Your Audiologist is Wrong: Real Ear Measurements are ESSENTIAL for Your Hearing Aids to Work Well

Didn’t much of Canada cover only one for a while? Need two get one. Need one get none.

Yes, it’s still the case where I am that most adults are only covered for one, but for the last…at least ten years kids get two.

What therapy are you referring to?

It was a program let by a speech therapist but was tuned to listening to understand what was being said instead of how to pronounce words. It is a means to concentrate on what someone is saying. And it was tuned to being able to do so without having to strain to understand. It worked a long with slowly having my aids having to volume increase. My aids are actually set gor more sound power than what my audiogram indicates I need. Because of that I hope I never have to have a different audiologist to deal with. In the frequency range of 1500 to 4000 my aids are set to 110% of prescription and my lows are set to 105% and my highs are set to 90%. Of prescription. I wear 105db receivers where the fitting software says I need 85db receivers.

Aliasing, as you know, arises when audio frequencies come into conflict with those of the digital sampling - and usually, hopefully, only when audio is a bit too high level. Further, lower, frequencies get added. You make a good point about individual hearing: yes where normal high sounds might mask some lowdown aliasing, those of us who don’t hear much highs may well be more aware of junk in the lows.

My HA’s created crud out of highs that I could not hear - and it was remedied by rolling off highs above my cutoff of 4 kHz. Playing a little keyboard in clinic gave the clinician the info she needed.

Something comparable was happening when I fed my keyboard into a digital delay box (not wearing aids): Top octave, to 4 kHz, played upwards, brought on a descending pitch - not at all harmonious! Simple remedy again: Roll down the top end.

In case anyone finds it useful, here is an /s/ and /sh/ sound: Western University9

Allow me to toss a little kerosene on this REM discussion.

In 2021 I was wear Phonak Marvel 70-R with power domes. These were purchased in November 2019 and REM was NOT performed because the audiologist did not believe it was beneficial.
I was preparing for an extended International trip and I decided to roll the dice to present myself for REM fitting. I was already having trouble hearing conversation at retail point of sales and restaurants. Read that again. It’s not that conversation wasn’t clear, I couldn’t pick up anything.

I have posted fitting reports from March 2022. The top fitting report was non-REM using NAL-NL 2 and the bottom is REM fitting, also using NAL-NL 2. If you look at the gain values for Speech in Noise program for both fittings, the REM fitting did provide more gain than non-REM.

REM fitting DID NOT allow me to hear any better in challenging environments, i.e. retail point of sale; airport check-in; hotel check-in; open air markets and restaurants. Conclusion? The Marvel 70s had insufficient noise filtering, which is the same problem I am having with Infinio 90-Sphere when background reaches 75db.

If you look at my audiogram on these photos and compare to what is on my profile, I had better hearing in 2021/2022 than I do now. Yet I struggled greatly with background noise. The Infinio 90-Sphere probably would have been a miracle in 2021, now they are just ok.

I will let everyone draw their own conclusions about REM. Have I considered REM fitting with the Infinio 90-Sphere? Yes and I had a discussion with one audiologist. I was told REM would NOT allow me to hear conversation any easier. I was quoted $500.00 to perform REM fitting. Will I get $500.00 worth of better hearing? I have serious doubts.

I have a severe loss and for others that have a serious loss, what has helped speech intelligibility (TV & radio sound, Bluetooth music streaming, speech in Calm Situation ==> Switching to Adaptive Phonak Digital Contrast algorithm and choosing Semi-Linear Compression.

Thanks for reading.

My usual AuD is an hour away. I am trying a new one two hours away to see if there is improvement. I have a CI and 2 hours is the closest in state office that services my brand. I figure it’s worth the try to see if I hear better. It’s not that I have to go very often. Hope you get some better results soon!

@Bimodal_user said:

My questions which arised after REM:

1. Why, after using the REM with both the Paradise and the Sphere (both with DSL), am I off target with the low frequencies up to ~400 Hz, especially to 180 Hz?

• Is it because the 0.9 mm vent in Paradise allows LF to enter?
• On the other hand, the NAL-NL2 fitting is almost perfect. Perhaps this is due to the imperfect REOG in the NAL attempt?

2. Are the REM results suggesting which vent I should use? Or should I not use a vent at all? This is probably the most important question, because I’ll soon be sending my titanium earmould to be remade with changing from P to UP receiver (main cause of complaint is AOV vent in Sphere cShell instead of ordered 0.6mm).

I’ll consider getting UP receiver with silicone earmold in another place than Phonak manufacturer “for science”.

3. Why, despite getting the targets even in the loudest DSLv5 pediatric, the final volume was so quiet for me? The sounds have definitely too little power after fitting, especially in the low freq.
   It’s because of that subtle new audiogram difference than previous ones? Or it’s simple my hearing habit?

I am a bit shy to ask for it, but I’ll get the job soon and it would be good to finalize my issues with my eamold.

Does REM in the cited post gives any useful info before remaking earmold? Currently I use Sphere with Unitron power domes with P receiver. @Neville, @Um_bongo, @Hearing_Potential?

I plan to buy cShell with UP rec., I’ve not know with which ventilation yet.

I don’t think 0.9 vent versus no vent will make a difference for you. Looks like your feedback control is perfect, closing it won’t make a really audible difference. I don’t know if opening it is ont he table–sounds like you’re not bothered by the closed fit.

As for the other questions, it’s just really hard for me to know without you in front of me hooked up to the system. It’s also weird looking at insertion gain rather than SPL at the eardrum.

@Bimodal_user said:

However, in accidental NAL-NL2 fitting REIG of the lows is normal…

Yeah, I saw that too. But I don’t know off-hand what it is. I’d need to have the software and the Avant in front of me and start poking around. Can you hear it?

Not really feel a difference, maybe because of my probably overamplified HA, before procedure:

@Bimodal_user said:

There is my graphs before REM-based fitting:

Now I have NAL-NL2 +9 step up gain in all frequencies, and +2 steps in 1-2kHz so for now didn’t hear it. It’s the only algorithm, in which gain could be increased without destroying the proportion of particular channels gain.

@Bimodal_user said:

rely on compression, which is safer when there is a very loud noise source

Doesn’t the UL limit loud sources irrespective of compression?

@user490 said:

Doesn’t the UL limit loud sources irrespective of compression?

Yes and no. Anything really loud will come in around the hearing aid and you should be wearing hearing protection instead (with some caveates for well fit full silicone molds) so we’re talking about regular loud noises. MPO manages loudness comfort. Damage is caused by your volume dose over time. I’ve said elsewhere, we know that DLS child targets are safe. We don’t know whether or not anything above them are safe. If one is fitting above DSL child targets, you’d need to start looking at threshold shifts.

@Bimodal_user It’s rare that I have to turn hearing aids down so much to meet targets. It’s a bit odd. Do you have really tiny ears? Or custom tips that are so deep that they basically reach your brain?