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Why Real-Ear Measurements Are Essential for Proper Hearing Aid Fitting
When you invest in hearing aids, you expect them to work perfectly from day one. Yet many people find themselves frustrated with their new devices, struggling with unclear speech, uncomfortable volume levels, or that annoying "hollow" sound that makes everything seem artificial. The solution often lies in a precise fitting technique that many practices skip: Real-Ear Measurements (REM).
At Southwest Balance, Dizziness & Ear Institute, we understand that every ear canal is unique, just like a fingerprint. This individuality means that generic programming based on your audiogram alone simply isn't enough to optimize your hearing aid performance. Real-Ear Measurements bridge this gap by measuring exactly how sound behaves in your specific ear canal when wearing your hearing aids.
Understanding Real-Ear Measurements
Real-Ear Measurements involve placing a thin, flexible microphone inside your ear canal alongside your hearing aid. This microphone measures the actual sound levels reaching your eardrum while your hearing aid is active. Think of it as a quality control check that ensures your hearing aids are delivering the right amount of amplification across all frequencies.
The process is completely painless and takes only a few minutes per ear. During the measurement, you'll hear various tones and speech sounds while the microphone captures data about how your hearing aid is performing in real-time. This information allows us to make precise adjustments that generic programming simply cannot achieve.
The Science Behind Individual Ear Differences
Your ear canal's size, shape, and length significantly impact how sound waves travel and resonate. Some people have narrow canals, others have wide ones. Some canals curve more sharply, while others are relatively straight. These variations can cause the same hearing aid settings to produce vastly different results from person to person.
Without Real-Ear Measurements, your audiologist is essentially making educated guesses about how your hearing aids should be programmed. They might rely on manufacturer guidelines or average ear canal measurements, but these generic approaches often miss the mark. What sounds perfect for someone with an average ear canal might be too loud or too soft for your unique anatomy.
The resonance characteristics of your ear canal also play a role. Natural ear canals amplify certain frequencies more than others, and this natural amplification changes when you insert a hearing aid. Real-Ear Measurements account for these changes, ensuring your hearing aids work with your ear's natural acoustics rather than against them.
Common Problems Prevented by Real-Ear Measurements
Many hearing aid complaints stem from improper fitting that could be avoided with Real-Ear Measurements. Feedback (that whistling sound) often occurs when hearing aids are over-amplified in certain frequency ranges. Without REM, your audiologist might simply reduce overall volume to stop the feedback, but this reduces audibility for sounds you actually need to hear.
Speech clarity issues frequently result from inadequate high-frequency amplification or excessive low-frequency boost. Your audiogram shows what you can't hear, but REM shows what you're actually receiving through your hearing aids. These measurements reveal whether consonant sounds like "s," "t," and "f" are reaching your ears at appropriate levels for clear speech understanding.
Comfort problems also improve with proper Real-Ear Measurements. Some people find their hearing aids uncomfortably loud in certain situations, while others struggle to hear soft sounds. REM allows for precise adjustments that maintain comfort while preserving audibility across your entire hearing range.
The Technology Behind Modern Hearing Aids
Today's hearing aids, including the advanced models we fit like the Phonak Infinio, Starkey Edge AI, and ReSound Vivia, contain sophisticated processing capabilities. These devices can make thousands of adjustments per second, but they need accurate initial programming to function optimally.
The Phonak Infinio's dual-chip architecture processes sound with remarkable precision, but without Real-Ear Measurements, this processing power might be working with incorrect baseline settings. Similarly, Starkey Edge AI's neural processing technology excels at speech enhancement and noise reduction, but only when properly calibrated to your specific hearing needs and ear canal acoustics.
ReSound Vivia's artificial intelligence learns from your listening preferences over time, but this learning process becomes more effective when the hearing aid starts with accurate Real-Ear Measurement-based programming. The AI can fine-tune performance, but it cannot compensate for fundamental fitting errors that REM would have prevented.
The Real-Ear Measurement Process
During your fitting appointment, we begin by conducting a thorough hearing evaluation to understand your specific hearing loss pattern. Next, we select and physically fit your hearing aids, ensuring proper placement and comfort. Then comes the Real-Ear Measurement phase.
