COSI or APHAB questionnaires.
COSI or APHAB questionnaires? As someone who repeatedly requires the optometrist to go back and forth, just to answer "which is better - 1 or 2 ? ", and of course having interacted with hearing care providers of some qualification for over 30 years, I truly doubt that there can be much clarity or should I say accuracy in those self measured responses. One invariably fails either by being over or under critical, or by being over or under confident.
Can anyone know what the patient is hearing?
How can the patient know what he is not hearing?
What is more of a fantasy than reality?!?
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I know there would be a better way to reply, such as a 0 or 1 answer, as in optometry. However, it is not always possible; therefore, there are other tools, like the Likert scale, which was apparently used in that questionnaire.
In COSI, accurately marking a point on the scale is less important than identifying general trends after repeated questionnaires following rehabilitationâŚ
There are many tests, exams, and check-ups, probably not only in medicine, where they are more reliable in showing a trend rather than a condition at a particular moment.
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There are indeed some good points. This is why we need objective verification, like REM, to avoid at least some subjectivity-based problems.
However, the drawbacks of REM-based fitting are that it is on the grounds of averages, so additional adjustments may be needed. These would be more of an art, based on Audi/HIS experience and your feedback. This issue may be impoved with new AI-based fitting algorithms, like NAL-NL3, weâll see.
Nevertheless, even now, REM-based fitting is a good starting point to make sure that a particular patient does not have, e.g., 10 dB SPL quieter sound than he or she should. After that, additional adjustments are rather smaller, like 1â5 dB SPL.
The download link did not work⌠or perhaps I needed to provide credentials for it to start. But from the article, if I can guess an understanding⌠it is a glorified list limited by our ability to detail countless factors, experiences, micro scenes, and in so doing - eventually feel better that fewer negatives and more positives are listed.
I have a huge problem believing it could at all be accurate and really useful.
From my experience in life it is a way to get the patient to feel better about the experience. I guess if nothing else it converts hearing which is problematic to seeing ( what one has written ) which may be confidence building.
I truly am not trying to be cynical. It just comes naturally or I need help understanding what I am missing here?
Indeed, it is. There are probably many patients who keep complaining about HAs, but when they perform VALIDATED questionnaire - they found out there is an improvement, even slight.
The key word is VALIDATED - the same across the world, which is useful especially in researches.
I think that although it is good to strive for better solutions, everyone should be aware that there is a very limited quantity of tests that give 100% satisfactory answers. Present-day tests, exams, and check-ups, in the majority, give us the general probability of a particular condition and should always be considered with a set of additional factors.
Optometry is wonderful, because there is a near-perfect, accurate solution to improve vision after accurate measurement of sight defects (âReal Eye Measurementâ 
verification part) and âWhich set do you see better in, 1 or 2?â (validation part).
So, in short, I think we should be aware that test limitations do not mean they are uselessâŚ
There are many useful points about REM here. And APHAB is here too:
Customizing Real Ear Verification of Hearing Aid Gain and Output
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Some tests yield more precise data points and result in more gained knowledge due to the test, than others. That I surely understand.
The operative words are are EVEN SLIGHT. So a slight improvement is equal to virtually NO improvement mostly. As my friend often asks, âwho you trying to convince, me or yourself?â This conversation began from my questioning a response a pro gave me regarding REM not being important.
And Baltazard asking what was the Validation?
So I still donât know that answer, and it seems that the more it is defended, the more it looks like the Emperorâs New Clothes. Not addressing the APHAB till I read more about that. But the COS questionnaire does not fool me. It is a glorified distraction; a over valued rationalization. YES, I guess even the most unfortunate person, has SOMETHING to be thankful about. Granted. But lets get real. A person has a physical, mechanical, measurable situation that they are trying to compensate for with a BIG investment in money, time and effort. Their real joy should be the experience and their realization that they can hear little and big moments better due to that investment. The COSI from what i see and I say this with some level of my own expertise as I spent some years as a deprogrammer getting persons out of destructive cults(!!!) - mind you - I was never in any cult myself. People want to believe. People are gullible. They find it more pleasurable to believe good things than the opposite. I suggest that the very same COSI approach that can be used to assuage someoneâs negativity and make them feel more satisfied with their investment, could be used with a person who has NOT Made any investment in any hearing aids, or tests or therapy. That very same sort of questioning, can be used to help a person zero on on some ways in which things are better than they could be, that today is not all bad, and that there is something more to look forward to tomorrow!
In a way that approach may be what is used to talk a person off the ledge who is about to jump.
The fact is that if the instruments offered substantially better hearing over no hearing aids, it would be obvious, and if the improvement is so very slight that the descriptions have to be micro defined⌠than maybe we are grasping at straws.
All this, is not really applicable to my situation. Thankfully my HAs, offer MAJOR, night and day improvement to no aids. I am trying to get better, more comfortable, easier, an experience with them, and to have reason to feel confident that all their hidden potential is being utilized. In a situation like mine, the COSI would be even a worse approach, as it might lead me to acquiesce rather than to keep pushing to advance!
