Real-ear measurement (REM) is how an audiologist knows that hearing aids are working the way they should in each patient’s ears.

Ears are as unique as a fingerprint. Because of this, every ear will collect sounds differently.

Even if I had two patients with the exact same hearing loss and hearing aids, there’s almost no chance the hearing aids would be programmed the same way.

The first step of real-ear measurement is cleaning any earwax or cerumen that is in the ear canals because it can change the acoustics of your ear and plug electronics.

The next step is putting a little microphone into the ear canal – placed very near the eardrum.

The microphone, or probe tube, is a very soft and flexible tube. It can be daunting for some patients when we’re putting something so close to their eardrum, but most patients say that it tickles.

real ear measurement

To ensure that the tube is deep enough, I then measure the acoustics of the ear canal without a hearing aid.

If it isn’t deep enough, I will modify the depth and remeasure until it’s correct.

The next step is making a similar measurement with the hearing aids on; I measure the output of the hearing aid while the patient is listening to a speech passage.

I then compare the results to targets based on the patient’s age, gender, hearing loss, cognitive health, noise tolerance, and hearing aid experience.

Finally, I make incremental changes to the hearing aid programming to ensure that the hearing aids meet the targets for soft, medium, and loud sounds.

This part probably takes the longest, as I’m a perfectionist when it comes to hitting the targets.

Every once in a while, I might need to change the earpiece or strength of the hearing aid to ensure that the targets are being met appropriately.

Once I’m satisfied that the targets are appropriately met, I verify that the sound is comfortable in the patient’s ear.

real ear measurement

I also go over the patient’s results as an educational tool and so they are kept informed of the processes behind their hearing health.

There is overwhelming evidence supporting the absolute necessity of real-ear measurement in long-term hearing aid satisfaction, but REM can be somewhat controversial.

It takes time, knowledge, and the proper equipment, so many healthcare providers do not complete REM regularly.

REM should be completed at every hearing aid fitting, whenever hearing has changed, and whenever ear-canal acoustics change.

If you see an Audiologist that does not do REM routinely, they are not following Best Practices.

While I love every step of the journey to better hearing, REM is probably my favorite. I cannot tell you how many frustrated hearing aid users I’ve helped by “adopting” them and refitting their current devices using real-ear measurement after the Communication 365 Assessment.

There is no better way to individualize a hearing aid fitting or optimize a patient’s current hearing aids.

If you have any questions about real-ear measurement and why it’s so important, please call us at 256-319-4327 or schedule a no-charge 15 minute “Pick My Brain” appointment with one of our audiologists.

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Dr. Susan Sheehy

Dr. Sheehy earned her bachelor’s and master’s degrees in audiology at the University of Alabama before beginning her career as a clinical audiologist in Huntsville. In 2005, she received her doctorate in audiology from Salus University. Dr. Sheehy is one of a specialized subset of audiologists certified in tinnitus retraining therapy (TRT). By appointment from the governor, she has served as a member and chairperson of the Alabama Board of Examiners in Speech-Language Pathology and Audiology.
    Basic Hearing Test

    A basic hearing test begins with an air conduction test. You will be seated in a soundproof booth and single-use, foam earphones will be inserted into your ear canals. The Audiologist will ask you to push a button or raise your hand when you barely hear a series of beeps (tones) presented at various frequencies (pitches) to obtain your air conduction thresholds.

    To determine whether your hearing loss is a conductive (mechanical) loss, sensorineural (permanent) loss or combination of the two, we perform a bone conduction test.  

    For this test, a head band is place on the bone behind one of the ears to obtain your bone conduction thresholds. This process provides a different form of sound transmission using vibration, which bypasses the eardrum and the middle ear bones and directly stimulates the auditory nerve. When you hear the beeps/tones, you will push a button or raise your hand.

    If bone conduction thresholds are better than air conduction thresholds (through the foam inserts), you have a conductive hearing loss. This suggests a problem with the mechanical structures (moving parts) of the ears.

    Conductive hearing loss is often a medically treatable condition for which we will provide you with a referral to an Ear, Nose and Throat (ENT) physician. However, if bone and air conduction thresholds match, it indicates a sensorineural hearing loss (permanent), and the treatment will likely involve hearing aids.

