Skip to content
HearingTracker
Log in

Audiologist "doesn't do" REM?

114 replies4k viewsLast reply

Jump
Link to this topic
Reply
@hearingMac said:

I happen to know are 2nd and 3rd gen away from current and with the implication you’re lucky they’re discounted

Really?? What models are you talking about? As far as I know they are only selling the latest premium models.

They are the latest models. At most they are a few months until the signia line turns into Reach, oticon into Philips etc. It is often parroted that they are years or multiple models old but this is patently untrue.

Edited

Oops… I’ve got to update my description. They were delivered with a P receiver, but upgraded to UP as mentioned elsewhere. Initially, the audiologist thought that P would deliver better quality high frequency response, but we abandoned that quickly due to clipping.

In reply to @Neville

@Neville

Is another factor age? I’m 78 and got my first real hearing aids just about 15? years ago.

My dispensing Audi used ; even though I had hearing aids for some time, he set things low to start. And the “longer run” was quite some time.

Finally, I’ve been told that workman’s compensation makes audis work really hard to get paid (lots of paper work.) In the time that I’ve been supplied I was told by Peel Audiology some time ago that they’ve gone through periods of cost cutting.

I’m very grateful that my current provider took me on when he couldn’t provide new hearing aids.

@DaveL said:

Is another factor age?

Yes. I don’t think the direct research exists yet to support that, but yes anecdotally I would say that age is a strong factor in how easily people adapt to gain.

@DaveL said:

I was told by Peel Audiology some time ago that they’ve gone through periods of cost cutting.

Yes, WSIB changed their reimbursement last November from fee for service to a bundled model that seemed to be based on some sort of average. The result is that clinics doing the bare minimum for patients got a pay raise and clinics providing preferred practice got a pretty heavy pay cut. So yes, we’ve been scrambling to figure out how to meet our high standards in less time. BUT, they can still afford to book you two appointments to make and then fit custom tips. Or… Maybe things really are THAT expensive in Toronto.

@hearingMac said:

I was told TREM is a PR protocol so the Audiologist…

As opposed to best practice according to every audiological oversight body for the past three decades? Clinicians who don’t do really will say the damnedest things.

There was some research out of boystown a few years back looking at what predicted language outcomes in children with hearing loss. They looked at all sorts of SES and speech therapy and school factors in my recollection and at the end of the day the biggest factors were: hearing aid wear time and deviation from prescriptive targets on REM. This is pediatrics of course, but it’s illustrative. At the end of the day, the brain can’t use what it can’t hear.

In reply to @Bimodal_user

@Bimodal_user said:

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.

Speech Enhancer works well for me in ‘Calm situation’. It just gives me a little more clarity

Ive been reading thru the comments and the first question I have is this. If she doesn’t do RE (sadly) she should at least be doing soundfield (SF) aided vs unaided warble tones and word recognition. It is an old method but a good method still and is what RE replaced. So if she hasn’t done the SF then you should ask her to do it. It is a standard in profession and part of best practices. This will give here the areas she needs to focus on to fix your concerns.
But, also there are almost always some voices more difficult than others to understand. And I’m not sure what your WR ability is but I’m betting its not 100%.

In reply to @Um_bongo

@Um_bongo said:

If you’ve got the option: nearly occluding fitting (1mm vent), music program and subtle gain with a volume control. Build it up 10% week on week until you get to where you need it.

Just making notes to take back to y audiologist on Monday. So, at my last appointment before my trip, I had the power domes put on, and also had the high and mid frequencies boosted a bit.

When the power domes are in the right place, they sound excellent. However, some sounds – mostly soft male voices – are a bit muddy. Does this imply that the boost to the low and mid frequencies was too much? I tried fiddling with the equaliser to answer this question, but couldn’t make up my mind for sure.

The power domes are tricky to get int he right place, and are pretty uncomfortable. The right one also has a tendency to squeeze itself out. So, definitely going to ask for custom tips on Monday, and will ask for these to be nearly occluding with 1mm vent.

