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

@Neville said:

If someone has a perforation, for example, the audiogram if done with custom tips can show a low frequency loss which isn’t really there but it’s just an artifact of the ear canal volume being much larger (because the middle ear is included).

yeah my surgeries have left my middle ears open and available for removing material from my mastoid. Makes for interesting fitting decisions.

Oh, nothing to worry about then with the probe mic.

Yep, my accredited surgeon has a lot more instruments to work with than my audi with his REM probe.

Brilliant!

No, she just means that there’s no obstacle to hit with the probe tube.

As far as I’m concerned, REM is a gimmick. I’ve multiple Audis/HIS perform REM and never once did it make the HAs better. In every single case (at least 10 different fittings) it made them worse. The initial first fit software and then manual adjustments work best for me. Too many people listening to Dr Cliff.

This just isn’t true. I’ve been fitted for hearing aids many times over the last 25 years and I’ve always benefited from REM. It isn’t a gimmick.

Jordan

REM has an important place in a fittint, and that is to ensure that your aids perform the way they should in your ear canals. But that doesn’t necessarily mean you do the REM and stop there. It is a starting point. Actually the REM for me leaves me with no speech understanding. But my aids are adjusting to 110% of my audiogram and not 80 to 90% like so many aids get set up.

On my previous hearing aids, REM made a massive difference. It turned hearing aids that were not well configured, where I was struggling to hear into aids where I could actually hear in most environments - although still not amazingly configured.

Like I said in an earlier post - REM is useless if the fit is not good. Or rather in my case, while it helped with my previous aids, because the fit was poor, REM was still not optimal.

However, with my current aids, the fit is considerably better as my current audio is far better than the previous.

REM obviously did not help you, but that is not to say it doesn’t help others! Others for example Widex for it’s natural sound. I, on the other hand, found that I could hear everything except what I was trying to hear with Widex. Does that make Widex a bad product?

I suspect the problem with REM is that it may have increased the lower frequencies too much overwhelming the higher frequencies, so the clarity of speech was lost? I don’t know, but that would be my guess.

I agree with others. I would consider REM a starting point

Is it possible they were just going through the motions? Or that there were other limiting factors such as less than ideal acoustic coupling? Why make such sweeping statements based on limited data?

A couple of things. As an audio file, not audiologist, but someone who’s had a lifelong obsession with music reproduction being accurate, I can absolutely say that the theory of REM is 100% correct. Correct. However, in practice it may not necessarily be that everybody likes the result.

I don’t think the only reason for an audiologist to not do REM is the cost of the equipment. In fact, I think it probably has more to do with the extra hassle and time involved in it, and also that there’s going to be a certain percentage of patients who don’t like the result, so the audiologist just skips it because in the past they never had to do it.

From my perspective, I don’t understand your hesitation to drive 1 hour. To me, at least living here in Southern California, that means pretty much nothing. Distances, or not necessarily distances but time in the car. And 1 hour is pretty much nothing. If this is what it takes to get you happy with your hearing. A couple of 1-hour drives shouldn’t be important.

Lastly, if you want to hear what it sounds like in the backseat of my car, listen to this

Source: YouTube https://share.google/s5dfb1YD8GuqMmgiy16

Did you need the 105dB receivers due to the 110% fitting?

Are you not very near your uncomfortable levels?

How common is it for people to overdrive the fitting by 10%ish?

It is a long story but the short answer is it took almost two years of therapy and many adjustments to find my level to be able to understand speech. Yes I have a lot of overhead left in the receivers, that is why I don’t get any feedback issues. And my wife says she hears what I hear.

@drcrandon said:

From my perspective, I don’t understand your hesitation to drive 1 hour. To me, at least living here in Southern California, that means pretty much nothing.

If I was living in South Africa still, I would agree with you. An hour is nothing.
But living in the UK, near London, it’s an hour in a lot more traffic, at slow speeds.

It is just not comparable. It’s not really the distance or time, it’s the traffic that is un-enjoyable.

I have only limited opportunity to test the hearing aid in Nal-NL2, but as far as I can tell, it’s only an improvement over the default fitting. Especially when I consider that Nal-NL2 is at default settings, with no changes from my audio.

At default:

• I can hear reasonably well on the phone, but would like that improved a bit
• Hearing in the car has actually improved, although still issues
• Hearing people, especially certain people speak softly - still issues
• I need more testing on this, but it doesn’t seem like I have any volume imbalance issues using NAL-NL2, but this more needs more testing in environments where I know this is a problem.

I believe that NAL-NL2 along with REM and maybe minor tweaking should be all that I need. I have zero issues with NAL-NL2 in terms of too loud, too sharp etc - I was actually quite impressed and there is definitely a big increase in clarity of speech compared to Vac+ and this is all on NAL-NL2 on default settings! Vac+ on default settings, was nowhere near as well suited for my hearing and required a lot more tweaking. I will push for a bit more higher frequencies, but it is clear that NAL-NL2 has done most of the boost I needed.