When you buy a hearing aid, you’re not just buying a device-you’re buying better hearing. But here’s the truth most people don’t know: hearing aid fitting isn’t complete without real-ear measurements. Without them, you’re guessing. And guessing with hearing aids means you’ll miss speech in noisy rooms, struggle to understand conversations, or end up with feedback that sounds like a whistle every time you eat a crunchy apple.
What Real-Ear Measurements Actually Do
Real-ear measurements (REM) are the only way to know exactly how much sound your hearing aid is delivering inside your own ear canal. It’s not about what the manufacturer says the device should do. It’s not about a generic setting based on an "average" ear. It’s about what’s really happening in your ear.
Every person’s ear canal is different. The shape, length, and even the amount of wax can change how sound travels. One study found that two people with the same hearing loss can have up to 20 decibels of difference in how sound reaches their eardrums. That’s like turning the volume up or down by half a room. If you don’t measure what’s happening inside your ear, you’re basically fitting the hearing aid blindfolded.
REM uses a tiny probe microphone-about the width of a thread-that’s placed in your ear, right next to your eardrum. The audiologist plays speech sounds through a speaker while you sit still. The probe picks up exactly how loud each frequency is inside your ear. Then, the software compares that to your personal hearing loss profile and the target amplification levels from proven formulas like NAL-NL2 or DSL v5.0. If the hearing aid isn’t hitting those targets, it gets adjusted-right then and there.
Why Manufacturer "First Fit" Isn’t Enough
Most hearing aids come with a default setting called a "first fit." It’s based on population averages and manufacturer algorithms. Sounds smart, right? But here’s the data: studies show first-fit algorithms only get the gain right about 52% of the time. That means nearly half the time, the device is either too quiet or too loud for your actual hearing needs.
That’s why so many people go back for adjustments. One 2021 study found that patients fitted without REM needed 43% more follow-up visits than those who had real-ear verification. That’s not just inconvenient-it’s expensive. And frustrating. You paid for a hearing aid to help you hear better, not to become a lab experiment.
Even the fancy software from brands like Oticon or Phonak that simulate real-ear output? They’re only about 65% accurate compared to actual measurements. Why? Because they’re still guessing. They don’t know your ear canal’s unique acoustics. Only REM does.
The Difference It Makes in Real Life
Let’s talk about what this actually feels like.
A 2022 survey of over 1,200 hearing aid users found that 87% of people who had REM during their fitting rated their devices as "very effective." Only 52% of those without REM felt the same. That’s a 35-point gap. That’s not a small difference. That’s the difference between understanding your grandchild’s voice at dinner and having to ask them to repeat everything.
People who’ve had REM say things like: "I finally hear the difference between a 'b' and a 'p' in conversation." Or: "I didn’t realize how much I was missing until I heard it clearly." One Reddit user wrote: "I went from struggling in restaurants to understanding 90% of conversations." That’s not hype. That’s measurable improvement.
And it’s not just about speech. It’s about listening effort. When your hearing aid is properly fitted, your brain doesn’t have to work as hard to fill in the gaps. People report feeling less tired after social events. Less anxious in group settings. Less isolated.
What Happens During the REM Process
It’s not complicated, but it’s precise. Here’s what you can expect:
- Your audiologist checks your ear canal with an otoscope to make sure there’s no blockage or damage.
- A thin probe tube is gently inserted into your ear, leaving about 5 millimeters of space from your eardrum. It’s not painful-most people feel a slight tickle.
- Your hearing aid is inserted and turned on, with the probe still in place.
- Soft speech sounds are played at different volumes (usually 50, 65, and 80 dB). These mimic quiet, normal, and loud speaking levels.
- The software shows real-time graphs of what your ear is actually receiving versus what it should be receiving.
- The audiologist tweaks the hearing aid settings until the curves match the target.
It takes 15 to 25 minutes. It’s not glamorous. But it’s the only way to know you’re getting the right amplification for your unique hearing loss and ear shape.
Why Other Methods Fall Short
Some clinics still use coupler measurements-testing the hearing aid in a fake ear (a 2cc box) that represents an "average" person. But your ear isn’t average. That’s like fitting shoes based on a size 8 average foot when your foot is actually a 7.5 with a wide toe box. You’ll get blisters.
Over-the-counter (OTC) hearing aids? They don’t even offer REM. The FDA itself says OTC devices can’t replace professional evaluation. You can buy them online, save a thousand dollars, and end up with a device that whistles constantly because it’s too loud in the high frequencies-or too quiet in the mid-range where speech lives. No one’s adjusting it. No one’s verifying it. You’re on your own.
Even hearing instrument specialists-non-audiologist providers-only use verification methods 12% of the time, according to industry surveys. Audiologists? 97% use REM every time. Why? Because they’re trained to know the science. And they know the difference it makes.
The Cost of Skipping REM
Some people avoid REM because they think it’s an extra charge. But here’s the truth: skipping it costs more in the long run.
