#14

I am going to show my ignorance on this probably.
Why would you set up REM prior to the initial
programming of the hearing aids?
The rational of using frequency lowering is for those with little to no hearing in the upper frequencies. Purchasing SP or UP aids to cover those high frequency losses is foolish. Why set up REM before setting up frequency lowering programming?
Thanks

#15

In the procedure recommended at the first link provided by @mindsil, an article by a professor who seems to specialize in freq. lowering, freq. lowering is turned off before REM is done. Then it is turned on and the probe mics are used to adjust and assess the freq. lowering parameters.

That many practitioners follow a procedure like that seems doubtful to me.

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#16

In this case, REM does not mean that you are focused on making every frequency audible. Often NAL-NL2 will drop the high frequencies. There is some information out there concerning the fact that a hearing loss above a certain level in the high frequencies may lead to sounds being distorted once they are audible and it can make speech comprehension more difficult.

The REM is important so that you have verified the output of the hearing aid and what is actually making it near/to the eardrum. That way you can calculate the maximum audible output frequency to determine the minimum amount of frequency lowering necessary. As the article talks about, it also depends on what technology that brand uses for their frequency shifting/lowering/compression.

In general, if you aren’t going to verify with PMM what the frequency lowering is doing, then it is probably better to leave it off. This is a generalization but a pretty good one.

#17

I would agree that very few clinicians use REM to set up frequency lowering. I think most typical is to turn it "on, " hear you don’t like it and turn it back off. I think using REM is the ideal way to set up frequency lowering, but trial and erroring until “s” sounds sound like “sh” and backing off a bit until they sound like esses again does a decent job. This is assuming profound high frequency loss. I guess first one needs to determine if one might benefit. Another approach would be to start with very mild settings and gradually increase.

#18

This doesn’t make since to me. Why do REM twice? The first one without frequency lowering is a waste of time. Or am I missing something?

This got a chuckle out of me. You need to understand my hearing a little.
I can see setting REM while using frequency lowering or just not using REM on the upper frequencies that the patient can not hear well. that makes since.

#19

The idea of doing REM initially without frequency lowering is to get an idea of how high of frequency the aids can make usable. Then repeat REM after frequency lowering is set up to make sure you didn’t make things worse. I’m convinced very few, if any do this unless they’re the people researching it like Josh Alexander.

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#20

My thoughts were that’s what the audiogram was for but your point makes since.
Thanks

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#21

That’s what I would of thought, this is why we have the “fitting range” we already know when fitting ones loss (after the audiogram) that the higher frequencies can be met within the fitting range of the HAs, having it confirmed by REM certainty helps some.

#22

REM with frequency lowering turned off is used to determine the highest aided audible frequency meeting a certain threshold of loudness.This in turn will be used to determine the upper frequency bound of the frequency range that will be the destination of the frequency lowering.

The audiogram provides frequency thresholds of unaided response. There’s no way to tell from an audiogram what should be the destination range of the source frequencies to be lowered.

#23

That’s what the software does, after inputting the audiogram, different formulas will give you different outcomes, of course this can all be checked by REM and adjusted to suit.

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#24

You complete REM without frequency lowering and once you have a good fit-to-targets you confirm /s/ audibility. If it is audible, then you don’t turn on frequency lowering–no point in introducing extra distortion where you do not need it. Even if you know you are going to need frequency lowering, you need to start with a good fit-to-target prior to adjusting for /s/ audibility.

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#25

Thanks, your explanation clears this up well.

#26

So, returning to this. It’s not implausible at all, but. . . while I don’t have access to the Phillips software the pre-REM gain at high frequencies seems low relative to your loss.

How’s it sounding?

#27

I never listened pre-REM except for the initial 10-minute walk around the warehouse on the first visit. The post-REM experience has been quite good! I’ve heard some sounds I’ve not heard before, even after 8 years wearing (no-REM) HAs.

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#28

Then your post REM settings are probably correct.

There can be some really dramatic differences between what the manufacturer software says hearing aids are doing and what they are actually doing, due both to how the manufacturers have set things but also to the shape of the ear and the acoustic coupling. I always think of the clinicians who are not doing REM when I’m seeing a difference like that, because they must simply never know that this is the case. I think that if a clinician didn’t have experience with how much REM can differ, it would be pretty scary to crank the hearing aids up that much–how would you know that you weren’t setting the hearing aids in a way that could be damaging?

#29

IIRC the HIS said that the REM was to NAL-NL2. And the post-REM insertion gains look pretty close to (pre-REM) NAL-NL2’s. So yesterday I, a DIYer, made a couple of adjustments to the audiogram to make a judgmental average with two others that I’d had recently, and changed the rationale to NAL-NL2. Here are the diffs between what I ended with yesterday and the original post-REM fit at Costco (Costco audiogram, Fit2Speech):

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#30

I support averaging audiograms in cases where loss is stable, and dumping outliers. That said, if you’ve been comfortable with a setting and adjusting the audio reduces gain prescriptions, keep in mind that you’re just reducing audibility.

I’m not sure I’m totally clear on what you’re saying here. Had the software not been set to nl2? That would help explain how things were so off. But additionally, if the HIS said it was “pretty close” then why all the gain changes? Though I suppose “pretty close” is subjective and it was indeed pretty close on the middle.

#31

The HearSuite fitting software had been set to Fit4Speech, not NL-2. “Pretty close” is my description, not the HIS’s (I’m a DIYer.)

#32

So, if you were happy with his settings… Don’t reduce things. Especially not at 2k. Unless you were finding things uncomfortable or unbalanced.

#33

OK, I’ll go back to the original post-REM. Thanks for the counseling!

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