One thing you can do is make the rationale switch. See how you like it. If you decide to put it back to the original rationale the prescription will be as before.
1 Like
I think it’s a little muddy here if the fitting rationale chosen after REM adjustment is completed is not the same as the fitting rationale chosen as the REM target. For example, VAC+ is designed to be more for all-around comfort and therefore less sharp on the highs compared to something like NAL-NL2, which was designed specifically for speech understanding.
So for example, if you can choose VAC+ as the target rationale of choice for REM, and let’s say that the hearing aids perform up to the VAC+ target, then no REM adjustment is needed. But if NAL-NL2 had been chosen as the target rationale for REM, but VAC+ is the actual rationale that is used, then it’s likely that REM will show that the hearing aids underperformed on the higher frequencies, hence REM adjustment will be made to bring the high frequencies up to the NL2 target. So now what you’re actually hearing is what NL2 sounds like (harsher) at the target level. You’re not really hearing what VAC+ sounds like (not as harsh) at the target level.
It’s not always a given that the HCP can choose a proprietary rationale to be the target rationale, however, unless the HCP has REM equipment that is compatible with the programming software (like Oticon Genie 2) and run REM inside the mfg’s software in order for the software to be able to calculate what the target value for that proprietary trainable is. An external REM setup would not be able to calculate what the proprietary rationale target values are because the formula is proprietary and is not available to external third party equipments. Only the standard rationales are available for third party equipments to do target value calculations on because the standard rationales are not proprietary.
Not an expert, but asking one of the pros might clear the air.
Fitting algorithms are are pretty well set for a given hearing loss. Once the hearing loss is entered into the software a prescription is made by the software.This I believe is standard information across the hearing industry, not brand specific. Knowing this and also knowing REM is for acoustic deviations to verify and adjust proper sound at the eardrum to meet the prescription.
So it makes since that changing fitting algorithms would make no difference to REM because sound levels have been properly set for acoustics and a calculated algorithm.
Does this clear the muddy water a little.
I may be way off on this but it’s just logical.
Don’t mind being corrected.
1 Like
I had this discussion with @Neville a while back and he confirmed with me that if NAL-NL2 is set as the target curve, any REM adjustment done (by manually changing the gain values) to fit this NL2 target will make the proprietary rationale (like VAC+, if that’s what the program being REM adjusted is set for) sound like NAL-NL2 at the target level. He’s copied here so he can chime in if my recollection of what he said is wrong.
So with my example above, if the hearing aids are performing to VAC+ target level but are shown to under perform at NL2 target in the highs (due to the difference between the 2 rationales), and REM adjustment is made to match the NL2 target curve, then the VAC+ based program will have been modified and will no longer sound like VAC+ but will now sound like NAL-NL2, at least at the target level. At other levels, it might sound like a combination of the two maybe, but it won’t sound exactly like VAC+ anymore.
Thanks, curious what is said. I seem to remember him/her talking about this. I thought it was to basically build an algorithm that wasn’t available and maintain REM gains.
I sure might be way off on this, will learn something either way.
Okay, incoming coffee-fueled saturday morning write-up.
Prescriptive targets are the amount of gain recommended at different levels and frequencies for a particular hearing loss. NL2 (Australia) and DSL (Canada) are the modern winners for adults (although people will still use NL1 in certain places, or even CAM) and they have converged over time as research has tried to optimize them, which you might expect they would if there is truly some sort of platonic ideal for gain prescription. There are still differences stemming from underlying ideology of how they were developed and you can generally expect NL2 to be a little bit more compressed, less loud/sharp. Currently research comparing user outcomes shows that people do well in both prescriptions with DSL maybe having a very small edge in noise situations, but the evidence base there is too small to really lean on. For children, DSL has separate child targets that are generally the only ones used; they have a strong focus on audibility are and significantly louder than adult targets. (Note, users who grow up with child targets are not and should not be transitioned to adult targets once they are adults. Adults with later onset hearing loss may do very well in child targets, but many cannot accept them due to loudness tolerance issues). Proprietary targets are developed by manufacturers largely based on NL2 and reasons for their differences are mysterious and may include increased initial user acceptance (# hearing aids sold), marketting (“our hearing aids sound ‘different’”), and internal research that suggests some change is good either based on small-n internal research or more recently large-n datamining (yay!). Historically, proprietary targets have on average just been quieter than independent targets which would certainly be the case if they were focussed on intial user acceptance. I looked closely at proprietary target implementation of current hearing aids last summer when I was discussing targets with Volusiano and that appeared to still be the case on average with the exception of Oticon VAC+ which is applying more gain than NL2 at 2kHz.
