Real-Ear Measurements, Speech Mapping, & HA Testing


Real ear measurements (REM) and live speech mapping (LSM) are two distinct fitting procedures used by hearing care providers to ensure that a hearing instrument is tailored to a patient's individual ear characteristics. While REM and LSM are often used interchangeably, they involve different testing procedures and serve different purposes. As a hearing care professional, it can be challenging to decide whether to conduct REM or LSM, and how to distinguish between them.

Below are some key differences between REM and LSM that can help you choose the best fitting procedure for your patients. We also include two equipment options for you to check out.

What Are Real Ear Measurements?

Real ear measurement (REM) is an in-ear verification method first developed in the early 1980s to ensure that a hearing instrument is accurately customized to a patient's individual ear characteristics. REM is also known as in-situ or probe microphone measurement and is the first type of testing produced by diagnostic manufacturers. Today, REM is often used as an umbrella term to describe both true REM and speech mapping.

The main difference between REM and live speech mapping (LSM) is the type of stimuli used for fitting and how adjustments are made to the hearing instrument. Traditional REM typically use only non-speech stimuli, such as white noise or pure tones, to adjust the gain or output of hearing aids. However, modern REM systems like MedRx AVANT REM Speech+ or Interacoustics Affinity 2.0/REM440 can use several different types of stimuli to improve accuracy such as Warble Tone, Pure Tone, Random noise, Band limited white noise, Chirp, ICRA, and Real Speech, along with any other sound file you choose.

When fitting with REM, a hearing care provider conducts multiple tests, including an unaided response test, to decide a patient's gain or output levels. The results of these tests are then used to adjust the hearing aid's fitting software. Overall, REM testing typically takes a little longer than live speech mapping, however, real ear measurement provides valuable insights into the patient's unique ear characteristics, ensuring that their hearing instrument is optimally customized to their needs and preferences.

What is Live Speech Mapping?

Live speech mapping (LSM) is an advanced method of fitting hearing aids that uses speech as a stimulus to help the specialist adjust hearing aids to the right settings for each wearer. Hearing aid manufacturers have more recently included features that offer patients a more well-rounded listening experience, making speech mapping more important than ever.
LSM can use various stimuli, including recorded speech that uses phonemes, the smallest units of linguistic sound that people use to distinguish one word from another. Typically, hearing aid providers prefer to use live speech from a spouse or family member's voice. In contrast to traditional REM, LSM allows the provider to analyze the patient's aided response to the stimulus in real-time and compare it to the patient's audiogram.

Fittings with LSM can save time and improve the overall fit for a patients' hearing aids. By proving how a patient would perceive sound pressure levels with their new device, LSM helps providers ensure that their patients receive the best possible hearing care.

Why should I Use REM/LSM to fit hearing aids?

To ensure that your patients receive the most exact fit for their hearing aids, it's recommended to conduct some form of real-ear verification, whether it be REM or LSM. This is considered audiology best practice and can potentially reduce hearing aid returns and re-fittings.

By using real-ear verification, you can confirm that the hearing aids are fit not only for the patient's prescriptive loss but also for their unique ear characteristics. This personalized approach can result in a more pleasurable listening experience for your patient.

While it may require added time upfront, conducting real-ear verification shows your commitment to helping your patients get the best fit possible for their hearing aids.
If you currently use REM and are interested in learning speech mapping, MedRx offers intuitive LSM modules that are easy to learn, especially if you're already familiar with real-ear measurements. MedRx offers two hardware options to conduct REM and LSM tests using their STUDIO software. These options are designed to provide hearing care professionals with flexibility and choice when it comes to selecting the right hardware to meet their specific needs for patient verification. Both options include the REM and LSM modules, allowing for comprehensive testing and analysis of a patient's hearing aid fitting.

Equipment to Check Out

MedRx's AVANT REM Speech+

AVANT is an innovative REM and LSM verification system that offers a range of features to meet your needs. It is designed to work seamlessly with MedRx's original AVANT software or the newer STUDIO modules. The AVANT REM Speech+ is a PC-based binaural verification system that includes a range of advanced features to supply a comprehensive hearing aid fitting.

The REM Speech+ includes the REM AutoFit Capability, which allows for quick and easy verification. The system also includes targets for MSS (Modified Speech Spectrum), DSL v5.0, NAL-NL1, and NAL-NL2, supplying flexibility and accuracy in fitting hearing aids. The HLS (Hearing Loss Simulator) and MHA (Master Hearing Aid) features make it easy to show third-party devices to patients.

The MedRx REM module offers a Manual Signal Control (MSC) feature that allows the clinician to play the stimulus for an unlimited amount of time until the MSC button is pressed again. This feature supplies greater control over the duration of the stimulus to adjust the hearing aid software while it is still running. Similarly, the Live Speech Mapping module includes an "on top mode" that allows for real-time adjustment of the hearing aid's software while the stimulus window is open and running.

The AVANT REM Speech+ is compatible with Noah, Blueprint OMS, TIMS, and Sycle, making it easy to integrate into your existing workflow. With its advanced features and compatibility, the AVANT REM Speech+ is a top-of-the-line, cost-effective choice for REM and LSM verification.

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Interacoustics Affinity2.0 / REM 440

A user friendly, all-in-one system for audiometry, real-ear measurement, and technical hearing instrument testing. The Interacoustics Affinity2.0 also offers robust counseling tools and a variety of special tests for advanced audiometry.

Depending on your needs, you have the ability to mix and match modules:

  • Audiometry (basic audiometry & a wide range of specialized tests)
  • Real-ear measurements with optional Visible Speech Mapping
  • Hearing Instrument testing

The modules are upgraded as new stimuli or other advanced techniques become available so you can always stay up to date. All associated client records are stored through Noah or through the Interacoustics database called OtoAccess™. The software is networkable and allows you to include other Interacoustics modules within the same suite, for example, VIOT video otoscopy.

The Affinity2.0 permits personalized test configurations as well. User-defined protocols are saved under a unique name for easy recall via a drop-down menu. This enables multiple users to make test selections that are suitable for their own applications. Larger clinics or dispensing facilities will find this useful as the protocols can be downloaded and transferred to sites over the internet.

A Visible Speech Mapping module is available with Interacoustics Affinity2.0 to assist you in educating clients and family members about the complexities of hearing aid amplification and the benefits they will receive. Likewise, the Hearing Loss Simulation (HLS440) and Master Hearing Aid (MHA440) modules engage clients and relatives in the fitting process which is especially important in establishing the trust and confidence of first-time users.

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Hearing Aid Testing Equipment and e3 Diagnostics

As the leader in audiological equipment, e3 Diagnostics provides a robust selection of hearing aid test systems. Whether you need a device to perform real ear measurements, hearing instrument tests, speech mapping, or all the above, we have a solution for your unique needs. Take REM measurements to confirm what your patients are hearing, assess telecoils, test directional microphones, and much more.

e3 Diagnostics represents the very best hearing aid testing and verification systems from Interacoustics, Audioscan, and MedRx. Your local sales consultant will provide a hands-on demo to help you choose the most versatile and efficient audiology equipment according to your preferences so that you always know your hearing aid fittings are precise and tailored for your patients.


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