The Difference Between Hearing Aids You Tolerate and Hearing Aids That Work
Hearing aids arrive from the manufacturer with software that calculates settings from your hearing test. Those settings are a reasonable starting point, but they are only a prediction of what the device will do once it is in your ear. The sound that actually reaches your eardrum can be quite different, and the only way to know is to measure it.
That measurement is called real ear. Every major professional organization in audiology considers it the standard of care for hearing aid fittings, and it remains one of the most frequently skipped steps in the process.
Here is what the procedure involves, why it affects how well you hear, and how we use it at Capital Institute of Hearing & Balance.
What Real Ear Measurement Is
Real ear measurement, also called probe microphone measurement, tells us how much sound your hearing aid is delivering inside your ear canal.
We place a thin, flexible probe tube in your ear next to the hearing aid, with the tip sitting near your eardrum. Sound plays through a speaker, and the probe microphone picks up what arrives. We compare that to your prescriptive target, which is the amount of amplification your hearing loss calls for at each pitch, and then adjust the programming until the device matches.
Speech mapping is a version of this that uses speech as the test signal, so we can see how the device is handling the frequencies that carry conversation. You will hear the two terms used interchangeably, and we use both procedures depending on what we are checking.
Why the Measurement Is Necessary
No two ear canals are alike, and that is really the whole reason.
Hearing aid software controls how loud the receiver plays a sound. It has no control over what happens to that sound after it enters your ear canal. The length, width, and shape of your canal all change the sound before it reaches your eardrum, and the manufacturer’s calculations are based on an average ear rather than on yours.
Try this at home. Play music on your phone, then set the phone in an empty cereal bowl. It sounds louder, though you never touched the volume. Move it to a large mixing bowl, then to a coffee cup. The sound changes each time, even though the phone has not changed at all.
Your phone is the hearing aid, and each container is a different ear canal. Until we measure the output in your ear, we are estimating what your anatomy is doing to the sound.
This is not just theory. Studies comparing the two approaches have found that manufacturer settings often fall short of the prescription, and that patients whose hearing aids were measured and adjusted to target understand speech better than patients whose devices were left alone.
What the Professional Guidelines Say
Real ear verification is not a premium service or something we invented. The audiology profession’s standards call for it.
The American Academy of Audiology and the American Speech-Language-Hearing Association both name probe microphone verification as best practice in their hearing aid fitting guidelines. Consumer Reports has advised consumers to look specifically for providers who perform it.
How Often Is It Actually Performed?
Not often, and the profession has been tracking that gap for years.
Survey data revisited at the American Academy of Audiology’s 2021 conference found that about 30 percent of practicing and dispensing audiologists perform real ear measurements regularly. A separate industry survey put the number closer to 34 percent. Those figures have barely moved in more than a decade. The barriers are mostly the cost of the equipment and unfamiliarity with the procedure, not any real disagreement about whether it helps.
What this means for you is that a hearing aid fitting is not a standardized procedure. Two providers can fit the same device to the same patient and get measurably different results.
How We Use Real Ear Measurement
We verify every hearing aid we fit, and we verify again when your hearing changes. A new audiogram means a new prescription, and a device that matched your hearing two years ago will not match it now.
Verification gives us a known starting point. Prescriptive targets are calculated to give you the best chance at clear speech understanding, so that is where we begin, and we confirm we are there by measuring rather than assuming.
After that, adjustments become a conversation. Patients tell us their own voice sounds too loud, or that dishes clattering in the sink is sharp, or that they would like things a little warmer overall. Those preferences are real, and we make the changes. We do want you to know what you are trading, though. Moving away from your target may make listening more comfortable while also giving you less of the speech information you need, and the most comfortable setting is not always the clearest one.
We would rather you make that choice deliberately. Because we measured at the beginning, we can tell you exactly how far an adjustment has taken you from your prescription, and we can put you back if it turns out not to be worth it. When a device has been adjusted by ear for years with no baseline, nobody can say where it stands.
Real ear measurement helps with troubleshooting as well. If your hearing aid stops sounding right, measuring it usually sorts out whether you are dealing with a device problem, wax or moisture, or a programming issue.
What the Appointment Involves
The procedure is quick and painless. We look in your ears first, since wax in the canal will interfere with the measurement and needs to come out beforehand.
We place the probe tube, put your hearing aids in, and seat you in front of the equipment. Speech and other signals play at several volumes, soft through loud, because a hearing aid has to handle a whisper and a crowded restaurant differently. You can watch the measurements on the screen alongside your prescriptive targets, so you see the adjustments happening rather than just hearing about them afterward.
Most patients find it far less involved than they expected. It does add time to the appointment, which is a fair trade for knowing the device is set correctly.
If You Purchased Hearing Aids Somewhere Else
We perform real ear measurement on devices that were fit at other practices, and we encourage anyone who bought hearing aids elsewhere to come in for verification and reprogramming.
When a hearing aid is programmed straight out of the manufacturer’s software with no verification, that is called a first fit. The software takes your hearing test and applies an algorithm built around an average ear. Research has repeatedly found that first-fit settings miss prescriptive targets, and that patients fitted to verified targets understand speech better.
In our clinical experience, that is the most common reason patients are unhappy with their hearing aids. The problem usually has nothing to do with the technology or the brand. The devices were never measured in the patient’s own ears, so they have been running below target since the day they were fitted. People in this situation often decide that hearing aids do not work for them, when what really happened is that these particular hearing aids were never set to their prescription.
Verification tells us which situation you are in. Often the device can do considerably more than it has been doing, and the fix is a programming change rather than a new purchase. Sometimes the measurement shows that your hearing loss is beyond what that device can handle, which is also worth knowing before you spend more time and money on it.
Real Ear Measurement and Tinnitus
Verification matters for tinnitus patients for a reason that is easy to miss.
When hearing loss and tinnitus occur together, restoring the sounds you have been missing is itself a form of sound therapy. Ordinary environmental sound and speech, made audible again, give the tinnitus something to blend into. If your amplification falls short of target in the pitch range where your tinnitus sits, you lose that benefit, and there is no way to know without measuring.
We go into this further in our article on cognitive behavioral therapy and tinnitus care.
Frequently Asked Questions
Does real ear measurement hurt?
No. A soft, thin tube rests in your ear canal. Most patients describe it as a mild awareness rather than discomfort.
How long does it take?
Generally thirty to forty-five minutes, depending on whether we are verifying an initial fitting or checking a single adjustment.
Can you verify hearing aids I bought somewhere else?
Yes. We verify devices obtained at other locations. If your hearing aids have never been measured in your ears, verification is often the difference between devices you tolerate and devices you are glad you bought.
Is it covered by insurance?
Coverage varies by plan. Our team can review your benefits before your appointment.
My hearing aids seem fine. Do I still need it?
Verification often turns up gaps in hearing and clarity that patients had adapted to without realizing it, particularly for soft speech and higher pitches. Comparing your measured output to your prescriptive target is the only way to know what you have been missing.
Why do some providers skip it?
The most common reasons are the cost of the equipment and unfamiliarity with the procedure, rather than any professional disagreement about whether it improves outcomes.
Schedule a Hearing Aid Verification
If you wear hearing aids and are not certain they have ever been verified, that is worth finding out. We perform real ear measurement and speech mapping at both our Silver Spring and Chevy Chase offices, for devices we have fitted and for devices purchased elsewhere. Schedule an appointment or contact us with any questions.