Audiologist does not do speech mapping or REM - is this common? considering switching

I have low frequency loss and am trying agil pro and looking at the excelia (and anything else that I can get my hands on) in order to be able to hear speech (in particular male voices) clearly enough to function at work.

Folks on the site recommended I ask for speech mapping and REM and I asked my audiologist about them and they do not offer them in the office. I’m demo-ing a pair of agils but have not paid and am considering switching to an audiologist who not only has more experience but who can also to speech mapping and REM. Is this a common enough fitting type that I should expect my audi to have it or is it relatively rare?

I hate to leave this audiologist as she has been great with letting me try products (I bought my old aids from her), but I am finding that (in addition to lack of REM and speech mapping) she just doesn’t seem to have answers to my questions or much knowledge beyond how to program at the recommended settings based on my audiogram.

thanks for any insight…

yes, you should switch

I think only 30% of hearing prof. do actually use speech mapping or rem. We are a minority. You should be asking for speech mapping not rem…

If you have Agil none of the machines will have target gain for agil since agil uses
Voice alinged compression. Speech mapping is the correct way to go

Thank you for your comments

Called more audiologists today and none did speech mapping. One said they had the equipment but it was broken. :frowning:
the search continues.

What machine are you referring to (that would not have target gain)? If the audiologist uses the Oticon software (Genie?) doesn’t that program them properly? thanks

The point is that the fitting software (all fitting software) sets up the aids to output to a “target” that, in an “average” ear, should help to augment sounds to make up for your hearing loss and so help you to hear.

If you don’t have an “average” ear, then the sound reaching your eardrum will not match the target and may be too loud or too soft at various frequencies because of the unique accoustics of YOUR ear (plus possible manufacturing variations in YOUR hearing aid).

Speech mapping “feeds” the hearing aid with sound clips representing speech (which therefore also “drives” the speech-processing algorithms in the aid in the same way as normal speech doesb - including any noise reduction features etc).

It also measures the combination of sound coming from and coming “past” the hearing aid (via a small microphone very close to your eardrum) and shows the audiologist exactly what sound is arriving at your eardrum and how this varies from the values suggested by your audiogram.

The audio then adjusts the aid until the measured fit is corrected.

This SHOULD make for a better “fit” and ensure that all the sound making up speech (i.e. low and loud sounds, male and female voices etc) is actually audible to you and corrected at each frequency to “fit” inside your remaining range of hearing.

My own experience is that this helps to achieve a better start point versus the common problem of “its louder but I still can’t understand speech” - which is often caused by certain frequencies for “soft” sounds falling under your threshold and therefore being inaudible and spoiling comprehension.

In practice, hearing is not that simple so you should still expect to need tuning to allow for how YOUR inner ear and brain actually receive and process the sound coming through the eardrum.

Its a great start though and much better than expecting “first fit” to work…

That’s right, we are a minority, so you may have a hard time finding one in your area. But it sounds like allthough she is pleasant, you aren’t getting some of your questions answered to your satisfaction. That would be just as good a reason to find a new audi.

Good luck!

dr. amy

Do you mean speech mapping cannot be done (or done properly) with Agils?

If you can’t find an audi in your area to do speech mapping or rem, consider purchasing aids you can program yourself with your computer. Trial and error adjustment at home is much better than trial and error for 15 minutes in an audi’s office every week. Consider America Hears aids ( They supply you wth the software, cables, and hearing aid to computer interface to adjust your aids yourself. They have a 60 day risk free trial period. My mom purchased america hears aids some 6 years ago and I took over adjusting her aids with my laptop. It works out much better than the many trips to the audi’s office we were making weekly to try to get her previous aids adjusted. As one person said on another board, “no one knows better than you what you hear and no one can adjust your aids to your hearing preference better than you”. At least if you have the software and equipment at home, you can make adjustments at your leisure and try the adjustments immediately in the real world.

the purpose of either speech mapping or Rem is verification. That is to ensure you
are getting the correct gain. In other words, In genie- there is a screen where
there is a target gain, so the idea is to see if YOU are receiving the gain theat genie says you are supose to get at eardrum level.

