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Question On REM

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I purchased Oticon Intent 1 ’s through ZipHearing a couple of days ago. I will be getting them fitted locally next Wednesday.

I called the local Audi yesterday to make sure he performs as part of his fitting procedure. He asked me why I wanted REM. (??) I told him I wanted to verify what I’m actually hearing matches my settings so adjustments can be made to match.

He told me he normally doesn’t do REM, but will do it If I want to have it done. He said with newer hearing aids REM doesn’t take into account when other features kick in on the hearing aids. I’m still trying to wrap my head around why that would be the case. That doesn’t make sense to me. I would think everything would be relative.

What do you all think?

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First, I might ask the audiologist why Cliff Olsen and Andrew Allsop, the two most popular influencers of hearing aid knowledge on the planet, have never mentioned anything about that and continue to state that R.E.M. is essential for accurate hearing aid programming to a specific users anatomy. If they claim never to have heard of these two people, I would look for another audiologist.

Secondly, I might also ask them if they are knowledgeable and capable of using the hearing aid manufacturers software that automatically incorporates results. An example that I know of is Phonak’s TargetMatch. Oticon call theirs REM AutoFit.

The only thing that does is measure the sound level near the eardrum, nothing else .

His explanation doesn’t make sense to me because REM doesn’t automatically change anything. It’s just a measurement that can help the fitter refine the programmed gains.

It’s like a doctor saying he/she won’t take your blood pressure because you’re already on blood pressure medication.

If a / told me this, I would seek another one because I would lose trust in him/her. However, he/she agreed to do it. I hope everything goes well.

Just doing is not the issue, does the person know HOW to use REM to fit the hearing aids. I personally witnessed a friend going to Costco for a fitting. They did REM but did not know what to do with the results. If he normally does not do REM, he may not be the best at using it to fit the instruments.

Edited

I failed to mention that he also said he has better results with feedback to make adjustments. Problem with that is I can never express properly where I need to have adjustments made.

I do my own self programming with In-Situ after the initial hearing test and fitting. So I’m not too worried as long as he agreed to do .

My first hearing aids, ~15 years ago, were the first Phonak Audeo. The also didn’t do REM and I must have gone back 7 or 8 times for adjustments and was never happy.

I bought the Oticon OPN1 6 years later and started doing my own programming. I’ve been happy with my results ever since.

As far as knowing what to do with the results, I’m pretty sure I will be able to incorporate them if he can’t.

Edit: For fairness, I want to add that the audi, “Hearing Experience” has a 4.9 rating on yelp. So they have a pretty good track record.

Edited

Keep in mind that about 66% of audiologists in the US who fit hearing aids do not use . One of the audiologists on this channel noted that REM can be more helpful if your ear canal differs from the average. Once hearing aids are fitted just with first fit (fitting shown in the fitting software based on your ) or REM that is just the beginning because then adjustments will be made to make you hear as well as you can through a give and take with the audiologist. Having a YouTube channel with a lot of clicks does not make you the end all of audiology. Those of us who just make adjustments until we can hear as well as we can, usually without REM.

Edited
@Mikejl said:

He said with newer hearing aids REM doesn’t take into account when other features kick in on the hearing aids.

This is untrue. My now great Infinio Sphere 90 was near the crap when the basics weren’t fitted appropriately.

“Basics” - I mean proper acoustic coupling, wire lenght, receiver power and proper amplification reaching verified target.

No or another bells&whistles (“features” in the quote) will provide you audibility and clarity if you have insufficient gain.

Edited

So isn’t magic but it does tell us a lot more than just the at the ear drum. the point of measuring the SPL at the eardrum is to make it conform to a prescription level for each frequency at various input levels. those prescriptions are based on decades of research. depending on the REM software you can also see if once reaching the prescription, if that frequency is then audible. and if not, your audiologist can focus their energies on other frequencies or managing expectations instead.

it can tell you if once the feedback manager is kicking in what kind of limit is on the volume at particular frequencies. and all of that is not even half of it.

my audiologist once said “REM is just a starting point, and if I put something in your ear i think i have an ethical responsibility to measure it if only got safety.” you could scoff at this because I did at first but the REM’d response has always sounded 1000x better than the first fit.

i think the youtubers are smug, self important w*nkrs but there’s a reason why REM is gold standard and the clinics that don’t do it are always forced to justify not doing and lash out at those who do for slavishly sticking to “rigid guidelines”.

@choccybiccy69 said:

it can tell you if once the feedback manager is kicking in what kind of limit is on the volume at particular frequencies. and all of that is not even half of it.

If feedback threshold does not allow someone to set the desired gain according to or NAL-NL3 or 5.0, this is an indication that you should change the acoustic coupling to a more closed one.

@choccybiccy69, out of curiosity, might I ask what hearing aid you use? Naidas?

@Mikejl said:

He said with newer hearing aids REM doesn’t take into account when other features kick in on the hearing aids.

Hi Mikejl,

What you said mirrors some of what two different audiologists told me. The can hear what is getting to my ears, but it has no way to know what happens as my devices modify the sound. They can, on their computers, see a real-time graph of the sound with the device’s modifications- without REM instruments.

