REM and the DIY'er who use a provider initially

Hearing Aid Self-Fitting and Adjusting [DIY]
#22

REM is not about testing your hearing, it’s about making sure that the hearing aids are performing to the target prescription. The target prescription is derived from the audiogram which is the result from your hearing test.

If the hearing aids are not performing to target prescription for various reasons (built-in amplification for target prescription is compromised by ear canal or fitting or is simply not matching due to conservative algorithm, etc), then the provider will manually fine tune the amplification to meet the target prescription.

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#23

So if you are doing DIY, is REM the only way to verify that the hearing aids are performing to your needs? Especially when talking about Marvel?

#24

REM is a standardized way to verify that the hearing aids are performing to your target prescription. Note that the target prescription is based on your audiogram. But your audiogram is only one angle of looking at your needs. The audiogram cannot anticipate your need for soft sound management, loud sound management, speech clarity, etc. That’s all the fine tuning that you get to do for yourself as a DIY. But you need to be mindful to make sure that your fine tuning still preserves the REM adjustment (if any) and not wipe it out by a completely new re-prescription from a new in-situ audiometry or something like that.

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#25

If I by accident wipe out the REM, can I somehow re-enter it manually (in Target for Marvel)?

#26

You could make screen prints of “all” your settings.

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#27

Yes, the RECD and REUG tabs allow for manual input. After the input you can choose between the input values or estimated values. The RECD are estimated during the feedback test. No idea on what they base the estimation of the REUG. Hopefully based on some empirical data taken from large groups. :slight_smile:

#28

Do we have to fill in these? Are these values important?

#29

If you don’t have them, you’ll need to go with the provided estimations. I got those values (Real Ear Unaided Gain) from the Oticon Genie software, when I hooked up a pair of HA’s that I was testing. You could try your audiologist at the hospital. They also measure those values, when you go for their confirmation of correctness of your HA’s. (Not necessarily new HA’s! But this step is a must if you want the insurance to pay their share.)

#30

My audiologist did a REM, but the hearing aid is not ok (yet).

#31

My audi is nice and is willing to provide me with any data that I want or need in order to tweak the programming of my hearing aids at home.

What is the absolute minimum data I need from my audi to maintain REM calibration for self-programming? I know that I need the REUG data for sure. My audi didn’t know how to retrieve the RECD data from Otosuite.

I have a few other related questions:

  1. Is there a specific way I should ask REMs to be performed, i.e. NAL-NL2 target, manufacturer’s module, etc.? Is there a specific way that will yield better results for my purposes, i.e. preserving the REM calibration so I can do further tweaking at home?

  2. Am I understanding correctly that once I have this data, I theoretically don’t have to run REMs again for every change that doesn’t involve changing the acoustics? That is my ultimate goal.

#32

Any tweaking you do after REM is moving off of prescription targets. The reason you want to have REM completed in the first place is to ensure you are at least meeting prescriptive targets and not just being dramatically underfit at one or all frequencies as is common with hearing aids that don’t have REM completed. It also ensures that the hearing aids are taking into acount your individual ear canal acoustics as well as the venting/coupling acoustics.

Prescriptive targets are the best AVERAGE settings we have come up with so far. Not everyone is average and so things may need to be tweaked, but keep in mind that the auditory system has often been deprived for a long time in advance of hearing aids and takes some time to re-adjust. Loud and moderate volume perception is also quite flexible (to a point), so things that sound loud at first may not sound loud over time. So you want to make sure you’re meeting prescriptive targets to start and then make sure you are giving your brain that time to adjust before deviating too far off of target, particularly by turning things DOWN. Tweak upwards at will with the exception of the MPO, which you should leave alone after the audiologist sets it.

Just save the entire fitting so that you can roll back to it if necessary.

If you’re in Oticon hearing aids and your audiologist is friendly, you could ask for a program set to NAL-NL2 targets AND a program set to DSL 5.0 Adult targets, and then you’d have both and could see what you liked.

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#33

If one has a copy of the REM showing the target curves for Loud, Moderate & Soft, how can a DIY’er use this info in adjusting the gain of the hearing aid? I can see that the REM is showing REAG (y-axis) and Frequency (x-axis)

  1. How does one correlate the numbers in REM with the manufacturers fitting program (e.g. Phonak Target)? What setting in Gain & MPO (e.g. output, 2cc etc) should be displayed in the Phonak program in order to see the correlation between the REAG numbers in REM?

