Audiogram Direct

Hearing Aid Self-Fitting and Adjusting [DIY]
#12

In-situ can be accurate, Widex has used the method (Sensogram) for years to establish in situ gain adjustment. It’s simply not transferable, which is often the basis for such studies - which involve comparisons of efficacy.

However, within the closed loop of a single fitting, the gain adjustment from the transfer function generated by the in-situ measurement works - and you can check the result with a separate R.E.M. However, the gain will not necessarily reach the full R.E.M. target, simply because the manufacturer wants the hearing instruments to sound good on the first fit, rather that the potentially ‘harsh’ full prescription.

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#13

It would be a fascinating run in-situ and then choose NAL-NL2 over the manf’s own fitting rationale in the programming software, and then verify a NAL-NL2 target. My guess is even then the REMs would be off … not sure such a study has been done. I performed in-situ with Widex/Oticon/Phonak in the past and was never happy with the resulting REMs, but it’s been a while, and I can’t recall whether NAL rationales were available or whether I selected them.

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#14

In theory… In practice, I’m not sure.

#15

I’m very new bee and a HA user.

I use PHONAK AUDEO serie and SIEMENS PURE BINAX, both RIC type.

Considering PHONAK AUDEO, I have 2 pairs;
S SMART III-312 xP
Q70-312 xP

If I interchange the receivers (both are xP) from S SMART with Q70, my final hearing sensibility is different. I guess it is due the intrinsic difference in receivers production.

So when a ha user measures using in-situ or audiogram direct … I think that this process consider the particular difference between RIC pair or even HA deviation.

Just my humble thought.
Sincerely

#16

I raise this topic from the grave, here is the topic from 2017. But I’m just wondering what the situation is now with the AudiogramDirect option.

Has anyone now worked with the new Paradise series of hearing aids to see how effective this IN-SITU option will be compared to the one done according to the audiogram and of course according to the REM measurement.
Could the measurement now be carried out with the installation of noise shields to eliminate external noise. Because new hearing aids do not need a wired connection.

#17

in situ and audiogram direct is same…
REM is different
onl audiologist can perform REM with costly equipment

#18

I figured it out.
We do the audiogram in a cabin that is soundproof and we raise our hand when we hear the slightest quiet sound and it is then marked on the chart.

And “In-situ” is when we do it with hearing aids.

REM is a measurement of hearing to determine if a hearing aid is delivering sound as prescribed by an audiogram. The hearing aid may measure the volume differently, or perhaps the cause of the insufficient or excessively amplified sound may be in the mold or uneven channels in the ear. I read that somewhere on some forum.

In-situ should be the most accurate measurement, because we do the same thing we do when we make an audiogram. The chart may not be the same as in the Audiogram.
And when we go to REM, it will look at the audiogram to see if the hearing aid is delivering the same sound. Whether I understood correctly or not, correct me if I am wrong. Isn’t REM wrong then? The equipment we use for Audiogram will probably not be calibrated in the same way as the hearing aid.

#19

wrong
REM is to find prescriptive target is correct
let say you wear dome so gain is to give 20 db
but actually its giving 15 db even though software show 20 to compensate REM will add another 5db …

#20

Reviving this topic once again.

For the past 10 years I have always relied on the Audiogram done by competent audiologists. I have a record of them over the years and can see my hearing decline gradually as I age (and hopefully not because of bad hearing protection habits).

And, for my last three annual “checkups” I was able to benefit from REM adjustments to my HAs (currently M90-R). My last Audiogram was 14 months ago. Before planning to travel 2 hours to my audiologist again I spent some time (quite a lot of time) experimenting with AudiogramDirect (Target’s in-situ hearing test software). Here is the final result - the grey is the 14 month old Audiogram and the red is my right ear AudiogramDirect result…

image

The difference could be due purely to a 14 month decline in my hearing, but I doubt it (based on my 10 year trend pattern of decline). And, after applying the results of the AudiogramDirect my hearing is greatly improved across the range (not surprisingly). So, I don’t yet have the benefit of REM on top of these AudiogramDirect results but my hearing is currently about as good as I can ever remember (i.e. since before 10 years ago).

Could it be that conducting one’s own AudiogramDirect is “more accurate” than the audiologist’s Audiogram? Note: I probably ran the AudiogramDirect tests over 20 times overall to get them as exact as I could, in a very quiet room. I tried various levels of “I can hear that”, applied the results, and tested the sound of the HAs over a few days. Each time going back and adjusting up or down the amount to which “I can hear that”. The happy medium, for me, was when I could just barely hear “something” then went another step louder to where “I know I can hear that” but softer than “I definitely hear that very clearly” - if that makes sense.

I’m just offering my personal experience at this and hope it helps someone else. It’s definitely worth a shot and I think I’ve gotten my HAs “better” (for me) than what my various audiologists have arrived at in the past (no knock on them - they are very good at what they do but, I think, appropriately err on the side of being a little conservative.)

