I have always thought that the Achilles Heel of the REM system is that the target audiogram itself is, to my mind, very suspect for severe/profound patients.
False patient responses to tones at high levels is well documented.
For this group, I believe, the only valid meaningful test is speech comprehension. Ed
I really think this thread is a lesson in the importance of consumers educating themselves.
I wanted to read up on REM as its been suggested I have my fitter try it, and now after reading this thread I am starting to question how decent my fitter is. I have oticon ino, open fit, RITE.
When the aids came in the fitter used the Oticon program, adjusted for feedback, and she asked me to speak to adjust for my voice. Then that was it.
I came back a week later telling her I was having problems hearing men (I could even hear some news channels on TV at lower volume better without the aids), and so she added in some lower frequency tones by tricking the Oticon program into thinking I had different domes. She set the aids to better fit my hearing loss (something to do with the Oticon program). It took all of five minutes. That was it. edit: I notice no difference.
Outside of my adjusting to sounds I haven’t heard for a while, I don’t have this sense I am getting out of the aids what I should. I often can’t hear people three feet away from me if there is any noise at all. I hear the TV better sometimes (not always) if I turn it up without the aids on than I do with them off.
The long and the short of it is: I am clueless. I have no idea what is good or bad. I don’t really have the option of shopping around (I could only afford aids by going through a not-for-profit discount program as I am in school), but man I would love to.
I guess it depends on how much the mechanical compliance of real ear canals vary from the artificial ear canals & artificial mastoid bones.
BTW, IIRC, the elec. analog of mechanical compliance is capacitance.
What about the resistive element?
The Web says inertia, but I know in a rotational mech. system it is a rubber coupling, e.g., the harmonic balancer that couples the flywheel to the engine crankshaft.
T.C. Gordon Wagner clued me in to this stuff. That was about the most difficult course I ever took and he was brilliant (and hard to follow).
This stuff is useful for designing loudspeakers, mics and phono cartridges, where you have to bridge the gap between the mech. and elec. domains.
The engineers who model the systems do it in the same way, but you have to consider that every function has resistance AND capacitance which varies with frequency. This gives you Z or impedance in ohms as a function of frequency. In the physical world the property is called ‘reactance’. Basically it’s all pendulums and masses, you’re either altering the length of the string or you change the mass.
No two canals are alike. They vary in size, volume, and the walls vary in acoustic properties.
Therefore REM is essential as it indicates what is actually delivered to the tympanic (ear drum). Ed 
Looky here. No two canals are identical in resonance, acoustic properties, period. Ed:mad:
I found this discussion quite useful to me as a soon-to-be HA user. REM seems to be a valuable tool in the process. Does anyone know if a typical Costco does REM? I pick-up my HA tomorrow and have been reading so I know what to expect and how I might contribute to the process.
Well, my Costco which is in small city (about 75k) did REM when I picked up my HAs today - glad that is a tool that they use in the fitting procedures.
2011/12?
REM, IMO for every set of aids going out the door is a waste of time. first you need to know how accurate your audio-gram is. REM is good if for some reason you are not getting the results you expect from the software. a bad receiver, processor, whatever. you could do a REM and verify you are getting exactly the output you expect vs the audio-gram but maybe it would sound like crap to the user. as always your mileage will vary. with your numbers I would be looking at RICs with molds.
IMO, it doesn’t matter what you do, if the audiogram is wrong the outcome is going to be terrible BUT if your audiogram is correct then using REMs to fit to evidence-based targets has been proven to improve client satisfaction and reduce the average number of follow-up appointments on average from 4 -6 without REMs to 1 -3 with REMs. If you want to save time and get better results first time, performing REM is a benefit to your client, and your practice. There is plenty of evidence to support their use. It’s a mystery as to why so many dispensers of hearing aids continue not using them in the USA. The following is an article that you might find useful: http://www.audiologyonline.com/articles/20q-probe-mic-measures-12410.
— Updated —
IMO, it doesn’t matter what you do, if the audiogram is wrong the outcome is going to be terrible BUT if your audiogram is correct then using REMs to fit to evidence-based targets has been proven to improve client satisfaction and reduce the average number of follow-up appointments on average from 4 -6 without REMs to 1 -3 with REMs. If you want to save time and get better results first time, performing REM is a benefit to your client, and your practice. There is plenty of evidence to support their use. It’s a mystery as to why so many dispensers of hearing aids continue not using them in the USA. The following is an article that you might find useful: http://www.audiologyonline.com/articles/20q-probe-mic-measures-12410.
opinions are like… every has one. I work at the VA and have more equip available to me then 10 practices. get more continuing education then most private practice AuDs. if my client satisfactions surveys were not next to perfect there are a whole list of AuDs wanting to get into the VA. I adjust the aids to make my the clients happy not to some perfect number that may or may not sound good to the client. as far as finding your link useful if I cared to waste time I’m sure a could find a link to an article that says the opposite. everyone has to run their railroad however they see fit…
— Updated —
opinions are like… every has one. I work at the VA and have more equip available to me then 10 practices. get more continuing education then most private practice AuDs. if my client satisfactions surveys were not next to perfect there are a whole list of AuDs wanting to get into the VA. I adjust the aids to make my the clients happy not to some perfect number that may or may not sound good to the client. as far as finding your link useful if I cared to waste time I’m sure a could find a link to an article that says the opposite. everyone has to run their railroad however they see fit…
It’s a shame that none of your many continuing education classes taught you the difference between “then” and “than.”
ain’t it…
— Updated —
ain’t it…
Newbie here I have a simple question. Is the REM when done used for all hearing aids or just the ones that fit inside your ear? Hope thats not a dumb question.
— Updated —
Newbie here I have a simple question. Is the REM when done used for all hearing aids or just the ones that fit inside your ear? Hope thats not a dumb question.
[quote=Miki;109914]Newbie here I have a simple question. Is the REM when done used for all hearing aids or just the ones that fit inside your ear? Hope thats not a dumb question.
— Updated —
Miki,
All hearing aids.
Seb, I got your message. You inbox is full so I cant reply.
Thanks.
In terms of technical progress, this thread has aged 3-1/2 years without posts. In 3 days time, I’m scheduled to have (what sounds like) a REM exam. I have already been fitted with the HA and done 2-1/2 weeks of self-tests of it. Only when I was about to return the HA for a refund was this test offered. It is increased overhead for the Audiologist; but if it has been around as long as this thread, it would seem the resistance to it persists. I should add that, after the second week of self-testing, I asked if the volume could be boosted at all–so it was! Then, the offer of REM was introduced–but would need to be scheduled in a week or so. Am I missing something here?–if the purpose of the HA is to hear better, why wouldn’t the amplification be started at its maximum capability, and reduced if necessary? I’m obviously not a technician, just a deaf person.
That would be too overwhelming for new hearing aid users. It takes time for the brain to adjust to amplification, and new users are often set to 70 or 80 percent of target. The gain is then increased over time.
Thank you for the response. I should think that a ‘new hearing aid user’ would not normally require a lot of amplification; so I would agree with you. I’m a 20-year or more HA user, and having undergone recent retesting and been found profoundly deaf, would your answer still apply? (My old hearing aid died of old age before I did.)
— Updated —
Thank you for the response. I should think that a ‘new hearing aid user’ would not normally require a lot of amplification; so I would agree with you. I’m a 20-year or more HA user, and having undergone recent retesting and been found profoundly deaf, would your answer still apply? (My old hearing aid died of old age before I did.)