Friday Audiogram: Real Ear Measurement (REM) with Dr. Steven Taddei

Ever wonder why some hearing aids feel too loud yet somehow still muddy? We dig into the exact method that fixes that mismatch: real ear measurement. By placing a tiny microphone in the ear canal, we verify whether amplification reaches prescription targets where it matters most—right at the eardrum. No more guessing, no generic presets. Just a precise, research-backed way to make speech clearer, reduce listening effort, and help you forget you’re even wearing devices.

We walk through the full journey from diagnostic hearing tests to fitting algorithms and targets, then show how verification turns theory into results. Think of it as graphic EQ with purpose: mapping your unique ear canal resonance and dialing in gain for soft, average, and loud speech without blasting everything. Along the way, we share patient-friendly visuals and explain why “louder” isn’t the goal—clarity is.

Then we shift to hearing conservation, because preventable noise damage is still far too common. Using the sun exposure analogy—intensity plus time—we offer practical, no-judgment tips for daily life: keychain earplugs you’ll actually carry, high-fidelity filters for concerts and rehearsals, smart positioning away from speakers, and strategic listening breaks. Musicians and audio pros will hear candid talk about fading stigmas, the reality of noise-induced injury, and how small habits protect the career you love.

If you care about hearing speech clearly, enjoying music safely, or getting the most from modern hearing technology, this conversation gives you the playbook. Listen, learn, and try one change today—like adding earplugs to your keys—then share this episode with someone who turns it up to 11. If this helped, follow the show, leave a review, and tell us the one hearing habit you’re committing to this week.

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Chapters

• 0:00 What Real Ear Measurement Means
• 1:15 From Hearing Test To Targets
• 2:05 Measuring In The Ear Canal
• 3:03 Verifying Speech Clarity Over Loudness
• 3:25 Hearing Protection Matters
• 4:16 Noise Exposure Is Preventable
• 5:00 Practical Everyday Earplug Tips
• 6:07 Stigma, Musicians, And Changing Norms

Transcript

SPEAKER_01: 0:00

I want to just dovetail off your comments about real ear measurement because we have been doing real ear measurement for years, and unfortunately, not enough hearing healthcare providers are implementing real ear measurement. Steven, can you let our listeners know what real ear measurement is and why it's so important? And it's okay if we go off on a tangent because this is something that is really important in the industry, specifically now, because hearing aids are only as good as the individual who is fine-tuning them.

SPEAKER_00: 0:31

Yeah, and I I completely agree with what you just said about it's how the hearing aid is, the hearing device is programmed. So to start it off, before you are fit with any type of hearing instrument, you should have a hearing test. And what that hearing test is going to do is tell you and the, you know, the hearing care professional that you're working with. It's going to give them what is your hearing profile. And then when we look towards hearing aids, we want to make up for that. We're basically providing some type of correction factor. So as you mentioned before, if there is a high frequency hearing loss, what we're going to do with the hearing aid then is we're going to try and provide amplification to make up for that high frequency hearing loss. It's kind of the stance between what is left, what is the fidelity of your hearing system, and then what are we capable of doing with the technology that's available. So to get to real ear measures, what we are doing in a nutshell is we are trying to verify that they're giving an appropriate correction factor for you. And it's a very fun, I find it a very fun and exciting process doing it because everyone's ear canals are a different size, a different shape, the size of their head, their body, it's all different. And all that goes into this crazy equation of how things sound to us. So for real ear measures, as I mentioned before, we're going to put some microphones inside your ear canals, and we're looking for a portion of it where there's a really strong resonance where we're really getting a good sense of how things sound at the point of roughly your eardrum. And then we take different measurements with your ear canal open, with your ear canal plugged up or occluded as it's called, and then we turn the hearing aids on. And hearing aids always have an algorithm that they are going to do, providing that correction factor based on you know your hearing loss. And those are called targets. And there are there are there are lots of different fitting algorithms that we use. So what we're doing is then we're going to present different speech sounds, take measurements inside your ear canals with the hearing aids on, and just see how closely we are meeting that prescription, that target that we're supposed to be hitting. And ultimately, the goal of that, in a nutshell, all the science behind it, we're just trying to make sure that the hearing aids are providing you with the appropriate amount of speech sounds so that when you go about your life, you can almost forget about the hearing aids. And they're providing as much of a benefit as possible, an improvement of quality of life as much as possible, too.

