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Audiologist "doesn't do" REM?

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  1. Ask about Speech in 360° program

  2. Maybe it is worth to give a try to earmolds?

  3. Ask about printed fitting report and from

Just for reminding:

Phonak Infinio sphere v Oticon intent
This is what I need to do lately. Nothing pleasant. Make a list with questions and proposals and keep it in one place, because our advices are scattered in the forum. Some propositions here: Earmold as occluded as possible depending on your occlusion (I have the possibility to start with the smallest diameter - pressure vent, because I don’t feel occlusion at all, especially when I have deep placed receiver, YMMV) - this is the most bothersome part Maybe redone audiogram if last test was…
Edited

Great advice.

I had my first hearing test with Rob 6 months or more ago. I had a couple of appts after. I had . It helped I don’t know …. Old and stressed.
My hearing test was 10 to 20 worse than the “hearing test” first fit given by my dispensing Audi when we parted.

Last change was a revised set up program. It helped noticeably.

As a car tuner I used to go back to basics when I didn’t get results.

To me that’s a good hearing test with REM.

I was a sailor. Lasers. I feel like I’m P.$$ing into the wind with my hearing aids.

Time to buy a lottery ticket. I’ll win. quit work. And buy new hearing aids.

I just moved last year from a town that didn’t have any audiologists who did . However, I liked my audiologist at my old location. They fit me with my present ’s which are Phonak Paradise P90s. After moving, I did a lot of research on audiologists in my new town and went for an initial consultation and evaluation with one I had picked. They do REM at this one. First thing they did was a word recognition test followed by a cleaning of my HAs and a check with their software. Then another word recognition test. Second word recognition test was very good and better than the first one. She said based on that, she did not recommend refitting me using the REM. However, she did say at the point when I get new aids, she would then use REM for the initial fitment.
Anyway, it sounds like my new audiologist must have felt my hearing aids were set up pretty well for me without using the REM process.

stops at the eardrum.

It’s a useful tool, but remember that the measurement only goes as far as the eardrum.

If your ear canal is fairly typical, what the fitting software displays is generally a good representation of what’s happening in your ear canal.

Measurements of gain, through tonal and word recognition tests, reflect what reaches the brain.

I perform for every patient.

However, let’s not overlook the limitations of REM in hearing aid fitting. If someone claims that REM alone is sufficient to fit a hearing aid, they’re either misleading you or are incompetents.

Hearing doesn’t end at the eardrum.

Good to hear. It’s often the case that clinicians who don’t do it come up with some snappy sounding reason why they don’t, which is what I feared. Glad to hear that’s not the case here.

I feel like you’re setting up a bit of a weird strawman, but at the end of the day we probably agree on best practice and I’m just misinterpreting you.

In reply to @Neville

Not sure what you mean about your statement about software not being “available”. The Jabra Enhance Pro 20s are exactly the same as Resound Nexia 9s and the Resound software will program all features of the Jabras I got at Costco.
Your comment on having to "turn up the volume and freqs. from 2000 and up to meet targets sure sounds like what my COSTCO fitter did. The result was that the volume was so loud and tinny I had to turn the App volume down to 3 or 4 and adjust the equalizer mid and high freqs way down. A follow up appt. without REM made the sound better and tolerable.
Maybe REM is not all that great for “acceptability” of the result without a “break in” period to get the brain accustomed to the “new” frequencies it has not heard for a long while?

See above.

You can mess up with an improperly placed probe tube, incorrect equalization, or incorrect placement of the patient, and overfit the highs. However, living with an uncorrected hearing loss, sound deprivation, also leads to changes in the auditory system and it can take some time to adapt to apprioriate gain. First fit absolutely is biased towards acceptibility rather than audibility. Some patients benefit from a break-in period. Others can just ride to volume for a week or two and be fine. Some research suggests setting things low to start is less likely than just fitting to target to get the patient to fully adapt to appropriate gain in the longer run, but many clinicians do it that way.

In reply to @CaptainTrips

I understand there are benefits to , but what you describe, may not be a benefit at all.
Everyone differs in so many ways beyond the ear canal and its sound conductive properties.
So while REM is good in better approaching the levels needed from the , to get through the canal’s properties, leaving it as the be all and end all of adjustments I can say from experiences is most certainly failing the patient!

Oh, I agree. is the necessary second step. But for hearing loss like mine, there’s likely more to be done.

I had my wife come in and talk for awhile so that the audiologist could manually tune for her voice, for example.

This is the reason that I abandoned Costco. I’m paying extra fo this customization from a 25 year veteran.

