Why not repeat hearing tests with hearing aids in ears?

Audiologists test a patient’s un-aided hearing to get a frequency curve, word recognition score, speech in noise score, etc. in order to see where they deviate from normal. Then they fit and program hearing aids to try to get hearing as close to normal as possible, within the limitations of the aid’s capability and the degree of the patient’s hearing loss.

It seems to me that a good way to check how much the aids are helping is to do another hearing test with the programmed aids in. Then compare the frequency curves etc. to see how close to normal the hearing aids get the patient’s hearing. Maybe do this in addition to REM.

But in all my years of reading about hearing aids, watching Dr. Cliff and Matthew Allsop on youtube, as well as other youtube Audi’s, I have never heard anyone suggest this. So it must not be a valid means of verification. Anyone know why it’s not done? Has your hearing care professional ever done this?


Isn’t this what REM does?


I think it’s largely not done because hearing aids don’t return hearing to normal. The goal of hearing aids is ultimately to make speech more understandable and the approach to that is to make sounds audible that are not currently audible.


REM tests whether or not the hearing aid is doing what it was programmed to do* (in situ). It doesn’t test the human response to sound. So, it’s half way there I’d say. I think we really should have both, and I think a lot more data points would help too. We get maybe a few points on a graph for our prescription, but then the hearing aids have many times that number of channels. It’s far from being an exact science at this point IMHO.

  • I’m reminded of the old computer adage: garbage-in, garbage-out.

When my Osia BAHA was activated the audi performed tests in a sound booth with the Osia in place. I was the first person she knew who had the device and she was really curious! The Osia performed very very well–she was awestruck. Me too! My right ear hearing levels measured right around normal across the entire spectrum. Remarkable! My speech recognition tests also improved a lot. I have loss in the bass frequencies going to severe and then profound in a typical ski slope in that ear. She had earlier also performed tests with my BTE aids in place, so she could compare results, I suppose.
So this can be done! This audi works for Kaiser.



My audiologist did a hearing test with the aids in,on first fit, to see how it differed from the initial test. They will have been set unaided. He did this to test how my hearing was with the Receivers being in the canal. My hearing was slightly better. This is done in the Phonak Target software. He then spent over an hour fine tuning the aids to my needs, with this revised test as the starting point.

Peter H


Is there an emoticon here to show “NAILED IT”? Cuz that is exactly and precisely what I’ve been thinking about - and there HAVE been some threads here I believe where that timely topic was raised?

It seems like a ridiculous no-brainer to test the person’s hearing BEFORE and AFTER aids have been set to the individual’s preference. Granted, this may come after 3-4 visits, but WHO wouldn’t want that kind of positive feedback - validating that the expensive device purchased actually DOES make a difference?

I’ve worn aids for almost 35 yrs and the many audis I’ve had have never even considered doing this. Perhaps it’s cuz my ears UNaided are like two stones: virtually nothin’ goin’ on there.

But put my Phonak Lumity Life aids in, and yes, my current audi MARVELS (pardon the pun) at how I hear everything FAST - no hesitation. I may miss a word and ask for a repeat, but conversation with me is rapid-fire! No hesitation. Proof enough? I’d still welcome the full tone and word comprehension tests.


I have taken hearing tests online with my Phonak Audeo Paradise P90R in place. My hearing was about 75% if I remember right

I did that about 6 months before my audiologist quit and told him my results

he told me hearing aids don’t fix hearing. I should do it again now an expert has done a quick fit for me. I’m hearing much better than before with my Audi s setting up and using REM


Easy enough to get a ballpark test online. My initial online tests were very close to matching those at CostCO. I think I’ll try one of these now and see.

Here is the MD hearing test. I have some mid and high freq turned down for me (DIY, Philips 9030) and only set to 90%. Tested with the general program I use most of the time but I did boost the volume in the app by 5 db to make up for my program changes. This setting is just too loud for me, especially for my voice or loud sounds but here are the results and you can compare to my original audiogram. It’s no wonder I’m still saying huhh a lot, lol.


I’d also ask about having repeat testing after using hearing aids for awhile to gauge the improvement to the neuroplastic element in comprehensions skills, or changes in tinnitus effects… so as to fine tune the hearing aids.


When i got my new Phonak Lumity we had a hard time getting molds that would stay in, but double-domes, pushed all the way into the bony portion of the canal, would stay in all day. I felt like i “should” get better hearing with molds, so i asked my audi if she could do aided word recognition, and she said yes. So, surprising both of us, my aided mold word recognition was 52%, while my dome aided word recognition was 67%, both at 55db. So im wearing domes. I want to try again to get molds that will stay in, but they will have to beat domes.


When I was evaluated for a CI, they tested me both aided and unaided. In the aided condition, they turned the hearing aid up to it’s maximum output.

1 Like

Couldn’t agree more with you DaleM. My previous audiologist did the speech recognition in a sound booth. After two years of returning to have the aids adjusted with basically no improvement, I had the same question. Why don’t they put me back in the sound booth and simulate real world conditions to test the speech recognition. Very frustrating.
My recent experience online for new ReSound aids worked extremely well. I had the audiologist do the sound test basically in reverse. Start the tones loud and reduce the volume. I’ll tell you when I can’t hear them anymore as I have tinnitus (constant tone). This was the best fitting I’ve ever had. The previous two audiologist did it the preferred way which resulted in over amplifying the upper frequencies. If your technology capable, I’d also recommend getting your own Noah Link Wireless and discovering how to obtain the software to program your aids yourself as a just in case solution. Hopefully you’ll have better audiologist experiences than I’ve had.


Thanks this is fascinating!
I got my hearing aids 2 years ago. I’ve changed hearing aid providers and now they finally work!
I think there are flaws in the system!
20 years ago I got the name of a provider from Yellow Pages! How good is that? As my hearing loss got worse an audiologist I found provided the best of service. She sold her business and retired. Since then I’ve been very poorly served by two audiologists. My new hearing aid provider is excellent.

Thanks for your post. It makes great sense to me!

I think that overstates what is accomplished. HAs amplify first and foremost. Some higher end ones do things like compression that shift sound to frequencies you hear better.

Word recognition is done at a certain power level (dBs) and I suspect HAs exceed this so the test is not done under the same conditions. A pure tone audiometry is also power dependent.

Maybe in the end audis know that the tests will show limited benefit, even when the actual benefit is more. And maybe that’s because the amplification is greater. I can’t believe that there are studies that look at this very issue. Where are they?



Agreed on this. As you suggest, results of such tests may be less than complimentary and misleading.


They certainly can help you hear just as a normal hearing person if they’re programmed properly… now a days, hearing aids can amplify down to very soft sound

They should do hearing tests with hearing aids in to determine whether they are effective for you



Your idea is excellent.
I got my hearing aids 2 years ago. My audi worked miracles getting them for me (truly. It’s a long story.)
However, now that I have changed to a new practitioner they work well. They didn’t work for me for 2 years. I sure didn’t hear like a normal person. I have hope now!



it’s pointless to test with hearing aid in your ear. I get a consistant 20-40 db with my left ear hearing aid my right is CI and it gets 20-30 db. the number is garbage because you have a computer that amplifying the mic of the hearing aid/ci and you are just testing how good your microphone mainly is…