Whether a hearing aid is actually delivering prescriptive gain to your eardrum depends on the acoustic coupling and shape of your ear canal (effects can be huge), as well as the implementation by the manufacturer. There was research a while back showing that what the manufacturers called “NL2” actually differed quite dramatically from actual NL2 targets and from one manufacturer to another. Things have gotten better since that was ‘outted’, but there are still differences. DSL is a little bit more likely to be implemented in a static way across manufacturers because, as far as I recall, manufacturers need permission to use DSL and have to demonstrate to the National Centre for Audiology (that developed the targets) that they are implementing it following their guidelines. So the job of REM is to ensure that you are actually getting prescriptive gain and, yes, if you set a hearing aid to a proprietary strategy and then verify it against an independent stretegy and wrangle it to those targets across levels then you are essentially just turning it into the independent strategy. But remember that audiology as a whole is sort of a game of fuzzy precision. If you were fit to proprietary targets and then complain that the hearing aids are too sharp and the clinician rolls off the highs, you are now no longer using proprietary targets. If you do not have a perfectly kemar-average ear and first fit a set of hearing aids, you are not using proprietary targets. If the clinician only adjusts frequency-specific gain but not level-specific gain using REM, then compression strategies will still be proprietary although frequency strategies are now independent. And then the whole game is complicated further by neural adaptation and the limits thereof (e.g. hearing aids can sound one way at first and then your brain just readjusts over time and they sound natural again, so how much should you be tweaking them to comfort versus just waiting for your brain to get there).
You might imagine that if you set a hearing aid to NL2 and adjust it with REM so that it is taking into account your individual ear and meeting targets appropriately, then when you switch to DSL targets the hearing aid will just maintain the gain changes that were done to meet REM targets and apply them to the new prescription. This would be lovely, but it is largely not the case. There are even differences between manufacturers on whether they will do this for changes in audiograms. For example, if you input a new audiogram into a Sonova hearing aid it will (try to) simply adjust for audiometric changes and maintain fine tuning, but if you input a new hearing test into a Demant product it will try to just first-fit it again (annoying). For this reason, a clinician may regularly update the audiogram in the first product, whereas they may never update the audiogram in the second product for the life of the device and will simply readjust with REM for audiometric changes because they don’t want to totally refit.
Inputting a well-measured RECD into the software, if the software allows it, will typically get it closer to targets at first fit. The effectiveness of in situ to try to address this is, in my experience, not great. It’s maybe(?) better than nothing in a situation where a clinician does not have REM, but it is not generally the intention of the manufacturer that it be used in conjunction with REM in places where that is available–keep in mind that manufacturers are also trying to develop products for international situations where not only is REM not available, but audiometers might not even be easily available.
13 Likes
Thank you so much for your excellent description of fitting algorithms and REM. Comparing hearing aid brands in this detail is something I can not do.
The differences between Phonak and Oticon might explain where Volusiano and I have different opinions.
Thanks again for your time, help and experience.
3 Likes
I also have the Signia C&G 7-IX, they perform excellent for me and they are the newest from Signia, I am surprised your AuD is suggesting the Oticon Intent 1 since they are also the newest.
I have personally experienced that the programming and type of done used, as well as the receiver wire thickness has a lot to do with how well the HAs work for us.
I would highly recommend trying out first to reprogram the devices correctly, try out a thicker receiver wiring, and use the Tulip domes or even the custom mold to see how well they work for you.
We are talking a huge out of pocket expense that you might really don’t need. Have you also try to use the AirPods Pro2 exclusively for listening to music? If you have an iPhone you can upload your audiogram on the settings for the devices to adjust to your hearing loss.
Don’t give up, you can get those to work for you, you have the top of the line #1 best in technology with Signia.
Best wishes….
3 Likes
Signia isn’t much appreciated on this forum. I also have the Signia C&G 7-IX and couldn’t be happier.
7 Likes
I have two versions of the Signia C&G 7-IX HAs, one under the brand name Rexton Reach from Costco, and the other branded TruHearing 7 Premium through my Medicare Advantage insurance plan.
The testing and fitting from Costco on the Rexton Reach far exceeded the very limited testing and fitting done by the TruHearing provider. Not only did Costco spend five times as long performing multiple tests for me before ordering my HAs, they performed Real Ear Measurement (REM) during my fitting session, which improved my HA experience so well that I relegated my one month old TruHearing aids to backup status.
The cost of the Rexton Reach at Costco was approximately the same as the insurance deductible I paid through TruHearing, but Costco also included a portable charging case while TruHearing only provided a counter-top plug-in case. (Both HAPs did help me set up Own Voice Processing to help overcome the dreaded occlusion effect.)
2 Likes
I was given the Rexton BiCore Li-20 by Medical through HearUSA (same HAs that Costco sells for a lot less -$1,500 cheaper) with the portable charger. I was going through hell understanding conversations with several people, outdoors, restaurants, etc.
It is then that I started my research among several FB Groups, YouTube Videos, etc and found the Signia C&G 7-IX with Telecoil.
I decided to buy out of pocket the Signia at only $2,850.00 on line vs the $5,850.00 that HearUSA wanted.
