Impact of Probe-Microphone Measurements and NOAH Quick-Fit on Patient Satisfaction and Loyalty

Amyn Amlani, PhD
Amyn Amlani, PhD

Amyn Amlani, PhD, returns to Hearing Economics after a long absence, having written on “Efficacy of Smartphone-Based Technology in Improving Hearing Aid Adoption Rates” last July.  

Dr. Amlani’s sustained interest in economic principles related to efficacy and consumer satisfaction are evident in these posts as well as several he wrote for the Hearing Health disruptions section several months ago.    


Probe-microphone measures were first introduced into clinical practice in the early 1980s .1 This procedure affords clinicians the opportunity to verify that the amplified signal delivered by a hearing aid in an individual ear canal does, indeed, maximize speech audibility without exceeding uncomfortable listening levels.


An Underused Verification Tool


Surveys on the clinical use of probe-microphone measurements are abysmal.  Only 20% to 40% of clinicians who dispense hearing aids use the procedure as part of their practices’ standard of care,2,3 despite evidence-based recommendations from professional organizations, such as the American Academy of Audiology4 and the American Speech-Language Hearing Association.5

Rationales for not employing probe-microphone measurements cover a wide range of clinician responses:

  • cost of equipment
  • the procedure is time intensive
  • lack of reimbursement
  • lack of knowledge to perform the task

We are Hindering Our Own Growth


Continued efforts are ongoing, on a global basis, to understand why hearing aid adoption rates are relatively unchanged over the past four decades, despite advances in technology.

One aspect that has hindered the growth of the profession are the services, or lack thereof, provided by practitioners.

This statement is supported, in part, by evidence that first-time users tend to experience greater emotional distress than their experienced counterparts during the hearing aid adoption process,6 and that 50% of experienced hearing aid users do not return to their previous provider when seeking new hearing aids and audiology services.7,8

In this blog, we assess the positive impact that providing probe-microphone measures can have on patient satisfaction and loyalty.


Quantifying Satisfaction and Loyalty 


A collaborative study between Audioscan and the University of North Texas is currently underway. To date, we have collected data on three groups of 12 (n = 36) adult listeners with mild to moderately-severe sensorineural hearing loss.

  • Group 1:  experienced users of amplification (> 1 year of use, devices are used > 8 hours/daily),
  • Group 2:  users of amplification who did not use their devices on a frequent basis (i.e., hearing aids are in the proverbial “drawer”)
  • Group 3: non-adopters of amplification that experienced hearing difficulties and who are interested in amplification

Six listeners in each group were fit with an experimental hearing aid programmed to a NOAH quick-fit only, while the remaining 6 listeners in each group were fit using a real-ear measurement protocol that included real-ear aided responses (REAR) at multiple input levels.

Post-fitting survey responses were obtained for the two fitting procedures (NOAH quick-fit, real-ear measurement protocol) assessed in this study. The surveys included:

  • A modified version of the Perceived Value Measurement – Service Scale (SERVAL) which measures a respondent’s attitude and behavior toward perceived value assessed in five dimensions: perceived quality, perceived value, behavioral intent, emotion, and price;9
  • the RAPID Loyalty Survey10  which quantifies three transactional components:
    • retention:  the degree to which consumers remain consumers to the same business
    • advocacy:  the degree of positive perceptions that lead to advocacy of the business
    • purchasing: degree to which consumers will increase purchase behavior
  • Willingness-to-pay (WTP) for professional services anchored at $250 for the single verification session

Real Ear Fit Protocol Improves Satisfaction and Loyalty


Findings from the SERVAL, Loyalty, and WTP scales (Table 1) showed significantly (p < .05) improved responses across surveys when the real-ear measurement protocol was administered compared to the NOAH quick-fit condition in all three groups.


 (total # of subjects)


(# of subjects)

Test Measures Outcome

(n = 12)

Real-ear (n = 6)


Quick-Fit (n = 6)




Real-ear increased perceived value/quality, intent, loyalty (i.e., retention, advocacy, purchasing), and WTP over Quick-Fit

(n = 12)

Real-ear (n = 6)


Quick-Fit (n = 6)





(n = 12)

Real-ear (n = 6)


Quick-Fit (n = 6)




Real-ear also increased perceived value/quality, intent, loyalty, and WTP over Quick-Fit, and also significantly reduced emotional distress over Quick-Fit

Our data suggests that the real-ear measurement protocol improves patients’ satisfaction and loyalty towards audiology professional services in experienced listeners, while lessening emotional distress in first-time adopters of amplification.

Collectively, our findings indicate that real-ear measurements, and not the NOAH quick-fit protocol, should be implemented as a standard practice in the clinic practice.


Note: In-depth results of this study entitled, “Improving Patient Satisfaction and Loyalty through Real-Ear Measurements,” including results not reported in this blog, will be presented at AudiologyNow! 2016, on Friday, April 15, 2016, from 7.30 to 8.30 am PST.




