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

Hearing Aids
#11

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!

#12

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

#13

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.

#14

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

#15

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.

#16

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.

#17

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.

#18

agree 100%

#19

http://www.otometrics.com/7-26-7560_01_std.pdf

#20

I can tell you don not own Verifit…

#21

Yes and no - it actually does decrease the cost of follow up appts and that sort of cost because typically we will see less follow up visits when REM are done because we are closer to targets to being with. BUT anytime a professional acquires equipment, the cost will usually be reflected in Hearing Instrument price. I should probably have explained myself better - thanks! :slight_smile:

dr. amy

#22

At least I have thought about the issues.

Maybe 80%+ of dispensers simply want to focus on another key technical device … the pen that the client will use to sign the cheque!

#23

Thank you ghat was a good one… :smiley:

I needed a good chuckle this evening.

#24

You are right, I spend less time fine tuning than before… It actually saves money…
most clients love it…

#25

I think Xbuilder meant technically it is a Verifit trademark or something. I use the MedRX REM/Speech map and wouldn’t dream fitting any hearing aid without it. I would feel naked and blind using just the manufacturer’s settings as I have seen far too many horrible fittings where speech mapping and/or REM haven’t been performed or have been performed, but by someone who does not understand what they are visualising.

#26

I have a choice of two dentists who have offices the same distance from me. Both are excellent in all respects. One is more old school, with good equipment, but not so different than when I was younger 30 years ago. The other invested in all sorts of new equipment. Old school takes xrays with slightly painful thigamajigs in my mouth, several teeth at a time. The other sits me in a booth, puts painless strips on my teeth and a whirlygig thing goes around my head and we’re all done. Same cost for both. Guess who I go to? Old school is a relative of my partner and is struggling for more patients. New tech guy is always busy.

Amy, as a fellow health care practitioner who has a small private office, we may have something in common. As a business person, I look at return on investment (ROI). So, whenever I take expensive training or buy relatively expensive equipment or do anything that costs significant money (including advertising) I consider ROI and don’t make the investment unless I get an ROI of at least 2x.

E.g., the investment may bring in new patients by broadening my services or something like that. It’s a hit or miss proposition, but if I do my homework I’ll take the chance. If the investment leads to an increase in cost to the patient/customer, I wouldn’t do it unless it’s necessary to maintain my license or something similar.

Edit to add: Is speech mapping related to word discrimination when the audi does a hearing test?

#27

Audioscan is a 1 product company. They make a damn good product. Having used FP 35, aurical and tested an Affinity, audioscan ins the best machine out there. Speech mapping
can be done in as little as 3 min.

#28

Looking at the fitting business from a hourly rate standpoint:

Capital equipment cost is usually offset by controlling two parameters:

  1. Average hourly rate charged
  2. Chargeable hours

Most businesses increase revenue by
a) Offering better value per hour to the customer
b) Convincing the customer that a) is the case (Advertising, information sheets and mailers explaining the superior value of your service)
c) Charging a higher hourly rate in keeping with your superior value to the customer
d) Getting more chargeable hours due to word-of-mouth referrals, advertising, etc.

Charging a fixed amount for the whole process is in my opinion a poor fit for the customer and the professional as well.

[Start of Rant to fitters and manufacturers]
It is interesting however that things as obviously important as REM, Speech Mapping, AudiogramDirect, in-situ audiometry, etc. are far below the radar of almost all hearing patients. That’s not the patients’ fault. That’s the industry’s fault. That’s the practitioners’ fault.

It’s clear that even in this forum, many are hearing about these critical services for the first time. That’s a failure by instrument suppliers and also a failure of the service (fitting) sector.

To be specific, it’s part of service sector’s business to educate the customer (and potential customers) as to what will be valuable (even critical) to him. If you don’t you are failing the customer and (if you do indeed supply a premium quality fitting) you are failing to adequately educate the target customer base so that the premium value of your service can be understood.

We (customers) shouldn’t have to probe for this critical information.
[End of Rant to fitters and manufacturers]

All that being said we (HI users like me) do recognize and appreciate the time and effort the professionals on this forum spend each week to offset this problem and expect that in the long run, both groups (professionals and customers) will gain by it.

1 Like
#29

I failed the speech mapping.

I couldn’t understand many words. The audi said it is because I need to learn the words again and I need to read to myself loud to do that . That is not realistic. Is it?

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#30

you cant fail speech mapping! you mean your spech disc. is low? You might be a good candidate for aural rehabilitation. Maybe lace is something you need to do.

Looking at your audiogram maybe the Medel or the new Hybid from cochlear
could work for you