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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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.)
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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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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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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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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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.
insomuch as I understand it;
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We start out with a puretone audiogram, or an in-situ self measurement as Step1.
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Then as Step2, we let the software calculate the prescription from one of the above.
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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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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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You don’t need to enter an audiogram to run AudiogramDirect. You run AudiogramDirect to GET an audiogram.
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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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I find this a very interesting topic.
First, let me say that I don’t believe all audiograms are created equal. Add to that, the way an audiogram is interpreted by an Audiologist can vary widely. In the past, during an audiogram, if I even thought I heard a tone, I indicated that I did. Lately, I make sure I am actually hearing it before indicating that I do. This should account for at least a few dB difference between audiograms. However, when I was at my local VA getting fitted for my latest aids, after the audiogram, the Audiologist said my audiogram had not changed since my last one done a couple of years ago. About a year ago, I went to a local ENT, and had an audiogram done. It showed significant decrease in my hearing at low to mid frequencies. This does not correspond at all with what the VA Audiologist told me. So, although in situ tests might not be all that accurate, I don’t really believe that professionally done audiograms are all that good either. I have used Audiogram Direct in the past, and found that the results I got were pretty consistent with professional audiograms. There are things I don’t like about Audiogram Direct, such as the fact that it doesn’t do low frequencies. And, at the higher frequencies, it can’t put out a high enough level for me to measure my loss well. These are things that might not pose issues for most users though.
I would not recommend using in situ methods for someone who has not had their hearing professionally evaluated. Once you have done that, and you want to do self fitting, then I believe it is a pretty good tool.
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I agree with you John_Green. As I detailed in an earlier post, I spent a lot of time (probably 20 tests) of using AudiogramDirect (the Phonak Target version of in-situ). The “sweet spot” for me was when the result was a nice crisp sound without feedback across the hearing spectrum. It is definitely better than the comparative “dull” sound I had when just using the professionally administered Audiogram test. But again, I’m not blaming audiologist or suggesting that an AudiogramDirect approach is “better” just that for me, with a lot of OCD time spent on it, I was able to get what I experience to be an improved HA experience as a result of using AudiogramDirect, as a DIYer. YMMV.