When you buy a hearing aid, you’re not just buying a device-you’re investing in clearer conversations, less frustration, and better quality of life. But here’s the hard truth: real ear measurement isn’t just a nice-to-have add-on. It’s the only way to know your hearing aid is actually working the way it should. Without it, you’re guessing. And guessing with hearing aids means missing speech, struggling in noise, or dealing with constant feedback.
What Real-Ear Measurement Actually Does
Real-ear measurement (REM) is a simple, science-backed process that checks exactly how much sound your hearing aid delivers inside your own ear canal. It’s not based on averages. It’s not based on manufacturer presets. It’s based on your unique anatomy.
Your ear canal isn’t like everyone else’s. It has its own shape, length, and natural resonance-like a tiny musical instrument. That means a hearing aid that sounds perfect in a lab test tube might be too quiet, too loud, or distorted when it’s in your actual ear. Research shows these differences can be as big as 20 decibels. That’s the difference between hearing a whisper and hearing nothing at all.
REM uses a thin probe tube, placed just 5 millimeters from your eardrum, to measure the real sound pressure levels. A tiny microphone picks up what’s actually reaching your eardrum while you’re wearing the hearing aid. The audiologist then compares that data to your personal hearing loss profile and a validated target like NAL-NL2 or DSL v5.0. If the numbers don’t match, the hearing aid gets adjusted-until they do.
Why Manufacturer ‘First Fit’ Isn’t Enough
Most hearing aids come with a default setting called a ‘first fit.’ That’s the algorithm the manufacturer thinks will work for most people. It’s based on data from hundreds of average ears. But you’re not average. And neither is your ear canal.
According to MarkeTrak data, only 52% of hearing aids fitted using manufacturer presets alone meet the target amplification levels. That means nearly half of new users are getting less help than they should. And it’s not because the device is broken-it’s because the settings were never verified for their specific ears.
Compare that to REM, which achieves 92% accuracy in matching targets. That’s not a small improvement. That’s the difference between hearing just enough and hearing clearly. Studies show patients who get REM-guided fittings understand speech in noisy places-like restaurants or family dinners-35% better than those who don’t.
The Science Behind the Numbers
REM doesn’t just measure volume. It looks at how sound changes across frequencies-from low rumbles to high-pitched consonants like ‘s’ and ‘th.’ That’s critical because hearing loss isn’t uniform. Most people lose high-frequency hearing first. If your hearing aid boosts low frequencies too much and misses the highs, you’ll hear people talking but still can’t make out what they’re saying.
The process uses standardized speech signals at 50 dB (soft), 65 dB (normal), and 80 dB (loud) to simulate real-life situations. It also accounts for something called RECD-Real-Ear-to-Coupler Difference. This measures how your ear canal changes the sound compared to a standard 2cc test coupler. RECD varies by up to 15 dB between individuals. Without measuring it, you’re fitting based on a fictional ear.
ANSI S3.46-2013 standards require REM equipment to measure within ±2 dB of true sound pressure. That’s precision. And it’s not optional. The American Speech-Language-Hearing Association (ASHA), the American Academy of Audiology (AAA), and the American Medical Association all recognize REM as the gold standard. In fact, 97% of board-certified audiologists use it for every fitting.
What Happens When REM Is Skipped
Patients who skip REM often come back frustrated. They say things like, ‘It’s too loud,’ ‘It whistles all the time,’ or ‘I still can’t hear my grandkids.’ These aren’t device failures. They’re fitting failures.
Over-the-counter (OTC) hearing aids, which don’t require professional fitting, are a growing market. But the FDA itself warns these devices ‘cannot replace the need for professional evaluation and fitting.’ A Trustpilot review from April 2023 sums it up: ‘Bought OTC aids online, saved $1,000 but they whistle constantly.’
Even in clinics, not everyone uses REM. Only 12% of non-audiologist hearing aid specialists consistently use verification. That’s a red flag. If your provider doesn’t mention REM, ask why. If they say, ‘It’s not necessary,’ they’re not following the science.
What the Patient Experience Is Really Like
Some people worry REM will be uncomfortable. The probe tube is thin-about the size of a piece of thread. It’s inserted gently, and most people feel only a mild tickle. In one survey, 22% of first-time users reported discomfort, but 98% said it was brief and tolerable.
And the payoff? Huge. In a 2022 HealthyHearing survey of over 1,200 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.’ That’s not hype. That’s data.
