Hearing the Truth: How Real-Ear Measurements Guard Against Unwarranted Hearing Aid Upgrades

Over the past few decades, the hearing aid industry has undergone transformative growth and innovation. While these developments have significantly improved the lives of individuals with hearing impairments, concerns have arisen regarding certain practices. Particularly, the avoidance of Real-Ear Measurements (REMs), an essential procedure, is seen as a way to promote the sale of high-cost upgrades.

REMs are fundamental to the effective fitting and servicing of hearing aids. This procedure involves the placement of a small microphone inside the ear canal while the hearing aid is in use, enabling a true representation of the device’s performance in its actual operating environment. The critical aspects of REMs include:

Patient-Specific Fitting: REMs provide a custom fit by assessing the volume and acoustics of each patient’s ear canal, ensuring the hearing aid is both comfortable and maximally effective for the individual’s specific hearing loss (Moore & Sek, 2020).

Mitigating the Occlusion Effect: Considering the unique acoustics of a patient’s ear canal, REMs can help minimize the occlusion effect, an echo-like sound some users experience. This results in a more comfortable and natural hearing experience (Hawkins & Cook, 2003).

Sound Compression Setting: REMs play a critical role in adjusting the hearing aid’s compression for soft, medium, and loud sounds according to the resonant frequency of the patient’s ear canal. This adjustment ensures that louder sounds do not become uncomfortably loud, maintaining optimal acoustic output (Alcantara, Moore, Kühnel, & Launer, 2003).

Detecting Manufacturing Defects: An often-overlooked advantage of REMs is their ability to identify manufacturing defects in new hearing aids. Simply removing a hearing aid from the box and fitting it to the patient’s ear does not eliminate the potential for factory defects. REMs can determine if a hearing aid’s output is faulty or if its performance is not optimized acoustically, ensuring that patients do not receive sub-standard devices (Mueller & Picou, 2010).

Regrettably, some private hearing aid providers avoid this crucial procedure, particularly around the fourth year of hearing aid usage. This neglect is linked to the industry’s trend of encouraging patients to upgrade their hearing aids every four years, leading to an unnecessary cycle of upgrades. Such practices can financially burden patients and compromise patient trust, distorting facts for sales-driven tactics, thus undermining the ethical foundations of audiology.

It is essential to debunk the myth that hearing aids ‘get old’ or become ineffective over time, unlike smartphones, which become obsolete due to outdated technology with each new model’s introduction. A well-maintained hearing aid, when properly adjusted via REMs to match the user’s latest hearing profile, can be just as effective as a newer model.

Moreover, evidence suggests that the push for frequent upgrades and avoidance of REMs are driven more by sales strategies than by patients’ needs. The goal appears to be steering patients towards purchasing newer models, thereby creating a potentially lucrative revenue stream at the expense of patient care. This sales-driven approach neglects the importance of REMs, resulting in sub-optimal patient outcomes.

This issue presents both ethical concerns and barriers to effective, accessible hearing care. Advocating for patients’ rights and educating about routine REMs’ importance are key to addressing this problem.

Audiologists and hearing aid providers bear significant responsibility in this regard. It is their duty to prioritise best practice guidelines and patient care over sales targets. The routine use of REMs can significantly improve patient satisfaction and enhance the quality of life without imposing unnecessary financial burdens.

In conclusion, the audiology industry must prioritise a patient-centered approach over a sales-driven one. Routine implementation of REMs, patient education, and advocacy are critical in combating the issue of unnecessary hearing aid upgrades. By shifting focus from sales to patient care, we can maintain the integrity of the audiology profession and ensure that patients receive the high-quality, ethical care they deserve without the undue burden of unnecessary upgrades (Valente et al., 2006). Together, we can steer the industry towards practices that respect patient needs, fostering trust, and promoting long-term, effective care.

The implications of the sales-driven approach in the hearing aid industry are profound, but the solution begins with awareness. By understanding the vital role of REMs and advocating for their regular implementation, we can pave the way for more ethical practices and superior patient outcomes. Let’s strive to ensure that hearing care is as comprehensive, ethical, and effective as our patients deserve.


Alcantara, J. I., Moore, B. C., Kühnel, V., & Launer, S. (2003). Evaluation of the noise reduction system in a commercial digital hearing aid. International Journal of Audiology, 42(1), 34-42. doi:10.3109/14992020309056080.

Hawkins, D. B., & Cook, J. A. (2003). Hearing aid software predictive gain values: How accurate are they?. The Hearing Journal, 56(7), 26-34. doi:10.1097/01.HJ.0000293005.18386.fa.

Moore, B. C., & Sek, A. (2020). Real ear measures of hearing aid performance. Journal of the Acoustical Society of America, 147(4), 2757-2767. doi:10.1121/10.0001184.

Mueller, H. G., & Picou, E. M. (2010). Survey examines popularity of real-ear probe-microphone measures. The Hearing Journal, 63(5), 27-32. doi:10.1097/01.HJ.0000373449.63609.12.

Valente, M., Abrams, H., Benson, D., Chisolm, T., Citron, D., Hampton, D., Loavenbruck, A., Ricketts, T., Solodchikov, D., & Sweetow, R. (2006). Guidelines for the Audiologic Management of Adult Hearing Impairment. Audiology Today, 18(5), 32-36.

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