  2. Does one have to apply the REM results to all the program settings of the hearing aid? As an example Phonak Brio has 9 automatic programs (Quiet, Noise, Loud noise, etc). Do we need to adjust each of these automatic programs one by one according to REM results?

Thank you!

#34

For some reason the post above is a reply to one of my previous posts, but I think @Neville is more suited to answer these questions so I’m tagging him here for awareness.

#35

I’m not really clear what is being asked. If one has their REM results and it looks like they are off target in some way they could adjust blind in the areas that they are off target, but the manufacturer numbers don’t correlate as closely as one might like. If one just has a print out of the desired targets… There’s nothing you can do with that because you have no idea where the manufacturer has started you out.

#36

Thanks @Volusiano & @Neville. My purpose is to understand how to interpret the REM results and how to adjust the hearing aid using the manufacturer’s fitting program. I have watched the video of Dr. Cliff regarding REM and he mentioned that at the initial fitting using manufacturer’s algorithm it will likely deviate from the prescriptive amplification in REM. If that is the case, the audiologist needs to adjust the amplification of the hearing aid using manufacturer’s fitting program then run the REM again to see if it matches the prescriptive target. So how does one adjust the gain on moderate, loud & soft using the manufacturer’s fitting program by referring to the deviation in the REM. As a example Phonak Brio 5 has 9 automatic programs (e.g. quiet, noise, loud noise, echo etc.). Since 3 curves should be adjusted where do you start adjusting these 3 curves in manufacturer’s fitting program. Do you have to adjust each curve in each automatic programs then run the REM again?

#37

I’ve programmed my Phonak Hearing aids with the REUG curve given by the audiologist.

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REUG Phonak
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(The trouble with data input is that the frequencies available in Phonak determine the form. So if a peak is between two frequecies it results in a platform.)

Looking at the explanation on this page the REAG should also only give you one set of value-pairs: difference versus frequency. Just with the aids on inside the ear.

Phonak’s other tab for RECD also only allows one set of value-pairs. This also follows from the explanation given on the linked page.

So I don’t think that you were given REAG values. Rather I think you were given your amplification values that took into consideration your REAG values. (Apparently, DSL even needs those before the aids can be fitted.)

I remember when I trialed Audika G500’s, I hooked them up to my PC using a serial Hi-Pro. I loaded the settings from the HA’s and found the REUG values sitting pretty:

REUG-AudikaG500-anonymized
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So maybe you could take another look at the software?

#38

Gross to fine, typically. Adjust all programs together overall, typically frequency first (again, gross to fine) until you are matching the 55 dB curve, and then you check compression and sub-programs, so on.

But there isn’t a firm one-to-one relationship between the steps in the manufacturer program and the results in REM, so you’re basically just turning things up “some amount” and then running the curve again to see whether you are where you want to be or you’ve overshot. For some manufacturers, one step is bigger and for some one step is smaller and you get to know that with experience. Additionally, lack of change on REM after software adjustments will highlight other problems, like acoustic coupling issues.

#39

Thanks for the explanation. Now I understand why I cannot see a pattern how the Costco Japanese audiologist is adjusting the Brio 5 in Phonak Target as he shifts from REM to Target to align with REM prescriptive amplification.

#40

I am trying to understand how the Phonak Target automatically fine tunes the hearing aid with “unintelligible” issue. Could you please advice the steps on how to manually “reduce compression for moderate speech at all frequencies” to improve intelligibility? The Phonak Target does this automatically, but it would help if we know the steps and execute manually so we can understand the concept. Thanks.

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#41

I came across this thread when I did a search for “diy”

I’m very interesting in learning more about self adjusting my hearing aids.

DaveL
Toronto

All of my audiologists used REM until the last appointment with the audi that provided my hearing aids.
He did a quick fit using Target.
I’ve moved on.
The new practitioner did a quick fit too. I can finally hear.

I’m confused though. I don’t understand why the hearing aids didn’t work for me using REM, then were reset using a quick fit by someone else, and they work so much better.

DaveL