5 WORST Excuses to NOT use Real Ear Measurement

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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