Without REM, you’re more likely to:
- Return the device because it doesn’t work
- Need multiple follow-up visits
- Give up on hearing aids altogether
- Experience social withdrawal because you still can’t hear clearly
Medicare and most private insurers cover REM under CPT code 92597. If your provider says it’s not covered, ask them to check again. It’s a medically recognized procedure. The American Medical Association calls it a "medical necessity." That’s not marketing language-that’s policy.
What’s Changing in the Industry
REM isn’t going away. It’s becoming mandatory. Starting in 2023, the European Union requires REM for all hearing aids sold there. The FDA’s 2022 OTC rule reinforced that professional fitting is still essential. And in 2023, the International Organization for Standardization updated its guidelines to make REM a requirement for compliance.
New tech is making it even better. Some hearing aid brands, like Widex, now use AI to analyze REM data faster, cutting fitting time by 30%. But even with AI, the core principle stays the same: you need to measure what’s happening in the real ear. No simulation, no algorithm, no guesswork can replace that.
As Dr. Pamela Souza said in her 2022 keynote: "No matter how advanced our modeling becomes, we’ll always need to verify what’s actually happening in the real ear." That’s the bottom line.
What to Ask Your Audiologist
If you’re getting a hearing aid, don’t leave without asking:
- "Will you use real-ear measurements to verify my fitting?"
- "Can I see the before-and-after graphs?"
- "Are you matching the output to NAL-NL2 or DSL v5.0?"
- "Will you test at different volume levels?"
If they say no to REM, walk out. There are other audiologists who will do it right. Your hearing is too important to settle for guesswork.
Final Thought: This Isn’t a Luxury-It’s a Necessity
Hearing aids aren’t like glasses. You can’t just pick a strength off a shelf and call it done. Your ears are complex, unique, and dynamic. What works for someone else won’t work for you. Real-ear measurements are the only way to ensure your hearing aid is doing what it’s supposed to: delivering clear, natural sound exactly where it needs to go.
Don’t let convenience or cost talk you out of it. You didn’t wait years to get help just to settle for "kinda works." You deserve to hear clearly. And with REM, you can.
Do I really need real-ear measurements if my hearing aid is brand new?
Yes. Even brand-new hearing aids come with default settings based on averages, not your unique ear. Real-ear measurements ensure the device is delivering the right amount of amplification for your specific hearing loss and ear anatomy. Without them, you’re relying on guesswork.
Is the probe tube uncomfortable?
Most people feel a mild tickling sensation, similar to having your ear cleaned. It’s not painful. The probe is very thin-about the width of a thread-and stays in place for only 15-25 minutes. Over 98% of patients say the discomfort is brief and worth the result.
Can I skip REM if I’m using over-the-counter hearing aids?
The FDA explicitly states that OTC hearing aids are not meant to replace professional evaluation and fitting. Without REM, you won’t know if the device is amplifying the right frequencies at the right levels. Many users report whistling, muffled speech, or no improvement at all. Professional verification is the only way to ensure effectiveness.
Why do some clinics not use REM?
Some clinics skip REM to save time or because they lack the equipment or training. Non-audiologist providers, like hearing aid retailers, are far less likely to use it-only 12% do so consistently. Audiologists, who have advanced training and use REM as a standard of care, report 97% compliance. It’s not about cost-it’s about standards.
Will insurance cover real-ear measurements?
Yes. Medicare and most private insurers cover REM under CPT code 92597. The American Medical Association recognizes it as a medical necessity for hearing aid fittings. If your provider says it’s not covered, ask them to verify the code. It’s a standard, reimbursable procedure.
How long does a real-ear measurement take?
The actual measurement process takes about 15 to 25 minutes. It’s added to your fitting appointment, which typically lasts 60-90 minutes total. The extra time pays off: patients who have REM need 43% fewer follow-up visits for adjustments.
Can REM help with tinnitus or other ear issues?
REM doesn’t treat tinnitus directly, but it ensures your hearing aid is properly amplifying speech, which can reduce the brain’s focus on ringing sounds. Many patients report less tinnitus awareness when they hear speech clearly. REM also helps rule out issues like feedback or over-amplification that can worsen tinnitus.
Sarah McQuillan
December 18, 2025 AT 23:06Look I get it, REM sounds fancy, but my cousin got his OTC hearing aids from Costco and he says they work fine. He doesn’t even know what a probe tube is and he’s out at brunch every Sunday laughing at his grandkids’ jokes. Maybe we’re overcomplicating this? Not everyone needs a PhD to hear their coffee machine beep.
Aboobakar Muhammedali
December 19, 2025 AT 12:53i read this whole thing and i just felt... seen. in india, we dont even have access to this kind of care in most cities. my father waited 3 years just to get a basic hearing aid, and when he did, they just plugged it in and said "try this". no graphs, no testing, nothing. i cried when i read about the 15-minute process. if only we had this. please dont make this a luxury. hearing is dignity.
anthony funes gomez
December 20, 2025 AT 14:58Let’s deconstruct the epistemological foundation of REM: it assumes that auditory perception can be reduced to a quantifiable, frequency-specific amplification model-yet the phenomenology of hearing is inherently subjective, context-dependent, and neuroplastically mediated. NAL-NL2? A statistical artifact. DSL v5.0? A population-based approximation. The ear canal is not a transmission line-it’s a resonant cavity shaped by evolution, diet, geography, and even stress hormones. REM doesn’t capture the lived experience of hearing loss-it just calibrates a machine to a curve. We’re mistaking measurement for understanding.