Regarding the music program, are you saying I should have this as my default? Sounds odd? I currently just have whatever is the standard program. Someone else mentioned asking for the 360 degree program?

I’m not sure how long custom tips takes, but I jet off to New York on the 13th, and I’m guessing it won’t be before then. I’ll be there for quite a few weeks. Is there an audiologist in NYC that anyone would recommend?

The price of a machine can be as low as 5k (and even cheaper if they buy used). Pays for itself quickly because patients do better, refer friends, need fewer follow up appointments, and return their hearing aids less often. It’s a no brainer and astonishes me that it’s not universal in 2025. We’ve known about the benefits for decades.

Edited

@abrambaileyaud, getting rid of habits is very difficult, and if the “young” employee tries to suggest something to improve, I suppose it threatens him in extreme cases with losing his job for “smarting off”.

EDIT:

I found perfect post describing the situation. @Neville, I hope you don’t mind copying this here:

Real ear measurement vs. in-situ audiometry
My father once told me about an experience he had in a continuing education class for doctors. A question was posed about particular treatment for a particular condition. He carefully researched current guidelines and recent evidence indicating what the best modern standard of care was, and provided his answer with citations. Another doctor answered, “I do [some other answer] because that’s the way I have been doing it for 30 years.” And that’s why some providers don’t use REM.

In reply to @Bimodal_user

I don’t mind at all. Though to be fair, my father was in his mid 50s when he took that course. He spent much of his career with a metaphorical horse whip, pushing the doctors around him to do better to the benefit of our local hospitals and patients, our province, and sometimes to the detriment of his interpersonal relationships.

But yes, young employees can absolutely get knocked down anywhere if they aren’t bull-headed enough.

@Neville said:

Though to be fair, my father was in his mid 50s when he took that course. He spent much of his career with a metaphorical horse whip, pushing the doctors around him to do better to the benefit of our local hospitals and patients, our province, and sometimes to the detriment of his interpersonal relationships.

But yes, young employees can absolutely get knocked down anywhere if they aren’t bull-headed enough.

Thanks. Oh yes. Speaking for myself, a few years ago I was forced to leave my job because during working hours I often suggested a new way of doing something, more in line with the guidelines. I made these suggestions in a friendly way, without belittling or malice to anyone, to be clear, but it didn’t help, they only saw what they wanted to see… It was after almost first year of my work.

Of course I had to be very stubborn and still friendly with some guarding to not let them cross my boundaries…

I had impressions taken for the custom molds today, and also had smaller power domes put on while I wait, These are much less uncomfortable.

They have said they’re not going to get the machine for after all. I also asked about sound field testing, and they don’t do that either. They did something I think they called in-situ auditory testing, and that has definitely made some improvements, even with the smaller domes.

We’ll see. I have an appointment on the 29th to get custom molds put on, but I probably won’t be back from New York by then… I might just order a new set out there, if I can find an audiologist I like.

I had a similar issue.
Peel Audiology.
New graduate.
Power Domes
Lasted two days. (One of my ear canals is large; one is medium) He didn’t bother to check.

Oh…another issue. He gave me two spares. So I had to return if I ran out.

A good audi is amazing!

It’s very frustrating. My audiologist is very nice, easily available, and somewhat patient, but she doesn’t seem to know much beyond the Genie 2 fitting software, and she doesn’t have necessary equipment.

I’m off to New York for a while on Sunday, and I’ve emailed the Adult Hearing Aid Dispensary at the New York Ear & Eye Infirmary of Mount Sinai. Hopefully they’ll be… well, better.

So I’ve spoken to an audiologist at NYEE and they seem great. They’ll do , sound field, and other things. They’re just gonna take new impressions next week and order molds from Oticon US.

She does also say, “the upward slope of your hearing loss makes listening in noise very difficult. Hearing aids these days are smart, but not that smart!”

Still, it sounds like they’ll do the best they can with them. And, hey, maybe when I upgrade next time, it’ll be even better.

Related discussions