SPEAKER_01: 2:43

Steven, I'm I'm sure you have a blast conducting real ear measurement because let's be honest, it's like it is graphic equalization. It absolutely is graphic EQ. And to be able to show the patient as well. This is Target. This is where you hear without the hearing instruments, this is where you hear with the instrument turned on and where it thinks you should be. And these are your corrections. Our patients always say, Oh my gosh, this is it sounds so much clearer, right? And the goal of a hearing aid is not to make everything louder, it's to make speech clearer, right? To decrease that overall listening effort and increase that overall speech understanding. Now, Steven, you work with a lot of patients throughout the week conducting real ear measurement, helping individuals and patients start their journey on their new hearing world. Now, as an audio engineer, you need to ensure that your hearing is protected. How important is it for individuals to protect their hearing?

SPEAKER_00: 3:46

You know, I would say it is probably one of the most important things. This is something I get on a soapbox on all the time blaze. You know, when we look at hearing loss, obviously the prevalence of it is far too much, it's skyrocketing. And when we look at permanent cell damage, permanent, you know, it's called sensory neural hearing loss. What we find is that in almost all cases, there is some tie with sound or noise exposure, which means that one of the number one causes of permanent cell damage is preventable. And I always feel like I need to repeat that when I mention it, because it's kind of a crazy fact that one of the number one causes of permanent hearing loss is completely preventable. And what that means is as a society, we do not understand the implications of loud noises or music. And then even as a field with hearing care providers and professionals, I don't think we're necessarily doing as much justice as we could to educate people on how they can be protecting their ears. And it doesn't have to be crazy. It's not like, oh no, you can't, you know, drive with your radio cranked in your car anymore. It's a matter of, it's a two-sided coin. It's how loud is the sound you're listening to, and then how long are you gonna be exposed to it? So it's very similar to sun exposure, right? If you're gonna be, let's say on, let's say we're in California, right? Somewhere nice and warm, it's sunny. And if you're gonna be on the beach for five minutes, probably don't need to put on you know suntan lotion. But if you're gonna be there all day and it's sunny, you really need to make sure you're applying suntan lotion on a regular basis. And that's what we see with our hearing system. You need to make sure you are protecting your ears when you're exposed to loud sounds, and then simultaneously, hopefully limiting your exposure to those hazardous levels. I I think it's something that there needs to be a lot more focus on and just general awareness. And I think many people are afraid that being hearing conservation conscious means that they like can't go to concerts anymore, they can't go to bars, they can't listen to loud music. And the best recommendation I have, and I say this all the time, is if you can get a set of earplugs that has a keychain with it, you will make your life so much easier. If you can get a keychain, put it on your car keys, no matter where you go, you will have hearing protection with you. Because I don't think any of us want to be that, you know, that person like, oh, hang on, I need to grab my earplugs before we go to the bar or something. It's no one wants to think like that. So if you just have them with you all the time, you you don't know when, you always don't know when there's going to be loud noises. So it's important.

SPEAKER_01: 6:07

Steven, you you remind me when I was about 21, 22, went out with a couple friends. There was a group of us, there was loud music, and there I am, I put my earplugs in and they were foam earplugs. They were foam yellow earplugs. And honestly, I did not care because I think a lot of individuals, when we talk about hearing conservation and how important it is, how important it is to protect your hearing, you gotta get to that point, and I'm sure a lot of individuals will say, People are gonna look at me, I'm gonna be the yod one out. Listen, I was like 22, out with a group of friends, I wore the foam plugs sticking out of my ear, I looked like Shrek, but I didn't care. You know why? Because I did not have that ringing in my ears the following morning. And Steven, when we talk about hearing loss essentially being preventable, right? We have the ability to prevent hearing loss by utilizing hearing protection, limiting exposure, things of that nature. There's different comorbidities, you know, that are concomitant with untreated hearing loss, such as cognitive decline or dementia of the Alzheimer's type, cardiovascular disease, depression, anxiety, things of that nature. So you see it as I'm an audio engineer, I need to protect my assets, and those are your ears and your overall hearing to continue to do what you love. And how many musicians do you know, Steven, maybe your age or a little bit older, who are younger and present with hearing loss and play music, and that's going to affect their career?

SPEAKER_00: 7:39

Mm-hmm. Yeah, there's many of them. And what I will say is it actually surprises me because I know quite a few, I'm still in contact with quite a few bands that I, you know, recorded back in the days, just general friends, and even for some of the people who come into the clinic now. And it does seem as though some of those stigmas, as you were mentioning, are going away. I think people are realizing, you know, that the noise exposure that you have in kind of that rock and roll lifestyle, it's just not worth it. And we're seeing a lot more people who are professionals within the field coming out and acknowledging the fact that I am having to stop this thing that I love. Music. I've devoted my entire life, my career to music. And now music hurts because of the injury that I've caused my hearing system as a result of 20, 30, 40 years of loud sounds without exposure. So, as I said, I do think those stigmas are starting to change on some of the younger people that I'm at least in contact with.