This is what the Nielsen rating (and other similar types of data gathering) is for. It’s a survey of ‘typical’ US households, that determines what people are watching at any given time.
TV stations then use that data (not just how many are watching, but also their demographics) to sell ad spots. So ad spots can be priced based on the amount of viewership, and can also be used to target specific kinds of people.
So part of the answer to the question is that companies can actually choose how many eyeballs are exposed to their ad, based on the prediction for that show and time slot. And they get the ‘real’ results later.
And the second half is that they compare it to their sales/revenue figures. If they ran an ad at a specific date, and it corresponds to a big spike in their sales (accounting for delay), they’ll know that the ad was effective.
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