How reproducible is REM? What can skew the results?

I don’t recommend MedRx over anything else. It’s just what I could get my hands on. They all are basically the same system with a slightly different interface. It’s had to find any used if you are not in the industry.

The only one that is consistently available is the Verifit VF-1, but I’d make sure it is verified working as the price ranges are dramatic on those things on Ebay. Right now some Aurical Free-fits are available, which are good. I think you’re going to pay at least $2-3 thousand US dollars for a system that is somewhat modern. Mine is a 2008 version and was over $2000, but it is software based so I can use Windows 11. If you get much earlier than that, It’s not going to be too modern. (For instance you can go really old school and get a Frye FP35 for several hundred dollars but it’s one ear at a time, difficult to use, and I’ve tested it and it gets you in the ballpark but doesn’t seem as consistent as the MedRx system, to the point where it may not be worth even trying to mess with it.)

For me the REM was worth it because I get my hearing aids on Ebay, and help some older relatives out that are underfit from big-box stores. For me, self-fitting without REM made me realize I was underfitting myself quite dramatically, even though I thought I made adjustments, but was never satisfied with my non-rem results.

I think for most people, self-REM is not practical, cost effective, or necessary.

@wtolkien said:

That’s probably not the recommended method, but the tube is so soft that I don’t think it could cause any damage.

I couldn’t pierce tissue paper/Kleenex by tube, so it’s safe.

@wtolkien said:

Below are the results from my 2nd ‘self-REM’, which resulted in gain settings that sound very good to me.

Disclaimer: all the graphs below were from REM at one appointment. MedRx was used. The loudspeaker was too weak for 85 or 90 dB input measurements.

Thank you very much. Your REOGs are very surprising for me - you have relatively little earplug effect from your power domes.

For comparison - there are mine Sphere REOG (L size Unitron power domes, placed very deep) on the left and, for comparison: from paradise in the center and on the right - REOG froom full schell silicone antinoise earplug:

My REIG (Real Ear Inserion Gain) was quite strange in the lowest frequencies. Look at the NAL-NL2 one. From the left:

• Sphere 90 DSL 5.0 Pediatric (with that I ended the REM procedure - there was too quiet low frequencies for me despite “overamplification” according to the graphs)
• Paradise 90-RT DSL 5.0 Pediatric
• Sphere 90 NAL-NL2

Just for science, during REM with NAL-NL2 for Sphere, there was different REOG despite the same power domes.It was o ne of the first things measured after I got here, so maybe I put the power domes in the wrong place?

@wtolkien said:

Curve #1 is a 85dB sweep for MPO (I think )

Have you thought about changing the MPOs based on the target lines?

@DrJimmyJoeJimbob said:

For me, self-fitting without REM made me realize I was underfitting myself quite dramatically, even though I thought I made adjustments, but was never satisfied with my non-rem results.

This is what I was told by a pro here on the forum about 7-8 years ago. So when I was done self fitting I started bumping up gains across the board. This proved to be a huge help for my word understanding. So it’s a good idea as a hearing aid self programmer to carefully bump gains up just a little to compensate the manufacturers fittings.

The variance is not linear and sometimes not small. Doesn’t increasing the gain across the frequencies risk the gain being excessive for some frequencies? Of course with DIY one might notice and dial it back.

Is there data about whether it is better to slightly under or over amplify?

@Neville said:

I also bump my eardrum and then back out to make sure I’m in the correct spot. I wouldn’t worry unless it were a surgical eardrum

Welcome to my world. I have one barely existent ear drum and another that’s fragile. Look, I allow my ENT to perform technical procedures on my ears, such as debridement. No way I’m allowing a techie in an office, or a GP for that matter, to mess around with my ears. My ENTs have all told me to run when a GP wants to perform some procedure on my ears, like a pressure flush to remove wax. Oh and my canals open onto my mastoid and middle ear, to allow access for debridement. I can easily imagine some techie with a probe bumping up agains hammer, anvil and stirrup and messing that structure up. People who lost hearing due to cholesteotoma (conductive loss) often have re-structured ear canals that allow a dr. to bypass the tympanic membrane in order to access the middle ear. You don’t want a probe in the hands of a techie who doesn’t recognize what he’s dealing with to search around where he shouldn’t a be-a searchin’, as some song might say. “Those probes aren’t made for walkin’, but that’s just what they’ll do: one of these days that probe is gonna bust your eardrum through”. as for a DIY probe: are you mad? This isn’t like taking your temperature.

Yes, that’s fair. GPs don’t do a lot of ear stuff. I cannot count the number of times someone has come in with fully occluding wax and they say “but my GP said my ear was clear!" or the opposite. Knowing what is normal in an ear takes looking at a bunch of ears. Some GPs have done that and donet haven’t.

I think the record for me so far is sending someone 3 times in a row, with pictures.

And another time, when I was new to all of this, and someone asked for their ears to be checked because they wanted to come in for a hearing test. I checked and they were fully occluded binaurally. They asked about OTC products and I suggested they see a doctor. They asked for OTC options. I said if they wanted to do that, they could look for debrox and follow the instructions but that they should have it cleared professionally.

They came back a week or so later and I could see straight into their middle ear on both sides. It was very very shiny. They were not aware of any prior damage to their eardrum. I asked how long they used the debrox and they said for a week. I asked if it hurt, and they said that yes, it hurt quite a bit. I told them that they should definitely see a doctor before we made any appointment for them.

Erp. Ouch. I’m always surprised by people who don’t know they have been walking around with huge eardrum perforations. The hearing loss alone should tell them to go in and get checked.