In reply to @IGZO

I tried the same 9050. They were just OK for me. Before that I got the Starkeys with etc from my audiologist. $4300 with AARP United Health care. They were just OK. So I got the Philips and disappointed. When I returned the Starkeys to the audiologist she said $6k for the Phonaks. So after the 9050 bombed I checked around and Phonaks are getting huge reviews. So a friend gave me an oline seller. I checked with them and they wanted $5400. They said if I looked elsewhere for online I’d get better price but less care. So I checked with Injoy and spoke to rep right away (No fill in your form and we’ll call you…). After a great chat I bought the Phonak Audeo Infinio Sphere I90’s for $3200. Came in a few days. Immediately did the facetime and set up the App (Which I rarely need to use.) And they sounded great. Then a week later another session. Best I’ve heard in yrs (I had the Oticon top tier from 2017). Did some tweaking recently–all “teleaudiology.” I had the Costco treatment and it didn’t help with the 9050s. I am 110% happy with the Phonaks. Amazing tech and work great. phonecalls clear as if the person was in the room with me. I was told TREM is a PR protocol so the Audiologist can say if you go to someone who doesn’t use it you’re not getting the best. I totally agree the fitter is key. Also the communication with the audiologist is the 2nd top key. Frankly I don’t miss driving to the , waiting in the office for an hour, a talking with a bad personality in order to get the same treatment (only in my case much better) over the phone. BTW Injoy had my from the audiologist to start. I highly recommend anyone on the fence about saving THOUSANDS with online ’s make the plunge. You’ll never regret it.

In reply to @IGZO

9050 is not Oticon Intents even though made by the same company. I tried both and bought the Philips. Didn’t sound as good as my 7 yr old Oticons. I also had near perfect customer service experiences with the audioolgy team at Costco. That’s why I don’t think they’re selling the top tier even though they say they are told they are.

@hearingMac said:

9050 is not Oticon Intents even though made by the same company

They may or may not be, no the spec’s tell us they are more like Bernafon/ Sonics from Demant.

@hearingMac said:

That’s why I don’t think they’re selling the top tier even though they say they are told they are.

They are definitely the premium models, you can’t possibly base this on what you “thought” worked best for you, so we could say Phillips are selling their “top premium” models at Costco, just like the other premium models being sold.

Edited

In reply to @CaptainTrips

@CaptainTrips said:

Oh, I agree. REM is the necessary second step. But for hearing loss like mine, there’s likely more to be done.

I had my wife come in and talk for awhile so that the audiologist could manually tune for her voice, for example.

This is the reason that I abandoned Costco. I’m paying extra fo this customization from a 25 year veteran.

Did you try Naida Lumity e.g. 90 SP? I know there is no Naida Infinio lineup yet (will be soon), but you could at least check if it would provide better audibility in quiet with soft voices.

If you don’t get the basics, like audibility in quiet, there is a risk of obtaining little to no benefit from “bells and whistles” like StereoZoom 2.0 or Spheric Speech Clarity.

See:

I got my new Phonak Naida L90-UP
I got my new L90 aid on Tuesday and am very happy so far, I only wear an aid in the right ear as the left is very bad. It is physically larger but still relatively small and that didn’t matter much anyway. It does have more power which partly explains the size I presume. So far I am very happy with it. It is picking up things that weren’t with my 5 year old Naida yet I am fairly certain helping noticeably with the background noise not being so intrusive. The old aid also had the Bluetooth …
Phonak Lumity Naida 90 UP BTE Review
I got my Lumity 90, right ear only, Tuesday and so far am very pleased. Just driving home I noticed that the background road noise was far lower than my 5 year old Marvel. It is a larger aid but not that much and doesn’t really make any difference. My experience so far is limited but clarity does seem noticeably better and I am hearing things I didn’t before. So far though it is good to hear things better rather than annoying. Right off though having full functionality again with working BT…

I was poised to trial the Naida last year and actually kept an appointment for fitment, when the Sphere was announced… but when I went in, they had forgotten to order the earmolds. I ended up trialing the Audeo 90 instead (we used the existing UP from my KS9s). After that, we just skipped over them to the Spheres, which my audiologist recommended instead.

Right now, my Spheres are dialed in pretty well.

It truly baffles me that an audiologist with a full 4 year degree would be either so cheap or so uncaring that they would diminish themselves into nothing more than a button pusher. If they aren’t doing even the bare minimum they aren’t worth what you are paying them.

In reply to @tenkan

Good points well taken. I have to say chatgpt taught me more about my than anyone in the “biz.” I had more success telling the Injoy audiologist what I needed by phone call than I ever got in person–2 in FL and 2 in . Personally I wish I could so I could nail it without intermediaries. BTW Costco is selling several tech items I happen to know are 2nd and 3rd gen away from current and with the implication you’re lucky they’re discounted. Not the Costco I know from several yrs back when “premium” really was except for the Costco special model #.

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