Real ear measurements: why they matter in hearing aid fitting

One of the most common worries about hearing aids is simple: how do you know they will be fitted properly?

Real ear measurements help answer that question. They allow your audiologist to check what your hearing aids are actually doing in your ears, rather than relying only on the manufacturer’s software or a standard starting point.

At Alto, real ear measurements are part of careful hearing aid fitting. They help us fine-tune the sound more accurately and create a measured baseline for future adjustments.

What are Real Ear Measurements?

Real Ear Measurements are a way of testing how sound behaves in your ear while you are wearing your hearing aids.

From the outside, two people can look very similar. Inside the ear, they are not.

Ear canals vary in length, shape and volume. Those differences change how sound arrives at your eardrum.

A computer fitting based only on your hearing assessment and the hearing aid’s prescription will never see that.

These measurements complete the picture.

How it works, in plain English

• A very thin, soft tube is placed in your ear canal, next to where the hearing aid sits
• That tube is connected to a tiny microphone
• The audiologist plays speech-like sounds through a loudspeaker
• The microphone measures how loud those sounds are right at your eardrum
• Your hearing aids are then adjusted until the sound at your eardrum matches what the prescription says you need

Instead of guessing how your hearing aids are performing, we measure it.

Why Real Ear Measurements matter

If you have worn hearing aids before, you may have experienced any of these:

• Speech sounds “muffled” or “thin”
• Voices are clear in the clinic but tiring in real life
• Sounds feel harsh or sharp after a while
• You keep going back for small adjustments that never quite settle

Real ear measurements reduce that trial and error.

The benefits for you

Greater clarity of speech

By checking amplification at the eardrum, your audiologist can fine-tune the parts of speech that carry detail. This can help make sounds such as “s”, “f” and “t” clearer in conversation.

More natural sound

Real ear measurements help your audiologist balance soft, average and louder sounds more carefully, so the fitting can be adjusted for audibility and comfort.

Less listening effort

When important speech sounds are more accessible, listening can feel less effortful. This is especially useful in conversations where you would otherwise be working hard to fill in the gaps.

Safer, more controlled volume

Real ear measurements help your audiologist see whether some pitches are being under-amplified or over-amplified, so the fitting can be adjusted with better control.

A solid baseline for future care

Once your measurements are recorded, they become a useful reference point for future reviews, changes in hearing, technology upgrades and further fine-tuning.

Not every hearing aid fitting includes real ear measurements. At Alto, they are built into our fitting and follow-up process where clinically appropriate.

When we use Real Ear Measurements at Alto

At Alto, these measurements are carried out either:

• At your initial fitting
• At your first follow-up appointment, depending on the case

Why sometimes at the fitting

Many people benefit from having real ear measurements done there and then. You leave knowing your new hearing aids have been verified against your prescription on the day.

Why sometimes at the first follow-up

For some clients, it makes sense to separate “getting used to the aids” from “precision fine-tuning”.

For example:

• If you are new to hearing aids and very sensitive to sound at first
• If we are introducing amplification gradually
• If there are medical or practical reasons to keep the initial visit shorter

In those cases, we may start with a conservative, comfortable setting at the fitting, then run full real ear measurements at the first follow-up once you feel more settled.

Either way, real ear measurements are part of the fitting and follow-up process, not a separate add-on.

What happens during a Real Ear Measurement appointment?

Many people are surprised by how simple and comfortable the test feels.

Step 1: A quick look in your ears

We start with otoscopy, a careful check of your ear canals and eardrums. We confirm there is no wax blockage or irritation that would affect the measurement.

Step 2: Placing the probe tube

A thin, flexible tube is gently placed into your ear canal. It sits alongside where your hearing aid will be.

You will feel a light sensation, similar to a cotton bud placed very shallowly, but it should not be painful.

Step 3: Measuring your ear without the hearing aid

We may run a short measurement without the hearing aid in place. This tells us how your ear canal naturally shapes sound.

Step 4: Measuring with the hearing aid in

Your hearing aid, mould or dome is then placed in your ear with the tube still in position.

We play speech-like or test sounds from a loudspeaker in front of you. The computer measures exactly what reaches your eardrum and shows it on screen in real time.

Step 5: Fine-tuning

Your audiologist adjusts the hearing aid settings while watching the curves on screen. The aim is to fit the output of your hearing aid to a scientifically validated target that matches your hearing loss and listening goals.

We check this for soft, average and louder speech and for both ears.

The whole process usually takes only a few minutes per ear.

Common questions about Real Ear Measurements

Who benefits most from these measurements?

Most people being fitted with hearing aids can benefit from real ear measurement verification. Some groups may notice the value particularly strongly:

• First-time hearing aid wearers
  • Getting it right from day one builds trust and confidence.
• People who tried hearing aids elsewhere and were disappointed
  • Real ear measurements can be the missing step that explains why previous fittings never felt quite right.
• Those with more complex hearing loss
  • If your hearing loss is steeply sloping or affects certain pitches more than others, accurate verification is especially important.
• Clients who are highly sensitive to sound
  • Real ear data helps us make fine adjustments so that sounds are present but controlled.

How real ear measurements fit into Alto’s long-term care

Alto is built around hearing aid treatment plans. Real ear measurements are one part of that, alongside:

• Detailed diagnostic testing
• Careful hearing aid selection
• Ongoing rehabilitation and support
• Regular reviews as your hearing and lifestyle evolve

That ongoing hearing aid aftercare is what turns fitting data into practical support over time, with reviews, fine-tuning and advice as your hearing needs change.

Each time we run real ear measurements, we add to your record. Over time, this creates a clear picture of how your ears and your hearing aids are working together.

That history helps us make better decisions when:

• Upgrading technology
• Adjusting settings for new environments
• Coordinating with ENT or other specialists where needed

What to do if you are curious about real ear measurements

If you already wear hearing aids and are unsure whether they have ever been verified with real ear measurements, you can simply ask at your next appointment.

At Alto, we will:

• Review your current hearing aids and settings
• Explain whether real ear measurements would add value in your case
• Build them into your fitting or follow-up schedule if appropriate

If you are considering hearing aids for the first time, the best starting point is a Complete Hearing Assessment. We will assess your hearing properly, explain whether hearing aids are appropriate, and show how fitting, verification and follow-up work at Alto.