Technically speaking it would be , Speech mapping. - SII index. In case of Vac + instruments you can not check to target. Neither Aurical nor Verifit have preloaded VAC+ targets. That said you can do speech mapping and check against SII.
The Rem auto fit is a very nice feature. On average, Oticon aids do hit more or less high frequency
targets, on average.
For context, most hearing aids fitted in the world - Oticon or not, do not use Rem. agree that is highly desirable
The good old Sensei, did some insitu RECD (not technically REM) but you
use a programming boot with a mic like a probe in the ear and it has an algorithm
took into account ear canal acoustics. It was pretty neat, suppose to work well
with pediatrics but no one used it they discarded.
I think the issue of calibrating the equipment, inserting the probe and inserting the
audiogram (at least the very fit ) was very time consuming so some dispensers
often perform Speechmapping in the last session to validate audibility
I can tell you the two main reasons I had heard other than the $12,000 cost of the machine (if not more)
it is time consuming, when I had my first FRYE (if you know what im talking about you are very old school) setting up the parameters was a 20" task, before performing the test, same goes for the Verifit 1
and the aurical was all noah based so it was rather fast. Those who perform would tell, the Verifit, is the machine to have. Nothing compares to that.
The second reason, at least for my experience often times there is little discrepancy. Many people perform it simply because itās required for reimbursement. This is a very popular view if your dispenser is in their late 50 or older.
I was under the impression that the variability being compensated in REM was the geometry of the ear canals (which affects the gain of various freqs differently) so that could be dialed in. The test box should catch if the gains are off in the aids themselves, id think. But what do I know? Iām just a curious engineer.
One last thought. Gain level satisfaction might be able to be judged by experienced users, but I know that my new HAs seemed WAY TOO LOUD when I first wore them. I adjusted in a couple days. But I would have been a poor judge of how was gain I should haveā¦. My audiologist used REM and made a couple simple adjustments. Probably would have been no big deal.
WH
Good point. My aids were re adjusted to my new audiogram two days ago and seem WAY TOO LOUD, especially because my hearing loss is in the lower decibels, and boosting those apparently also boosts our sense of loudness.
My audi has REM availableāhe showed it to meābut prefers not to use it unless a patient is having issues. He feels that itās time consuming, invasive and most often not helpful if a patient is happy with their settings. This is audi is highly professional and not one to shirk. He offered to have me use REM if I wanted it.
Just to clarify to avoid misunderstanding that MY HCP claimed to me that āOticon aids are usually not very much off targetā. It was not me personally who said that.
Not sure what test box youāre referring to, but I think the REM equipment just does the measurements using the mics placed inside the ear canals and reports back to the software. The software reads the audiogram that the HCP inputs into it and calculates what the target gain should be based on the audiogram, after the HCP tells it which fitting rationale to base on to calculate the target gains. If the software used is the Oticon Genie 2 then the HCP may be able to specify the Oticon VAC+ fitting rationale as the target gain.
I would think that if the actual hearing aids donāt amplify as expected (to target), maybe due to the variability from the receiverās performance, and/or due to the variability from the hearing aidās analog amplifierās performance, it would all be ābunched upā together with the variability in the ear canal and also the variability in the fitting (dome or mold), altogether as the final sound that is picked up from the REM mics inside the ear canal. I donāt think thereās really a way to separate these variables apart in the first place. The bottom line is that I donāt think REM is purely to compensate for variability of the ear canals. Itās to compensate for the whole systemās performance combined.
And yes, for gain level satisfaction, itās not usual for first time users to find the initial gain too loud. I think usually itās more due to new patient or new aid acclimatization as opposed to the hearing aid system actually overperforming above target, although this can happen in theory as well. Probably all HA softwares now have some kind of acclimatization feature to start out on a lower volume level and gradually/periodically increase it to final level.
I would estimate that REM for me was less than 10 min. Would have been less than 5 if one of the mic hadnāt buried itself in some wax. I was shocked how quickly it went. But my audiologist went so fast I wasnāt sure what was going on until she told me.
WH
thatās what Iāve heard. Maybe my audi is still new to this. heās young, but very good.
Providers who do not do REM consistently simply donāt know. They donāt know if a certain aid regularly hits targets or not because they donāt do it to see. They donāt know what might be missing in the fit because they havenāt checked. You canāt run REM once, see a reasonable fit and assume itās going to be that way for everyone.
Providers who run REM regularly know. And as a result, they continue to run it regularly.
These days you can get an REM machine for $5k. Sure, not a verifit, but something. If my employer wouldnāt provide one Iād simply buy it out of pocket.
The test box checks out an aid to be sure it is up to snuff before being dispensed. Why have the patient come in to a failed aid? My audiologist said sheād run both my aids through the test box long before I came in so they could be reordered if something were wrong.
