No REMs for new IIC hearing aids

There are some tests that look at consonant detection with and without hearing aids, to try and measure level of benefit delivered, but these tests are rarely used. If the output of the hearing aid is matched to your amplification prescription using REMs then this should put you in a good place to receive benefit from your devices. Skipping REMs and relying completely in the manufacturer software is likely to yield reduced benefit.

Further reading: http://ir.library.illinoisstate.edu/aucpcsd/6/

Don’t worry about the “dumb” question; mine were that for too long. :slight_smile: It is “dumb” but figuring out what is going on. We all arrive here wondering.

You can ask the audiologist to give you the Word Recognition test that you should have had unaided. Remember the series of words like popcorn and football? If that didn’t happen and he isn’t doing REM, then your services were incomplete. You may have a lazy provider. Figure that out before the trial expires. If things aren’t going as well as hoped, don’t be afraid to ask him to extend the trial. If he won’t, think about another provider.

Word lists are not necessarily all that unless you’re doing a side by side comparison - not one separated over a few weeks. I know some people swear by them, but you can really achieve ‘any’ result with enough bias in the presentation.

Small sample sizes (as in the paper you’re referring to) make it very difficult to evaluate these studies. In the first link, 2/3 of customers “preferred” the REM-validated fitting; somehow, that doesn’t fill me with confidence (1/3 is an awful lot). The second link points to what I’ve mentioned before: that manufacturer’s “first fit” methods are all over the map, and yet … that’s what the manufacturer’s recommend and what many fitters actually use. So using REM with a manufacturer’s fitting may “validate” a woefully inappropriate group of settings. Also, none of these studies attempts to validate modifiers such as noise management, directionality, etc. I still contend that REM is a “nice to have”, rather than a “must have”, based solely on unconvincing evidence otherwise; I’d rather have my fitting done without REM but with a better fitting rationale and understanding of the manufacturer’s software than the alternative. Just my opinion of course.

Would you mind sharing your conflict of interest disclaimer along with this opinion? I’m fine with you expressing this opinion so long as you are upfront with readers.

Regarding this point. Good manufacturers are actually recommending that fitters use new automated REMs matching procedures. Please see this press release from Phonak and watch these videos:

From Phonak (Target Match)

From Oticon (REM AutoFit)

Further reading: http://www.hearingreview.com/2017/04/easy-fast-accurate-hearing-aid-fittings-via-automated-rem-system-using-imc-2/

@chatteremail REM isn’t an alternative to the fitting software’s choice or fitter’s choice. It just verify that what was programmed is what is reaching the ear. After the aid is programmed to prescription or what the fitter entered, a tube goes into the ear and reads what is the actual results and compares that to what’s been programmed.

If the programming is incorrect, REM would still accepts that when it falls within the program. Because each ear is different, REM is used to correct to programmed with what actually reaches the ear.

I’m speaking as a customer of an online reseller (and has a good relationship with the proprietors) and someone that can (and often does) program my own aids. Will you share YOUR conflict of interest in all of your posts that include opinion?

My conflict of interest should be fairly obvious to all. And for those who want to know more, I refer them to this note that I sent to one of our community moderators:

Regarding the forum, I do believe there is a way to keep the forum open and free, while at the same time making it pay for itself. If you take a look at my main site hearingtracker.com, you can see that what we do there is mostly display advertising. We also do some marketing on Facebook for our advertising partners … I feel like it’s a nice way to not “commercialize” our content (ie. turn into an ecommerce shop), while at the same time keeping the information objective and unbiased. I hope to expand our marketing reach, and stick to similar activities, here in the forum. Since no hearing aid company owns even a tiny piece of my company, I am able to work with any number of companies on my own terms, and that means no favors on the editorial or user submitted content… Since we have grown our audience to a reputable size,companies are willing to work with us on our terms … and this means we can keep educating consumers the way we have for years about how the industry really works, and how to navigate it. For the record, we have not ever sold, and have no intention to sell, our user database (emails, etc). As an internet user and privacy advocate myself, I try to treat my users as I would expect to be treated.

