Real Ear Measurement: Real Significant?

The VA did, or at least the clinic I go to did and still does.

I got new Oticon hearing aids this Spring, and I was the one to push for Real Ear Measurements. Just setting the hearing aids based on my hearing test means that I still end up missing a lot of the boost that I need to hear well. It makes a HUGE difference for me. Your mileage may vary, but I’ll pay for that out of pocket every year with a giant smile on my face.

I was fitted with KS-8 hearing aids at Costco in early 2018. They were doing REM then.

A lot of stuff posted here. If I had to venture a guess as to why many independent audiologists don’t use REM is due to the cost of the machine. A good REM, such as the Aurical^® Freefit, can run over $6000. If someone has been fitting for years without using one, they may simply believe they don’t need one.

I’ll say this - when I bought both my KS9s and Sonite Rises, I asked to test them prior to final REM measurements and adjustments at Costco. To test, I walked around the store, talked to my wife, walked outside the store, sat in my car, etc both before and after the final REM adjustments. To me, REM greatly improved many of the nits/minor issues I’d have observed/asked to adjust during fitting. And at Costco, there was no extra charge - it was simply part of the fitting.

So, it’s up to the individual. If you think you’ll be happy without an REM setup, then you most likely will. And if you want to have another step in the fitting to possibly refine your fit, then you’ll be happy that way. I know for me, I’d insist on an REM. To be honest, my experiences at Costco with thoroughness of testing AND fitting greatly eclipsed the experiences I had with independent audiologists who never could seem to get my fit right, despite many repeated visits (this isn’t meant to bash audiologists, at all - just relating my experience). In the end, I never kept my aids past the trial with the aids I was looking at from audiologists. But I’ve been very happy with my two experiences at two different Costcos, 5 years apart.

@tenkan said:

I don’t think it’s that, 6k-they sell a set of HAs for that (or more!) so 3 or 4 sets and they’d have it brought.

… and the reason they charge that much is because of the degree hanging on the wall that says that says that they follow evidence-based best practice. I mean if you charge that much you do absolutely everything- even if you’re a bit meh about it- to give the client the best chance at a good outcome.

Yeah, I’m not sure it’s money either. The Verifit is closer to 20k CND and there’s annual calibration/upkeep/repair and single-use disposables that sort of nickle and dime you every appointment (or loonie and twoonie you, really). But you spread that out across its 10+ year lifetime and the hearing aids you fit during that time and it doesn’t add an enormous amount to the device/appointment cost. I think the barrier to adding it is more sunk educational time, uncertainty in where to go for help/mentorship/answers, and maybe the unwillingness to admit that you are potentially doing a sub-par job without it.

When making the change from KS9 to Rise, I also had a fresh work up with complete testing. So, they sounded better right away (but I was able to update the audiogram and get my KS9s sounding better to me). The Rise is way better in a noisy situation, such as a restaurant. And the Easy Remote software, offers more controls for reducing background noise, widening/narrowing speech pickup, increasing soft/decreasing loud sounds, etc. It’s MUCH better in reducing wind noise, possibly due to the mic placement. And streaming, in the app on the iPhone is far easer with a simple slider switch to enable/disable. If you are a DIYer, there are more controls when setting them up, including access to tinnitus management. Since KS9s were Marvels, and KS10s were the next gen of Phonak, I may be experiencing a greater number of new things than you may. There is a chart somewhere in one of these “Sennheiser Sonite Rise posts that illustrates all the differences. My subjective appraisal, though, is that they were a very nice jump up from the KS9s.

I mean, REM is one PART of best practice. But listening to the patient, co-develping goals and monitoring outcomes is another.

However, one role of an audiologist is to moderate patient expectations. Hearing aids can’t do everything that we want them to do. But the idea of moderating expectations without confirming that you’ve actually hit a limit is something that I find pretty upsetting. Or, to put it another way: patient has zero audibility, first fit hearing aid gives them 30% audibility when an appropriate fit could give them 65%, but because the clinician has no idea when the patient comes back to discuss their outcomes they just counsel on reasonable expectations. They don’t just turn them up because of fear of damage (because they don’t know that the patient is underfit) or because the patient reports that then it is too loud (when actually it is just peaky at one frequency but the clinician has no idea, OR the gain is appropriate and the patient needs to adapt but the clinician has no idea). So patient continues on thinking that their hearing aids are doing the best they can, and they live underfit and struggling for decades and maybe eventually see someone who wants to do better, but now the patient has been sound deprived for so long that they cannot tolerate more gain and their clarity has gone to crap.

@bradw said:

but with adults that can communicate, it’s more efficient or whatever to just say…”I still strugle to hear my daughter when she says F sounds for example….

I think that’s a common attitude. I also think it’s kind of nuts. It assumes that all adults have the ability to identify and isolate their own hearing deficits and the language to communicate that to an audiologist. And great, really, for audiologists who spend the time teasing that stuff out of their clients. There’s still no reason not to do REM and then start doing that stuff.

Absolutely true, however the amount of intervention someone is prepared to accept is proportionate to the level of perceived ‘disability’. If the client accepts certain limitations as ‘normal life’, being overly prescriptive to a particular standard can be inherently flawed.

Even with identical losses, on identical canals; loudness demands can be subjectively different. It’s an inexact science at this point as distortion/variation from the receiver, tymp impedance, ossicular chain and cochlear pathology come into play.

So the ‘suck it and see’ approach is effective for many people over the (slightly religious) certainty some people ascribe to REM.

It’s a lot easier to communicate that you’re satisfied than that you’re not, because you have less you need to communicate (a simple thumbs-up sometimes suffices). And sometimes we simply don’t have the words to explain what’s not working for us. There’s also a bunch of psychological forces at play- feelings of failure, wanting to please, not knowing how well we can expect it all to work anyway…

I’m saying that the more that can be done to get to some sort of agreed verifiable objective before the subjective stuff begins the better. And I circle back to the cost of hearing aids. For an audiologist to charge someone 8k and then quibble over 15 minutes of their time because they think they can do better flying by the seat of their pants… Please.

@d_Wooluf said:

It’s a lot easier to communicate that you’re satisfied than that you’re not, because you have less you need to communicate (a simple thumbs-up sometimes suffices). And sometimes we simply don’t have the words to explain what’s not working for us.

This imo is a huge thing fitting hearing aids. Most people just don’t know the terminology to get the most out of their hearing aids at fittings. This is also where this forum can be a huge help. So much help here for new members to learn their way though getting the most out of their new aids.

Twins born apart. I wish everybody read and understood this post by cvkemp.

But one sentence needs clarification: “My VA audiologist uses REM to verify that my aids do what they are supposed to.” Likely your audiologist thinks so, but as your post depicts, your aids are not doing what they are supposed to, even after REM confirmation, as I previously explained.

The appropriate REM-like procedure is to compare the REM curve after delivery with the REM curve before you get your aids BUT using a generic mushroom or other replica of your choice of aid.

Anybody ever had THAT done?

More generally, big difference between tonal tests of threshold and ability to hear voices.

BTW cvkemp, as I am sure you will understand, pure tones is lousy way to test human hearing using even the best humans, loudspeakers or headphones. The right way is use warble tones. Has anybody been tested THAT way? (There is a website that uses warble tones and the familiar frequencies on the web to test yourself. And everybody should, especially as a benchmark in youth.)

I disagree my aids are doing what I need them to do. They are allowing me to understand speech. If my aids are purely set with REM I cannot understand speech nearly as well. Also by my audiogram at least by that most audiologist would read my audiogram, they would not order the correct receivers for my needs. My aids have the 105db receivers and not 85db receivers.