We place a tiny microphone in your ear canal, positioned near your eardrum but not touching it. This probe microphone measures your ear canal's natural response to sound before we insert your hearing aid. These baseline measurements help us understand your ear's unique acoustic properties.
With your hearing aid in place, we repeat the measurements while presenting various test signals. The probe microphone captures exactly what's happening at your eardrum, allowing us to see whether your hearing aid is providing appropriate amplification across all frequencies. We can immediately identify areas where more or less amplification is needed.
The beauty of this process lies in its precision and immediacy. Rather than asking how things sound and making adjustments based on your subjective feedback alone, we have objective data showing exactly what your ears are receiving. This combination of subjective preferences and objective measurements creates the most accurate fitting possible.
Long-term Benefits and Follow-up Care
Real-Ear Measurements provide benefits that extend far beyond your initial fitting appointment. When you return for follow-up visits or need adjustments, we can reference your original REM data to maintain consistency in your hearing aid programming. This historical data becomes invaluable if you need repairs, replacement devices, or upgrades to newer technology.
The objective nature of REM data also helps us track changes in your hearing over time. If your hearing changes, we can compare new measurements to your baseline data, making informed decisions about programming adjustments. This approach ensures your hearing aids continue providing optimal benefit as your needs evolve.
For those upgrading from older hearing aids, Real-Ear Measurements help us match or improve upon your previous settings while taking advantage of newer technology. We're not starting from scratch but building upon a foundation of precise, individualized data.
Making an Informed Choice About Your Hearing Care
While over-the-counter hearing devices and online hearing aid sales might seem convenient and cost-effective, they cannot provide the individualized fitting that Real-Ear Measurements enable. Generic programming might work for some people by chance, but it leaves too much to luck when it comes to your hearing health and quality of life.
Professional hearing aid fitting with Real-Ear Measurements represents an investment in optimal outcomes. The difference between a properly fitted hearing aid and one that's merely functional can mean the difference between struggling to understand conversations and effortlessly engaging with the world around you.
Experience the Difference at Southwest Balance
Our team of experienced audiologists, Dr. Dana Day, Dr. Susan Schmidt, and Dr. Mckell Larson, understand that successful hearing aid fitting requires both scientific precision and individualized care. We use Real-Ear Measurements as a standard part of our fitting process because we've seen the dramatic difference it makes in patient satisfaction and hearing aid performance.
If you're considering hearing aids or feeling frustrated with your current devices, contact Southwest Balance, Dizziness & Ear Institute at (602) 265-9000 to schedule a comprehensive hearing evaluation. Let us show you how precise, individualized fitting with Real-Ear Measurements can transform your hearing experience and help you reconnect with the sounds that matter most in your life.
Latest Articles
Shocking Hearing Loss Stats and Data
Are you looking for some facts and data to finally get a loved one to have a hearing test or be fitted for a hearing aid? Chatting about some of the data related to the prevalence, causes and effects of hearing problems may finally get them to make that initial appointment. The following are some facts and statistics to help you make your case:
- More men than women experience hearing loss.
- Roughly 13% of the population over age 65 will experience tinnitus – ringing in the ears.
- The number of Americans with hearing loss has doubled in the last 30 years.
- Nearly one of of every 5 individuals in the US have some form of hearing loss – that is 36 million people!
- Ten million people have irreversible loss of hearing because of noise, and 30 million more people are exposed to harmful levels of noise every day.
- Many more people could benefit from a hearing aid than in fact wear one. Some estimates claim there are 4 additional people who could benefit, for every 1 actually using a hearing aid.
- One million Americans have tinnitus that is so serious it gets in the way of daily life.
- Hearing loss categorization studies report that 5% of cases are severe, 30% moderate and 65% are classified as mild.
- Roughly 13,000 adults and 10,000 children in the United States have cochlear implants.
- Approximately 26 million Americans aged between 20 and 69 suffer from high frequency hearing loss caused by recurring exposure to loud noise either on the job or during leisure activities.
- Those with hearing loss delay an average of 10 years before doing anything about it.
Does that describe you or someone you love?
