Whether other testing is “necessary” is a judgement call. If your loss has always been sensorineural with no conductive loss and you’re not complaining of significant changes in your hearing, there’s no benefit to masking that I know of. REM is considered best practices, but there’s nothing magical about it. If your hearing loss is similar to what it was last time and your new hearing aids have similar amounts of gain to the old ones, I’d doubt you’d see much benefit to REM. Do share your hearing challenges with your audiologist and if not getting satisfactory assistance, consider returning aids if possible. You can always try to get another audiologist to adjust them, but that can be quite challenging.
The Jabra aids that Costco sells are very similar to Resound aids. However, Costco will not adjust your Resound aids for you. They could sell you a pair of Jabra aids and do their standard fitting practices with them.
Just for my edification: would Costco not adjust the Resound aids if you paid them to do so?
It’s been mentioned that they won’t do this, only the ones they sell, bit like they won’t sell you any accessories unless you brought the HAs from them as well.
My understanding is that they will only deal with product purchased from them. The only hard example I have is a PartnerMic purchased elsewhere that they would have nothing to do with.
They are a simple retailer and all they care about is their retail. As far as helping a client hear better and patient well being, they are not paid for that. It may sound crude but facts are facts. I asked them to read a Phonak hearing aid my neighbor had and check the settings of the Brio he bought from them against his old aid, they would not/could not do that. Simple retailer!
Is finding a different provider within the Nations Hearing network an option? Perhaps you can call ahead and ask about REM before.
@gorgeguy , as far as I know, the majority of audiologists won’t service HAs not purchased directly from them either, so I don’t think that concept applies just to Costco. ¯_(ツ)_/¯
Correct me if I’m wrong but he said his Medicare insurance didn’t cover hearing aids purchased through Costco. Now I don’t know if it does or not but if that’s the case then shelling out $3000 in cash may not be practical
How can you tell me what the main focus of my post is? I did not purchase my aids at Costco. My questions are about REM etc.
Thank you. I value your input.
@25Firefighter: I’m sorry - I don’t have a clue what you are accusing me of. It doesn’t matter anyway, since Costco won’t be able to adjust your aids, as I thought they might, at the time I posted.
Most audiologists or HIS will work with aids they did not fit, they will just charge you for their services. It is important that they are very familiar with the brand of aids, if they are not they will probably refuse to work on them.
Back to 25Firefighter’s original question, I feel REM is very important (assuming the practitioner really knows how to use it). Best practices call for “Validation and Verification” REM helps validate the fitting and COSI or APHAB or similar will help verify the fitting. You may be happy without the use of REM but until it is done you don’t know how much happier you could be if REM is used properly.
Gus Mueller (a very well known audiologist) compared validation and verification to baking cookies. Validation is making sure you followed the recipe. Verification is when you take a bite out of the cookie to make sure it tastes good.
My audiologist didn’t use REM with my fitting/set-up… At first I wondered about this sort of thing…and somewhere along the line I learned about REM. I thought it seemed like a very plausible thing to call a “best practice”. As an engineer by schooling verifying performance when tweaking settings is kinda necessary…
I asked my audiologist the next time I was there, about REM. Her answer…more or less… was basically that verification depends on the goal really…and that’s true in this case anyway. The primary goal of the aids might be better understanding of speech, with secondary goals of things like hearing music, or hearing ambient noises. So by exploring how well I can understand speech, or how natural things in my life sound…or annoying…or whatever I happen to experience… and then by adjusting the settings to optimize, you’ll home in on the right settings.
When I think about the purpose of hearing aids I think that concept seems good. In my experience, after several return visits we were able to pretty much perfect my experience for my own individual needs.
I might still be having trouble understanding my young daughter…so she adjusted something a bit in that range to turn her up. I found that footsteps on carpet were grossly unnatural… change a setting to turn that down a bit…etc…
So… the verification was a continued discussion about my experience.
My audi made a point that REM really becomes more important when the patient can’t really accurately report their experience…like a young kid that either just doesn’t understand or have the words.
In reflecting on the whole experience though, it seems to me that REM would probably be a somewhat useful tool for the initial setting, but in the end I think you still need to go through the other process.
I think about it this way
if my hearing test showed that I have theoretically perfect hearing except at one particular frequency I have a 5.2 dB loss…and it’s right in the range of something that I want or need to hear or understand
So my aids are supposed to amplify that one frequency exactly 5.2 dB.
REM can verify that in my ear canal the aid is doing exactly as it’s supposed to…5.2dB more in my ear than the sound really is.
but
when listen to that thing I need to hear, it’s wrong…maybe just not quite loud enough for good understanding.
So, the audiologist cranks up the amplification…ultimately landing at 5.8dB…and I report a perfect result.
so did REM really result in hitting the target?
This is all just speculation…and perhaps some logic
I haven’t had the REM experience but I really would like to try…
Bradw, you are absolutely right about the fine tuning work that needs to be done in a good fitting. The thing with REM is that it gets you in the ballpark right away to start the fine tuning. I think back to when I got my first REM back in 1984. I fit a full shell ITE on a patient, I had checked the target (NAL) in my test box with a 2cc coupler and it was spot on. The patient came back a week later and said he heard better without the aid than with it. I rechecked the 2cc coupler NAL prescription and still spot on. I had just gotten a Real Ear system and he was actually my first patient to get to use it. When I measured the output at his ear drum, he had 12 dB insertion loss at 1500-2000 hz with the ITE in and turned on to MCL. Instead of thinking the man was crazy or just difficult to work with, the RE proved he actually heard better without the aid. I switched to a BTE with an open mold and remeasured and suddenly he was gaining benefit from the hearing aid. Without the RE, I may never have gotten him hearing correctly. Either he or myself may have just given up because the ITE should have worked. I still maintain that “professionals” who don’t use RE are either too cheap to buy a system, too lazy to spend the time doing it or don’t really know how to use properly.
Why do you continually bad mouth costco? No, they don’t work on products they don’t sell as they are not setup to do that, but that is a corporate decision and the employees in the store cannot change that. However that has nothing to do with whether they care about their patients. I, and many people I read from on here, talk extensively about how far they go for their patients. Instead of just making blanket negative statements about costco how about just referring to specific incidents you may have had with them and skip the generalizations, which are unhelpful.
@janofh: FWIW, I agree with you, Howard. Without Costco, many would have to forego treatment for their hearing loss.
I’m fortunately looked after by Veterans Affairs Canada for my service-incurred hearing loss. I wouldn’t be able to afford Oticon More1s without them, so I’d be heading to Costco, myself.
Sure, they’re a retailer, but so are audiology clinics - which are of the “boutique” variety!
janofh, I don’t continually bad mouth Costco. I have said many times that some of them do a great job, I personally know Costco HIS that even I would go to. But on the other side of the coin I have seen many terrible fittings from Costco. Many talk about Costco as if it the Holy Grail of hearing aids, it is not. It is an option and price wise it is a very good option. But is by no means a guarantee of success and a good fitting, the old adage “Let the buyer beware” is appropriate. I have seen the Good, the Bad and the Ugly and unfortunately the bad and ugly stick in my mind the most. But I think Costco is a viable option for many.
Another thought, the happy ones are usually not seen in other clinics. Usually only the unhappy ones go to other clinics. Hence, a lot more of the bad fittings are observed.
That I get. Although you did state that they are only about the sale and not the patient and this aIstrongly disagree with. The first private audi I went to was an incredible turn off, and I realize that not all but I try not to say all are just share my experiences.
Good morning, my Costco does sell resounds,maybe you could check around other Costco’s in your area.
I do feel the REM test is important,