The COSI approach to digging for micro accomplishments/micro successes, are seeking acknowledging details that for most of us, are overlooked or taken for granted. Deep seeing is valuable. But mostly that value is due to our ability to see more of and enjoy more of everything⌠being more observant. More present. All that is good. Lets try to do that all the time. Not as a retroactive attempt to rationalize getting less than is at all possible!
I apologize for any typos⌠please ask if any error has created confusion.
Perhaps I misunderstood, as I thought your lines quoted below were about COSI/APHAB, not REM:
If you had REM in mind, my answer is:
IIRC, if REM is done accurately and ceteris paribus (all things done the same way), it is more accurate and repeatable than the tonal audiogram (!), which allows for a 5 dB error.
Ah, yes, I agree. Iâve never filled that questionnaire, but indeed, my willingness to improve my HA user experience has lead me to this forum and much action to achieve better results (such as more specific earmold, DIYing and finally, I hope - REM). So it is quite possible that I also coudnât perceive much benefits from COSI/APHAB.
Simultaneously I know also that currently we probably have not anything better, but we do need something that could document the validation, so for now we need to stay with these imperfect tools.
Fully agree about wanting to believe, even to lies; however we should be also careful not to seeing something suspicious even in a widely used tool.
My REM question resulted in COSI being mentioned.
When I wrote this below, it was referring to COSI
YES Agreed!
I am sure you have a good thought there, but due your syntax, I am unsure what that might mean - please clarify?
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I must add that COSI/APHAB is probably necessary for some to have protocolized records, somewhat like medical records.
I may have misinterpreted your post, reading quickly; if so, I apologize. I understand that unethical activity for profit is common in companies, but I doubt COSI/APHAB tools were invented primarily to convince people to buy unhelpful products. Itâs only a tool.
The COSI is not about optimization. Itâs about determining the patientâs hearing goals at the outset, (counselling on unrealistic expectations,) and returning to those goals at the end to make sure they have been sufficiently addressed. For example, if an initial goal was set up as âhear better on the landline phone so I can talk to my grandson in Germanyâ and this was totally ignored and thereâs no landline phone solution at the end of the whole fitting process, perhaps both parties should pause and think about that.
Validation, overall, is basically saying, âdo these help youâ, and it actually IS important to make sure that that is at least a little bit the case. If hearing aids arenât actually helping my patients I really do want them to return them. But there do exist predatory clinics out there who will skip this step, who will resist a return even in the case that the devices arenât helping.
You can improve that variability on audiograms by averaging multiple measurements over time. But it confuses my colleagues and I havenât figured out how to manage that yet.
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Speaking jokingly, it should be like awarding style points in ski jumping competitions: five grades, one from each judge, and the two most extreme (the best and the worst) scores are removed.
This discussion has wandered off a bit. Outcome measures like COSI are as much to do with client experience and motivation as actual measurement: nice for the individual, productive in a subjective fashion, but way less objective accuracy. They are a âslightlyâ better version of asking someone âdoes that sound better?â with some scoring tacked on.
I donât agree with everything Dr Cliff preaches, but in respect of REM the basis of his argument is spot on.
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REM is not antiquated at all and is part of a best fit standard of care by gold standards. It may not be perfect but it is better than anything we have at present. As fittings change so will our ability to be more accurate. Soundfield used to be the standard but it has its drawbackks as well. The sad thing in the states is many dispense and your lucky if they do any verification testing. Asking the patient how its sounds is not a test and should not be the verification. At least with REM with mic placed near the TM we can get a good picture of what is being received. May times fine tuning is needed but usually not much. Biggest thing is remembering it adds lows not required when fit with the rubber domes. I donât do any fits with out REM being completed. And it fast and basically accurate and easy to do and to even train someone to do. Anyone that tells you different are either being lazy or just didnât want to spend the funds to purchase the equipment so justifies it with some excuse or another.
And like any measurement there will be those who can find only fault in it without really learning it and what it can do. JMHO
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I purchased a set of HAs online and was told they performed REM remotely during my first online fitting session. The question I have, Can REM be performed remotely?
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I am not a pro. But I do not believe that is possible. NO.
They did a remote inSitu test and figure most people, just want to hear that the REM was done. So they told you it was.
But I love being wrong.
That is how I learn.
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Definitely no. For REM, the plastic thin tube is placed in the ear canal with his ending within 2-3 mm near the eardrum.
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Yes: you need to be physically at a location to get any form of REM done.
Running some feedback managers run and âre-mapâ the gain levels automatically, but this doesnât necessarily yield accurate or even desirable in terms of your hearing loss. I had one recently where the aids became incredibly muffled following running it: even though the software was âadamantâ that the gain was âoptimisedâ following the remap.
Itâs like trying to tell how fast youâre going in a car with your eyes shut, you can make an approximation by judging the suspension responses, but itâs very easy to be significantly out if the road surface changes.
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It shows how important the setup is. The care providers values and skill are most important.
My good hearing aids were rendered useless. By my hearing provider. Iâm glad we parted company.
@Um_bongo thanks.
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