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#21

This (Oticon Genie2) in-situ Audiometry in Genie2 tutorial says that in-situ is used in addition to/with your audiogram. Previously I thought that the fitting software would use one or the other, but not both. Also, this topic is about Phonak Target and the tutorial is about Oticon so it is possible that it works differently for different manufacturers.

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#22

That’s interesting. I would be a little surprised if Target works “with” or “in addition” - but maybe it does. I would have thought “one or the other” because you have to choose in the software which one to apply. (You can see that at the bottom of the screen shot.)

#23

Well, chosing which results to apply doesn’t rule out Phonak’s in-situ working with your audiogram. It could have worked with your audiogram prior to showing the final results.

I had always assumed that in-situ was completely separate from your audiogram until Oticon (in that tutorial) says that it works with your audiogram. But we don’t even know what working with your audiogram means, exactly. It’s a squishy statement that could mean many different things. So I’m confused by this Oticon declaration, and I don’t know exactly what it means??

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#24

This is a fantastic write up and a theory that I have employed many times as well. One difference for me is that I try to keep the frequencies up to 750 barely audible so that voices might be a little clearer.

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#25

I do this as well. Beeps below 1K for me, I select when I can barely hear it.

Now I can stream much better in noise.

AutoSense is not overpowering as well.

Don’t have any other programs.

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#26

Okay, I think I may understand what Oticon means when they say that in-situ works with your audiogram. In the audiogram/in-situ comparison that was linked above it says;

Results: At 500 and 1500 Hz, almost all threshold differences (conventional PTA minus in-situ data) were negative, i.e., in the low to mid frequencies, hearing loss was overestimated by most devices relative to PTA. At 4000 Hz, the majority of differences (7 of 12) were positive, i.e., in the frequency range above 1500 Hz, hearing loss was frequently underestimated. As hearing loss increased (M→MS→S), the effect of the underestimation decreased. At 500 and 1500 Hz, Resound devices showed the smallest threshold deviations, followed by Phonak, Starkey, and Oticon instruments. At 4000 Hz, this observed pattern partly disappeared and Starkey and Oticon devices showed a reversed effect with increasing hearing loss (M→MS→S). Because of high standard errors for the estimates, only a few explicit rankings of the devices could be established based on significant threshold differences (5% level).

In less scientific language, here’s what I think that means;

Results: At 500 and 1500 Hz, almost all threshold differences (audiogram minus in-situ data) were negative, i.e., in the low to mid frequencies, hearing loss was overestimated by (most devices/using in-situ) relative to the audiogram.

At 4000 Hz, the majority of differences (7 of 12) were positive, i.e., in the frequency range above 1500 Hz, hearing loss was frequently underestimated (using in-situ).

As hearing loss increased (M→MS→S), the effect of the underestimation decreased.

At 500 and 1500 Hz, (Resound devices/using in-situ) showed the smallest threshold deviations, followed by Phonak, Starkey, and Oticon instruments.

At 4000 Hz, this observed pattern partly disappeared and Starkey and Oticon devices (using in-situ) showed a reversed effect with increasing hearing loss (M→MS→S). Because of high standard errors for the estimates, only a few explicit rankings of the devices could be established based on significant threshold differences (5% level).

So here’s what I think the Oticon’s statement means; Since the manufacturers obviously know about the differences in (audiogram/in-situ) measurements based on low/high frequency, I think it simply means that Oticon in-situ considers the frequency measurement differences when producing the in-situ results. The other manufacturers may also make adjustments based on frequency? Who knows?

To summarize, I think it means nothing, except that Oticon uses an algorithm to calculate in-situ results as opposed to pure-tone only .

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#27

A thoughtful analysis PVC, thank you!

With a 5% Std, Dev. seems safe to assume that using an in-situ hearing test by a DIYer such as ourselves would be a reasonable thing to do. I’d probably not recommend it without having a professionally administered audiogram done first in order to have something to use as a baseline.

Then self administer the Audiogram Direct type feature within the software to “fine tune” that audiogram.

I’m not sure where in those steps REM should be conducted, if at all. The answer to that is above my pay grade.

#28

insomuch as I understand it;

  1. We start out with a puretone audiogram, or an in-situ self measurement as Step1.

  2. Then as Step2, we let the software calculate the prescription from one of the above.

  3. Then as Step3, REM (Real Ear Measurement) can be used to measure-and-make-fitting-adjustments to ensure that the sound close to your eardrum matches the calculated prescription.

However, Expensive equipment (and placing probes next to our eardrums) prevents us from DIY accomplishing Step3.

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#29

I just received a new pair of phonak P50R heading aids. I did not need to enter an audiogram to run Audiogram Direct to program these aids. With a little back and forth fussing with the tones levels I have them dialed in pretty nicely already.

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#30

You don’t need to enter an audiogram to run AudiogramDirect. You run AudiogramDirect to GET an audiogram.

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#31

Exactly, that’s what audiogram direct does, in-situ fittings don’t require both, but when you do enter both, you get a choice of which one to use.

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