Hearing health

Real-ear measurement: importance, procedure, and benefits

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Author: EarPros Team

Doctor conducting patient's hearing level test

Real-ear measurement (REM) is a critical tool in the field of audiology, ensuring that hearing aids are optimally fitted for individual needs. This process provides an objective method to verify how hearing aids amplify sound within the unique anatomy of a person’s ear. Despite its importance, REM is not universally performed, leaving many hearing aid users without the benefits it offers. In this article, we will delve into the definition, importance, equipment, and procedure of real-ear measurement, while addressing common concerns and benefits.

What is real-ear measurement?

Real-ear measurement is an audiological test that objectively assesses the sound pressure level (SPL) generated by a hearing aid in the ear canal. By placing a probe microphone within 5-6 millimeters of the eardrum, audiologists can measure the amplification and ensure it meets the specific prescription for the user’s hearing loss. This process accounts for the unique acoustic properties of each ear canal, which can significantly influence the performance of hearing aids.

Real-ear measurement definition

Real-ear measurement, sometimes referred to as real-ear verification, involves using specialized equipment to measure how sound behaves in the ear canal. The goal is to verify that the hearing aid provides the correct level of amplification across different frequencies. Unlike subjective feedback from the user, REM provides precise, data-driven insights into the hearing aid’s performance.

Why is real-ear measurement important?

The primary reason for conducting real-ear measurement is to ensure hearing aids deliver the right level of sound amplification tailored to the user’s needs. Without this verification, hearing aids may either underperform, leaving sounds too soft, or over-amplify, causing discomfort or distortion.

Personalization for unique ear anatomy

Every ear canal varies in size, shape, and resonance, meaning a one-size-fits-all approach cannot guarantee optimal results. Real-ear measurement allows audiologists to tailor hearing aid settings to the user’s specific ear canal acoustics, improving comfort and speech clarity.

Verification of advanced features

Hearing aids often come with features like directional microphones and frequency-lowering technology. REM helps verify that these advanced functionalities are working as intended, maximizing the device's effectiveness.

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Real-ear measurement equipment

The equipment used in real-ear measurement is specialized and precise. Key components include:

Probe Microphone: A slim, flexible tube inserted into the ear canal to measure sound levels near the eardrum.
External Microphone: Placed outside the ear to capture ambient sound levels for comparison.
Loudspeaker: Delivers test sounds or speech stimuli to the ear during the measurement process.
Measurement System: A computer or dedicated device processes data from the microphones and generates a visual representation of the results.

These tools allow audiologists to adjust hearing aid settings in real-time, ensuring the output matches prescribed targets.

Real-ear measurement equipment cost

The cost of real-ear measurement equipment can vary widely based on the brand, features, and level of sophistication. Entry-level systems may start around $3,000 to $5,000, while more advanced models with additional functionalities, such as wireless connectivity or integrated software for data analysis, can exceed $10,000. These devices are a significant investment for audiology clinics, reflecting their importance in ensuring accurate hearing aid fittings. Despite the high upfront cost, real-ear measurement equipment provides substantial long-term value by improving patient satisfaction and reducing follow-up visits for hearing aid adjustments. Many clinics consider this investment essential for delivering quality care, as it aligns with best practices in audiology and enhances the effectiveness of hearing aids.

Doctor measuring a patient's hearing level

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How is real-ear measurement performed? The REM procedure

Real-ear measurement (REM) is a detailed and precise procedure designed to ensure that hearing aids are optimized for individual needs. This process uses advanced equipment to measure how sound behaves in the unique acoustic environment of the ear canal. By following a systematic approach, audiologists can fine-tune hearing aids to deliver accurate amplification and improved auditory experiences.

Step 1: Initial calibration

Before beginning, the audiologist calibrates the REM system to ensure accurate measurements. This involves setting the loudspeaker to a specific distance (usually 30 cm to 1 meter) from the user.

Step 2: Otoscopy

The audiologist inspects the ear canal for wax, debris, or abnormalities that could interfere with the measurement. If issues like excessive wax are found, they must be addressed before proceeding.

Step 3: Probe insertion

A thin probe microphone is carefully inserted into the ear canal, positioned close to the eardrum. Proper placement is crucial, as incorrect positioning can lead to inaccurate results.

