What is the most critical issue to address before conducting real-ear measurements?

The presence of cerumen blockage is the most critical issue to address before conducting real-ear measurements because cerumen, or earwax, can significantly impact the accuracy of the measurements. If there is a blockage in the ear canal due to excessive earwax, it can distort the sound that reaches the eardrum and lead to misleading results when fitting and adjusting hearing aids. Therefore, ensuring the ear canal is clear allows for proper measurement of the hearing aid's effectiveness in amplifying sound to the patient's actual hearing level during the fitting process.

While understanding patient history, fitting the hearing aid properly, and ensuring patient comfort are all important aspects of the fitting process, they do not directly influence the quality of the real-ear measurements as much as cerumen blockage does. Filtration of accurate sound measurements is paramount, making the identification and removal of any obstructions in the ear canal the top priority before proceeding with testing.