Overview of the 5 Primary Forms of Hearing Loss
Hearing loss is grouped in a variety of different ways. The specific section of the auditory system affected determines the categorization. In this short article we provide an introduction to five categories – sensorineural, conductive, functional, central and mixed. The starting point in creating a therapy plan is to accurately diagnose the type of hearing impairment.Conductive hearing loss – In situations where sound waves aren’t adequately conducted to the inner ear through the parts of the outer and middle ear, conductive hearing loss occurs. Conductive hearing loss is very common and can be caused by a buildup of ear wax, a buildup of fluid in the eustacian tube, which prevents the eardrum from moving properly, a middle ear infection, a perforated eardrum, disease of the tiny bones of the middle ear and other obstructions in the ear canal.Most instances of this type of hearing loss are reversible, presuming there is no permanent damage to the regions of the middle ear, and with proper treatment the problem usually resolves fairly quickly. In some cases surgery can help to correct the condition or a hearing aid may be recommended.Sensorineural hearing loss – This type of hearing loss accounts for over 90% of the instances in which a hearing aid is worn. Sensorineural hearing loss is the result of damage in the inner ear or damage to the acoustic nerve, which blocks sound signals from reaching the brain. Also referred to as nerve deafness or retrocochlear hearing loss, the impairment is more often than not permanent, though breakthroughs in technology have enabled some formerly untreatable cases to see some improvement.The most frequent factors that cause sensorineural hearing loss are aging, extended exposure to noise, complications with blood circulation to the interior of the ear, fluid disturbance in the inner ear, medicines that cause injury to the ear, some diseases, genetics and problems with the auditory nerve.Hearing aids are sufficient for the majority of people that have this kind of hearing loss, but in more serious cases, a cochlear implant can help restore hearing to those individuals for whom a conventional hearing aid is not enough.Central hearing loss – This condition occurs when a problem in the CNS (central nervous system) prevents sound signals from being processed and interpreted by the brain. Affected individuals can ostensibly hear just fine, but cannot understand or interpret what is being said. Many cases involve a problem with the individual’s ability to properly filter competing sounds. For example, the majority of us can hold a conversation with traffic noise in the background, but individuals with this problem have a really hard time with this.Functional hearing loss – A rare occurrence, this type of hearing loss is not physical. Functional hearing loss is due to psychological or emotional problem in which the person’s physical hearing is normal, however they do not seem to be able to hear.Mixed hearing loss – As suggested by the term, mixed hearing loss is a combination of multiple types of hearing loss, in this case the combination of conductive and sensorineural hearing loss. Though there are a couple of other types of hearing loss, the combination of these two is most frequent.
Ryan’s Story
Lost In the Crowd
How I Discovered My Child had APD
When Ryan was about 9 months of age I started noticing that my baby boy was not so happy in certain situations. When I took him to the gym daycare he would cry. Sometimes he would sit in the corner, and every once in a while, rock back and forth against the wall. At birthday parties he seemed to be in his own world. There were never any red flags about Ryan’s behavior at his doctor visits in the quiet examination room when I would take him and my daughter to their well exams. At home he was just like other toddlers. However, he was a different child in a crowd.
By the time my child went into preschool, his teachers told us that there definitely was something wrong with him. He couldn’t play appropriately with all of the other kids. If there was more than one kid in the room, he was lost. He was preoccupied with sounds that no one else would pay any attention to such as tapping of pencils or lights bussing above him. He would say things that were off topic and not be able to understand the rules to games.He went through several preschools until the school district diagnosed him with developmental delays in the social/emotional and behavioral areas. After that, he was placed in the developmental preschool. Still, he could not sit in his seat for very long or follow oral directions and still had a hard time making friends.The next school year did not go so well either, to say the least. By now, the school psychologist was trying to get my son to see a psychiatrist, she said over the phone something about there being medications for these issues. I told her “No way! I will never medicate my son!” She also told me that they wanted to change his label from Developmentally Delayed to Emotionally Disabled. I just knew that it had something to do with the sounds that he heard, or crowded places. I knew that my son did not have any type of mental illness.Meanwhile, he was a good sight reader, for a five year old, and he was good at memorizing things and was also a wizard on the computer at home. However, Ryan was still not making many