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

Evan Grolley, AuD

Audiologist

15 March 2018 - 9.71K 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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Doctor of Audiology in Easley

15 March 2018 - 9.74K 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

15 March 2018 - 9.74K 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

19 March 2018 - 9.6K 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

15 March 2018 - 9.69K 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

15 March 2018 - 9.72K 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

Audiologist

15 March 2018 - 9.69K 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

15 March 2018 - 9.74K 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 - 9.66K 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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