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Real Ear Measurement vs Pure-tone Audiometry

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I was recently fitted with Signia MaX 5 hearing aids, and felt they were pretty well set up with the usual Pure-tone audiometry, except for needing a bit more volume. After reading about the importance of Real Ear Measurement, when I went back in for an adjustment a few days later, I insisted they perform the tests and adjust my 's accordingly. Bad mistake! In the office they sounded "OK" but a bit harsh. Outside, in various settings, they were horrible! Fortunately they've saved the previous settings and will be able to go back to where they were, for starters. Is my experience out of the ordinary? Is REM not as good as it's often touted to be? I'm curious about your experiences and comments.

Real Ear Measurement is a technique. There are many parameters that the audiologist has to get right in order for it to be effective. If your audiologist isn't experienced in performing it correctly, then it can result in poor outcomes. I've seen plenty of poorly performed real-ear measurement where the quick fit settings would've been less offensive to the end user.

In reply to @MoHearing

If these are your first hearing aids, it is quite normal to find the full prescription loudness harsh. Faucets, fans, a hundred things will sound overwhelmingly loud. Many just jump in with the knowledge it is temporary. You can get used to it. (I did). Others derate the volume and jack it up in stages. You become accustomed over time either way. Truly hearing properly will depend on getting to that level. Otherwise you are leaving sound on the table you’d otherwise be able to hear.

As was mentioned, your fitter needs to be skilled in applying . It is not an absolute black/white type procedure. It is part of the art of getting your fitting close to your prescription. It can be done quite poorly. If they “never do that” then I’d pass on them doing it. My audiologists have had it a part of the process every time something changes like a mold or receiver type.

WH

Not a first-time wearer. And I've been pretty good at adapting to my two provider experiences: CostCo and now HearUSA (insurance mandated). I'm guessing the bigger problem is I'm trying the Signia MaX 5 after having very positive experiences with my previous Phonak Marvel and then Lumity aids. Anyway, my question is really about the "role" of in the process. I thought it might be more accurate, but that has not turned out to be the case, at all. I suppose it is a combo of the science and the art, in fitting correctly.

isn’t done vs. Pure-Tone.

Pure-Tone gives you a fair indication of your hearing loss, a prescription based from it derives a target. That target is what you should measure to using REM.

Alternatively, you simply put the values into the manufacturer’s software, punt out a target and set the aid to that output: irrespective of the coupling or actually measuring the output. After several stages of personal tweakery (or just the lucky chance of averages), you might find you get a level of sound that suits you.

REM is an objective short-cut to the optimum setting. Fitting without REM can work and may sound subjectively ’nicer’, but objectively it might not be optimised for you.

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