Is this standard practice for an Audiologist? Real Ear Measurement?

Hearing Aids
#1

I am still new to HAs (Phonak Lumity 70R) and this is my first go around with hearing specialists, so I don’t know what to expect/what is considered normal. I have two questions about my current audiologist, and if her procedures are in accordance of accepted practices.

In February I had an audiogram done, and since my hearing loss was not quite symmetrical, also an MRI to rule out any tumors (all ok).

It took 6 months until I got to see an audiologist for fitting of hearing aids. I had never met this person before, she was new. Two things I’m curious about:

  1. She never looked in my ears. I realize she probably has access to all digital information from my MRI and records of my visit in February, but this strikes me as a bit odd for someone fitting me for HAs, no?
  2. When she was taking real-ear measurements (I think that’s what it was) she had me sit in front of a screen displaying graphs, and with speakers and told me to squarely face it. Then while the measurement was taking place, she kept rotating/swiveling the office chair I was sitting on at different angles so that I was no longer facing the speakers, but maybe 20 to 40 degrees off to the side. She kept adjusting the angles, I think based on what she saw in the screen(?). This seems off to me, shouldn’t the programming be verified without moving me?

Should I be concerned about these two items? Or is this standard practice, all ok?

Thanks!

As an aside, she also seems to resent when I mention that I’m reading this forum and what I have learned (e.g., about firmware updates, or that the startup program can be modified, which she denied as being possible, etc).

#2

Not looking in your ears is odd unless she knew somebody else had recently. That doesn’t sound likely as it took 6 months to get the appointment. They really should verify that your ears aren’t full of wax or that you don’t have some other abnormality if they will be sticking things in your ear.

I’m not sure what the test in the rotating chair was. REM (Real Ear Measurement) is done with hearing aids in place and microphone probes inserted in between your ear drum and the hearing aid receivers. Since I have no idea of what she was doing, I can’t really comment.

Expressing resentment at a patient for wanting to be more informed is not a good sign. I don’t know what other options you have, but this doesn’t sound like a good match between provider and patient.

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#3

I probably didn’t explain this very well, the chair was just an office chair that can swivel. I believe she inserted probes into the ear canal and I was wearing the HAs while she was doing this measurement. I would think that getting meaningful REM measurements would mean I’m stationary, not that she would rotate my angle to the speakers generating sound.

100% agree that it seems odd she didn’t bother to take a look at my ears. Her whole approach seems to be to dismiss any of my concern, and minimize any of her own effort.

She’s super defensive, and doesn’t like questions, or contributions from me based on what I have learned. She also offered almost zero advice on the HA brand/model on our initial visit, but went along when I said that I had hear Phonak worked well with Android phones.

I agree, it’s a very poor match, I’m trying to see if I can switch audiologists. This is part of a large university hospital system, so lots of people on staff. I just don’t know if the 3 year service agreement is with her specifically, or if I can switch to someone else. She acted quite unprofessionally during my last visit.

#4

She should be looking in your ears to see the shape of your ear canal. That matters. Whether it’s an audiologist or any other specialist, she should not be defensive or objecting to any other input you’re seeking. When my wife was experiencing GI problems, the GI specialist objected to including tests which had been suggested by relatives who were doctors. He reluctantly included them. Those extra tests revealed that she did not have a GI diagnosis but a cancer diagnosis.

You must be able to have open communication with your audiologist so that s/he can have the proper information to make the adjustments necessary to get the best fit. If you don’t feel comfortable with the hearing care professional, find another one.

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#5

Thank you for your post, I agree.

I’m doing my best to get another audiologist assigned, who will also hopefully check the programming and REM.

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#6

I’m sorry for your experience. She should definitely be looking in your ears at every appointment, I don’t know how REMs could have been completed as you check the ear canal before and after probe tube placement.
I love it when patients are interested in their care and their technology and the more questions the better in my opinion!

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#7

Thank you, hopefully I’ll be able to switch to someone a bit more vested in my outcomes.

#8

I find it difficult to think she didnt look at your ears prior of putting a probe mic
Although the new Verifit, has a neat new feature which will allow to see if the
probe mic is correctly placed.

that is odd that she didnt do it. Maybe she use a video otoscope?

#9

I don’t recall her ever using a regular otoscope (had to look up this term), not sure what a video otoscope would be like, but I don’t remember her looking at a screen with a live feed of my ear canals which I assume I’d see? She really seemed to be just phoning it in/doing the minimum :-/

I am going to see a different audiologist in about 10 days who I’ve requested do another REM, I’ll be curious to compare the two procedures. There should be records of the previous measurements right? I wonder if he can compare his REM vs the one before (they work for the same university, so all shared offices/equipment etc). Of course he may also not want to share if he felt his colleague didn’t do a good job (I’m just spitballing, I don’t really know enough to assess this, hence my query here).

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#10

even if both did it right there might be differences in targets, arising remember you are sitting in front
of a speaker, if perhaps she move the chair slightly or if the probe is not place the same etc.

Depending of what machine she uses - being Verifit the absolute gold standard - what you want to
see is the SII index, which correlates to speech understanding.

Some manuf- like Oticon has Rem auto fit so the instrument autoajust. I dont really like this

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#11

Indeed! From your descriptions it sounds to me like you’re being treated like just a variable in the process, when it should be focused on your experiences and benefit with hearing aids.

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#12

That’s exactly how it felt … hope the new audiologist I’ll be seeing in about 10 days will work out much better.

#13

These weren’t initial adjustment, she was adjusting my angle continuously during the test. I just don’t know enough about all of this to know if this was normal/necessary or what.

I’ll see what the other audiologist does, same medical unit (Uni Health services), so I’m expecting same equipment. And I’ll ask him after he’s done with the REM.

#14

I have REM done at any new HA fitting. There is no “chair rotation” involved. My audiologist also looks in my ears, and last time even removed a good deal of cerumen to save me an appointment with the PA who does that in the ENT clinic. The attitude about self-educating alone is enough to never see that person again.

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#15

100% agree, thank you for the post. I’m going to see a new audiologist next week and will have another REM done.

#16

Visual inspection of ear canals is essential.
First to see if there is a wax blockage that would interfere with the hearing measurement tests.
Second to see if there is an abnormality in the ear canal shape that will affect the size of hearing aid domes. My right ear canal has a physical bump in it that means a smaller ear dome is needed compared to my left ear canal to ensure both acoustical sealing and comfort.

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#17

Yes, definitely wasn’t happy with this audiologist, she just seemed to be doing the absolute minimum, and I’m not even convinced that was done right.