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Are Real Ear Measurements Necessary?

Real Ear Measurements (REM) – also called Probe Microphone Measurements (PMM) – are considered the gold standard in hearing aid fitting and verification, allowing audiologists to determine whether a hearing aid user is receiving the precise level of amplification needed at every frequency to maximize their hearing. This blog explains how REM can improve customers’ hearing, as well as drive better business outcomes and serve as a key differentiator for hearing clinics.

Many hearing clinics experience high volumes of hearing aid returns, with customers complaining that they can’t hear properly, even with their hearing aids in. These clinics often conduct multiple rounds of troubleshooting to identify – and resolve – these problems.

So yes, real ear measurements are necessary if you want to stop seeing the same customers repeatedly and prevent your audiologists from seeing new customers and making additional sales.

These problems could have been resolved quickly and effectively if the audiologists had used Real Ear Measurements (REM) in the initial appointments to verify and validate customers’ hearing levels. Studies have repeatedly shown that using REM during hearing aid fittings delivers better results and happier customers.

Unfortunately – and surprisingly – REMs have not been widely embraced in the audiology industry, with less than 30% of audiologists using REM to verify hearing aid fittings, even though it’s an established best practice and has been proven to offer extensive benefits to both the customers and the clinics.

Real Ear Measurements Improve The Following Metrics:

Reduces Return Visits

After using REM, 76% of patients experienced above-average success with their hearing aids after only one or two visits. Without REM’s verification and validation, nearly half (47%) of patients had below-average success and required four to six visits to readjust their hearing aids.

Reduces Hearing Aid Returns

Studies show that customers are happier with their hearing aids when they’re fitted using REM. Happy customers mean fewer hearing aid returns, which translates to greater time efficiency, higher profits, and other positive outcomes for your clinics.

Increases Customer Satisfaction

Multiple studies have shown that REM testing increases the hearing aids’ benefits and customers’ ability to hear better when wearing them. These positive outcomes boost customer satisfaction and loyalty.

Increases Customer Referrals

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

Saves Time And Money

The initial cost of your REM equipment will be quickly repaid. Since it accurately measures customers’ hearing with hearing aids, it takes the “guesswork” out of the exam and allows the fitting to be right the first time.

A Real Ear Measurement Takes No More Than 10 Minutes To Perform

Not only is REM an effective revenue driver for any hearing clinic, but offering REM will differentiate your business from over-the-counter options, online providers, and other hearing care businesses in your area that doesn't provide them.  

Additionally, REM testing is quick and easy. REM takes no more than five or ten minutes to perform.

Auditdata’s Measure audiology instrument offers REMs as an add-on module that integrates well with the hardware. The Measure Audiometer guides users through the process in a clear step-by-step manner, with a helpful nudging feature to ensure best practice standards are consistently followed, and no steps are skipped or forgotten. 

It’s important to note that the process is painless for customers. Inserting the probe tube will not hurt the customer or damage their tympanic membrane (TM). The probe tube is extremely thin, flexible, and made from a very soft material.

In addition, the transducer has an integrated measurement tool that helps the audiologist insert the probe tube to a proper depth.

If an audiologist fits a full prescription using REMs, the customer may not initially like it because the louder sounds may be startling at first. Therefore, it’s wise to use the acclimatization feature to help customers get used to the new sounds gradually.

After fitting the customer to full prescription and verifying with REM, set the gain to an acceptable level using the auto acclimatization feature. By slowly introducing the gain that each customer needs, they’ll have time to get used to the louder sounds, and it won’t seem as severe or uncomfortable initially.  

Be aware that when some customers get to their full prescription, they don’t like it. Everyone is different, and some people prefer a slightly diminished sound. Show your willingness to customize the hearing aids – and the experience – by caring for each customer as an individual.  

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 Measure 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 Measure REM probe tube has an adjustable marker that helps you place the tube optimally.

Measure's REM transducer has a groove where you can fixate the probe tube close to the reference microphone to ensure proper probe tube calibration.

The Measure REM probe holder enables uncomplicated, optimal insertion depth of probe tubes, thanks to an adjustable marker on the probe along with an integrated measurement scale on the transducer.

Step 2

Ensure a proper probe tube placement

First measure the Real Ear Unaided Gain (REUG). This measurement helps you verify the position of the probe tube. The curve has a peak around 3-4 kHz and should not fall below -5 dB around 6 kHz. If it does, reposition the probe tube.

In Measure, the probe tube calibration is fully automatized and further measurements cannot be commenced unless the calibration is successful. In addition, if the probe tube is blocked or poorly fitted, this will be detected while calibrating.

Step 3

Check for sound leakage

Turn the hearing aid off and place the hearing aid mold or dome in the patient’s ear. Make sure not to change the probe tube placement while doing this. Measure the Real Ear Occluded Gain (REOG). This measurement helps you decide whether to choose an open or closed fit in the Primus software.

Step 4

Measure REAR and adjust the hearing aid

Activate the hearing aid, choose a target amplification (e.g. NAL-NL2 or DSL), and measure the Real Ear Aided Response (REAR). This measures the SPL level in the ear canal with hearing aid output.

In the Measure software you can place the curves in so-called “On-top mode”. This enables you to easily monitor the REAR, while at the same time adjusting the hearing aid gains using the manufacturer’s separate fitting software

Choose a target amplification

Use the hearing aid fitting software to adjust your hearing aid amplification to fit your target. Don’t worry: Measure will warn you if you are too far off target.

Measure REM offers a very useful tool called Match-to-Target (MTT). This functionality warns you if the hearing aid gain deviates too much from the prescribed target during a REM hearing aid fitting. The max deviation can be set by the user for each measured frequency. Both SPL and gain can be used as references.

Free guide

Everything You Need To Know About Real Ear Measurements (REM)

This guide will explain why REMs are crucial in modern audiology and will dispel the misconceptions that may cause audiologists to avoid this test. We will also discuss the process for REMs, and the benefits of this approach.

Learn more

Real ear measurement equipment is inexpensive, accessible, and user-friendly. In fact, REM equipment is more affordable, accessible, and mobile than ever before. The Measure software includes everything you need to perform a quick and reliable REM measurement, such as software, speaker, and transducers.

The REM speaker and transducers are small and portable, and setting them up is quick and easy: just plug them into Measure. Using the equipment is as simple as pressing a button and following the automatic process.

Contact us for more information about REM, Measure, and our other best-in-class audiology solutions that can help drive better business outcomes and improve your customers’ hearing ear by ear. 