Oticon Intent 1 versus Widex Allure 440 + INSET vs REM

Does INSET = in situ test?

If so, it isn’t replacement for REM, because you and your audi:

1. still didn’t know, how much dB are near the eardrums
2. In situ test assess only threshold levels compared to 50, 65, 80 dB stimulus (or 55, 65, 75 dB) it is also 85/90 dB sweep tone to assess MPO of the hearing aid.

It probably stands for in situ test. No idea at all. The impression that I got is that it is something newer than the REM, but does something similar in that the test is done with the hearing aids in the ears and has the same function.

I can’t remember why he said it was better than the REM - he did explain, but I have forgotten what he said. I will ask him next time.

However, from talking to him, it is very clear to me that he is very knowledgeable and was able to explain why I was having the issues I am having with my current aids. End of the day, all that really matters is results. I will see what happens when I start the trial of the aids.

I have read this topic - Real ear measurement vs. in-situ audiometry and it is clear that some are all for REM and others think REM is not as essential as many state. I honestly don’t know enough about the issue to know either way. But the fact that many audios do not use REM does suggest it is not the all powerful solution that it is made out to be?

Also had an interesting discussion with Chatgpt about the issue and the reality is - it depends or how long is a string kind of answer. Many are for and many are against. Chatgpt leans towards Inset because Inset is used for fitting, REM is used for verification.

With regards to my new audio, apparently it is known that REM does not work well with Widex and that may be the reason why he does not really recommend REM as most likely prefers to fit Widex.

I will just simply state to him (as I am trialing both Widex and Oticon), I don’t care whether he uses REM or INSET as long as he delivers results, but I will remind him that it was only with REM that my current Oticon actually reached the point they were usable! Widex - I accept that REM does not work as well with their fitting rationale, but I know (or at least I have heard) that Oticon do advise audiologists to use REM when fitting Oticon.

Real ear measurements are:

Using a calibrated environment, calibrated equipment to measure the response of thin microphone, and then placing that microphone in the ear near the eardrum. Then the calibrated equipment will measure the sound that gets picked up by the microphone so that it can cancel that from the final measures to make the probe microphone ‘invisible’. Then the hearing aids are placed, and you are now set to perform real ear measurements and have an accurate reading of the sound pressure reaching the eardrum. Using this, you can manipulate the response of the hearing aids however you would like and see whether the sounds are audible or not. The common practice is to use a researched and reviewed prescription such as NAL-NL2 as the targets for the response, and use three levels. One for soft, medium and loud.

Nothing about this precludes any other method being used. If a provider really wanted to make a case that insitu was “better” then verifying the results with REM equipment would still be possible to verify that sufficient amplification was given for soft sounds, and that the persons uncomfortable limits were not exceeded.

If an electrician told me a multimeter was useless, I would find a new one.

@Roberto said:

My new audiologist uses INSET which I understand is a modern replacement for REM? But everyone on this forum always talks about REM, I don’t recall anyone saying go get an INSET? What do you think.

Not heard of it, but I don’t use WS product. If it’s just their modern version of Sensogram, it’s likely based on an in-situ threshold test. I’ve noticed that a few manufacturers now ‘tune’ responses based on the broadband response of the feedback manager to model the canal impedance. So it could be a combination of these technologies.

While this definitely doesn’t replace REM for verification (to Dr Cliff standards), at least hearing aids fitted this way have an indication of the canal performance as well as an indication of the veracity of the audiogram reproduction through the transducers in the aid.

It might be an uncomfortable thought for some, but there’s possibly a time in the not to distant future when self-calibrating aids become a reality. Ball-park them with an audiogram and then let the floating fuzzy logic do the rest.

AI Overview

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Real Ear Measurement (REM) and inset (or in-situ) hearing aid testing are both methods used to verify the effectiveness of a hearing aid fitting, but they differ in how they measure the sound pressure levels in the ear canal. REM uses a probe microphone inserted into the ear canal, while inset audiometry measures hearing thresholds directly through the hearing aid.

