Sorry, I’m not very familiar with how the free field measurement process works to measure speech clarity so I can’t really offer any comment on this question. If you can elaborate on what this free field measurement process is, maybe it’ll help me understand it better. Is it just a word recognition test, but instead of listening through the headphones in a quiet booth, it’s played through the speakers at various loudness levels? Word Recognition Score is completely different than Speech Clarity. Word Recognition Score is based on single word hearing in a quiet environment and the ability to recognize what the word is. Speech clarity is the ability to understand a sentence or two or three or more of normal conversational speech in a noisy environment. So when you talk about speech clarity in a free field measurement, it puzzles me about the details on how such a thing would be carried out inside an HCP’s office environment?
2.a. I would think dome selection can simply be common sense. The HCP would look into your ear canal to determine whether your ear canal is a typical size or smaller or bigger, then dispense the appropriately common sized dome base on their assessment of their experience on what size dome is a good fit for what ear canal size. Then go up or down a size based on your feedback after you’ve worn it for a little while.
2.b. Probably due to inexperience or laziness or a combination of both in trying (or not wanting to try) to professionally do a good guesswork for you based of their experience, if they have any/enough experience.
2.c. I think usually the answer is yes as long as they fit snugly the same way. Also, if you use closed domes with vent holes, just be mindful that one with a single vent in one brand would give you a different response versus one with a double vent in another brand. It would be best to match the number of vent opening(s) closely to get a more accurately matched prescribed amplification. For open domes, the vents are fairly big and wide open so it’s not as critical to match them more closely.
3.a. REM should be done in your initial fit. If you change your fittings (like go from open to close domes, or from domes to custom molds), or change receiver size, you should probably do REM again because the physical fittings can alter how the sound is delivered to your ear canals.
3.b Yes, in general. But let’s say if you switch from an Oticon open dome to a Phonak open dome, then maybe not necessary (imho). Or if you switch from an Oticon closed dome with 1 vent hole to a Phonak closed dome with 1 (same size) vent hole, then probably no. But if you go from an open dome to a close dome or a power dome, regardless of same brand or different, then REM should be redone because the openness or closeness of the domes will cause a difference in the leakage of the sound output that reaches your canal.
3.c I’m not an HCP, but in my opinion, your HCP is not correct to transfer the REM result from one hearing aid brand/model to another hearing aid brand/model, because that is based on an assumption that the Real and the Omnia aids deliver the exact same sound output volume at every single frequency, which is highly unlikely, even if possible. REM is done to make up for not just the variances in the physical fittings (domes or molds) of the hearing aids, and the variances in your own ear canals compared to other people’s ear canals, but also as importantly on the variances of how the actual hearing aids perform. If the hearing aid underperforms and does not deliver enough amplification at various frequencies (in combination of the fitting and ear canal variances), REM would catch this deficiency to let the HCP know to boost up the gain to the target (or conversely, if overamplified against target, then to tame down the gain to the target).
Even if you replace your Real hearing aid with another exact same brand/model/tier Real hearing aid, who’s to say that they would deliver the exact same amplification performance? More than likely, they will, but variances in the manufacturing process (if loose tolerances are condoned) may still result in slightly different amplification between one aid and another.
But I would not argue with my HCP if they transfer my REM adjustment from one Real hearing aid to another as long as they’re the exactly same brand/model/tier. But transferring REM adjustment between one brand of hearing aid to another brand? Heck, no. That’s just lazy and a lame excuse.
OK, the insertion gain of 1 dB in one device may be the same as 1 dB insertion gain in another device, regardless of whether they’re same or different brand or model or tier, as long as they’re accurately calibrated somehow to be actually 1 dB.
4.a But to take the gain curve from one brand/model/tier and copy it to the gain curve of another brand/model/tier is a big no no in my opinion. The gain curve is a result of many things, the amplification prescription based on your audiogram, then your fittings, then your REM adjusted amplification, not to mention the processing parameters anywhere from the fitting rationale selected, to the program of choice (like music or speech in noise or outdoors), to technologies like frequency lowering, sudden sound stabilizer, wind handling, feedback management, the amount of noise reduction selected, the personalization for either clarity/sharpness or comfort/softness, etc and etc. Many, if not all, of these things can affect what the gain curve will look like. To just copy the gain curve of one device over to another is just a lazy cop-out to replace doing the proper job of fitting and adjusting to arrive at a proper and effective result.
4.b Exactly. To begin with, most hearing aid mfgs have their own different proprietary fitting rationales, based on many things, like the hearing loss profiles (ski slopes or cookie bites or flat loss or reverse ski slope or reverse cookie bite, etc), and all of these nuances in their fitting rationales will affect the end result of the prescribed gain curve, not to mention all the parameters mentioned above in 4.a. So even laymen like you and I already see through the farce that tells us that all insertion gain curves are identical between devices. I don’t really know where they’re coming from to be telling us that gain curves are identical and can just be copied from one brand/model to the next. If it’s from the exact same brand/model/tier for the same settings as a replacement to a defective hearing aid, then OK. Otherwise, it’s nonsense.
Without know the interaction between you and your HCP that arrived at these curves, nobody can really know what to say about these end results, except that if you’re happy with this end results, then OK, your HCP must have done a good job. But it’s not possible to look at the end results like these and be able to determine what techniques they use. There seems to be a lot of emphasis in the 2 KHz range while your hearing loss is flat. It may not be any set technique used per se. It might just have been trial and error adjustment based on the many sessions they spend with you to arrive at this final result from a differently looking original beginning result.
I can only comment if this question pertains to the Real Feedback Management setting, which is the new Real Optimizer feedback prevention technology. If it’s in regard to other brands/models/feedback management technologies, then my comments here don’t apply. But yes, in general, if you don’t really have any issue with your HCP setting the new Real Optimizer Feedback Management setting to Normal, which is the max level (other than Low or OFF which are the other 2 levels), then it’d be the appropriate thing to do, to set it as Normal. There’s no downside to it, UNLESS you start hearing fluttering sounds on occasions (that is designed to stave off feedback when the potential for feedback to occur is detected), and this fluttering sound happens often enough to annoy you, then it can be changed to Low to minimize the fluttering issue. But in return, the potential for feedback to occur may be higher if you set this to Low or OFF. But if it must be at Low or OFF, then your HCP can activate the older traditional Feedback Analyzer that is still available to supplement the newer Optimizer Feedback Management feature.