My experience with the Signia have been FLAWLESS, I can now understand conversations among multiple people, restaurants, etc. They are indeed AWESOME!
The battery lasts me over 36hrs with heavy streaming. I usually don’t listen to music but when I do, I would say the music sounds nice but not as clear and great as my AirPods Pro2.
I wouldn’t change them for any other. Highly recommend them.
Again, programming, type of dome, and receiver wiring is key for success to any HA out there.
2 Likes
Can that information be pulled from the fitting software and then reused or does it vary with time, dome/mold, etc? Is it roughly repeatable from different REM runs?
Are you saying that inputting measured RECD and then letting the fitting software prescribe would be close to REM even for evolving audiograms and different aids/receivers/domes/molds? Is that because without weight change each person’s ear canal shape is relatively stable?
Why would music not also be linked for fine tuning?
Because it’s a completely different fitting formula than the others, can only be set to “target” and fine-tuned on its own.
I mean you could link it if you want pre-REM, but the results are horrible (I know, because it was done by mistake to me once).
You may or may not be able to pull it from the software. Clinicians may input it or may not. It’s always saved in the REM device anyway. The benefit of putting it into the software is that, depending on how the manufacturer implements it it may get your fitting closer to target so that you don’t have to adjust as much. But some software pulls it quickly from your REM machine with the click of a button and in others you have to type the numbers in which might slow things down, so depending on how quick they are at adjustments they might skip putting it into the software and just keep it in the REM device, which is fine.
But yes, it is certainly repeatable if someone has some degree of skill, and it may get you closer to REM depending on the manufacturer (although it can still be off and would not compensate for a manufacturer simply diverging their targets from true independent prescriptions). It is fairly stable over time in adults although the ear canal does change over time–stable enough to only run it every few years unless something changes (perforation, growth, big weight changes).
RECD doesn’t really compensate for acoustic coupling though. That has more to do with how much the venting in your actual ear differs from the expected venting. This can be wildly variable with domes and the only thing you can do is measure it.
Sorry, are you saying that REM shouldn’t be run on music programs because you had a bad experience with it once? That’s not correct. What if the consequence of someone’s huge ear canals is that software targets only provide 10% of intended gain?
No, I’m saying if you’re doing REM on P1 (General) & the rest of the Philips programs you don’t have it linked to music at the same time, it’s not designed to be. You actually don’t even have the option to set it to target the P1 Program in the fitting software when you add a Hi-Fi Music one.
Sure, you could always then perform a separate REM on that one specifically I guess if the REM software was able to be somehow loaded with the matching targets of the proprietary Hifi Music mode’s internal rationale (which AFAIK isn’t based on either NAL or DSL).
But it’s an interesting point you raise, and possibly why some people really don’t enjoy Oticon/Bernafon/Philips Music Mode while others do (I’m one of the latter).
1 Like
Nah.
I don’t fit Costco hearing aids so don’t know Phillips specifically, but I fit oticon and bernafon. Proprietary targets aren’t as complex and magical as people on these forums think. Usually they’re just boosting the lows and maybe rolling off the highs a bit and turning off features. If your clinician sucked at adjusting your hearing aids for music it’s not because of REM.
1 Like
Have you read the Oticon whitepaper on MyMusic (which is rebadged by Philips as ‘Hifi Music’)?
If so, you can see it’s not just a tweaked NAL or DSL curve but uses a different base altogether; which, as I said, is why upon adding it as a new mode the fitting software doesn’t let you link it to another mode that uses any other standard rationale - it’s a manufacturer restriction.
But - my Costco audi did accidentally link them before doing a DSL REM on General and the resultant Music mode was awful (but all the other DSL-based modes were fine). I flagged the obvious mistake, got it reset back to target, and all is well now as music sounds fantastic to me.
So… I’m actually not sure what you’re trying to argue about here? I’m certainly not anti-REM. I’ve even acknowledged that based on other comments I’ve seen in these forums Oticon/etc Music mode doesn’t work as well for everyone as it did for me by default and probably would need further adjusting for them to get the best out of it. 
I certainly understand that a musician program isn’t set to the same parameters as other everyday programs. I’m a musician. Is it possible to do and REM for a musician program, independently of the other programs? I’ve had a ton of surgeries done on my ears and their architecture is…strange, let’s say. Due to the need of getting to the mastoid bone to remove wax and cholesteotoma. My outer canals are weird as well. I wear my Signia Ax7 for music alone, although they function well otherwise. But I have a BAHA for everyday use. So the musician program on the Signia is paramount for me.
Costco sells the Rexton Reach with portable charger for just under $1500 - and it is a twin of the Signia you bought for $1350 more. The Rexton BiCore that Costco sold was a twin of Signia 7AX, while Reach is a twin of Signia 7iX with many improvements.
My Costco HA tech set my Rexton Reach up extremely well for me - much better than my managed care tech did for my TruHearing 7 Premium HAs which were also a twin of Signia 7iX.