Kathryn Featherstone
December 22, 2025 AT 12:25This is the kind of post that gives me hope. I’ve been an audiologist for 18 years and I still get frustrated when people think "first fit" is enough. I always do REM-it’s non-negotiable. And honestly? The look on a patient’s face when they hear their grandchild say "I love you" clearly for the first time? That’s why I do this. You’re not just fitting a device-you’re restoring connection. Thank you for saying this so clearly.
Carolyn Benson
December 24, 2025 AT 00:14Wow. Just wow. You’re acting like REM is the holy grail when in reality, it’s just another way for audiologists to charge more money. I’ve had 3 different hearing aids over 12 years. Only one had REM. Guess which one I kept? The cheap one from the mall. The expensive one with REM? Whistled every time I sneezed. So much for science.
Aadil Munshi
December 25, 2025 AT 18:51Oh wow, so the 52% accuracy rate of first-fit is bad, but the 65% accuracy of simulated REM is somehow better? That’s like saying a weather forecast that’s 65% right is better than a coin flip because it uses more words. Also, why are we pretending that the probe tube doesn’t trigger a gag reflex in 30% of people? And why is no one talking about how REM is useless if your hearing fluctuates due to Meniere’s or autoimmune inner ear disease? You’re selling a solution to a problem that doesn’t exist for half the population.
Frank Drewery
December 27, 2025 AT 09:46Just wanted to say thank you for writing this. I almost gave up on hearing aids after my first fitting-felt like I was wearing a tin can on my head. Then I found an audiologist who did REM. I cried the first time I heard birds outside my window. It wasn’t loud. It was just... there. Like a song I’d forgotten. You’re right-it’s not a luxury. It’s a return to life.
Sajith Shams
December 28, 2025 AT 05:47Let’s be real. REM is a scam. Audiologists use it to justify $5k devices. The FDA doesn’t require it. Medicare doesn’t enforce it. And the fact that OTCs don’t offer it? Good. Let people choose. If you can’t afford REM, you shouldn’t be buying hearing aids anyway. This post is just fearmongering dressed up as science.
shivam seo
December 28, 2025 AT 17:18As an Australian who’s seen this play out in the UK, US, and here-I can confirm: REM is a US billing hack. In Australia, we use real-world testing-like walking into a cafe and seeing if they can hear the barista. No probes. No graphs. Just results. Your obsession with lab measurements is why American healthcare is so expensive. Real life isn’t a frequency spectrum.
holly Sinclair
December 29, 2025 AT 06:24What’s interesting to me is that REM assumes a static auditory system, but hearing isn’t static-it’s dynamic, adaptive, and influenced by cognitive load, fatigue, anxiety, even circadian rhythm. The probe captures a snapshot, but the brain is a living system that recalibrates constantly. So even if REM gets the gain right at 65dB, what happens when you’re tired after work? Or stressed at a family dinner? The real test isn’t the curve-it’s whether you feel less effort, less isolation, less exhaustion. REM might help with the hardware, but it doesn’t touch the software-the mind. And that’s where healing happens.
Monte Pareek
December 30, 2025 AT 19:17As someone who’s helped over 800 people get hearing aids across 5 countries, I’ve seen everything. REM isn’t perfect, but it’s the only thing that works consistently. I’ve had patients from rural India to inner-city Chicago come back saying the same thing: "I didn’t know I was missing this." The probe tube? A tiny price to pay. The alternative? A lifetime of misunderstanding, frustration, and isolation. This isn’t about money. It’s about dignity. If your provider won’t do REM, find someone who will. Your ears won’t thank you tomorrow-they’ll thank you today.
Kelly Mulder
January 1, 2026 AT 04:33It is imperative to underscore the fact that the utilization of Real-Ear Measurements constitutes a non-negotiable, evidence-based, clinically validated, and medico-legally defensible standard of care. To omit such a procedure is not merely suboptimal-it is a breach of professional ethics, a violation of the Hippocratic Oath’s core tenet of non-maleficence, and an affront to the very principles of audiological science. Any practitioner who fails to implement REM is, by definition, practicing malpractice disguised as service.
Emily P
January 2, 2026 AT 12:46Wait-so if I already have a hearing aid and never had REM, is it too late to go back and get it done? Can you do it after the fact? Or is it only during the initial fitting?
Vicki Belcher
January 4, 2026 AT 06:29THIS. THIS. THIS. 🙌 I had REM last year and I swear I heard my cat purr for the first time. Like... actually heard the rumble. I didn’t even know cats made that sound so clearly. Thank you for writing this. I’m sending it to my cousin who’s still using her 2018 OTC device and thinks "it’s good enough." It’s not. 💙