friends. He got in a few fights. He was not able to join in on the conversations in class, the lunch room, or the playground. He also would say a few bad words here and there. I guess he felt that at least the other kids would laugh or smile when he would say or do silly things. He mentioned to me that the other kids thought he was funny. Any where there were more than a few people, he would act lost. During “one on one,” at home or in the principal’s office, he would behave like any other kid. The only explanation he would give me for his behavior was that he could not listen. “What was I supposed to do with that information,” I thought.After months of phone calls home from the principal’s office regarding my sons’ weird behavior and pressure to get my son evaluated for his mental issues I ended up calling theArizonaCenterfor Disability Law and told them that I felt like I was being pressured by the school system to medicate my kid. They said that was not legal and sent me a book. I also forgot to mention that Able Child, my son’s Naturopath and CCHR was also helping me through this process; telling me that it sounds like my son has a learning disability and not a mental problem.I received the book fromArizonaCenterfor Disability Law. I went through the list of disorders and researched every single one on line. When I got to Central Auditory Processing Disorder I looked it up on the internet just like the other disabilities. OMG!! This is it!!! I showed my husband and he said calmly, “This is what wrong with our son.”From there, I called many audiologists in the area. I found out that only a couple places diagnose this problem, however, not until the child turns 7. I knew that if there was a will, there was a way. After a few days an audiologist office referred me to Arizona Balance andHearingCenter. They have the technology there to even diagnose babies. I made an appointment for the next week. After 3 hours of testing the staff came to get me and informed me that “Ryan meets the criteria set forth by the American Speech –Language-Hearing Association for an Auditory Processing Disorder.” They gave me a list of recommendations, from an FM system in the class room to working with an audiologist. They referred me to Susan Van Wie. That is where the healing began.Ryan was diagnosed a few days before summer vacation. We saw Susan for one hour of therapy every Sunday that summer. Ryan did about 45 minutes of therapy work about five days a week, mostly with auditory computer programs made for children with auditory processing issues. As a team we made alleviating his APD our mission.Little by little, I noticed my son was not turning up the television so loud. He was able to play more with his sister’s friends. He was not so “off topic” and he was saying “what,” and “huh” a lot less. He was turning into a happier kid and we were slowly becoming a happier family.We ended up changing elementary schools for my son so he could have a fresh start. Susan would meet me at the IEP meetings at his school in order to make sure the staff was educated about APD and for support on my behalf. She informed the school what APD was, how to elevate it, and helped the school get an FM speaker in Ryan’s class in order for him to hear speech in noise. An FM system is where the teacher speaks into a small microphone that is attached to her shirt, or around her neck, and her voice can be heard without the background noise of other kids. His classroom has one big speaker so it is beneficial to every child in his class.We kept seeing Susan for the next 7 months. He diligently did his daily auditory lessons that Susan prepared for us. By the end of that school year, my son made Student of the Month! I have to also mention that his new school has done a great job helping Ryan catch up on his social skills and understanding and working with his condition. Now Ryan could correctly hear what his friends and his teacher are saying to him. Susan was wonderful. Ryan just loved her. She is kind and patient and always treated Ryan and I with respect. Ryan, Susan and I were a team. In ten months my son went from a confused outcast to a well adjusted Student of the Month.It has been about 18 months since Ryan was diagnosed with APD. He can now hear most speech in noise and has tested well in most of the age appropriate categories. He will need a re-evaluation every year to make sure he is still doing well. Our days are not always perfect. He still needs directions repeated here and there at school and sometimes gets in trouble for not keeping his hands to himself while in line. Although, he still needs a FM System in his class, for now, to help him stay focused. He is a pretty good student who now just has age appropriate issues at school and at home.I feel so blessed to have been able to help my son and I hope his story will help other children who are misdiagnosed. I know that Auditory Processing Disorder will become recognized more by the schools and pediatricians. I was grateful that I stumbled across it under the learning disorders in the book sent to me. I cringe to think what could have become of my boy’s self esteem if he kept suffering with the confusion of his brain not processing sounds and words correctly. Ryan is proof that this disorder can be overcome with the right intervention and a lot of hard work.--Ryan’s Mom
What Nutrients and Foods Can Help Support Healthy Hearing?