Real Ear Measurement (REM)1:

• How it works:

REM measures the sound pressure levels in the ear canal while a person is wearing their hearing aids. This is done using a probe microphone inserted into the ear canal to measure the output of the hearing aid.

• Purpose:

REM helps audiologists determine how well the hearing aids fit, make any necessary adjustments, and ensure that the hearing aid output is in line with the prescriptive targets.

• Advantages:

REM provides accurate measurements of sound pressure levels inside the ear canal, allowing for fine-tuning and optimization of hearing aid performance.

• Disadvantages:

While accurate, REM can be time-consuming and may require multiple visits for adjustments, says The Hearing Solution1.

Inset (In-Situ) Audiometry2:

• How it works:

Inset audiometry, also known as in-situ audiometry, measures hearing thresholds directly through the hearing aid.

• Purpose:

Inset audiometry is used to verify that the hearing aid is providing the appropriate amplification and that the patient can hear sounds within the prescribed frequency range.

• Advantages:

It is a quicker and more direct method of assessing hearing aid performance.

• Disadvantages:

It may not provide as detailed information as REM about the specific sound pressure levels in the ear canal, and the results may be influenced by the hearing aid’s own characteristics.

In summary:

• REM offers a more detailed and accurate picture of the sound pressure levels in the ear canal while the hearing aid is in use.
• Inset audiometry provides a more direct assessment of hearing thresholds through the hearing aid.
• Both methods are valuable tools for verifying hearing aid fittings, but REM is generally considered best practice in verification of hearing aid fitting says Marin Hearing Center.

I have enjoyed the many comments here. The only one I find missing is that many audiologists do not want the expenditure to purchase a REM system. So they stay old school. Insitu is still dependant on the patient to respond which can vary during the day and really is more aided soundfield testing but uses the hearing aid to present instead of a speaker.
The AAA standard recommends REM and its purpose is non patient involvement to indicate best fit. I will also acknowledge it does take a little training and patients may have complaints on this but from these settings you have a better idea of what is going to the eardrum ™ and what you need to do to adjust it.
Personally I would only use an audiologist who uses REM. JMHO

@Dr_Palmer said:

The only one I find missing is that many audiologists do not want the expenditure to purchase a REM system.

Perhaps this is the reason why so many audios don’t do it? I have no idea how much they cost.

I have gone in to get my moulds done now. He has done moulds with 2 bends as he said that is much better than moulds with one bend, which a lot of audios seem to do. In a couple of weeks time, I will be able to report back when he fits both hearing aids (Oticon and Widex). I will trial the Widex first for one week and then the Oticon.

He has said that Widex no longer do the Sensogram (or whatever it is called) where the audiologist could manually tweak it. It is now completely automated and he is not happy about that. So, he said that the Oticon may now be a better fit because he doesn’t know how good the automated configuration is that has come out with the new Widex model.

Can’t wait to try them both out as I have no experience of Widex and apparently the new Oticon Intent are a big upgrade from my Oticon Opn S1 in terms of speech clarity.

@user490 said:

From what I can see it’s not cheap but also not expensive (mid four figures?) when one considers what audiologists are asking consumers to pay for hearing aids (mid four figures), sometimes with an over 100% markup built in

Source:
Simplifying hearing aid fittings with TargetMatch | Audiology Blog2

Another article (bear in mind this is Phonak-biased blog):
REMs: Worth the extra time? In my opinion, yes! | Audiology Blog3

The ear canal has two natural bends or “turns”: So designing the mould to go past the second bend/turn is what prevents feedback and makes it fit better. I don’t know if he is doing a canal lock - or if that is the same thing. But in short, he is doing a really deep impression. He says a lot of audios only go up to the first bend in the ear instead of both bends. So they fall out or they have feedback.

Hope that helps explain. I think you are doing the same thing, just different terminology?

I guess that is why many audios don’t use REM as they probably find its a startup cost that they don’t find worthwhile to them? I guess smaller outfits may not get quite the volume needed for ROI? Interesting to see what it costs.

the canal lock sits in the bowl of the ear to help hold the mold in. Especially helpful when there is significant jaw mobility affecting the mold as it can tend to work to push the mold out