What are real ear measurements? Is it worth spending an extra $1000 for?

Evan Grolley, AuD

Audiologist in Silverdale

15 March 2018 - 9.11K Views

Real ear measurement is important because it verifies the gain provided by the hearing aids (how much volume they add) based on the pitch and volume of the sound they pick up. Without a real ear verification measure, the audiologist is just going off of what the manufacturer software says. But studies have shown that the gain shown on the manufacturer software can vary drastically from the gain measured in an actual ear canal. That's because: (1) the microphones and speakers vary a little bit in every hearing aid, and no two have exactly the same output; (2) the placement of the microphones varies on every person's head; and (3) every person's head and ear is a different size and shape, and so they each shape the sound differently as it comes in to the ear.

Real ear provides actual quantifiable information to ensure that the hearing aids are set properly, and that's why it's been the gold standard in our industry for years. However, only about 30-40% of audiologists perform this measurement regularly despite evidence that shows patients are generally more satisfied with their hearing aids when real ear measurement is performed.

That said, a real ear measurement is not worth $1000. It only takes about 10-15 minutes to perform a real ear verification. So there may be some other factors at play that are contributing to the big difference in price. At my clinic, for example, we use an unbundled price structure so the services are not included in the hearing aid price. You might want to do a little more research with each practice to try and find out why there is such a big difference in price.

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Member 05 January 2019

IF REM is the gold standard then why aren't all audiologist required to perform this on each patient? And why on earth is the charge $1000?? Seems to me as per usual in every medical, dental and vet office it's not about the patient but the bottom line. 

I suffered sudden hearing loss due to a " virus" I was told in 2016 in my left ear and have yet to purchase a hearing aid for my right ear, which has hearing loss as well, due to the enormous and ridiculous price for ONE hearing aid. I was quoted around $2000 for a cross over. I was also NOT referred to a hearing specialist at the time I was diagnosed with sudden hearing loss which I have come to find out is the proper protocol. Very frustrated with the medical profession and as a sidebar I work in the medical field. 

Member 09 January 2019
Dr. Grolley, thank you so much for the information! Unfortunately I learned about REM about 2 weeks after my trial period ended for my Widex Evoke 300s. I am a new hearing aid patient, age 71, who had slight age-related loss, but suffered significant secondary loss from medication (which I still have to take). Also the speaker cone in one ear has never been comfortable despite trying different ones. Since my audiologist did not do REM and when I asked about it he told me it is not necessary, how do I get the REM test and any  necessary adjustment since my prescription and adjustments are on his computer?  This is a real quality of life issue for me since some sounds are harsh with the aids.  I will greatly appreciate your guidance! 
Member 22 January 2019 Replied to Member

I am so sorry but apparently there was a reply to my January 9 post, but I cannot get to it. To update, I asked my provider again and offered to pay for REM testing and adjustment separately.  His follow up response: they do "sound field testing" and "speech on noise testing"...how does that compare to REM? He is obviously avoiding giving me a direct answer about REM and I am so disappointed to be treated this way.  I continue to have harsh sounds and usually just have to leave the aids on "comfort"... I don't feel that I am getting the full benefit, just more volume. My right ear continues to be uncomfortable with the cone.  

I am sorry to be high maintenance but if you could repost the answer and also comment on these tests vs. REM.  As I believe I said before, this is a real quality of life issue for me.  

Thank you so much, Kathleen  

Alexandra Tarvin, AuD

Doctor of Audiology in Easley

15 March 2018 - 9.14K Views

Yes, it does matter. The technology is not as tailored to you and your body if it is not properly programmed to you. Real-ear measurements (REM) have been shown in the research to be beneficial to the patient and are a part of evidence-based practices. Overall satisfaction is higher when REM is performed.A small flexible microphone probe is placed into your ear canal with the hearing aid. A series of measurements are then run to incorporate the size and shape of your ear canals with your hearing loss data and the settings of the hearing aid. While this is running, the audiologist is reviewing the data and making educated changes to your settings. The audiologist may also change the way the hearing aid is coupled to your ear to ensure better access to sound.If you can afford best practices, the research supports your decision. 

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Christine Pickup, AuD

Doctor of Audiology in Rupert

15 March 2018 - 9.14K Views

I would suggest asking what is included with the price you were quoted.  In my experience, real ear measures make all the difference in accurate fit and patient satisfaction.  You are not saving any money in the long run if you are unhappy with the results.  

