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Best Practices Checklist

5 WORST Excuses to NOT use Real Ear Measurement

By: Dr Cliff Olson
September 15, 2018
Video Transcript


Like most industries, in the hearing care world we have something called Best Practices.  Best Practices are essentially a set of guidelines that are developed by reviewing Evidence Based Research.  This removes personal opinion from determining what the most effective forms of treatment are.  

If you would like to see the Best Practice Guidelines for the Audiologic Management of Adult Hearing Impairment, click here: 5. https://audiology-web.s3.amazonaws.co...

Yet no matter how much research there is surrounding a topic, and there is a TON surrounding Real Ear Measurement, I constantly receive emails from individuals who ask me if the Excuse their Hearing Care provider gives for not doing them make any sense.

That is why I created a list of 5 of the WORST excuses for not doing Real Ear Measures in this video:

Bad Excuse #1. New hearing aids are so advanced that they can self-calibrate to your hearing loss.

If you truly believe that a hearing aid self-calibration could perfectly fit your hearing loss, then why would you need a hearing care provider at all?  The truth is, even hearing aid manufacturers themselves advise providers to perform Real Ear Measurement.  They request this because they know more hearing aids are returned for refunds when these measurements are not performed.Bad Excuse #2. Real Ear Measurement is only for complex cases of hearing loss.Yes, some hearing losses are more complex than others.  However, all hearing losses have a prescription that must be met.  Does a surgeon only wash his/her hands before "complex" surgeries?  No, they wash their hands for all surgeries because best practices indicate that they should.  Complex or not, the only way to ensure that your hearing loss prescription is being met is to perform Real Ear Measurement.

Bad Excuse #3. Real Ear Measurement can't be used in cases of Single Sided Deafness (SSD).

When you have SSD, some of your treatment options included CROS and BiCROS.  This is when sound is taken from your deaf side and sent to your better hearing ear.  This helps to overcome headshadow effects.  It is comical to think that you wouldn't need to verify if the headshadow effect has been compensated for and if a prescription for hearing loss in the better ear has been met.

Bad Excuse #4. Real Ear Measurements don't provide any additional benefit over not using them.

Yes, in some cases default programming of hearing aids will provide some hearing benefit.  However, research study after research study indicate that performing Real Ear Measurement provides consistently better outcomes than not performing them. In a study be Levitt and Flexor (2012), the performance of seven hearing aids were compared with using REMs and without using REMs in a background noise.  In every device, the performance in background noise was better when Real Ear Measurement was used.  Even the Old Analog hearing aid programmed using REMs outperformed all of the Premium Digital hearing aids that did not have these measurements performed on them.

Bad excuse #5. Real Ear Measurements are not repeatable.

This is probably the worst excuse of them all.  The claim is that from measurement to measurement, you will get different results.  However, any Real Ear equipment that has been properly calibrated is designed to function within a specific +/- range of repeatability.  They even have reference microphones to ensure that the sound coming out of the loudspeaker is at the correct level throughout the measurement.  Just to be clear, there is no test in the history of the world that doesn't have at least some variability.  

The question is, does it fall within the pre-determined realm of acceptability?  With Real Ear Measurement, the answer is YES!

Ultimately, I find it sad that some hearing care providers feel the need to fabricate excuses as to why they don't feel the need to perform Real Ear Measurement.  After all, it is no secret that Best Practice guidelines indicate that REMs are the Gold standard for hearing aid verification.  So the next time a hearing care provider gives you a bogus reason not to verify your hearing aid programming, just politely tell them that you will be finding another hearing care provider who does.

Dr Cliff's Thoughts

Like many industries, in the hearing care world, we have something called best practices. Best practices are a set of guidelines that specify the most effective methods of administering care. These best practice guidelines are developed based off of evidence-based research that is compiled by a task force of industry leading professionals.

By using evidence-based research, you largely take opinion out of what the best treatment options are. If you would like to see these best practice guidelines for the audiologic management of adult hearing impairment, then I highly recommend you check out my PDF here.

No matter how much research there is surrounding a topic, and there is a ton of research involving Real Ear Measurement, I constantly get emails from individuals all over the world asking me if the excuse that their hearing care provider has given them for not doing Real Ear Measurement actually makes any sense.

That’s why I compiled this list of the five worst excuses that I’ve heard for not using Real Ear Measurement.

Terrible Excuse 1#: “Hearing aids are so advanced nowadays that they can self-calibrate to your specific hearing loss.”

If you truly believe that this is a good excuse not to perform Real Ear Measurement, then why would you even need to go to that hearing care professional? You could just go online, buy hearing aids, have them auto-fit to your hearing loss prescription and you’d be good to go.

