70% of audiologists skip real-ear measurements when fitting hearing aids

Only about 30% of audiologists in the U.S. perform real-ear measurements (REM) -- the gold standard verification that a hearing aid is actually delivering the right amplification for a patient's specific ear canal shape and hearing loss profile. The other 70% rely on manufacturer default settings, which are based on population averages. So what? Two-thirds of hearing aid users end up with incorrectly fitted devices. So what? They experience either under-amplification (can't hear well enough, conclude hearing aids 'don't work') or over-amplification (sounds are uncomfortably loud, so they stop wearing them). So what? The average pair of hearing aids costs $4,000-$7,000, and patients abandon devices they spent thousands on because the fitting was never verified. So what? They return to untreated hearing loss, which a Johns Hopkins study linked to a 2x-5x increased risk of cognitive decline and dementia. This persists structurally because REM equipment costs $10,000-$15,000, and many practices prioritize appointment volume over the extra 15-20 minutes REM takes per fitting. There is no regulatory requirement to perform REM, and patients have no way to know whether their audiologist skipped it.