    ALL INCLUSIVE PLAN

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    Comprehensive 5-Year treatment plan with premium technology

    If you want premium “out of this world” technology and the highest level of service and expert support, our All-Inclusive treatment plan is the right investment for you.

    The All-Inclusive treatment plan offers long-term value for your on-the-go lifestyle, providing everything you need to connect with family and friends for years to come.

    Includes:

    • Stellar hearing devices from top manufacturer (rechargeable option available)

    • Wireless accessory included at no charge

    • Comprehensive Annual Visit including hearing assessment, hearing device adjustment, and 19-Point preventative maintenance valutaion

    • Bi-annual hearing aid software update and reprogramming

    • Same day diagnosis and in-office repair during weekdays for devices dropped off before 3:00 p.m.

    • 5-Year full-service repair warranty

    • Unlimited remote hearing aid adjustments

    • 100% moisture removal by Redux and cleaning

    • Hearing aid supplies (stock receivers, batteries, domes and filters)

    • $1000 contribution towards purchase of upgraded technology within 48 months

    • 3-Year replacement warranty for loss or damage (no deductible)

    • Dedicated team of hearing care experts at your service

    • Unlimited teleaudiology appointments

    • Access to our “speed of light” repair specialists

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    Choose Your Level of Technology

    A Comprehensive12-Step Functional Hearing Assessment

    If you struggle to understand conversations in social situations, restaurants, or other noisy environments, you do not need to schedule a basic hearing test. You certainly don’t need to schedule a “free” hearing screening or online hearing test.

    You need to schedule a “Connect 365” Functional Hearing Assessment at Alabama Hearing Associates!

    Hearing Technology with a Methodical Plan

    Our community understands better than most what can be achieved when you combine technology with human intelligence and persistence. It is much the same with hearing technology.

    The latest hearing aid technology is incredibly powerful, offering stellar sound quality and performance. Wireless connections allow phone calls, music and television to stream directly to your hearing aids for exceptional clarity.

    But hearing aids do not fit and program themselves! For best outcomes, you also need the human touch and expertise provided by our Doctors of Audiology.

    How do I know my new hearing aids are working properly?

    Without verifying that the hearing aid is working correctly from the start, all of the other steps in the hearing aid fitting process are useless. The most sensitive quality control measure is something called Electroacoustic Analysis. We complete EAA on every new set of hearing aids, before delivery of repaired devices, and on an annual basis.

    What Is Real-Ear Measurement?

    Real-ear measurement (REM) is how an audiologist knows that hearing aids are working the way they should in each patient’s ears.

    Ears are as unique as a fingerprint. Because of this, every ear will collect sounds differently.

    Even if I had two patients with the exact same hearing loss and hearing aids, there’s almost no chance the hearing aids would be programmed the same way.

    Orientation, Counseling, and Follow-up

    Dr. Cliff (the creator of the Best Practice Pro Network) said it best:

    “Having a detailed orientation can dramatically improve how much success you have with hearing treatment.  Counseling & Follow-up care can also ensure that you have success for years to come.  Regular visits to a hearing care provider who spends the time to discuss treatment related information and who will maintain your devices is extremely important.”

    During the orientation, your provider will give you the tools you need to be a successful hearing aid user. Everyone has different learning styles and we want to make sure whatever works best for you is what’s used. After the 75 day adjustment period, routine checkups are necessary to maintain the hearing aids and to ensure optimal hearing healthcare. 

    Real World Adjustments

    Your hearing loss didn't occur overnight, so it will take some time to adjust to the hearing aids. Your patience and persistence will be well worth it.

    Wireless Connections

    Most hearing aids automatically come with wireless streaming from smartphones and it has been a lifesaver for those that are working remotely and spending hours on teleconferences. As for other wireless accessories, the two most popular solutions are a small microphone used in less-than-ideal listening environments and a TV streamer that streams the TV’s sound directly into your ears—which can be a lifesaver when watching British TV shows or during football season. If your audiologist believes they would be beneficial for you, they will discuss your options and demonstrate the device in the office.

    Assessing Outcomes

    To ensure the most success with your hearing devices, we measure the benefits of amplification at the end of your adjustment period—some of the surveys and tests included in the “Connect 365” Functional Hearing Assessment will be repeated to evaluate progress, quality of life, and patient satisfaction with the hearing aids.