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Real Ear Measurements & Hearing Aid Verification in Freehold, NJ
The gold-standard hearing aid fitting protocol — performed at every appointment at Haynie Audiology.
Real Ear Measurement
Real ear measurement is a clinical verification procedure performed during a hearing aid fitting that confirms your hearing aids are actually delivering the correct amount of amplification for your specific ears — not the amount a manufacturer's software estimates they probably are.
Here is the problem it solves. Every ear canal is anatomically different. Two patients with identical audiograms — the same type, degree, and configuration of hearing loss — will receive different amounts of sound at their eardrums from the exact same hearing aid programmed to the exact same settings. The shape, length, and volume of the ear canal changes the acoustic output in ways that software cannot predict from an audiogram alone.
Without real ear measurement, hearing aids are programmed to a manufacturer's "first fit" — a default setting calculated by software based on average ear canal acoustics. For some patients this default is reasonably close. For many it is not — and the result is a device that is under-amplifying at some frequencies, over-amplifying at others, and not performing the way the technology is capable of performing. A standard hearing aid fitting uses software estimates to arrive at the programming. Real ear measurement replaces those estimates with objective, measured data taken directly from inside your ear.
Individuals who have their hearing aid programming verified with Real Ear Measurement, not only perceive better sound quality, but they also understand speech significantly better in quiet and background noise. Real Ear Measurement is one of many Best Practice procedures provided at Haynie Audiology in Freehold, NJ
How Real Ear Measurement Works
A thin probe microphone is placed at the eardrum while the hearing aid is in the ear. The procedure is completely painless and non-invasive. Most patients are only mildly aware of the tube during the measurement. The measurement system plays a calibrated test signal and measures the actual sound level reaching the eardrum in real time, with that specific patient's ear canal acoustics fully accounted for.
Dr. Haynie then compares that measured output of the ear hearing aid against an evidence-based prescriptive target — the amount of amplification at each frequency that decades of hearing aid outcomes research has established produces the best results for that patient's specific hearing loss. Dr Haynie will then reprogram each individual frequency bandwidth at a time until the measured output of the hearing aid matches the target across the full range of frequencies. Then confirmed again.
The result is a hearing aid that is verified to be performing correctly — not assumed to be.
Why Fewer Than One in Five Practices Do This
The simplest way to find out whether your audiologist performs real ear measurement is to ask directly: "Do you perform real ear measurement at every hearing aid fitting?" A practice that does it routinely will answer yes without hesitation and will be able to name the equipment they use. A practice that does not may use phrases like "we program to your audiogram" or "our software handles the fitting" — neither of which is a substitute for objective in-ear verification.
So why do so few practices do it? Real ear measurement equipment costs over $15,000. The procedure takes anywhere from 40 minutes - 1 hour depending on the clinical complexity of the case and requires a separate appointment. It requires specialized clinical training. And in a high-volume hearing aid retail environment where appointments are scheduled back-to-back, adding this service reduces throughput.
The research on this is unambiguous. Studies consistently show that hearing aids verified with real ear measurement and fit to evidence-based prescriptive targets produce significantly better speech understanding outcomes than hearing aids programmed to manufacturer first-fit defaults — both in quiet and in background noise. Patients fitted with verified hearing aids report higher satisfaction, return their devices less frequently, and adapt to amplification more successfully.
The American Academy of Audiology, the American Speech-Language-Hearing Association, and the International Hearing Society all identify real ear measurement as a recommended best practice for hearing aid fittings. Despite this, surveys consistently find that fewer than one in five audiology and hearing aid practices perform real ear measurement routinely.
At Haynie Audiology it is performed at every fitting.
The Prescriptive Targets — What We Verify Against
Real ear measurement is only as meaningful as what you are measuring against. The two evidence-based prescriptive fitting targets used in clinical practice are NAL-NL2 and DSL v5 — developed through decades of hearing aid outcomes research and validated across thousands of patients.
NAL-NL2 (National Acoustics Laboratories — Non-Linear, version 2) is designed to maximize speech intelligibility across the frequencies most important for understanding conversation, while keeping overall loudness comfortable. It is the most widely validated fitting target for adult hearing loss.
DSL v5 (Desired Sensation Level) is a prescriptive target developed with particular strength in pediatric fitting and for patients with more severe degrees of hearing loss, where audibility at soft speech levels is a clinical priority.
Dr. Haynie selects the appropriate prescriptive target based on your audiogram, your degree of hearing loss, and your listening priorities — and verifies that your hearing aids are meeting that target across the full range of frequencies
The Complete Best-Practice Fitting Protocol at Haynie Audiology
Real ear measurement is one component of a complete fitting verification protocol. At Haynie Audiology every hearing aid fitting includes three objective verification steps:
Real Ear Measurement
As described above — probe microphone placed at the eardrum, actual output measured and compared to NAL-NL2 or DSL prescriptive targets, programming adjusted until the measured response matches across all frequencies. This is performed at follow-up appointments as your hearing and your brain's adaptation to amplification evolve over time. It is also repeated any time you notice a significant change in how your hearing aids sound or perform.
