Real ear measurements and hearing aid fitting

I was fitted with two naida V sp hearing aids a month ago. The audiologist didn’t do a real ear measurement and I wasn’t happy with the fitting. Sounds were low and weak. It felt as if naidas were useless. About a week ago , I went to another audiologist and she did real ear measurements before fitting , and now I am satisfied with my aids. Real ear measurement made a lot of difference . My audiogram is attached

What’s your opinion on real ear measurement ? Many audiologist don’t do it.

I have been back for several adjustment sessions and during a couple of them she has done the REM. I think it gives them a better idea what’s going on.

I am a fan of real ear measurements with a lot of caveats. It takes a lot of time for the audiologist to set up, and it’s prone to errors if not done exactly right. I believe this is the reason many audiologists avoid it. Many things can go wrong in the placing of the probe in the ear canal. Is it clear? or clogged? Is it tucked up against the ear canal? Is it in far enough? or too far? I’ve had it done many times and the best results were when the audi made sure the results were repeatable: that is, physically removes the apparatus, reinserts it, and see if the results repeat. If they do, the result can be good and a great indication of how the aids are actually working. In my case the REM results are different from the predicted result, but not too much except for a problem area. The real benefit was in identifying a resonant frequency of around 1500 Hz in both ears and resulted in a much improved fit. This same problem area also shows up in speech mapping, which IMO gives more predictable results.

If I were an audi, I’m not sure I would use it with all patients. It takes a lot of time and I’m not sure the payback is there. I would probably use it for troubleshooting, but what the heck do I know? I’m not an audiologist, just a retired engineer/executive. :slight_smile:

Interestingly enough, I just got my ENT’s to okay the purchase of one for each office we have (2) and I am thrilled. I have a few patients where I need it (weird complaints that I can’t figure out, surgical ears, etc.) and am very excited to be getting them in the next few weeks.

I will probably not use it on everyone for each fitting, but I will be performing a measurement at the end of the trial when the settings are where the patient wants them to document where they are set.

Let us look at the Real Ear Measurement testing for what it is.

It is to show what db Sound Pressure Level is being applied to the ear drum (tympanic membrane) by the aid at each of 8 or 9 frequencies which is the result of the combination of the hearing aid’s adjusted amplification as it is modified by the effective canal’s acoustic geometry.

And now this resulting curve is compared with the previously obtained Audiogram of db loss at those same 8 or 9 frequencies.

The theory is to match the general amplification CURVE with the patient’s loss CURVE at those same frequencies. It is not to match the exact db amplification with the exact loss db. Overall perceived loudness calls for lower overall amplification.

Note that it is critical to obtain an accurate Audiogram for the REM test to be meaningful. Ed

If you test at half octaves, you double the representation of the loss. Most REM’s sample at about 100 points across the spectrum too. The general theory is to reproduce the proportionality of the long term speech weighted average kayak, which is neither a line or always curved when re-produced in term’s of the dB SPL missing relative to somebody’s loss. (Looks nothing like my kayaks either TBH…)

Most systems provide the opportunity to include patient loudness growth data, but seeing that is massively subjective and not hugely helpful, it tends to be a step too far.

As the good Doctor says above, valuable for ratification and problem solving in unusual cases, though there is a methodology that says if you REM everybody, you cut down the number of subsequent adjusts (M. Poe’s Law).

What’s the issue with a good Audiogram? it’s not that difficult to get one with a decent set of inserts and a quiet room: I acknowledge the subjectivity, but the more than doubling of power over each 5dB tested means that it’s almost impossible to be more than one measurement out if the patient understands the test and isn’t appreciably wobbly in their own interpretation/has tinnitus.

Um Bongo: I must have been sleeping when they mentioned “kayak”. Please educate me. Ed :smiley:

The grey area here: (Which looks like a direct grab from the Med-Rx Software)

:eek: Um. B>

Oh,the speech canoe.

Ed

In my world it’s a speech banana!!!

On this side of the pond it’s a banana, on their side it’s a canoe or kayak, oh well they all float!

I use a double ended paddle I’m afraid; therefore it’s a Kayak. :slight_smile: Natch.

(it helps you to go faster when getting out of sh*t-creek.)