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Matt Hollis, AuD

Audiologist in Memphis

19 March 2018 - 9K Views

As a strong proponent of real ear measurement, I'm very happy to see the universal agreement among my fellow audiologists here.  I will state categorically that anyone not doing such verification measures is doing it wrong.  That being said, I wanted to add a note about price difference as well.  One of the posters above mentioned bundled vs unbundled pricing.  In bundled pricing (and I will state for the record that my clinic does bundle for all hearing aid sales, though we are discussing changing this), you are almost certainly getting more than just a 1-time real ear setup for your $1k.  Ask your audiologist, but there's a reasonable chance that you're getting a lifetime of adjustments (and each of those verified via real ear as well) as well as the convenience of being able to walk in for any reason at any time.  I can't tell you if that's worth $1k to you, but it merits consideration.

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Sheri Gostomelsky, AuD

Doctor of Audiology in Deerfield

15 March 2018 - 9.09K Views

In our practice we never let a hearing device walk out the door without performing real ear measurements.  Think of the ear canal as a tube.  If you roll up a piece of paper,  and speak through it, a short, wide tube will sound much different than a long narrow tube.  Each ear is unique in structure .  Real ear measurements or speech mapping is the most important procedure in the fitting of hearing devices.  These measurements  will assure that soft speech is heard, average speech is comfortable and that nothing gets so loud that it hurts your ears.  

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Christopher S. Frink, AuD

Audiologist in Salem

15 March 2018 - 9.12K Views

Real Ear Measurements ("REMs") are absolutely worth the additional cost.  Being fit with hearing aids without them is similar to obtaining prescription medication without a physician actually checking your medical history, your weight, other medical conditions or what other medications you might already be on that could cause complications.  Without REMs, the audiologist or hearing instrument specialist are basically guessing at whether the manufacturer's default settings are appropriate for you.  Would you want your physician to guess at what medications you should be on?As others have already stated, check with the less expensive audiologist and see if REMs are included in the fitting.  If they are, go for it.  If not, bite the bullet and pay the extra amount.  Or see if the more expensive audiologist is willing to "price match."  If not, you're still better off being fit with a scientifically proven method than you would be with someone putting the hearing aids on you and simply asking "how does that sound?"  

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Joe Baker, MA

Hearing Healthcare Provider in Strongsville

15 March 2018 - 9.09K Views

I agree with everyone above, that REM is currently the best way to ensure you are getting the best possible amplification from your new hearing aids. So, no sense in me chiming in to say the same thing.

What I DO want to add is that, the providers who make the investment in REM equipment and training are the real professionals in the industry. Hearing aid technology, and the diagnostic equipment, has evolved tremendously in the past decades. If your less expensive provider isn't serious enough about validating hearing aid fittings with REM, I'd wonder what other areas s/he hasn't kept up to date. I would equate this to an auto shop that says they will diagnose and fix your 2018 car without any of the computer diagnostic tools required to know exactly what needs repaired.

Best of luck. I hope this forum has been helpful to you.

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Kimberly (Peezie) Allred, AuD

Doctor of Audiology in Lafayette

15 March 2018 - 9.13K Views

Yes, real ear measurements are very important. This test is a verification tool used to ensure the output of the hearing aid is matching the target for your hearing loss in your ear.  Research supports over and over patient satisfaction is higher with real ear measurements.  If you are going to invest in hearing aids, it is important that you invest in the verification of a good outcome!

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Sarah Chipman

Professional Member

16 March 2018 - 9.06K Views

Which professional do you trust to do a more thorough job of fitting you correctly and taking proper care of you over the years? The one who tests the volume of the hearing aids in your ears, or someone else? It's possible the less expensive professional also performs real ear and just doesn't talk about it, but it's even more likely they don't bother and are trusting the educated guess on their fitting software computer screen.

I fit hearing aids for years without real ear, and here are some ways to kind of work around not having the equipment available, but I wouldn't want to go back now that I have it. In just the last two days, I discovered a couple computer fittings that were really off, and my patients either weren't hearing well enough with their aids or were hearing way too much from them. I wouldn't have known exactly which frequencies to adjust to fix their complaints without real ear, and we all would have been frustrated for a lot longer while I fumbled my way through guessing what to fix.

You know the saying, "Trust, but verify"? It's very good advice for hearing aid fitting! The aids don't do you as much good as you need unless they're actually set to do what they should, and no one can tell for sure without real ear. So choose your provider based on who you trust to do the best job for you, because you're usually choosing a service relationship that will last years. 