Understanding Hearing Instrument Test Box Measures
Quote from that page:
Hearing Instrument Testing is vital for evaluating hearing aids, testing parameters like frequency response and distortion. This meticulous process ensures tailored, effective solutions for individuals with hearing impairment, enhancing their quality of life and communication. A Hearing Instrument Test device can also be used for RECD measurements, to facilitate REM-based fittings on infants or patients with special needs.
Hope this helps!
WH
thatās a bit absolute. My provider knows all about Dr. Cliff. He and others simply have a different perspective. He says that he does testing when it seems appropriate. Heās not inexperienced with REM. Look, heās not the only audi who has a less than absolute use for REM, based on experience. Itās a bit much to claim that theyāre all ignorant and donāt know what theyāre doing because they disagree with youā¦ They have a different perspective. Who knows, two years from now you may think the same.
Real ear measures have been preferred practice for literally decades.
I started using REM around 1985 and had the first Rastronics CCI 10-3 in the Northwest. I used REM until I retired in 2007 and was amazed when I went into consulting and worked with practices throughout the US how many practices did not use it. REM (Speech Mapping) is a VERY effective tool) but just like all tools, if you donāt know how to use it, it is pretty useless. It provides very useful information that if the Practitioner know what to do with it, it can provide a better fit. If a practice does not use REM, you may be happy with your fit but you would not know how much happier you would be if it were fit properly. To me, any professional who does not use all the tools available to help their patients, is not doing the best job possible. This is just a personal opinion but an opinion from a professional who has been in the business since 1976 and has taught seminars to hearing professionals since the 1980ās.
I can maybe see skipping rem if your area is so under serviced that you are completely overwhelmed, booking months out, and struggling to see everyone. Maybe you only have five minutes to give.
But providers who are only booking out two weeksā¦ What are they doing with their time? What did they need that extra ten minutes for that Iām not providing my patients? Or, since they are spending less time with their patients, are their hearing aids way cheaper? Ten minutes cheaper?
Thanks, this definitely helps me understand what test box you were talking about now.
Along the same vein that an HCP runs through the aids they receive from the HA mfgs to verify their operational functionality, Iām sure that the factories also must have already run probably even more thorough testing of the hearing aids before they release them to the HCPs. So I really doubt that failed aids are released to the HCPs. But I guess itās another best practice, like REM is, to run them again through the test box at the HCPās office for a final sanity check.
I donāt know if itās common practice for all HCPs to run all the aids they receive through a test box first. I saw mine just took my aids out of a sealed box that she got from Oticon and just started programming them right there as I sat and watched, so I donāt know if all HCPs do this or not. Maybe itās similar to REM, some do, some donāt.
Regardless of that, I would imagine that no matter how thorough the factories tests are, or the test box tests are, thereās probably some kind of margin for the parameters that if the aids perform within those margins, they get passed and released for sale. But I canāt imagine that the tests from the factories and/or the test box are exhaustive enough, with stringently tight enough margins that all parts released can be expected to perform almost EXACTLY the same with little to no variations in any of the endless possible situations that they can be subjected to.
So thatās why the REM test is the final test on the system as a whole. But I can see your point that the biggest variability should be in the ear canal shapes and not the aids nor the receivers or the fittings. Maybe youāre right, but I donāt know. I think thereās also variability in the hearing aids that can be sufficient enough to add to the discrepancies.
So maybe let us ask the professionals who are participating here who advocate for REM (well @Neville and @gorgeguy so far): ā If your client has a bad hearing aid that needs to be replaced, when you get a new replacement hearing aid in, do you feel the need to run REM again on this new hearing aid? Or do you feel that the previous REM result is good enough because you donāt expect much variability on the replacement hearing aid compared to the old one (assuming that the fitting hasnāt changed)?
Apart from anything else, it shows the customer unambiguously that there expensive new appliance works as intended. Now to work out whether it fulfils its function.
The guy who sold me my OPN1s back in the day didnāt do until I asked him some time after taking possession. It made a significant difference.
Your post is really helpful. Thank you!
I had a hearing test 8 days ago. I feel the same way. Itās very loud. However, I hear better now. The last Audiogram was produced by the dispensing Audi. He quit. I found better care and can hear better now
Thanks for posting.
Hearing aids can arrive dead or they can arrive out of spec and best practice is to run testbox checks prior to delivery. With customs, they can arrive with the mics wired in backwards. However, checking in the test box is time-consuming and when quality control is good enough that the percentage of problem devices is low, this is something that can get dropped in a lazy clinic or a busy clinic. There are a couple potential problems that REM is unlikely to catch.
When hearing aids come back from repair and are reloaded, as long as they are passing other testbox checks is unlikely that something will be off with the fit, but if after completing REM the cognivue saves a testbox measure of the settings is very easy to compare against that.
One of the biggest issues that can happen without your notice is that the dmics break. Amplification will be the same.
My directional micās didnāt work because my hearing aids were not set up
Properly. I had to go to a different clinic to find out
Neville your post is really helpful!
the machine needs to be calibrated , the probe has to be placed exactly and depending on the equipment , some take longer.