Real Ear Measurement (REM)… It is a starting point, not the end point.
As a practicing audiologist, I have been seeing a lot of discussion about real ear measurements (REM). I agree that it is the only way to directly measure the amplification profile of a hearing aid as it actually performs in a patient's ear. However, I have encountered positions that I believe undermine the broader purpose of hearing healthcare — specifically, the stance that once REM-verified amplification matches the prescriptive targets, the intervention is optimal, and no further adjustment is needed. I believe this is equivalent to a physician saying: We gave you the medication, so there's nothing left to do.
REM is a sound way to confirm that a hearing aid is amplifying sufficiently at impaired frequencies. The concept is straightforward and gives clinicians justifiable confidence in the interventions they recommend. But while it works well for many patients, the resulting sound after REM verification may not be well-received by all of them. When patients report dissatisfaction after REM, further steps are warranted — including additional counseling, amplification adjustments, or reverting to pre-REM settings. This is neither abnormal nor extraordinary; it can be quite common. The reason is simple: whether a sound is appropriate is highly subjective.
This is why, if you spend any time in audio engineering or mixing communities, you will hear engineers joke about having to remix their entire project every morning. They finish a session at night with a satisfied grin, and by the next morning, the same work sounds completely off. This happens to award-winning engineers and experienced sound designers alike.
There is also a psychological and evolutionary layer at work. Because the ear functions as a 360-degree sensory radar, it is particularly sensitive to negative changes in the acoustic environment — and what registers as negative is inherently subjective. Combine this with the body's built-in drive to avoid aversive sensation, and negative changes to sound tend to be perceived as worse than they objectively are.
This is why the need for counseling is implied any time we adjust amplification settings, whether that means changing acclimatization targets or REM-derived settings. If a patient cannot adjust to a new setting within the appointment, lower the gain. It is better for a patient to wear hearing aids with slightly less than optimal amplification than to stop wearing them altogether. REM is a starting point, not an endpoint. The goal of hearing healthcare is to keep patients well-informed about their condition and to implement the best possible intervention with the least resistance — because long-term benefit depends on consistent use.
It is also true that the Verifit is a significant capital expense, and verification time is not reimbursed or valued as well as it should be in most practice settings, which means REM is simply not accessible to every clinic. REM should be encouraged across the field, but it should not be used as a standard to condemn practices that have not yet implemented it.