Why Audiologists Won’t Skip It
Professional audiology isn’t about selling devices. It’s about solving hearing problems. And REM is the only tool that proves you’ve solved it.
Dr. H. Gustav Mueller, a pioneer in the field and author of The Hearing Aid Handbook, put it bluntly: ‘Without real-ear verification, you’re fitting hearing aids by guesswork-there’s no other way to say it.’
That’s why hospitals, university clinics, and private audiology practices all use REM. It’s built into their workflow. Medicare and private insurers even have a specific billing code-CPT 92597-for REM. That means the medical community recognizes it as a necessary, billable service, not an extra.
And it saves time in the long run. While REM adds 15 to 25 minutes to the initial fitting, it cuts follow-up visits by 43%. That’s fewer trips back to the clinic, fewer adjustments, and less frustration.
What’s Changing in the Industry
REM isn’t standing still. New tools are making it faster and smarter. Widex’s 2023 MOMENT 2 platform uses AI to analyze REM data in real time, reducing fitting time by 30%. The International Organization for Standardization now requires REM verification for all hearing aids sold in Europe under ISO 12121:2023.
Even 3D ear scanning, which creates digital models of your ear canal, can’t replace REM. As Dr. Pamela Souza said in her 2022 AAA keynote: ‘No matter how advanced our modeling becomes, we’ll always need to verify what’s actually happening in the real ear.’
The NIH is investing $2.4 million into improving REM technology through 2026. That’s not a fluke. It’s a signal: verification is the future of hearing care.
What You Should Do
If you’re getting a hearing aid, ask for REM. Don’t accept a fitting without it. If your provider doesn’t offer it, find someone who does. This isn’t about being picky-it’s about getting results.
Here’s your checklist before your fitting:
- Confirm the audiologist uses real-ear measurement for every fitting.
- Ask to see the target curves (NAL-NL2 or DSL v5.0) and how your results compare.
- Make sure they measure at multiple input levels: soft, normal, and loud speech.
- Request a copy of your REM report. You have a right to it.
- If they say, ‘It’s not needed,’ walk out. You deserve better.
Hearing aids are powerful tools. But they only work when they’re properly fitted. Real-ear measurement isn’t magic. It’s math. It’s physics. It’s science. And it’s the only way to make sure your hearing aid actually helps you hear-not just turns on.
Is real-ear measurement painful?
No, it’s not painful. A thin probe tube is gently placed in your ear canal, just before the eardrum. Most people feel a slight tickle or pressure, but it lasts only a few minutes. Over 98% of patients say it’s tolerable, even if it’s a little unusual at first.
Can I skip REM if I’m getting OTC hearing aids?
The FDA explicitly states that over-the-counter (OTC) hearing aids cannot replace professional evaluation and fitting. Without REM, you have no way to know if the device is delivering the right amount of amplification for your specific hearing loss. Many OTC users report whistling, distortion, or poor speech clarity because the settings were never verified in their ear.
Why do some clinics not use REM?
Some clinics skip REM to save time or reduce costs. Non-audiologist providers, like hearing aid retailers, are less likely to use it-only 12% do so consistently. But skipping REM means fitting by guesswork. Board-certified audiologists follow professional guidelines that require REM because it’s the only way to ensure accuracy and patient outcomes.
How long does REM take during a fitting?
REM typically adds 15 to 25 minutes to your initial fitting appointment. While it extends the visit, it dramatically reduces the need for follow-up adjustments. Studies show patients who get REM need 43% fewer return visits for tweaks.
Does insurance cover real-ear measurement?
Yes. Medicare and most private insurers cover REM under CPT code 92597. It’s recognized as a medically necessary service. If your provider says it’s not covered, ask them to bill under the correct code. Many patients don’t realize this service is already included in their hearing aid benefit.
Can REM help with tinnitus or other hearing issues?
REM itself doesn’t treat tinnitus, but accurate hearing aid fitting can reduce its impact. When hearing loss is properly amplified, the brain receives more sound input, which can lessen the perception of ringing. REM ensures the hearing aid isn’t over-amplifying or distorting sounds, which can worsen tinnitus. It’s a key part of a full hearing health plan.
What if my hearing aid still doesn’t sound right after REM?
If your hearing aid still doesn’t sound right after REM, the issue might be with the prescriptive target used, or your hearing loss has changed. A good audiologist will re-check your hearing, verify the REM setup (probe tube placement, calibration), and may adjust the target curve based on your feedback. REM isn’t a one-time fix-it’s part of an ongoing process of fine-tuning.
