Rexton Adore Li REM graph Initial setup

Sorry to post this again but the original post was under a different title and I thought it might be best to re-post this question on it’s own thread.

We picked up my wife’s Rexton Adore Li about ten days ago. They seem to help quite a bit but of course we have no frame of reference as to *how it should be.(or how to could be")

At the first fitting, I asked if the REM looked OK. The fitter said it was fine, as long the graph showed it was within a certain zone.(maybe not her exact words). I couldn’t see the screen so we took them and went home. I requested a copy of the test which I have attached. It looks to my untrained eye, the graph could be closer with some tweaking. She has the M receiver with vented click sleeves. Another poster commented that perhaps they are set this way to reduce the possibility of feedback on her left ear. Plus these are her first HA’s. We will be returning for our second visit in a week or so.

“DR Cliff’s AuD” REM video seems to suggest they may need some adjustments to align the graphs better… Opinions? of anyone that knows?

[Kay%20B2%20REM ]

Thank you

Yes, from what I know of REM adjustment, the fitter seems to be low in the gains compared to the prescription target, and especially in the left ear. I can think of a couple of of possibilities. One would be that he/she is making the gains intentionally low for a new user to increase the probability of an initial acceptance. The other is that feedback is limiting the gains because of the vented sleeves used.

Here is what I see with a standard Experienced NAL-NL2 formula, M receiver, and vented sleeves. The right ear looks fine, but I know from my personal experience I would be in feedback trouble with the left ear at 3 kHz. I think my gains have to be about 10 dB below the feedback zone to avoid feedback.

Here is what the same setup looks like with closed sleeves. Now you can see there is about 20 dB margin in the right ear, and just 10 in the left. The gain may still have to be tweaked lower in the left, but not by nearly as much as with open sleeves.

I have tried both open and closed sleeves (as well as custom molds) and I think there are benefits with the closed sleeves. The allow for gain closer to the prescription, and they also improve the directionality of the microphones, and the ability of the aids to suppress noise. But, if your wife tries them, insist on doing the Own Voice Processing. It can help a lot with the own voice issues it may create. And keep in mind there are three steps to the Own Voice setting. Ask to try them all to see which one does the best on her own voice.

Hopefully the fitters who do REM will comment, as I have no experience in doing that. I have had many of them done, but I don’t see the screen to see what is really happening.

This would be an open click dome. It is worse than the vented sleeve for feedback. Less than 10 dB room on the right, and no room on the left. My expectation is that the gains in the 3-4 kHz zone on the left would have to be decreased by about 10 dB to avoid feedback. And that is kind of what I am seeing in your REM charts.

My suggestion would be to try the closed click sleeves and make sure the Own Voice Processing is done. If you watch the programming screen, this will be an item listed near the top left of the screen, and when it is done there will be a check mark beside it.

Her is a picture of her dome.

That is an open dome. A vented sleeve would be better, but not much. The closed sleeve would help a lot in allowing the gain to be set up to the full prescription.

Was able to pick up her new left HA (original stopped charging the third day of having it). So we will now be able to start evaluating different environments etc.

The first odd thing was that her right HA would come out of her ear occasionally. The fitter said we had the largest available dome already. (she had mentioned when fitting them, the right ear canal was larger. I find it surprising that there isn’t larger domes available. I can’t believe that her canals are so unusual. The fitter installed some “retention locks” and they seem to help, at least initially.

As far as the graphs seemingly off from the REM graph, the fitter said they use the NAL/NL2 formula in the beginning. After the patient wears them and gives the fitter some impressions of issues / needs, they will tweak the settings. Setting them lower reduces feedback issues and using open domes help with issues of hearing the wear’s voice. As the person becomes more familiar with using HA’s (and the brain begins to sync better with the inputs of new sounds) they will be able to make additional adjustments for the new user, at least that’s what I got from reading here and what the fitter explained.

Make sure they actually do the Own Voice Processing training and setup. It helps with the own voice issue. There are three levels it can be set at. Ask to try each to see which sounds the best.