@cjpines
I’m thinking you are interpreting the “Word Recognition” score (might also be labelled as the older term “Word Discrimination” or “Discrimination”). This is a test we use for all sorts of things, depending on what question we are trying to answer. If it shows 12% then it is saying that you got 12% of the words correct, when presented to you at “X” dB HL intensity level. This should not be confused as 12% of your hearing left. We use the % as a way of diagnosing certain things, setting realistic expectations, getting a rough idea of your unaided and aided performance (expected), etc. @MDB hinted at part of the problem as well - quite often word recognition isn’t done at an intense enough level to result in your peak performance; but again, it depends what question the audiologist was trying to answer. But even if it was at an intense enough level it is not a measure of real world communication because you have no visual cues and have no context (for example, if we told you all the words you are about to hear have to do with baseball then your performance will be better because you are primed to be expecting baseball related words). Perhaps you only understood 12% of the words, but in the real world when you add visual cues and context that percentage is exponentially higher (as you can tell from your ability to communicate with people).
So when you are watching TV you might have the volume “louder”, as @MDB mentioned. But the bigger contributors is that you have a context to work with to help figure out what you are hearing and you have visual cues (i.e. speechreading/lipreading).
All of this is assuming that what you were interpreting is the Word Recognition Score. There is also a possibility the audiogram had an SII percentage on it (SII = Speech Intelligibility Index). If this is the case then it has a different meaning all together, but it is less likely that this percentage would be on your audiogram.
1.I wonder why my audiologist doesn’t go into such detail. Can you tell me and everyone else how to find a good audiologist, what to ask?
2.How do we know what level of experience a audi has or if they keep up on new technologies. I asked my audi is there are any new technologies out there that would benefit me, he said no.
3. How do we know how extensive the hearing tests are and are they up to date?
Well, the wonderful audiologist who are devoting time to talk to us are the best answers.
There are a list of best practices around. One of the more recent is REM (Real Ear Measurements) that match the aids setting to the ear canal encountered. It is newer tech and not that cheap but it is important. So, it is a good indicator if the clinic is penurious or dated. Also a bit of an indication whether the fitter is industrious or just happy with the past. We can all get a bit lazy.
As to being informative, remember that their first goal is a sale. They don’t want to confuse things with facts that may make you question things the wrong way. Think car salesmen. They may have lot of info about the tech features but they want to sell the looks and get you on a test drive with that new car smell.
I don’t think REM is all that new. The audiologist I’m dealing with now has been practicing 28 years. He said he was taught to do REM with every patient in school and did so for years. He said many (most?) patients didn’t like it. Some were willing to work with him and others just gave up. He’s perfectly willing to do REM on request, but doesn’t find it that useful. REM is really the only objective measurement, but ultimately it comes down to can your hearing aid fitter/audiologist fit you with a pair of hearing aids you’re happy with. How to find a good one is still a mystery I’m trying to sort out.
Yes, I can understand not confusing things with facts, but I’m just the opposite, the more facts the more I understand and learn. My audi doesn’t give me much details and I’m always bugging him for more information as to why I’m looking for someone else who is willing to answer questions in detail.
I don’t believe so. REM is a probe that goes in the ear along with the hearing aid. It compares what it hears with what the prescription calls for. That adjust the aid to the canal closer to the need levels for various frequencies.
@canadian_audiologist
Terry, thank you!
You have a patient, layman’s way and I have just learned a few things I wasn’t even aware of, in a couple of very easy to follow posts.
@cjpines
As with all professions - there are good and bad. I am an avid believer that the more my clients understand about their hearing, the better. I spend alot of time with my clients/patients making sure they have a solid understanding of what their auditory system can and cannot do - as it always results in a more successful auditory rehabilitation process.
As for how to find a good audiologist - I wish I could answer that one. Its more difficult than it should be as far too many audiologists do not follow best practice protocols for fitting hearing aids. If you do some google searching for “best practice protocols in audiology or hearing aid fitting” you should read some good stuff. A fantastic researcher in this realm of audiology is Michael Valente and he has helped create alot of best practices protocols for hearing aid fittings.
It is difficult to determine an audiologists keep up with new technologies because if you ask them about it, most of them are going to give you the answer you are looking for so they don’t appear incompetent. As with any profession, people can feel “comfortable” and get stuck in their ways. “Well we have always done it this way and it has worked well.” Just because something works doesn’t mean it can’t be improved. We can always do better and there are always things we need to learn more about.
Experience doesn’t always result in a good audiologist. I know audiologists who have only practiced a year or two and are phenomenal at their job. I know audiologists who have been fitting hearing aids for 30 years and I would never refer to them. As to how to figure out who is who from a client/patient standpoint - that is a difficult question.
I would always ask the audiologist if they do Real Ear Measurements (REM). If they don’t do them and/or come up with an excuse as to why they don’t do them I would advise you to go elsewhere. It is a must when fitting hearing aids as it is the only way we can be certain we are amplifying things appropriately. There is so much current research that shows how important it is - yet the vast majority of hearing aids are fit without real ear measurements.
@KenP - REM is absolutely a best practice, thanks for bringing it up. REM has been around since the 1980s (re: @MDB and @Um_bongo ) and it is still not the norm when fitting hearing aids. From an audiologist standpoint you can get REM equipment for a very affordable price - and this would be a poor excuse on the part of the Audiologist or Hearing Instrument Practitioner as to why they won’t do it. It is simply ignorance. I would also ask you do be a bit careful when saying the audiologist’s first goal is a “sale”. Many people who fit hearing aids obviously are in it for the wrong reasons and only care about money (but this can be said about any health profession). But when I’m fitting hearing aids my goal is not a sale. My goal is to help my client improve their quality fo life by whatever means is necessary. If this includes fitting hearing aids then that is what we are going to do. If it includes a referral to an Neuro-Otologist to explore surgical interventions then that is what we are going to do. If your experience with audiologists has given you the feeling that they are a “used car salesmen” I would encourage you to find a different one.
