real ear measurement

Real-Ear Measurements Are a Must for Patient and Professional Satisfaction

Terry Ross

By Terry Ross

For the past decade of my 35 years (and counting) in the hearing care industry, I have been focused on the value, application, and necessity of real-ear verification of hearing aid fittings. It has become my primary interest and my primary challenge.

My journey has been an interesting combination of surprise, dismay, and hopefulness, as I continue to marvel at how slowly fitting verification has gained traction and legitimacy in our industry

Probe-microphone measurements have been a known and available protocol since the late 1970s, thanks to the great work of Steen Rasmussen and Dr. Earl Harford. However, for decades, these measurements gained very limited acceptance among practicing audiologists.

In the the past few years, as measurement technology has become easier to master and implement and hearing aid signal processing has improved, the benefits of in situ measurement have finally become apparent to a significant portion of the profession.


Benefits of Real-Ear Measurements for Hearing Aid Fittings


The American Speech-Language-Hearing Association (ASHA) recognized the importance of verification in 1998. However, it was not until eight years later that the American Academy of Audiology also indicated that we probably ought to take a look at what is happening inside the patient’s ear with a programmed hearing instrument.


As I noted above, “a significant portion of the profession” now recognizes the benefits of real-ear measurement. However, much to my consternation, a vast number of professionals have still not incorporated a consistent verification protocol into every fitting.


This is the case even though we now have numerous and legitimate studies, reports, and anecdotal information about the benefits and value of measuring the amplification characteristics that the hearing aid is providing to the patient.

As trained professionals, audiologists go to great lengths to obtain precise and accurate threshold information, frequency by frequency, across the entire hearing spectrum. But then they often turn around and rely on someone else’s guess from a faraway factory as to the proposed hearing aid output for our patient’s specific loss. To me, there seems to be a grand disconnect between assessment and fitting that often allows the newly fit patient to leave the office with a sub-par or even detrimental fitting.


Five Excuses–and Why They Are Invalid


Why hasn’t verification become a required standard of care for audiologists and for hearing instrument specialists as well? This protocol is not only proper for patient satisfaction, but it’s also plain good business practice.

I have heard many excuses for not incorporating this procedure into the fitting process. Here are some of them:


  • “It simply takes too long to do this measurement. This excuse is totally lame. Once you’ve mastered the protocol, it takes only 3-5 minutes per ear to ensure that the hearing device is optimally programmed to improve amplification in the impaired regions. What’s more, studies have shown a 45%-50% reduction in post-fitting visits and returns when probe-microphone verification is employed. So, using it actually saves time!
  • “I have been fitting hearing aids successfully for over 20 years, and I don’t need this tool.” This person may be a great salesperson, have super closing skills, and a great personality, but how does he really know that he has optimized the hearing instrument for the patient? Aside from professional arrogance, this is blind ignorance, in my opinion
  • “I rely on the manufacturer’s ‘first fit.’” Time and time again, studies have found that the actual performance of hearing instruments is far different from the predicted performance–sometimes as much as 15-40 dB from the desired target. I applaud the efforts of the audiologists and software engineers at the hearing aid manufacturing companies who develop and promote a “starting point” for a proposed amplification strategy based on the patient’s audiogram. Unfortunately, far too many of those who dispense hearing aids rely solely upon this “starting point” in fitting their patients. By failing to conduct real-ear measurement, they do not find out how close or how far off the actual results of this fit are from the desired results. First fit algorithms may get you into the neighborhood, but they rarely take you to the exact address!
  • “I am afraid my original fitting was not that good.”  Astounding as it sounds, a professional actually gave me this rationale. The audiologist was afraid that he had mis-fit the patient. In reality, he should have been elated that he could correct it with a simple verification!
  • “I am afraid of putting the probe in the ear.” This is a legitimate concern. Surprisingly, when you peel back the onion, I believe that this is the overriding reason that many audiologists do not do real-ear measurements. So, what’s my response? “Practice, gain confidence, and counsel patients before and during the insertion to prevent discomfort or from startling them. Like anything in life, if you want to master a technique, you need to invest some time in honing your skills.”


In an age when we have remarkable verification technologies that can help us do an even better job with our hearing aid fittings, I am at a loss trying to understand why this fantastic technology is not used every day, every fitting, every time.



Terry Ross is Director of Business Development at Beltone Corporation (GN Hearing Care).  Formerly, he was Vice President of MedRx, Inc., a global manufacturer of PC-based audiometric diagnostic and testing instrumentation and subsidiary of William Demant Holding Group. He has over 35 years of  executive management experience within the hearing care industry.  Mr. Ross has spent the last three decades in a variety of executive management positions in sales, training and marketing of hearing care-related products, equipment and services.   He received his B.S. degree from Mankato State University, Minnesota, USA and is a certified sales trainer from Wilson Learning® Center – an international professional sales training and executive development organization.



*Editor’s Note: This article originally appeared at Hearing Views on May 9, 2012. Last updated August 12 2016. Image courtesy wikipedia

About HHTM

HHTM's mission is to bridge the knowledge gaps in treating hearing loss by providing timely information and lively insights to anyone who cares about hearing loss. Our contributors and readers are drawn from many sectors of the hearing field, including practitioners, researchers, manufacturers, educators, and, importantly, consumers with hearing loss and those who love them.