Real Ear Measurement (R.E.M.)

I have only recently discovered there was such a thing as REM. I have since researched it in depth. Having done so, I realise how much I have missed out on as my audiologist never offered (or mentioned) REM

Yeah, the same thing happened to me–twice, since this is my second part of aids. (first pair in 2015, when I knew nothing about hearing aids.) Since then I have tried to learn a lot (such as from this forum), but I still have a long way to go.

I also determined that this fall, when I get new aids, REM will be done, or I won’t buy! I have an appt. in 3 weeks with a Dr. of Aud. and I will get a new audiogram and I will ask her a lot of questions, something that I didn’t do before. Things life warranty period, trial period, bundled, locked, REM, price, etc.

As far as the question of REM, the best I can come up with is: (and more informed persons may know more than I) A thin probe microphone is placed so that it fits in the ear canal with its end is near the eardrum, then the sound pressure level is measured. The goal of the process is to see if the hearing aid output matches the prescription target . The audiologist is trying to make sure that loud sounds are tolerably comfortable and soft sounds are still audible. If this process is skipped, then the hearing aids rely on first fit, or average settings, and post adjustments will be required because the target curve, especially in the higher frequencies, may be missed.

The value of REM is that it allows you to answer questions. REM by itself is not an intervention, but rather a method of measurement following which an intervention can be better guided e.g. where to increase/decrease gain.

Can a hearing aid be programmed without REM? Yes.

Can a hearing aid be programmed without even a hearing test? Also yes.

However, what are you trying to accomplish with a hearing aid, and how can you check your work? Certainly subjective feedback is necessary, but we can also measure things to help answer questions. The more you work with different people with different ear canals with even similar hearing losses, the more you will find that similar software settings will yield different levels at the eardrum. With REM you can measure those levels and then fine tune accordingly.

@Elderly said:

REM is the “gold standard” but not all REM changes make a real hearing difference to the person having it done. So is it gold–sometimes, and sometimes not.

Fair point. However, after paying for top tier Starkeys I feel that I (and everyone) should have been given the opportunity to discover if it was or was not gold for me.

REM is just a tool. I started using it in the mid 1980s and was sold immediately. Hearing aids can be fit without it but the changes made are made with guess work. I prefer the precision of knowing what my changes are doing. I have seen too many fitting that were way off when REM was not used.

To REM or not to REM is a personal choice—and in my case, $300. It’s a cost benefit ratio issue for me. .

In Australia, audiologists have to send REM printouts along with their application for government hearing aid subsidies to prove that the devices being sold are acoustically capable of meeting the persons’ needs in the long term.

Performing REMs with real-ear to coupler differences (RECDs) being measured to correct the audiogram thresholds according to your individual ear-canal acoustics (rarely happens anywhere) results in the highest satisfaction rates, best performance and lowest returns for new and experienced hearing aid users.

RECD’s are required for children due to the high variability in ear canal size at every age, but is rarely done for adults unless they have surgically altered ear canals or perforated eardrums. Average measures are used instead, but there is no average adult ear: its always better to measure.

@Hearing_Potential said:

In Australia, audiologists have to send REM printouts along with their application for government hearing aid subsidies to prove that the devices being sold are acoustically capable of meeting the persons’ needs in the long term.

Yeah I didn’t know this, but probably a fair thing to expect when us taxpayers are paying for the subsidies.

Also most of the states I’ve been to over the years just don’t offer it, my local university is one that does and just one other I found in Perth WA

@gorgeguy, (or any of the other providers) I’d be curious to know roughly what percentage of fittings were very different when comparing ‘first fit’ to ‘after REM’.
Do you find that certain vendors are closer together than others? Are there differences between more open and more closed fittings?

From personal experience I can say that on my Jabra EP20s the calculated gain was so far off from the values after REM, that the HAs would have been practically unusable for me without REM.

With my Phonak Spheres, the difference was still significant but not quite as bad as with Jabra/ReSound.

Have Oticon Intent 1’s purchased in 2025. I think I was one of the first people my HCP did REM on, and it was a nightmare, had to have the changes reverted back a few days later. Then had it a second time it was oddly very painful and I was left wishing I had never done it. The third time I actually flew into London from Portugal and had my first time with everything correctly done, domes changed and program changed to NAL fro VAL. They still have some strange glitchy sounds left over from first REM, but my point is, these tests and fittings are only as good as the fitter and how experienced they are. There are worse places I could go to than London

My audiologist’s practice does REM as a matter of course, so they do it a lot and are good at it. One time I was there to try different domes in one ear for a feedback problem (long time ago; I have molds now). She did REM for each dome we tried, so a few REM’s in that one session. Her fingers flew and it didn’t take much extra time at all. Given this experience, it’s strange to hear about a separate charge for REM, let alone a charge of hundreds of dollars.

@Hearing_Potential said:

Average measures are used instead, but there is no average adult ear

Are these average measures included in the software or is this something you estimate/calculate?
If REM is not done, are in-situ measurements more accurate than using the audiogram + the average measure in the programming software? Widex claims (or appears to claim) that their Sensogram is so effective that many patients are satisfied with their initial fitting.

Yeah In-situ audiometry gets the job done, NAL is the formula to use as this is what REM use, and yes for as long as I can remember Widex make the claim no REM needed for them, Sensogram will do.. mostly I’ve encountered test box in the clinics I’ve visited over the years.

@PaulC said:

We don’t verify with REM because it’s fun. We do it so we can be better informed about our decisions. It’s as simple as that.

No kidding.. but yeah of course it’s a simple decision to make, but I still don’t understand why clinic’s ask up to 1k to have it done,some offer as a “extra”