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I think you have a misunderstanding of what it means to have real ear targets vs manufacture targets. Real ear to couple difference (RECD and speech mapping) will account for the acoustics and physics of each individual ear canal and optimize the output of the hearing aid at the eardrum. Manufacturer settings are designed for acceptance of hearing aids for easy adoption but not for optimal hearing, after all they are in the business of selling as many hearing aids as possible not helping a patient hear as best as possible. Speech mapping and RECD is a huge necessity to optimize a hearing aid fitting without it the patient will not hear as best as possible. If a patient didn’t like a speechmapping hearing aid setting, it only means that the fitter did not have enough factors in place for the fitting such as pure tone UCLs and didn’t know how to adjust the hearing aid appropriately based off of the speech mapping results. Ethically speech mapping should be performed within the first 30 days of an in person fitting.

Marge Houston, my audiologist, hooked up by brand new Resound HAs & the REM tools, programmed them, tweaked them to move the output to the target level, & – viola! I heard better than I had for years! That was 2 years ago & I’ve not had them adjusted since! REM is wonderful.

Just want to be sure I’m understanding this. It still requires probes, but the REM is incorporated directly into the fitting process rather than after running the manufacturer’s software.

Second question. Is REM always run against a standard fitting formula (NAL-NL2 or DSL) or can it be run against a manufacturer’s proprietary fitting?

It’s often run against the translated version of the ‘speech banana’. Which gives a good starting target.

With Aurical, it looks like REM can only be run against NAL and DSL. Are there other probe makers that allow more flexibility?

Yes, I use Med-Rx systems, but there are others too. The individual implementation of targets varies by manufacturer.

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You can verify fittings against NAL and DSL prescriptive targets. Or you can incorporate your own targets and stimuli to suit the way you work.

Emphasis my own

Source: http://www.otometrics.com/solutions/hearing-aid-fitting-system-aurical/real-ear-measurements-rem-aurical-freefit#support

It was never really a before and after thing. Traditionally we set the aids up to manufacturer first fit. This involves telling the software what type of acoustic coupling we are using (length of thin tube, strength of RIC speaker, etc) and sometimes demographic data like age and gender (and previous hearing aid use), and usually selecting a fitting rationale like NAL or the manufacturer’s own rationale, usually based on NAL, but designed to reduce returns (usually means prescribing less gain and delivering less benefit)… THEN, we would setup a similar demographics profile on the REMs machine and confirm the fitting using the same rationale (like NAL-NL2)… if you are fitting to manufacturer’s rationale, there is no way to confirm this using REMs, so usually people end up trying to confirm NAL or something when starting from the manf’s rationale… Interesting technique :stuck_out_tongue: … Anyway, we’re usually still tweaking while probes are in the ear, so it’s more of a back and forth than a before and after. What this new tech enables is less back and forth. Just setup the manf’s software, do the initial fit, and then have it auto-adjust to REMs… Pretty neat.

I just want to emphasize how eternally GRATEFUL I am for the presence of this site, the knowledgeable community here, users like me who lump through so many issues, and all those who share their experiences in the trench.

Every time I see my aud-guy, I tell him the latest I’ve learned at this forum, and encourage him to check it out. Today, I return to pick up the Phonak Audeo B-Direct streamer, and I will be asking him to do the auto-adjust from REM on me. I’ve never had it done, and I really think that for my own feeling of “YES!” I want to see what the recommended settings may be for these Audeo B-Directs.

Fingers crossed …

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In some Rexton Connexx video on audiologyonline, the instructor claims that using their Smartfit with experienced user setting is the best way to approximate a NAL-NL2 fitting! Pretty interesting when one can also select a NAL-NL2 fitting. Anyway, thanks for the response. One has such a limited perspective on how this all works when one has just one’s own experiences as a hearing aid user.

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Thanks for the feedback @1Bluejay! So happy we at Hearing Tracker were able to help keep the forum running the way the previous owner intended!

Don’t be surprised if your audiologist is shocked and doesn’t know how to perform the test. It’s relatively new technology. He might need to upskill and bring you back for another appointment. Let me know how it goes.

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