Fitting using Hearing Test, instead of Real Ear

Hearing Aids
#1

Hi. I have worn hearing aids for 30 years, most recently the Phonak Paradise. My Audiologist retired, my Paradise warranty has ended and I have an opportunity to get new hearing aids this year so I started a trial of the Phonak Lumity last week. The new Audi gave me a hearing test with the Lumity in my ears and said that is how she fits new hearing aids, instead of using the REM. I asked if she could do REM and she said no, she has had plenty of success with doing hearing tests, instead.

Although I live in a large city, the closest Best Practices approved Audi is 80 miles away. I have found that this fitting has not only shifted the range of loudness significantly, it has also made other sounds too loud and distorted. This is also the first time I have ever worn custom ear molds, instead of the power domes, so can this be attributed to the ear molds? If you had an Audi who would not do a REM fitting, would you find someone else that will?

1 Like
#2

Oh boy this is a good topic. I am waiting to see what the professionals have to say. The audiologist who fitted my current aids did not do REM. I asked her why and she said she could not afford the thousands of dollars for the equipment. She offered to refer me to an audiology group at an associated hospital who would do REM plus a couple of follow up visits for $800. I checked with the audiology group at another hospital who would do the same for $850. I asked if she got the REM results for patients she had referred to the hospital group and whether they showed significant differences from her first fitting. Her response was that she had seen results from some patients and they were only slightly different that her fitting. I had a two pair of trial hearing aids fitted with REM at Hearing Life. The audiologist was just out of school and I did not see her make any changes as a result of the REM measurements. Maybe that is something I would not have seen but I did not buy the aids. I have purchased hearing aids from Costco who does REM and they seemed to be good initially. But being (of late) a DYSer I made changes that made the Costco aids sound a whole lot better. So, I guess, I would rather have a competent, experienced audiologist do my first fitting without REM than a newly printed audiologist or one interested primarily in sales do a fitting with REM. REM is best practices but I believe it is only a starting point in the fitting process, albite a pretty good one. So, if I had confidence in an experienced audiologist I might forgo the REM. I recall seeing somewhere that based on surveys only about 30% of audiologists do REM. That may be inaccurate by now.

4 Likes
#3

I think I know what they will say :heart_eyes:… the ones that use it will say it is the only way to fit aids … then there are the ones that don’t use it???

4 Likes
#4

I have been wearing aids for almost 20 years, my aids are from the VA. When ever I get new aids or have a receiver or ear molds changed my audiologist does a REM test. But for my experience and my audiologist’s comments the REM is mostly to insure my aids meets the standards claimed by the manufacturer. After the REM the real fine tuning takes place.
Is REM important? I do believe it is. Can hearing aids be properly adjusted without REM? Maybe for people with mild to moderate hearing loss, or possibly for the typical ski skope hearing loss, but not for the more complex hearing loss like my hearing loss or someone with a cookie bite ot reverse slope hearing loss.

2 Likes
#5

My audiologist used REM when I first got my HAs. She only spent a couple minutes fixing the initial NAL NL2 formula to the REM results. I really didn’t have any issues once I adjusted to the loud sounds. But when we have changed things up (different tips, switching to activevent receivers, then the titanium slimtips,) her response about my question about REM was that it wasn’t all that important. I’m not unhappy. YMMV.

WH

3 Likes
#6

If places are charging that much money just for REM and a couple quick appointments, I’m really confused why your audiologist can’t do that herself and get the money back for the equipment quite quick. Sounds more like she doesn’t want to do it, so she says it’s not necessary.

Let me unpack this one. If an audi fits you with hearing aids but does nothing other than fiddle with the software the same as you are doing at home, I’m not sure what you’re even paying them for. If someone does REM you at least have a quality starting point.

4 Likes
#7

In this case they did do REM, and as I said it sounded good initially. I used it for a couple of years until I got new aids elsewhere. When I started DIY, I went back and reprogramed the old aids from scratch and they sounded better with the new programing. As I said above REM gives you a good starting point but I don’t believe that you can’t get a good result from an experienced audiologist who does not use REM.

1 Like
#8

My dispensing audi did REM but couldn’t set up my Phonak Audeo Paradise P90R’s…a year and a half and lots of hearing tests. Couldn’t hear.

I’m going to a Hearing Instrument Specialist and drving a long way. He doesn’t do REM. I hear much better.

Little voice says “You need REM” My answer is it didn’t work before.

I don’t know if I need it or not…

#9

I’m in the UK and have worn HAs for 14 years. Until joining this forum, I had no idea what REM was (apart from the band and sleep mode of course!). No audi has ever mentioned it (I’ve been to several). I asked my new audi about it (who I found after a lot of searching) and he does this and showed me the equipment he uses for it.

Whether it’s necessary or not I have no idea but it seems odd that it has never been mentioned to me. Or is this primarily a US thing?

#10

From what I’ve been hearing lately, it’s primarily a Canadian thing.

In regards to clinicians who don’t use REM: You don’t know what you don’t know. They don’t know whether you need it because they don’t know what your hearing aid is doing on the ear. They don’t know if you are meeting your prescriptive targets, if you are exceeding them.

If you can afford $5k for a set of hearing aids, they can afford $5k for an REM machine–it might not have all the conveniences of the $20k machine, but it will still tell you what you need to know.

But you can be good and bad at REM. It’s not as foolproof as we might prefer.

7 Likes
#11

@Neville Thanks for weighing in. It’s good to get the professional viewpoint.

#12

What is Live Speech Mapping?

My hearing instrument specialist refers to it on his website I haven’t had it. Nor have I had REM.

#13

It’s the implementation of REM that superimposes the speech banana/kayak onto the dB/SPL output based on your residual dynamic range.

2 Likes
#14

Oh! Now that interests me.

Thank you so much!

#15

I am both an audi (35+yrs) and a user. I do know how to do it without the REM but it is not as good and to get close takes a lot of adjusting. With REM it varies by the person using it. The probe has to be in the proper place for accurate results. This is where I see most failures. Done correctly you will fit not only the loss accurately but also verify max power limits.
Before REM we used a test box and sound field to set and adj. But here’s a challenge- if first thing in the morning your going to be more alert/attentive than in the pm so when doing sound field testing you can have results that aren’t as good. With REM it doesn’t matter. And when it first came out we compared it to sound field testing and patient responses. REM won.
REM is used by those who truly care about doing the very best for their cleints

7 Likes
#16

What a beautiful post. Thank you