I fear I must again seek a new hearing aid SIGH
Can anyone tell me how to verify an audiologist is doing a RealEar test??
What should I ask or look for?? – since most anyone could answer ‘Yes’ and I might not know it’s not truly a RealEar audiogram test.
Thank you!!
They’ll stick a microphone probe into your ear canal with your HAs fitted, I wouldn’t be so concerned about REM, it’s not like your hearing is going to be magically restored.
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REM (real ear measurement) is used when fitting the hearing aid, not when the hearing is being tested and an audiogram is created. Only 33% of the audiologists in the US use REM, It can be a useful tool but is far from being a requirement.
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Costco does REM as part of their standard fitting.
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Why would you settle for ‘no REM’ if you can get it somewhere?
For me, the gain curve which the ReSound/Jabra fitting software derives from my audiogram is completely off. In-situ is similarly bad.
After REM, it’s completely different and the HAs sound much much better.
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You must have an ANSI-average-sized-male ear canal.
For some people REM doesn’t make big difference. For others it’s pretty critical.
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Weird thing is that I did in-situ self fitting with Signia IX hearing aids which I got as spares, and they sound good!
Neville, maybe you can clear up this whole REM thing for me. It is my understanding that REM just adjusts the first fit or the projected prescription to take into account the actual characteristics of the individual hearing aid device. This is helpful to the clinician in beginning the fitting. After that it is just a matter of educated trial and error. It would seem that a good clinician will get to the right place in any event after some educated trial and error as those without REM equipment do. Am I completely out in left field here?
REM allows you to make sure that you are hitting prescriptive targets. Deviations from targets are the result of both the manufacturers systemic deviations from true target and the individual ear canal acoustics in combination with the acoustic coupling, and sometimes are quite dramatic. REM also allows the clinician to verify appropriate gross audibility and pick up on weird artifacts.
Many people are then happy at prescriptive targets, particularly experienced users, and only minor tweaks may or may not need to be made after that–ideally the minimum tweak required to eliminate a particular issue without stealing sound across the board. New users may be overwhelmed by prescriptive targets, and then it’s a matter of weighing the benefits of adjusting to comfort (which often means removing audibility) versus encouraging the patient to use the devices and wait for neural adaptation to occur and figuring out the speed at which this can occur. Depending on the user, this can be harder or easier. I find most of my patients these days, in my area, understand the concept of rehabilitation and do well, but there are always those “I only want to use my leg twice a day but when I use it I want it to be magically strong” types.
At the end of the day, the brain cannot use what it cannot hear. In my experience, young, sweet providers will tweak their patients into worse situations over time trying to meet their demands for less sound. They may do their best to hit REM in the first place, but then will end up subtracting all the highs and all the lows piecemeal when the patient comes back and complains. It’s a little bit the patient’s fault for not trusting the process and demanding that things sound “normal” right away, even though their “normal” hasn’t been normal for years, and a lot the provider’s fault for not having the patience/language/temerity to push back against patients asking for changes that are bad for them.
Sorry, that’s a tangent. REM matters more for non-average ear canals (larger or smaller or surgical) and more open fits. These day, if the venting on the ear really is what the software expects it to be, which is more likely with a custom tip, and the ear canal is average, and the patient insertion is as expected, also more likely with a custom tip, the fist fit can be fairly close to prescriptive targets. And yes, someone mentioned above that on average a first fit will underfit everything above 2 kHz, although if the fit in the ear is poor it can also regularly underfit everything under 2 kHz.
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Thanks for the education. That makes a lot of sense. I can understand that REM can be a good aid when used properly. As a DIY person I hope I get to the right place in the long run through trial and error. The key word may be long run. Again, thanks for taking the time for an informative response.
I agree with the previous responses. It seems my audiologist is not performing best practices either, no REM test.
Mine does it, but reluctantly. I have to push for it, if settings are updated.
I think if I had a DIYer what I would like to do would be to give them a lower limit program and an upper limit program. The first would be “ideally we’d like you to be at least here or higher” and the latter would be “don’t go past this or you will be into a danger zone”. The DIYer would need to figure out their ideal coupling first though, or its gonna be a lot of REM.
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My audiologist is not performing a REM test. I am wearing Phonak Lumity hearing aids. I have this feeling that something is missing with the proper fitting of my HAs. I brought it up one time … but the response was rather evasive.
Thanks @Neville, I really appreciate your insights!
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