clinics that offer comprehensive aftercare as part of their service model, rather than charging for each follow-up visit, often see higher patient satisfaction because people feel comfortable returning when issues arise.
Red Flags: When to Seek a Second Opinion
Not all hearing care is created equal. Certain practices should raise concerns about whether you’re receiving evidence-based, patient-centred care:
If your hearing aids were programmed but never verified with probe microphone measurements, you have no assurance they’re meeting your needs. If your audiologist significantly reduced gain because “patients prefer a more natural sound” without explaining the implications for speech understanding, your devices may be under-amplified. If you’re discouraged from returning for adjustments or charged prohibitive fees for follow-up care, your clinic may not be supporting your long-term success.
Additionally, suppose you experience sudden changes in hearing, ear pain, drainage, or dizziness. In that case, these represent medical red flags requiring prompt evaluation by a physician or ear, nose, and throat specialist—not requiring aid adjustments.
The Independent Factor: Brand-Agnostic Care
One aspect of authoritative audiology care that deserves attention is independence from manufacturer influence. Some clinics are owned by or strongly aligned with specific hearing aid manufacturers, which can limit the range of products offered and potentially bias recommendations.
At The Audiology Place, we maintain a brand-agnostic approach, selecting from multiple manufacturers to find devices that best match your hearing profile, lifestyle needs, and budget. This independence, combined with verification through REM and comprehensive follow-up care, ensures that recommendations are driven by your best interests rather than business relationships or sales quotas.
Understanding what constitutes a proper hearing aid fitting empowers you to ask informed questions and recognise quality care. Real Ear Measurement isn’t an optional luxury, it’s a clinical standard supported by research and endorsed by audiological professional organisations worldwide. When combined with thorough initial counselling, functional verification, and committed follow-up care, REM forms the foundation of successful hearing rehabilitation.
If you’re considering he provides aids or struggles with devices you already own, seeking care from a clinic that prioritises evidence-based verification procedures can make the difference between frustration and genuine communication improvement. Your hearing is too important to leave to guesswork when measurement tools exist to ensure precision.
*The information in this article is provided for educational purposes and does not constitute medical advice. Individual hearing needs vary, and proper diagnosis and treatment require assessment by a qualified healthcare professional. If you’re experiencing hearing difficulties or have concerns about your current hearing aids, contact an audiologist for a comprehensive evaluation.*
