Keys on a tray is good idea. I plan to do just that and a few other tests with Audacity and then see what I can achieve with Hansaton Scout. At the very least it will hep me understand how it all fits together. I am a complete newbie with this DIY. But I believe it is good to understand that you don’t have to be a Michelin chef or an acclaimed food critic to tell if food tastes off, or a symphony conductor or world class musician to tell if something sounds out of tune…
I was hesitant to invest so much money in the NoahLink because of reluctance to fiddle with settings by the COSTCO audiology tech. However, the distance to COSTCO and what I interpreted as indifference to my specific hearing needs were by the audiologist I pulled the trigger. I now have my Jabra Pro20 programmed MUCH better than the defaults used by the Costco tech. in Norfolk and realized that I had been lied to several times about what the hearing adjustments could and could not do.
Although Costco has excellent prices for HAs, the fitting process and adjustments are minimal to get you out the door and hopefully to never return. If you do need adjustments, they will do them but don’t expect much more than minimal attention since you are impinging on time they could be selling more aids…is the feeling I got right or wrongly.
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Sometimes the match between the Costco audiology staff and patient is not good. That also happens with private audiologists. Those using Costco can always ask to try another person at Costco. People who live near multiple Costco locations or can otherwise go to another location can also try another store for even more staff options.
What type of changes did you make post REM to improve things?
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Despite what you see on these boards, it is actually very common to fit patients to prescriptive targets using REM, see them after an adaptation period, and have them be happy and want no adjustments. Research also supports that REM reduces follow-up appointments. I think users on this forum lean towards a particular type of nerdy, fiddly, optimizer (I’d count myself as one) that wants to make little tweaks to improve things. It’s not a bad thing for people here to promote the idea that it takes many, many visits to get things right because it keeps people from getting upset when things aren’t perfect after one try, but it’s not necessarily the case.
I have also come to believe that follow-up appointments after a patient is at 100% target gain are often booked a little bit too soon. I think a two-week follow-up is common, but two weeks is often insufficient for adaptation. So the patient comes back and wants a ton of adjustments made to remove gain to make things more comfortable, and if they could just leave it be for a few more weeks things would sound fine for them and they would also end up with better audibility overall.
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If instead of single tones (a long time ago), the clinic could have played twin tones, say half an octave apart, near my high end cut off, I would have immediately reported the middle-pitched distortion product rather than finding out after I got home and played music. Anyway, outcome was a swap to older and (in my opinion) much better HAs with fewer intermodulation artefacts and less ‘peaky’ speakers.
There’s not a single point in it except for a binaural balance eventually. The reason is simple, it’s very easy to just increase the hearing aids, but what would the patient gain from that ? It would be louder, that’s all.
What needs to be checked is WRS without HAs and with HAs, without background noise and with background noise.
“In theory there is no difference between practical and theory. In practice, there is.”
That’s one of my favorite sayings!
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Most hearing aid users complain about comfortable hearing and then complain they can’t understand conversations. I went through a process with my audiologist over 2 years and about 15 adjustments to adjust my brain to accept that comfortable was when I could understand conversations. It was very uncomfortable sound wise for sometime and even caused headaches for a time, but the final results has been amazing. Not only cn I understand speech and conversations but background noise doesn’t bother me as much either, another common complaint. And beyond speech understanding I can hear sounds that I didn’t know existed and now recognize. And the best part I don’t need anything but the default general program that Oticon INTENT1 aids offers. But it took way more than the average amount of time for me and way more than the average patiences and time from my audiologist.
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You’ve mentioned this elsewhere. Good job. 
There’s a big role in audiology for being a cheerleader, for having the right words to explain to patients what the role and importance of neural adaptation is, what to expect from it, and for pushing them where and when indicated. This can be hard for clinicians who are people pleasers, and who may not have the background/training to be good teachers. And if they don’t have REM. . . I’m not sure how they would know what room there might be for improvement.
The initial expectation of a new patient who doesn’t know much about hearing aids is that the hearing aids should just work right away, should just sound good right away, and that adjusting the device itself is the only factor.
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My audiologist is also a professor of audiology at our State University Medical School. I have had to pleasure to sat in and monitor some of his graduate level classes. Two of his previous students are now audiologist at the VA clinic I go to. And yes he is a great teacher. I also know I have caused him to spend many hours on the phone with Oticon the last 5 or 6 years. And he has even brought in one of Oticon’s audiology engineers to help with a few adjustments.
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I’m way late, but one audiologist sound booth had a loudspeaker.
She used it to check my custom ear molds.
Good point. Why guess? It’s not a school test. I have real trouble with word recognition. And I have tinnitus. I do the same as you.
At the Suvag clinic in Croatia, they did an audiogram with headphones and played tones, there was a word recognition test and at the end there was a brief test of how much we hear with hearing aids when he speaks. I don’t think that test was for creating an audiogram, but for diagnosing how good our hearing is with hearing aids.