As youngsters, most of us were most likely advised to eat our carrots for better vision. Most likely you did not hear any comparable suggestions about which foods were beneficial to your ears and hearing. Now we can teach our little ones what things to eat for healthy hearing and ears, and also sensible for us to adhere to our own recommendations! Noise, age and infections are among the many reasons for hearing impairment. Specific nutrients in the foods mentioned in this article may help prevent or impede the progression of some common reasons for hearing loss. Musicians, machinery workers, and other professionals in contact with loud noises, are at a greater risk for ear damage. Those with a profession or pastime subjecting them to intense noise, can help take care of their hearing with potatoes, artichokes, bananas, or any other foods abundant in the mineral magnesium. Despite the fact that the precise mechanism is not known, human and animal studies have shown that magnesium helps defend against noise-induced hearing loss (NIHL).Surprisingly, research indicates that fish such as salmon and trout that possesses vitamin D and omega 3 fats, may reduce the incidence of age-related hearing problems. Other smart omega 3 fats and vitamin D choices are the anchovies on your pizza and the tuna fish probably sitting in your cupboard. Eaten two times per week, any of these may help you hear better in your later years.Contact with high decibel noise can stimulate the generation of harmful free radicals contributing to the demise of delicate inner ear hair cells, according to The National Institute on Deafness and Other Communication Disorders (NIDCD). Folic acid and antioxidants can minimize tissue damage from free radicals in the inner ear. Particular foods are particularly rich in folic acid and antioxidants – among them asparagus, nuts, eggs and spinach.You know what? Dark chocolate is also ideal for your hearing health! Dark chocolate contains zinc, and zinc deficiencies have been related to age-related hearing loss. If you don’t like dark chocolate, grab some oysters on the half shell; any foods which contain zinc will work!Now we can help our children reduce future hearing damage with a couple of simple foods we most likely have in our kitchen. Simply add some of these suggestions to the grocery list next to carrots for good eye sight.
Directions for Do-it-Yourself Ear Cleaning and Wax Removal
Blockage of the outer ear canal due to an accumulation of ear wax is one of the most prevalent causes of temporary hearing loss. If you are rather confident that ear wax is the source of your short-term hearing loss, you almost certainly want to clean your ears. Although this is a normal desire, it is crucial to understand how to clean your ears safely, without causing hearing or ear canal damage.To stress health and safety when cleaning your ears, let’s start with what not to do. Avoid using cotton swabs or any other foreign objects that you insert into your ears, as they may cause the ear wax to become even more compacted. Never, use any gadget that sprays water under pressure. The pressurized water stream can perforate your eardrum. Lastly, if you know that you have a ruptured eardrum, leave cleaning your ears to a hearing specialist. The same holds true if you suspect you have an ear infection. Signs and symptoms of ear infections include fever, vomiting or diarrhea, ear pain and fluid draining from the ears.Cleaning your ears properly in your own home can be done with syringe or bulb and a rinse solution from the local pharmacy. You can purchase a carbamide peroxide solution at the local drugstore, or make your own using equal parts of glycerin, mineral oil and 3 to 4 percent.To use the solution, carefully squeeze the solution into the ear using the bulb or syringe. It generally works best to lay down on your side with a towel available to catch drips. Try to avoid touching the ear with the bulb if you can. Allow the carbamide peroxide solution to linger in your ear for a couple of minutes and then repeat for the other side.The solution will loosen and soften the built up wax so that it can be rinsed out. Use lukewarm water to wash each ear and towel dry. Again, do not insert anything into the ear while drying. If the blockage continues, repeat this process of cleaning your ears twice a day for 2 or 3 days. If the problem continues any longer, call your an audiologist or hearing specialist.
What Treatment Methods are Offered for Central Auditory Processing Disorder
There are several good reasons why Central Auditory Processing Disorder, or CAPD, is difficult to diagnose properly. Conventional hearing tests do not always catch CAPD because the condition originates in the brain, not the ears. Youngsters with CAPD can hear spoken phrases and sounds, especially speech, but their brains improperly process the signals sent by the ears. One more reason it is hard to diagnose is because children often develop advanced coping mechanisms. These children may be pros at using expressions or reading lips to conceal their condition.These characteristics of Central Auditory Processing Disorder also make treatment of the condition challenging, because any individual trying to enhance the child’s speech comprehension must continuously remain cognizant of them and develop approaches to work around them. Unfortunately there is no recognized cure or treatment for CAPD that works well across all kids. Each treatment plan is highly personalized and adjusted based on the patients’ capabilities and limitations. With that said, there are a number of treatment protocols which are greatly strengthening childrens’ learning prognosis.Central Auditory Processing Disorder therapy falls into three primary categories – environmental change, direct treatment and compensatory strategies.