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Member 23 July 2018
I have recently purchased a pair of Rexton Legato LI hearing aids. They followed up with a real ear test spoken in spanish (I only speak english). I was told that everything was great and he started to close out the computer. I asked to see the screen. One line was way above the other on the left then crossed to be way below the other on the right. He then closed it out. I asked if he was supposed to make adjustments so that one line would be somewhat aligned over the other and he told me no, everything was fine don't worry about it. He said my hearing aids would automatically take care of everything. I told him that when some commercials came on the TV they were so loud as to be painful and asked him if there wasn't an adjustment to limit how loud the hearing aids would go. He told me that TV commercials are loud for everyone and I should just mute the TV when they come on. I told him that my daughter often controls the remote and he told me that I should take the remote away from her and control it myself. He told me that the proper way to adjust the loudness on my hearing aids is for me to talk outloud to myself while adjusting the loudness on my HA, and when I liked the way my voice sounds to myself that is the proper loudness. I told him that it seemed to me that I should be more interested in how other people sound than to how I should sound to myself. He said I was wrong. Is the advice that I have been given in each of these incidents been good advice?
Member 15 August 2018 Replied to Member
In no way am I any kind of expert or specialist , but to me the guy sounds nuts! What crazy advice from a "specialist"!!! Run away fast!
Member 31 July 2019 Replied to Member

Is this guy in California and complain that his kids come home just to drink all of his beer?  I ran into a crazy ‘nut job’ that locked me in the hearing booth and never performed a test. Fortunately, he only got touchy/feely in front of his office staff and I ran like hell to get out of there.

I am on my third set of hearing aids in 5 years, trying to ask the right questions. I never knew about REM but will ask while I am shopping again. My first pair were close to $5000; and I learned alot. My audiologists took time to help me and reprogrammed the software, which was something I felt I could do as needed. (I have a book of their notes regarding my complaints with my Unitron Moxi’s). 

My second pair (the Signia 7nx) was purchased for $3500 online. I had zero customer support and the dealer had my hearing aids for more of my first 45 days than I did. I ended  up contacting the BBB and my credit card company to reverse the charges. In the meantime, the dealer refused receipt for my returned hearing aids and threatened me with criminal action. (Yeah, I needed that like a hole in my head.) 

So, here I am on round three. What have I learned?

1) I really love my Bluetooth technology but don’t want to wear a transmitter around my neck. 

2) Behind the ear, with a 4mm tip (making sure it stays attached as I was in the ER twice with them getting lost), is fine; but thinner is better to not rub my ears raw when I wear my glasses. 

3) Custom made ear molds make my ears sweat! There is no other way to describe it. Tips that remind you of a dog’s cone of shame rub and make sores in my ears.

4) Waterproof is handy so my grandson can talk to me while we are in the pool.

5) Training for different environments is time consuming.  If you are going out to lunch with a group of girls from high school some 30+ years ago, plan to try and retry, while you program your software weeks in advance.  Having good tech support is really important. Signia was awful!

6) Battery times have never been accurate for me. I love my rechargeable batteries but not when they run out before I do!  I would prefer to have both, so I could buy a set at the local drug store if needed. (Spent a very stormy night with my hubby in the ER, only to have the cardiologist not allow me to tape our conversation or look at me to read lips, and my hearing aid batteries were dead!) A sealed rechargeable battery is not my preferred option.

Member 23 August 2019 Replied to Member

To answer your question and to demonstrate how the lines must be aligned, go to the 9 min video Dr. Cliff Olson, on Real Ear Measurements. He does such a great job explaining the critical importance of REM:


Member 22 February 2019
I’m new to hearing aids and know nothing about them. I went to my primary physician for a referral thinking I may avoid being sold a hearing aid if  I could do without. Was referred to an ent md office that has an audiologist part time. Another thing I didn’t know. Not accessible but for one day every few weeks. I gather from what little I read on forum (just joined an hour ago) I did not have real ear measurements done. Nothing was said I was told there are 2 kinds of hearing aids pick one. Can a person change to a new center with hearing aids bought else where? I have to pay for office visits anyway so the only thing would be I “brought my own” hearing aids, kind of like with cell phones! I don’t know anything about targets etc. she just said I have profound hearing loss which doesn’t sound right to me!
Pat H
Pat H 24 February 2019 Replied to Member
Yes, in most cases you can take your hearing aids to another provider.  Just make sure the new provider deals with the brand you are using.  Also, if you really have profound hearing loss, you wouldn't have had a question of whether or not you needed help, but whether there was anything strong enough to help you.  I would definitely go somewhere else for a second opinion at least.
Member 31 July 2019 Replied to Pat H

Get copies of the hearing tests that were performed, so you can send them in to a new audiologist. They can see whether the hearing aids you purchased are programmed to work properly for you.  Ask what brand they recommend and their trial period. (Google your state and hearing aid trial period) Just beware that they want to make money too.  It is such a buyer beware marketplace for hearing aids, but so much information when you dig long enough. 

I posted above things I would do differently and things I am going to look for in set #3.

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