Hearing Aid Test Box Verification
Before any device goes in your ear, it is tested in a calibrated acoustic test box that measures the hearing aid's electroacoustic performance — output, gain, frequency response, distortion, and noise floor — against the manufacturer's published specifications. Test box verification confirms the device is functioning correctly and meeting its published performance standards before programming even begins.
This step is particularly valuable for identifying devices with subtle manufacturing defects or component degradation that might not be immediately obvious during use but affect long-term performance. It is also an essential part of the hearing aid repair and maintenance process when troubleshooting devices that are underperforming.
Patient-Centered Outcome Assessments
Objective verification measures confirm what the equipment is doing. Outcome assessments document what the patient is experiencing. Both are essential — a hearing aid can pass objective verification and still not be meeting a patient's real-world communication needs.
At Haynie Audiology we use validated outcome assessment instruments including the Hearing Handicap Inventory for the Elderly (HHIE), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Client Oriented Scale of Improvement (COSI).
The HHIE measures how much hearing difficulty is affecting a patient's emotional and social function — providing a documented baseline before fitting and a meaningful outcome measure at every follow-up appointment.
The APHAB measures perceived benefit across four listening domains — ease of communication, background noise, reverberation, and aversiveness of loud sounds — giving a detailed picture of where the hearing aids are helping and where further adjustment may be needed.
The COSI is a goal-setting tool used at the beginning of the fitting process, where patients identify the specific communication situations they most want to improve. At follow-up appointments, progress toward each named goal is measured and documented.
Together these instruments create a structured, documented record of your hearing aid benefit over time — not just a subjective impression at one appointment, but a trackable clinical picture that guides ongoing adjustments.
Who Benefits Most From Real Ear Measurement Verification
Real ear measurement is appropriate for every hearing aid fitting — it is not a specialized procedure reserved for complex cases. But certain patients benefit most from ensuring it is performed:
First-time hearing aid users — Getting the fitting right from the start dramatically improves adaptation and long-term satisfaction. First-fit defaults are most likely to be suboptimal for patients whose ear canal anatomy deviates from the population average the software was built on.
Patients who have worn hearing aids for years but are still struggling — If you have been wearing hearing aids and finding that speech is still unclear, conversations are still exhausting, or you are still turning the television up — there is a meaningful probability your devices were never verified to be delivering the correct amplification. Reprogramming with real ear measurement can significantly change performance even on devices you have worn for years.
Patients with unusual ear canal anatomy — Very small, very large, or unusually shaped ear canals produce the greatest discrepancy between software predictions and actual output. Real ear measurement is most critical for these patients precisely because the software estimate is least likely to be accurate.
Patients with more severe hearing loss — At higher degrees of hearing loss the consequences of under-amplification are more significant. Getting the prescription right matters more, not less.
Patients who have been told their hearing aids are programmed correctly but do not experience that — Objective measurement is the only way to definitively confirm whether a device is delivering what it should. If your current provider has told you your aids are fine but you are not experiencing the benefit you expected, real ear measurement verification is the appropriate next step.
Can You Verify Hearing Aids Purchased Elsewhere?
Yes — and this is one of the most common reasons patients who did not originally fit with us schedule an appointment.
Real ear measurement and reprogramming services at Haynie Audiology are available for hearing aids purchased at any practice — not only devices we originally fitted. If you purchased hearing aids at another practice, a retail chain, or a corporate hearing center and are not satisfied with your results, a real ear measurement verification appointment allows Dr. Haynie to objectively assess whether your devices are performing correctly for your specific hearing loss and reprogram them to an evidence-based prescriptive target if they are not.
This service is available for all major brands — Oticon, Phonak, Starkey, Signia, and Widex, as well as most other prescription hearing aid brands. Bringing your existing audiogram and any prior fitting records to the appointment allows for the most comprehensive assessment.
How Often Should Real Ear Measurement Be Repeated?
Real ear measurement should be repeated annually alongside your annual audiogram. Your hearing changes over time — and the prescription your hearing aids were originally verified to may no longer match your current hearing profile. Annual verification confirms your devices are still delivering the correct amplification for where your hearing is today, not where it was when you were first fitted.
Real ear measurement should also be repeated any time you notice a significant change in how your hearing aids sound or perform, any time your devices are returned from manufacturer repair with replaced components, and any time new hearing aids are fitted regardless of whether you have worn aids before.
Serving Freehold and Monmouth County
Haynie Audiology & Hearing Associates is located at 31 West Main Street in downtown Freehold — serving patients from Manalapan, Marlboro, Howell, Middletown, Aberdeen, Hazlet, Red Bank, Colts Neck, Old Bridge, Englishtown, and throughout Monmouth County.
No referral required. Medicare and most major insurance plans accepted.
Have more questions about real ear measurement or the hearing aid fitting process? Visit our Frequently Asked Questions page