What Is Real Ear Measurement — and Why Does It Matter?
If you've ever worn hearing aids that didn't quite sound right — too tinny, too loud, or just not natural — there's a good chance your devices were never properly verified. Real ear measurement is the tool that fixes that. And yet, most hearing aid providers don't use it.
As a hearing instrument specialist with over 10 years of experience, I've seen it firsthand: patients come to me with hearing aids they gave up on, devices collecting dust in a drawer, or aids that "kind of help" but never quite felt right. More often than not, the problem isn't the hearing aid itself. It's how — or whether — it was fit.
Real ear measurement changes that. It's the gold standard in hearing aid fitting verification, and it's something I use with every single patient at Riverside Hearing Care. Here's what it is, how it works, and why it should matter to you.
What Is Real Ear Measurement?
Real ear measurement — sometimes called REM or probe microphone measurement — is a clinical test that measures exactly how much sound your hearing aid is delivering into your ear canal, in real time.
Here's the key insight: every ear canal is shaped differently. The same hearing aid programmed to the same settings will produce different levels of amplification in different ears — because the shape, size, and acoustics of each ear canal affect how sound behaves inside it. A setting that's perfectly calibrated for one patient could be over-amplifying or under-amplifying for another.
"Without real ear measurement, a hearing aid fitting is essentially an educated guess. With it, you know exactly what the ear is receiving — and you can adjust until it's right."
Real ear measurement eliminates that guesswork. Using a tiny silicone probe microphone placed gently in the ear canal, we measure the actual sound level reaching your eardrum — and compare it to your prescription target. If the hearing aid isn't hitting the target, we adjust it until it does.
How Does the Process Work?
The test itself is straightforward and completely comfortable. Here's what happens during a real ear measurement at Riverside Hearing Care:
Step 1 — Baseline measurement
Before the hearing aid is even inserted, we measure the natural acoustics of your ear canal. This gives us a starting point — what your ear does on its own before any amplification is added.
Step 2 — Hearing aid insertion and live measurement
Your hearing aid is placed in your ear with a tiny probe microphone sitting just inside the canal. We then play a standardized speech signal — real spoken language, not just tones — and measure what your eardrum is actually receiving.
Step 3 — Comparison to your prescription target
Your audiogram (your hearing test results) generates a prescription — a specific amplification target for different pitches and volumes. We overlay the real ear measurement against that target on a screen and see exactly where the hearing aid is hitting the mark, and where it isn't.
Step 4 — Fine-tuning until it's right
If the hearing aid is over- or under-amplifying at certain frequencies, we adjust the programming in real time until the measured output matches your prescription. You don't leave until the numbers match — and more importantly, until it sounds right to you.
WHAT REAL EAR MEASUREMENT VERIFIES
Soft sounds are audible — you can hear whispers and quiet environments
Conversational speech is comfortable and clear
Loud sounds are not over-amplified or uncomfortable
The hearing aid matches your individual prescription across all frequencies
Both ears are balanced correctly relative to each other
Why Don't All Providers Use It?
This is a question worth asking — and the honest answer is a mix of factors.
Real ear measurement equipment is expensive, requires training to use correctly, and takes more chair time per appointment than a standard fitting. For high-volume practices or big-box retailers focused on throughput, it's often skipped in favor of simply programming hearing aids to manufacturer defaults and sending patients home.
Manufacturer default settings — sometimes called "first fit" — are programmed using average ear canal data. They're a starting point, not a finish line. For some patients they may be close enough. For many, they're not — and that's why so many people give up on their hearing aids within the first year.
Research consistently shows that patients fit with real ear measurement report higher satisfaction, better speech understanding, and are significantly more likely to continue wearing their hearing aids long-term compared to those fit without it. The evidence has been clear for decades — which makes it all the more frustrating that it remains underutilized.
Professional bodies including the American Academy of Audiology, the American Speech-Language-Hearing Association and the International Hearing Society list real ear measurement as a best practice standard for hearing aid fittings. It's not experimental — it's established, evidence-based, and widely recommended. It's just not universally practiced.
What This Means for You
If you've worn hearing aids before and felt like they never quite worked the way you hoped — this may be why. And if you're considering hearing aids for the first time, knowing whether your provider uses real ear measurement is one of the most important questions you can ask.
At Riverside Hearing Care, real ear measurement is a standard part of our standard of care in every fitting — not an add-on, not an upgrade, not something reserved for certain patients. It's simply how we fit hearing aids, because fitting them any other way means accepting unnecessary uncertainty about whether they're actually working the way they should.
Your hearing prescription is as individual as your fingerprint. Your hearing aids should be fit to match it — exactly.
"The goal isn't just to put hearing aids in your ears. The goal is to make sure those hearing aids are delivering precisely the right amount of sound — verified, measured, and adjusted until it's right for you specifically."
Questions to Ask Your Provider
Whether you're a patient at Riverside Hearing Care or anywhere else, here are the questions worth asking before your next hearing aid fitting:
Do you use real ear measurement? A simple yes or no. If the answer is no, ask why not.
Will you show me the measurement on screen? A provider using REM properly should be able to show you the target and the measured output side by side.
What speech signal do you use? The International Speech Test Signal (ISTS) or similar real-speech stimuli are preferred over pure tones for the most accurate results.
You deserve hearing aids that are fit correctly the first time — and verified to prove it. Real ear measurement is how we get there and a critical part of best practices.
Ready for a fitting done right?
Every patient at Riverside Hearing Care receives a real ear measurement fitting as standard. No matter if you’ve tried hearing aids before or if this is your first time looking into them, reach out to us and hear what you’ve been missing today.
Call to schedule: 207-481-3451
Ian Mishler, BC-HIS — Owner, Riverside Hearing Care
Ian is a National Board Certified Hearing Instrument Specialist with over 10 years of experience and a family legacy spanning three generations in hearing care. He founded Riverside Hearing Care in 2026 to bring independent, best-practice hearing care to midcoast Maine — in the office and in the community.