Even hearing aid manufacturers are begging hearing care providers to perform Real Ear Measurement on their devices. Manufacturers know that one of the main reasons that hearing aids are returned for credit is because they weren’t programmed appropriately to a patient’s hearing loss prescription.

How do they know this? They can actually do data readings off of these returned hearing aids and determine whether or not they were fit using Real Ear Measurement (showing that there were adjustments made to the devices) or whether they were just auto-calibrated to a patient’s hearing loss.

Terrible Excuse 2#: “Real Ear Measurement is only necessary for complicated forms of hearing loss.”

Yes, some hearing losses are more complex than other hearing losses. But all hearing losses have a certain prescription that needs to be met. Do surgeons only wash their hands for “complex” surgical procedures, or do they wash their hands for all surgical procedures? The answer is that they wash their hands all the time, because best practices indicate that they should.

It is the same thing for treating hearing loss. Whether you have a complex form of hearing loss or whether you have a more traditional form of hearing loss, you still need to verify that that particular prescription is being met, and the best way to do that is by using Real Ear Measurement.

Terrible Excuse 3# “Real Ear Measurement can’t be used for single sided deafness when treating with CROS or BiCROS devices.”

When you have single sided deafness, some of the more common treatments that you have at your disposal are CROS treatment or BiCROS treatment. This type of treatment takes sound from the side that you are deaf in and it transmit it over to a device that is on your better hearing ear. If you have normal hearing in your better hearing ear, you would use CROS treatment. If you have a hearing loss in your better hearing ear, you would use BiCROS treatment.

The whole concept that we’re trying to overcome is what we call the head-shadow effect, which is the effect that happens when sound is trying to get around your skull and by the time it gets to your better ear it’s already softer.

Of all the excuses that I see, here are some of the more comical ones, and it ranges anywhere from “Why would you need to measure the amount of sound in your deaf ear?” to “Well, when the sound comes over from your bad side and goes into your good side, that interferes with the sound that’s already coming into your good side, so it just mashes up the whole measurement anyway.”

Whether you have CROS treatment or BiCROS treatment, Real Ear Measurement is the only way to ensure that you’re transferring over enough sound to overcome that head-shadow effect and actually amplify the better ear correctly.

Terrible Excuse 4#: “Real Ear Measurement provides no additional benefit over not using them.”

Alright, yes, in some cases, hitting the auto program button in the hearing aid manufacturer software will give you some benefit. And in some cases, this benefit is enough for you to justify spending thousands of dollars for those particular hearing aids. However, research study after research study indicate that performing Real Ear Measurement when programming hearing aids provides better patient outcomes versus not performing Real Ear Measurement.

Further evidence is found in a graph from a study by Leavitt and Flexor that indicates hearing aid performance in a background noise setting. When comparing seven hearing aids programmed using Real Ear Measurement, they all significantly outperform the same hearing aids that aren’t programmed using Real Ear Measurement.

Even an old analog hearing aid that is programmed using Real Ear Measurement outperforms more advanced digital hearing aids that are not programmed using Real Ear Measurement.

The research doesn’t lie. No Real Ear Measurement equals poorer performance, especially in a background noise situation.

Terrible Excuse 5# (perhaps the worst excuse out of all of them): “Real Ear Measurement isn’t repeatable.”

The theory of this excuse is that Real Ear Measurement isn’t consistent and reliable enough to give you accurate readings from measurement to measurement. This excuse is completely inaccurate.

As long as Real Ear Measurement equipment has been properly calibrated on an annual basis, the results that you get from doing these measurements is consistent and reliable. In fact, all Real Ear Measurement equipment has reference microphones to ensure that the sound coming out of the speaker is coming out at the calibrated level to ensure that it doesn’t throw any variability into the measurements that are done inside of the patient’s ear canal.

Now, to be fair, there is no measurement that doesn’t have some level of variability. Let me say that again. There is no measurement that has ever existed in the history of the world that doesn’t have some level of variability. The question is, does the variability fall within a pre-determined level of acceptance? With Real Ear Measurement it does.

Ultimately, I find it sad that some hearing care professionals are still trying to come up with different excuses to justify their reasoning for not using Real Ear Measurement. It is no secret in the hearing care world that best practices indicate that Real Ear Measurement is the gold standard in programming hearing aids. And this is not my opinion – this is based off of research!

So, the next time that a hearing care professional tries to give you some bogus excuse as to why they can’t perform Real Ear Measurement, just politely tell them that you’re going to go somewhere else that does.

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