Strictly speaking, the only machine capable of doing speech mapping is the Verifit - speech mapping is a trademark procedure that has ONLY been licence to audio scan.
Speech mapping could be done @ eardrum level or using a 2cc coupler.

Speech mapping is interesting in that it combines output of the hearing aid with
your audiogram(SPL). You can use a speech pasage (soft) you will be able to
determine how much of that speech (soft) is audible - the machine uses a speech index.
You can then go in genie check your soft inputs and increase the gain to maximize
speech inte. index.

Speech mapping only has 2 fittting targets- 1) NAL- NL1 2) DSL 5.0A, agil uses
VAC - therefore when getting the aids mapped it is important to check for audibility.

So what am I doing on my Avant system then?

These tools check that SPL (not gain) levels at the eardrum are as the NAL or similar equation determines.

This is VERIFICATION, and can be useful to detect faulty hearing aids, canal resonances etc.

However this is NOT the same as VALIDATION which adds the user’s experience to the original equation.

Audibility is NOT directly connected to the calculated/measured sound levels at the eardrum.

As pointed out, fine tuning is then required based on what the user reports.

So what does REM or Speech Mapping actually give you?

Error and fault detection - yep.

An instant perfect fit. Nope.

There is no such thing as a silver bullet in the hearing aid world.

The coloured graphs DO however make a good marketing tool!

There’s no excuse for not having these tools on hand to help get the best fit for each individual client…go somewhere else.

I find all this focus on tools, hearing aid features etc a little worrying.

Fitting hearing aids involves more than making measurements, pressing computer keys and issuing the Invoice.

I could FILL my offices with testing equipment : It would be fun for me … but would that REALLY make my customers happier? Not so sure about that.

I agree, it’s definitely not a silver bullet.

With that being said, as with all things in life, I think a combination of both is best. True, you can use all the science and measurements you want, but you won’t get a satisfied patient unless you see how that science is reflected in the patient’s listening experience. But the flipside is true also. If you go through the fitting process using feedback from the patient only, and don’t ever use verification measures, that’s not optimal.

BTW, there IS a reason why many offices don’t have this equipment - its very expensive! That expense is inevitably going to be reflected by the increased price of the hearing instruments (not an excuse - it’s fact).

dr. amy

As a HA end user and a practitioner of a soft science, this entire discussion is quite informative. It seems the bottom line is that the best audi’s have a good grasp of both the art and science of what they do. Accordingly, they should have at hand certain technology to achieve the goal of properly fitting each patient, whose hearing deficits are both objective and subjective.

The objective part, matching the HA to the audiogram is difficult enough, given all the different HA’s out there. The subjective, well, I don’t know how to address that other than some folks like the HA sound they’re hearing and others don’t. Throw in audi bedside manner, cost factors and so on.

But back to the technology, other than basics all audi’s must have, who decides whether or not speech mapping devices are really necessary? I didn’t even ask mine if she has it. Another, who sounded great on the phone, has it, but rarely if ever uses it.

Edit to add: Dr. Amy, I’m not so sure it’s true that spending more money on keeping up with the state of the art increases costs (I’m not saying speech mapping is state of the art, I have no idea). It may be the opposite. Saved time, increased customer satisfaction leading to more customers, higher volume and lower costs elsewhere. Just looking at from a purely business perspective.

I do have REM kit - but I prefer to use in-situ audiometry.

Sure, it doesn’t test the microphone section … BUT … it DOES involve the user’s real experience, using the real hardware.

It also reduces the risk of over-testing, which can be a problem with the more frail customers.

By definition, spending money on expensive equipment increases costs. It is possible to decrease overall costs if the new equipment eliminates or speeds up procedures, but such is not the case here - it adds a procedure.

Increased customer satisfaction is always desirable. But I very much doubt it would increase business enough to allow economies of scale which result in lower costs. That is generally limited to larger industrial settings.

agree 100%

I can tell you don not own Verifit…