Step 4: Hearing aid placement

With the probe in place, the hearing aid is inserted into the ear. The audiologist ensures that both the probe and the device fit securely without causing discomfort.

Step 5: Measurement and adjustment

The loudspeaker emits test sounds while the REM system measures the sound levels at the eardrum. The audiologist compares these results to the prescribed targets and adjusts the hearing aid settings as needed.

Benefits of real-ear measurement

Improved hearing aid performance

By ensuring accurate amplification, REM enhances speech clarity and listening comfort. Users experience better overall satisfaction with their hearing aids.

Long-term success

Studies show that hearing aid users fitted with REM are more likely to continue using their devices and report higher satisfaction rates.

Objective validation

REM provides an evidence-based approach to hearing aid fitting, reducing reliance on subjective feedback and ensuring precise adjustments.

Common concerns about real-ear measurement

Some individuals may feel apprehensive about the procedure, but it is generally well-tolerated and painless. The probe insertion might cause a slight tickling sensation, but it does not pose any risks when performed by a trained audiologist.

Contraindications

In rare cases, REM may not be feasible due to:

Excessive earwax
Discharge or infection in the ear canal
Significant ear pain
Large perforations in the eardrum

Real-ear measurements in adults and children

REM is essential for both adults and children, but its application differs slightly. For adults, REM helps refine settings based on their subjective experiences and hearing loss profile. For children, whose feedback may be limited, REM provides objective data crucial for early intervention and speech development. Pediatric audiologists often use REM to adapt hearing aids as the child grows and their auditory needs evolve.

Why you should insist on real-ear measurement

Despite being the gold standard for hearing aid fitting, REM is not universally practiced. Lack of time and equipment availability are common barriers. However, skipping REM can lead to suboptimal hearing aid performance. As a hearing aid user, it is essential to advocate for this service during your fitting appointments.

What is the history of real-ear measurement?

Real-ear measurement emerged in the late 20th century as advancements in audiology called for more precise fitting techniques. Early methods relied on subjective assessments, but the introduction of probe microphones revolutionized the process. Over time, REM has evolved with sophisticated technology, making it the gold standard for hearing aid verification.

Conclusion about real-ear measurement

Real-ear measurement is a vital step in ensuring hearing aids deliver optimal performance tailored to the user’s unique needs. By using precise equipment and objective data, audiologists can fine-tune hearing aids for maximum benefit. Whether you are new to hearing aids or seeking better results from your current devices, insist on real-ear measurement for a more successful and satisfying experience.

Understanding the role of REM and its importance empowers you to make informed decisions about your hearing care, ensuring that your hearing aids enhance your quality of life to the fullest extent.

FAQs about real-ear measurement

Are real-ear measurements necessary?

Yes, real-ear measurements are widely regarded as necessary for ensuring optimal hearing aid performance. They provide a scientific, objective method to verify amplification and prevent common fitting errors, highlighting the importance of real-ear measurements for long-term satisfaction and efficacy.

Is real-ear measurement an assessment?

Yes, REM is an assessment that measures sound levels in the ear canal to verify hearing aid functionality. It is a diagnostic tool rather than a subjective evaluation, making it an integral part of hearing aid fitting protocols.

Does Costco use real-ear measurement?

Costco Hearing Centers often incorporate REM in their fitting process, though it can vary by location. It is recommended to ask your local Costco audiologist about their use of REM during appointments.

Does Oticon use real-ear measurement?

Yes, Oticon hearing aids are designed to support and benefit from real-ear measurement (REM). Audiologists commonly use REM to verify that Oticon devices, including their advanced features like BrainHearing™ technology, are calibrated accurately for the user's unique ear anatomy and hearing needs. This ensures optimal performance and improved user satisfaction.

Does Phonak use real-ear measurement?

Yes, Phonak hearing aids are fully compatible with real-ear measurement. Audiologists utilize REM to fine-tune Phonak's features, such as AutoSense OS and adaptive technology, to ensure they meet prescribed amplification targets. This process guarantees a personalized and precise hearing experience for the user.

What is the real-ear coupler difference measuremen

The Real-Ear Coupler Difference (RECD) measurement compares the sound levels in an individual’s ear canal to those in a standardized coupler. RECD is particularly useful for fitting hearing aids in children, where individual ear acoustics differ significantly from adult standards. It helps audiologists predict how hearing aids will perform without requiring repeated in-ear measurements.

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