As I understand it, a lot or REM versus No-REM measuring has to do with the cause for hearing loss. For me, it is mostly in the brain, not the ears.

Also mentioned was the importance of REM for certain brands/models of hearing aids, as well as for certain hearing loss causes. So, they aren’t anti-REM. They use it when appropriate.

I suppose it is like a machinist measuring things. She may really, really want to measure the diameter of a bore with a rule, but a bore gauge & micrometer will be more accurate. All situations are different.

I’d not dismiss an Audiologist simply because he or she doesn’t do REM for you.

Paul

In reply to @raylock1

@raylock1 said:

Keep in mind that about 66% of audiologists in the US who fit hearing aids do not use REM.

Best practices and standard of care is not defined by what the holdouts refuse to offer. Use buying power to go to the 33% and forget the rest. Tell them why. is unlikely to result in a worse fitting when compared to the lack of REM even if the fitter may not be competent with REM. You can ask to see the screen and check the amplification follows the prescription target curve.

If they are not using REM you are paying for what you can easily do as for essentially your time. At least with REM you’ve gotten use of the office equipment.

Edited

In reply to @PJB12

@PJB12 said:

She may really, really want to measure the diameter of a bore with a rule, but a bore gauge & micrometer will be more accurate. All situations are different.

This is not analogous. It’s saying not to measure the diameter at all because it’s not going to be accurate enough. You measure to confirm you are not only in the ballpark but very close. You can adjust from if there is reason to do so. If you do not measure you have no way to verify that the aids are delivering amplification close to target and sometimes they can be significantly off. There is no legitimate justification. The American Academy of Audiology and American Speech-Language-Hearing Association both recommend REM as standard practice for all hearing aid fittings. They are saving money and time and training and providing less verifiable patient care at the same high price.

In reply to @PJB12

pure rubbish from them though because they can just turn the sophisticated processing off, do one measurement, turn it back on and do it again. they are LAZY or don’t have knowledge and don’t want to admit it. OR company policy forces them to cut corners.

in the Phonak target software there’s a “verification mode” that switches them off. I’m guessing the software for other brands have them too.

In reply to @choccybiccy69

@choccybiccy69 said:

yep, like I said i didn’t cover everything. i

What’s your ? Left, rigt and ? You are probably eligible for evaluation. It doesn’t oblige you to the surgery and can provide you much useful information about your hearing.

I have CI in my left after over 25 years of no using, and the results are very good and I don’t even hit the ceiling.

@PJB12 said:

The REM can hear what is getting to my ears, but it has no way to know what happens as my devices modify the sound.

Could you elaborate? The probe definitely measures sound pressure level in (Real Ear Aides Response) so when sound is processed by the + unprocessed sound gitting through the venting by direct route to the eardrum if vent is wide.

@PJB12 said:

They can, on their computers, see a real-time graph of the sound with the device’s modifications- without REM instruments.

That graphs are HA microphones measurement, that says too little what is reaching to the eardrum. So, REM is still necessary.

@PJB12 said:

Also mentioned was the importance of REM for certain brands/models of hearing aids, as well as for certain hearing loss causes.

The necessity of REM is independent from the HA model or manufacturer.

@PJB12 said:

She may really, really want to measure the diameter of a bore with a rule, but a bore gauge & micrometer will be more accurate

Okay, the It can fit the hearing aid like 80% well, but why can’t it fit 95-100% well? The patient often pays a lot of money and has the right to have the potential of the device used to the maximum if the situation allows it, and most often this is the case.

The other thing that is important for, especially in new users, is showing them what they should be hearing. A lot of people who wait on getting hearing aids get used to listening to the world through the filter of their hearing loss and when you first get hearing aids, good audibility does not necessarily sound good and it takes time for the brain to adapt and for things to sound good again with proper audibility. If you’re working without REM and just going by “sound okay?” then you are often going to be underfitting, and then the patient lives with underfit hearing aids for years and years and reaching better audibility becomes even harder. Like, if you went to a physio after an injury and they just never tried to get you back to full range of motion. On the other end, if you’re pushing a patient to try to adapt and you didn’t do REM. . . you have no idea what you are asking them to adapt to. Maybe the gain really is peaky and gross and you’re just saying, “Suck it up and get used to it” and it’s legitimately junk.

@choccybiccy69 said:

directionality, speech enhancement and noise reduction

You can measure all of these things in the testbox. You can measure directionality on the ear with the verifit. But none of the special features are going to do anything at all if the speech sound you’re listening for is literally inaudible.

REM has been available since the 80s. There are REM systems available that are cheaper than a pair of hearing aids. I feel like if a clinician is not doing REM, what else are they not doing? What other preferred practices are they not following? Infection control? Are they completing their continuing education hours? Just do your job. Drives me nuts. Clinicians are like, “REM isn’t the be-all-end-all” and no, it’s not. It’s just one of the basic standards. If it’s too hard for you to learn, how’d you get your degree in the first place?

@PJB12 said:

As I understand it, a lot or REM versus No-REM measuring has to do with the cause for hearing loss. For me, it is mostly in the brain, not the ears.

Your hearing thresholds are normal? (Hearing aids for normal hearing individuals should still get REM, not in spite of being experimental but because they are experimental.)

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