What is a Real Ear Measurement (REM)

Real Ear Measurements (REM) are exactly what they sound like – measurements taken in a patient's ear in real-time. Real ear testing is used to assess hearing aid function in the ear canal. Often, REM is used during a hearing aid fitting to ensure appropriate and individualized hearing aid programming. 

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Watch video about Real Ear Measurement in Primus.

Why Perform Real Ear Measurements for Hearing Aid Fittings?

When fitting hearing aids, an audiologist will take the patient’s audiogram, or hearing test, and program the hearing aids at each frequency based on those results.  

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Individualized Hearing Aid Fit

In lifestyle, readiness to pursue amplification, hearing loss severity, and even ear anatomy. Although small, every individual’s ear canal and anatomy are different. Not only does this impact the audiologist's choice of device and its physical fit, but these small differences make a big impact on hearing aid acoustics.  


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Verify Hearing Aid Performance

Hearing aids are programmed through software that amplifies sound in different ways depending on the audiogram. Once programmed, however, the fit or sound may still not be perfect. This is where a real ear measurement comes into play. Once the audiologist has REM data, they can then adjust the hearing aids to ensure that that individual is getting the correct amount of sound.  


Save Clinic Time

Without a real ear measurement, fitting hearing aids properly can be a frustrating process of trial and error. An audiologist can adjust the fit to the hearing aid software’s recommendations, and the patient may still return several times for adjustments. By performing real ear measurements, you are reducing the likelihood of extensive follow-up visits, which take up precious clinic time.  

Real Ear Measurements are crucial for success

Are Real Ear Measurements Necessary?

Real ear measurements increase customer satisfaction and clinic efficiency by taking the guesswork out of hearing aid fittings.  Providing each individual client optimal gain and frequency response when programming new hearing aids ensures a more comfortable listening experience, improved speech quality, and overall intelligibility.  

Reduce the number of return visits

By fitting the hearing aids properly, the first time, customers will need less fine-tuning down the road, which means fewer return visits, follow-up appointments, and troubleshooting. This boosts efficiency and improves bottom lines.  

Increase customer satisfaction

Real ear testing delivers true customer satisfaction, which enhances a practice’s reputation while reducing the time and expenses associated with multiple return visits and returns. Increased customer satisfaction leads to patient loyalty and an increase in the number of referrals.  

Reduce hearing aid return rate

All available evidence shows that customers are happier with their hearing aids – and their audiology providers – when they’re fitted using real ear testing. Satisfied customers mean fewer hearing aid returns, which translates to more profitable businesses.  

Increase customer referrals

Happy and satisfied customers are more likely to recommend friends and family to a business. Leads from customer referrals are usually high quality and often have an increased purchase intent. 

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What you need to know about Real Ear Measurements 

This guide will explain why REM is crucial in modern audiology and dispel the misconceptions that may cause hearing care professionals to avoid this test. We will also discuss the process for real ear measures, the benefits of this approach, and ideas to use REM in your hearing clinics to set your business apart.  

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Contraindications For Real Ear Measurements 

While real ear measurements provide valuable information on a hearing aid’s output, there are instances where real ear testing isn’t appropriate. 

  • Pain in the ear canal
    As a small tube is inserted into the ear canal during testing, pre-existing pain in the ear should be considered.

  • Wax or discharge
    A significant amount of wax can not only affect the validity of your results, but it can also clog the probe tube. Should this occur, no response would be noted even with the hearing aid turned on. Discharge due to active infection can lead to the same problems. 

  • Eardrum Perforations
    While the presence of an ear drum perforation doesn’t completely preclude real ear testing, it should be considered. With a large perforation, results may be affected by the open middle ear space. Additionally, with any size perforation, probe tube placement should be performed carefully so as not to insert the probe through the perforation itself. 

Real Ear Measurements Step by Step 

During this test, an audiologist places a small tube into the entrance of the ear canal. This tube measures the sound going into the ear. They will then place the hearing aid in and play stimuli from a speaker – that may be tones or speech. The output from the hearing aid will be measured in the ear. This measurement will then be compared to validated “targets.” These targets are based on the individual’s hearing loss and indicate the appropriate output of the hearing aid at each frequency that is presented. 

Real Ear Measurement Equipment 

With the appropriate equipment, real ear measurements can be conducted quickly. To start performing real ear testing, you will need: 

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Primus Pro - Advanced Audiometer to perform REM

The Primus software's REM module enables you to perform real ear measurements in an easy and efficient way. 

The Primus REM module conveniently loads patients' audiograms onto the REM test screen. Gone are the days of manually entering audiogram data pitch by pitch into a separate REM device. 

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How to perform Real Ear Measurements

Step 1

Prepare the patient

  • Perform an otoscopy to check for any contraindications like ear wax, perforated ear drum, or discharge. Place the patient in front of the REM speaker at a distance of 80 to 100 cm. 
  • Calibrate the REM probe tubes by holding the REM headset in front of the speaker and running the calibration in the Primus software. Anomalies in the probe tube frequency response may indicate a blocked or broken probe tube. 
  • Insert the probe tube into the ear canal of the patient. Typically, the insertion depth is between 28 and 30 mm. The Primus REM probe tube has an adjustable marker that helps you place the tube optimally.