  1. Mueller HG. (2001). Probe microphone measurements: 20 years of progress. Trends in Amplification, 5, 35-68.
  2. Beck D. (2008, December 18). Hearing aids, real-ear measures, FM technology, and more: An interview with Michael Valente, PhD, American Academy of Audiology Web-based Interview.
  3. Mueller HG, Picou EM. (2010). Survey examines popularity of real-ear probe-microphone measres. Hearing Journal, 63(5), 27-28, 30, 32.
  4. American Academy of Audiology (2006). Guidelines for the Audiological Management of Adult Hearing Impairment. Audiology Today, Vol 18 (5), 32-37.
  5. American Speech-Language-Hearing Association. (2015). Guidelines for Hearing Aid Fitting for Adults.
  6. Amlani AM. (2013). Influence of perceived value on hearing aid adoption and re-adoption intent. Hearing Review Products, 20(3), 8-12.
  7. Kochkin S. (2009). MarkeTrak VIII: 25-year trends in the hearing health market. Hearing Review, 16(11), 12-31.
  8. Kochkin S. (2014). A comparison of consumer satisfaction, subjective benefit, and quality of life changes associated with traditional and direct-mail hearing aid use. Hearing Review, 21(1), 16.
  9. Amlani AM. (unpublished).
  10. Hayes BE. (2011).

Amyn M. Amlani, Ph.D., is an Associate Professor on the faculty of the Department of Speech and Hearing Sciences, University of North Texas. Dr. Amlani holds the B.A. degree in Communication Disorders from the University of the Pacific, the M.S. degree in Audiology from Purdue University, and the Ph.D. degree in Audiology/Psychoacoustics (minor in Marketing and Supply Chain Management) from Michigan State University. His research interests include the influence of hearing aid technology on speech and music; economic and marketing trends within the hearing aid industry; and playing bass guitar with The Moonlighters, a heavy metal cover band.   E-mail:

feature image courtesy of intuitive solutions

About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.


  1. Enjoy seeing an objective piece of research concerning REM. Having done REM since mid 80’s, I concur that the manufacture’s first fit doesn’t satisfied the patients hearing requirement’s…I continue to preform REM on manufacture first fit and then correct to target. I bet less then 1% of the time first fit is close to target. And that is probably by happenstance. I also find that if I meet target gain and output..I have very few issues with patients and they are more satisfied with the quality of amplified hearing.

  2. A very interesting article. I would be interested to know which hearing aid fitting formula was used in these groups. Attaining a REAR target is meaningless if the target formula is anyone’s guess. There are lots of formula out there but not all have been validated. If the patient is more satisfied with REAR regardless of the target formula it may just be placebo affect.

    Most clinics here in Ausralia have been using IG or REAR since the 1980’s consistently but we still come across these same issues but perhaps with lessor frequency than the US. Personally I don’t understand how an Audiologist could fit a hearing aid without actually knowing what the SPL is at the TM and its relation to the target to which they aspire. Sort of like shooting in the dark and hoping for the best.

  3. Interesting article and something Sergei Kochkin discussed in his 2010 MarkeTrak VIII: The Impact of the
    Hearing Healthcare Professional on Hearing Aid User Success article.

    Hearing aid satisfaction is tied to MELU – it makes sense that consumers are happier when they have high multiple environmental listening utility (MELU) with their hearing aids, i.e. they benefit from their hearing aid(s) in many listening situations. We all know that hearing aids do not correct hearing to normal. At best, only 50% of the loss of audibility is restored and that optimizing audibility is key in this process. This means that the more severe the hearing loss the more residual hearing loss remains and thus the more situations will remain problematic to the consumer. We also know that in places where distance, reverberation and background noise are involved hearing aids are often unable to deliver. (Think making a video of your children or grandchildren in a school auditorium from the last row.)

    Consumer satisfaction will not rise until consumers are fit with pro-mic verified hearing aids that include ACTIVATED telecoils, offered information on the benefit and demonstrated the use of telecoils, counseled on the ADA) that will allow them to hear in the public places where we all know hearing aids are unable to deliver. Explain that it is their civil right to be able to hear in public places through the use of Assistive Listening Systems.

    Besides offering hearing aids, we as professionals should take it upon ourselves to always ask for these assistive technologies when we go out in public to verify their performance and speak up when these systems are not offered, lack neckloops, are not working well or not mentioned in the venues. Offer praise and PR when a hearing loop is offered. This is what caring about ‘America’s Hearing’ is all about.
    There are not enough hearing loops in your area to warrant fitting telecoils, you say? Hearing loops will happen if we all work together. Imagine if every audiologist would support to foster one or two hearing loops in their community or would encourage their clients to help foster one or more hearing loops? We would quickly raise a national tipping point one that I have reached in North East Wisconsin. It is also my experience that many clients will step forward and donate part/all of the hearing loop installation expenses involved once informed. I am happy to help and can be reached via

  4. Thank you for providing yet more objective piece of evidence to illustrate the obvious: real-ear measurement improves patient performance and satisfaction with both the device and the provider. This is something the internet cannot afford the consumer.

    Thank you for focusing on this important aspect of provider driven care.

Comments are closed.