@MDB - as for your audiologist saying patients did not like REM I would advise him to read some current research. The plethora of research out there currently makes it indisputable to not use REM routinely (even if he or she has excuses otherwise, current best practice protocols calls for REM with all hearing aid fittings - for very good reasons). I would be more likely to think that when he was doing REM many years ago he was dealing with linear hearing aids (unlike our current hearing aids with wide dynamic range compression and floating linear gain variations of WDRC) with less accurate versions of our current validated prescriptions (NAL, DSL). Even with REM, all we could do was verify the hearing aids to a prescription that still had a lot of improvements do be made. So when he said that the patients did not like “REM”, it is likely more related to the technology limitations of hearing aids and the dated prescriptions (but even our current hearing prescriptions aren’t perfect, but they are always improving). Fitting hearing aids without REM is a very dangerous game and is a disservice to the patient. Don’t get me wrong, alot of audiologists are great at what they do without REM and can get hearing aids set to an acceptable place after some fine turning from the patient’s feedback. But the only way we have any idea as to the amount of sound we are putting in your ear canal is by measuring it. Without REM the gain we prescribe can be off by plus or minus 10 dB at all frequencies/pitches we are amplifying. If you know anything about sound - that is an incredible amount.
An ear probe for an eardrum test sounds like tympanometry. If you google “Rear Ear Measurements” you should find enough credible information to help you figure out if you had it done.
Thanks for your kind words @whahuh. I’m glad I was able to help you understand things better. I’m always happy to help in anyway that I can as audiology can be a rather difficult world to navigate.
And lastly @cjpines as for your question about how extensive should the testing be - that is a great question, but also a difficult one to answer. We have so many audiological tests that we “could” do, but to do them all would take a solid day of testing and that is simply not feasible. The most common test battery you’d likely see would be: otoscopy, tympanometry, pure tone air conduction and pure tone bone conduction audiometry, speech reception thresholds or speech detection thresholds, and word recognition testing in quiet at appropriate presentation levels. If a test does not include all of that then I would be disappointed (some speech testing might be skipped for language reasons though - e.g. client doesn’t speak english and is at an english only clinic). Next on my list would be a measure of speech in noise. Otoacoustic emissions would be nice to see done as well, but are less commonly tested for in the adult population compared to pediatrics. Acoustic reflexes are a nice bonus as well that can help diagnose certain pathologies, but they aren’t as commonly tested for as they used to be since medical imaging has improved and become more affordable.
@cjpines
Real Ear Measurements are done at the time of your hearing aid fitting, not during your initial assessment. A small probe tube is placed in your ear canal that is attached to a microphone. This lets us measure the exact sound pressure in your ear canal. Some measurements might also be done without your hearing aid using the probe tube. If you to a Google Image search for “Real Ear Measurements” you’ll see the setup on your ear and you should have an idea as to if it was done. Quite often a passage is repeated over and over during REM that involves “carrots” - so if you recall hearing the carrot passage on repeat…then you had REM done.
It is also possible to just run REM without using the measurements appropriately (or taking them appropriately for that matter). I know some clinics that just run REM because an insurance company requires it - but they don’t actually use the measurements. So just because REM was used doesn’t mean it was always used correctly. It is a tool, and if the person holding the tool doesn’t know how to use it then the tool becomes useless.
So, do you think my audi that did the Eardrum testing using ear probe, as was on my report, also said, air and bone conduction assessment of hearing loss and speech recognition is considered a REM? I’m not sure about that?
Tympanometry, air conduction, bone conduction, speech audiometry - these are not real ear measurements. Those are audiological assessments of the auditory system. Real Ear Measurements are measurements of the hearing aids in your ears. From what I am interpreting from you - I don’t think REM was done.
But I also don’t want to come across as saying REM is the be all end of of a hearing aid fitting because it most certainly is not - it is a very valuable tool in the audiologist’s tool box that is part of current best practice.
I wasn’t trying to tar all fitters with the car salesmen brush. I was talking about why some are not informative. As you said, it is hard to evaluate who is doing it right and who isn’t. Fitters like you explain and that differentiates you from the car salesmen.
I heard here and from others working for Costco how many shops operate. You are evaluated solely on how many sales you can close.
You point out how difficult it is for a layman to evaluate how good or poor there encounter is. It is unfortunate that there isn’t a policing body for audiology fitter and practices.
To those confused about REM:
It happens when the aids come in, Your aids are used along with a tube that goes beyond the receiver(speaker) in your aids. You are asked to look straight ahead. Sounds are broadcast into the aids. It isn’t English. It evidently covers the speech spectrum. On the fitting screen is display your first fit info and another line shows actual results. There are videos on youtube that display how it is done. It is done to make the sounds closer to the prescriptive graph based on how your ear canal affect the original intent.
Well, I guess I didn’t get the REM unless I wasn’t aware of what he did for the hearing exam and since he doesn’t communicate well I may have gotten the REM or maybe not. Oh well. Thank you for clearing this up and again we are grateful for your expertise.
REM is not part of the hearing test. It is part of the fitting of the new hearing aids. Where I go they put a small (tiny) flexible tube in the ear, then put the new hearing aid in. The tube picks up the sound that your ear picks up.
One benefit of REM is to verify the receivers (speakers) are working correctly, and you are getting the prescribed sound levels, and to adjust for that if they are not (or replace).