- Compensatory Strategies – The group of methods including attention, memory, problem-solving and language improvement skills is called compensatory strategies. These particular therapies give students better coping skills and techniques that enable them to do well at learning, and also make them learn to take responsibility for their own learning success. Lessons intended to improve these types of skills might contain “active listening” drills or solving word problems.
- Direct Treatment – Computer-aided learning and one-on-one therapy sessions fall under the category of direct treatment. These strategies make use of the brain’s inherent plasticity and ability to establish new neurological pathways and abilities. These treatment options routinely include, in the classroom, at home or in therapy sessions, the use of Hasbro’s “Simon” game or the “Fast ForWord” educational software from Scientific Education to help pupils to improve the sequencing, discrimination, and processing of acoustic inputs. Some direct CAPD therapy uses dichotic training which trains the brain on hearing multiple sounds in different ears and analyzing the blended inputs correctly. Houghton Mifflin Harcourt’s “Earobics” program, is also employed by some professionals to strengthen phonological awareness.
- Environmental Change – In the category of environmental change one technique is lowering the level of ambient noise via soundproofing and putting in acoustic tiles, curtains or wall hangings because surrounding noise is proven to make it harder for an individual with CAPD to comprehend speech. In certain school rooms, the teachers don a microphone and the CAPD pupils wear small receivers, so that the teacher’s voice is amplified and clarified, making it distinct from other sounds or voices. Some benefits are from better lighting, because lips and expressions are easier to read on fully lit faces than on dimly-lit faces.
So treatments are available if your child is diagnosed with CAPD, but bear in mind that the first step is identifying the condition, and doing this early. If there is a way we can assist with this, please phone or email us. Allow us to add our years of hearing expertise and connections with local Central Auditory Processing Disorder specialists to helping your child learn properly.
A Review of Common Hearing Aid Battery Types
It is hard to give a single response to the question “What kind of battery do I buy for my hearing aid?” because hearing aid types and styles vary widely, and so do the batteries used to operate them. If you already have a hearing aid, check the device’s manual or the hearing care professionals who sold it to you to verify the right battery type and size. If you’re still looking for a hearing aid and trying to choose which style is best for you, you might wish to do some comparison shopping to assist you in your selection. The explanation for this is that hearing aid batteries differ in price and in battery lifespan, and so an estimate of how many of them you’ll need over time can influence your choice of which hearing aid to get.Fortunately, hearing aid battery packaging uses a standardized color coding scheme. The sizes are all standard across manufacturers, so the color on the package is a dependable indication of the battery size and type.The 4 most common ones are:Size 10 / Yellow – Size 10 hearing aid batteries are identified with a yellow color code, and are currently the most extensively used, being used in a large number of In-The-Canal (ITC) and Completely-In-Canal (CIC) styles; due to their smaller size, they have an approximated battery lifespan of about 80 hours.Size 13 / Orange – Size 13 batteries are frequently used in In-the-Ear (ITE) and Behind-the-Ear (BTE) hearing aids, and have an average battery lifespan of 240 hours.Size 675 / Blue – Size 675 is always coded blue, and is typically found in Behind-The-Ear (BTE) hearing aids and in selected cochlear implants; the 675 batteries are fairly large and have the benefit of a long charge, lasting as much as 300 hours.Size 312 / Brown – Brown corresponds to Size 312 batteries. Size 312 batteries are on the smaller end of the spectrum and typically maintain a charge for about 175 hours. These batteries are commonly found in In-The-Ear (ITE) and In-The-Canal (ITC) hearing aids.These 4 battery types cover most hearing aids, however there are a few exceptions that necessitate alternative batteries. Most in-store providers of hearing aid batteries advertise and stock the more common battery types above, however if you inquire about a specific type, they can usually get it for you.Before stocking up on batteries, remember to read the manual that came with your device to make sure it doesn’t have rechargeable batteries; if it does, you need disposable ones only as back-up. To keep your batteries fresh and fully charged after you purchase them, always store them inside at room temperature and in their original, unopened packages.
Get in Touch
Conveniently located near the intersection of 7th Street and Indian School Road.

Southwest Balance, Dizziness & Ear Institute (formerly Arizona Balance & Hearing Aids)
4004 N 7th St.Phoenix, AZ 85014