Real-Ear Measurements (REM) are a form of hearing aid verification used to determine whether someone’s hearing aids are programmed accurately to the person’s hearing loss prescription based on their unique ear canal size and characteristics. What does that mean? Basically, sound travels into different people’s ears differently! If you have a smaller ear canal, you may need slightly different adjustments to your hearing aid programming than someone who has very large or long ear canals.
Real-ear measurements are typically done during the hearing aid fitting when the audiologist or hearing instrument specialist is setting up the hearing aid.
What happens during Real-Ear Measurements (REM)?
The hearing aid wearer will sit in a chair facing a speaker. The clinician will then perform otoscopy to observe for wax or discharge from the patient’s ear, because the ear canal needs to be clean, and the eardrum should be visible when performing REM. Then the clinician will calibrate their system.
Following the calibration, the provider may decide to perform feedback manager. During this, the hearing aids are in the person’s ears, and they will hear some loud beeps. This aspect of the fitting usually takes under 30 seconds, and is necessary to reduce and prevent any feedback or squealing that may occur with the hearing aids in.
The provider will then remove the hearing aids and put probe tubes into the ears, close to the eardrum, but not touching it. They will then take a real-ear unaided gain (REUG) measurement to first measure the size of the client’s ear canal to ensure that the appropriate sound pressure level is being applied. Once that measurement is taken, the next step is to place the hearing aids in the ears turned off. Then they will run a measurement called real-ear occluded gain (REOG), which determines if the dome or earmold chosen for the person is correct.
The clinician will perform real-ear aided gain (REAG). That is when the hearing aid is turned on, and the clinician plays different sounds to the hearing aid and measures the output performance of the hearing aid to ensure it matches the person’s target prescription.
During this portion of verification, the patient will typically hear 3 different levels of speech presentation (soft, average, and loud but not uncomfortable). Different clinicians prefer to use different stimuli; some may use the ISTS, which is an international speech signal made up of different languages; others may use what are known as the Carrot Passage or Rainbow Passage. Either way, the stimuli are meant to mimic sounds common in everyday speech to make sure the hearing aid is accurately and clearly picking up those sounds and sending them to the person’s inner ear.
Once this is all complete, the clinician will remove the probe tubes from the ears and will make minor programming adjustments to the hearing aids based on the wearer’s comfort and needs.
What if your provider does not perform Real-Ear Measurements?
While REM is considered a best practice, not every facility can perform them due to equipment limitations or other factors. Have no worries, though! There are certainly other ways to validate hearing aids without REM.
Speech-testing in the sound booth: This is one of my personal favorites because it is one of the closer-to-real-world scenarios that we can give customers to assess the performance of their hearing aids. In these cases, the person is tested unaided and aided in the sound booth with speech stimuli (typically with background noise present). This is a great way to test because the person is directly involved and can experience what they are hearing with hearing aids off vs. on and are immediately able to report back the differences they hear. The clinician also uses a score sheet to measure performance and can quantify the improvement.
Pre- and post-fitting questionnaires: Several different validated questionnaires exist to measure a person’s subjective experience before hearing aids and with them. Some of these options even include ones that a spouse, family member, or close friends can complete so that the hearing aid wearer has a report from someone they also spend a considerable amount of time with. By filling out these questionnaires, they can really take time to reflect on what they struggle with, what’s improved, what has room for improvement and what remains a question for them. It’s a great way to further the discussion with the clinician as well, and gives the clinician some tangible feedback so they can adjust as necessary.
Subjective report from the wearer: In most cases, the hearing aid wearer can immediately tell whether they notice improvement or are hearing more of their environment. Many people report hearing the air conditioner, water running, or the blinkers in their car. Another common report is hearing birds or shuffling of feet on the floor. When someone reports back at their follow-up that their environment is clearer, or even if they are still having some trouble with background noise, the clinician can work in the software to make programming adjustments based on what the person needs.
Real-ear measures are commonly performed in the hearing aid fitting and at follow-ups if the person is noticing trouble with their devices. It may also be performed following an annual hearing exam with changes in hearing. Read about how our Chief Audiologist used Real Ear Measurements to show how OTC hearing aids weren't measuring up for one of her customers.
If it is not measured at your appointment, it is okay to ask the clinician if they provide other means of validation, such as speech-in-noise testing or questionnaires. Sometimes a good discussion is all that is needed to ensure an accurate and comfortable fitting.
At the end of the day, the most important aspect of hearing aid fitting is making sure the person with hearing loss can hear clearly, comfortably, and that they feel they have a space to come to their provider as needed for follow-up care and adjustments.
If you’re ready to experience the personalized hearing care and solutions available at HearingLife, schedule your complimentary hearing assessment today.