Someone mentioned speech understanding. I also have problems with that, but not as often as before. Hearing aid technology has advanced significantly. But it should be taken into account that it also depends on the brain, the brain needs to be trained. As an example, I would mention the speech exercises that I went to as a child twice a week for an hour with an audiopediatrician who read sentences from a book and I had to pronounce what I heard. If I didn’t hear or if I pronounced it incorrectly, he would repeat the sentence. And with that, word recognition improved significantly… On this topic, I would mention that it is not the same if a person at work often talks to clients and a person who works in a warehouse and parks goods or works in a factory where they don’t communicate. Communication is very important if we want to preserve our hearing so that the brain remains maximally trained for speech recognition. I think that adults should also practice these exercises to preserve their hearing.
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That works for testing a cochlear implant but not a hearing aid. Since a hearing aid is non-linear, it would only test the gain for soft inputs which could change as the hearing aids adjust to the sound. Real Ear Measurement is the best way to test the performance of a hearing aid. Testing speech in the booth while wearing hearing aids provides helpful information but testing with tones gives very limited information. I can see how this could be confusing. Very good question!
There is at least one audiologist that does use the retest instead of the REM I cannot find her name now but if I find her I will contact her again! I have purchased the Apple AirPod Pro 2’s and I will test them before and after programming them to see if they tell and show the improvement. If anyone can get an audioligist to test in a booth with and without the programmed Hearing aids that will help answer this issue.
The REM tells the person how well the sound matches the amplification of the program ut does not tell how well the person hears.
Hubble telescope did the equivelent of the hearing what you heard and the REM but the first return pictures told the story. NASA was able to bring back what was needed to adjust what the optics saw so that it was corrected. That is what the hearing world needs and that is what people that program - correct - their HAs after the Audiologist does their job.
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Absolutely ! You said it better than I tried to 
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Because it’s expensive. They’re paying for an audiologist’s time. Also because it’s not that important. Your hearing generally won’t change that much. The hearing test gets you close. After that you’re going to learn what tweaks it needs as you use them in different environments like watching TV. That’s why i like the idea of having an app that you can tweak yourself. They always sound good when you leave the audiologist, but when you watch TV or talk with someone who speaks too loud or too low is when you find the deficiencies. Don’t hesitate to go back to the audiologist week after week until they get it right.
In-situ audiometry is probably the closest thing to repeating the audiogram test with the hearing aids in. But it doesn’t necessarily an indicator that the hearing aids work well or not. It just means running the same pure tones testing, but instead of using the audiometer’s calibrated headsets at the HCP’s office, now you’d be using the hearing aids to generate the pure tones instead. If anything, I guess if the hearing aids’ outputs don’t match well with the calibrated headsets used by the audiometer, then the 2 audiometry results would show this discrepancy, and you’d probably rather re-prescribe the hearing aids’ gains based on the in-situ audiogram instead of the original audiogram.
Note that it doesn’t necessarily imply that the headset used by the HCP’s audiometer is not well calibrated or anything like that. It simply means that the hearing aids, even if their outputs happen to be “off” compared to the calibrated headset, they are still THE reference devices nevertheless, so the gain prescription should be more accurate if prescribed against the reference devices instead.
Usually REM is much more encompassing and anything “off” by the hearing aids would be picked up and compensated by the REM adjustments anyway, so as long as REM is done, doing an in-situ audiometry test is not really necessary. But if REM is not possible, like for a DIY’er, then in-situ audiometry is better than doing nothing, especially if in doing so, you see a significant difference between the in-situ result and the original audiogram done at the HCP’s office that’s worth re-prescribing the gain with the new in-situ results.
Below is an example of my in-situ audiometry result compared to my audiogram test result from the HCP. You can see that they’re fairly close except at a couple of data points. The reason for the 2 high data points at the end is because I decided not to amplify in the 6-8 KHz region, since my hearing loss is really a goner in those 2 frequency points anyway. I simply could not hear any tone at the max possible amplification level at those 2 data points.
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I agree the Oticon Intent 1 is a game changer. I’ve had my now for 3 months and it is a world of difference. Word recognition is much better along with TV viewing, but music streaming and noisy environments are still a challenge.
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This is a question I see many responses on so let me give mine. I have been fitting amplification for over 35 yrs and have used unaided and aided testing for all of it. Then came Real Ear (RE) measurements and we used our tried and true sound field results to verify RE was a valid test measure. To this day I use sound field testing as my followup to verify both tones and word recognition. There many times a complaint that can be written of as just getting used to hearing better. But I find often there are things I see in the sound field results that show what they are complaining about and I can adjust. A good process is the gold standard for fitting and includes both ran at different times. RE initially and sound field to verify. Then every couple years I repeat this to make sure they are doing their best. Hope this helps
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