The way it works is you set the patient up for like normal, and then the manufacturer software interfaces with (controls) your REM system. The manufacturer software then runs measurements and adjusts gain accordingly. In practice, an audiologist would have auto-REM going while he or she charts or does admin, thereby saving time. I've done it once out of curiosity, and then found that what time I might have saved doing it was lost by me wanting to double check anyway.
so...auto . Does it still require a mic bumped up against the ear drum, or a quarter mm behind it, to work? Or does it allow a provider to forgo that procedure? I had a lot of surgeries when I was growing up, on into my teens. My inner ears don't look normal, and confuse GPs who don't understand what they're looking at; and my eardrums--or what's left of one on my right side--are fragile. Moreover my outer ear opens directly into my middle ear for easy access to the mastoid bones (cholesteatoma issues.) I don't want some provider poking around in there with an REM mic on a wire. So a non-intrusive REM is more appealing to me than the manual one, that I deliberately refuse.
I’ve been poked in the left ear drum with the mic by two different Audi’s, and was quite sore for several days after. Now anytime a REM is set up, I break out in a cold sweat.
Most systems now offer probe-guides that use acoustics signals to detect where the tip of the probe mic is along the length of the ear canal to ensure correct replacement. Existing REM systems have been upgraded with this feature. You shouldn't experience this problem in the future. If you're concerned ask your hearing care professional to use this feature. It is only unsuitable for use with children, surgically modified ear canals and perforated eardrums/grommets.
"correct placement". Again, surgeries have altered the architecture of my ear canals/drums/middle ear. So I fit into the "unsuitable" category. Story of my life.
p.s. as for "probe guides": probes are still manipulated by humans. My have all warned me NOT to allow GPs or techs to mess around with procedures in my ears. I had one GP use an exterior pressure bulb to supposedly "flush out" wax from my ears. I was lucky in that a recent surgery I'd undergone wasn't ruined entirely.
I had one GP use an exterior pressure bulb to supposedly "flush out" wax from my ears.
GP performed "flush out" with device which exerts significant pressure despite obvious contraindications.
Comparing that bulb pressure to even poking by the silicone probe (which does not have to take place at all if there is an otoscopic control) is like comparing fly landing on skin to applying strong pressure to the skin by the finger.
Your case is ideal example, why REM is necessary for - just for being aware of acoustics of your ear canal changed by your conditions and surgeries.
o.k. again, normal ear canals don't open directly onto the middle ear. Mine do. I'm not going to take the advice of some stranger on the internet over that of several doctors. I don't want some audi mistaking my semi-circular canal for my barely existent ear drum.
Why are people even suggesting this? An audi isn't an ENT who understands what he or she sees when looking into my ears, because she has my records and requisite knowledge.
. I'm not going to take the advice of some stranger on the internet over that of several ENT doctors.
I don't criticise that attitude, it's in general good to listen doctors. What I want to point out is many have no idea how delicate probe is. I would even recommend to get one silicone REM probe from your Audi and show to one of your ENTs.
I don't want some audi mistaking my semi-circular canal for my barely existent ear drum.
I think, it's a bit hyperbolic. Even very changed eardrum is dinstinctive that middle ear mucosa. The semicircular canals are usually found behind the bony wall and are much further than ~25 mm eardrum from ear canal entrance.
Because REM is particularly valuable in cases where patients have canals that are more severely changed than the population average. This is exactly your case.
That's not malicious, that is just performing best clinical practices. No one is going to drag you to REM by force. We're just giving you a precise answer for full awareness.
Besides, I know I'm repeating myself, but I would also highly recommend showing your ENTs an example of a silicone REM probe with length markings.
I think that ENT is not aware how delicate REM probe is. And he probably think that it is simpler to forbid everything.
"He probably..." at this point you''re just making things up. "He probably" in your imagination knows less than you, you assume. And yet you've never met me, or my , or know anything concrete about my situation. You're stating that a random person on the internet knows more about what's best for my ears than my personal ENT, that I've met with a hundred times in their office.
You're dispensing bad advice.
Again, you're advocating that folks trust you over their ENT specialists, even when you have no idea of what the architecture of my ears are, and my history. What's next, giving advice to stroke patients you've never encountered about why they shouldn't trust their specialists but listen to you instead? You want to "educate" my surgeon about "best procedures" according to you? You assume that "probably" he doesn't know what he's talking about? And I should ignore him?
@Bimodal_user isn't dispensing anything. They're providing their personal opinion based upon personal experience.
In my opinion it isn't clinically safe for someone with surgically modified ear canals to be fit with hearing aids without the measurement of an which requires the correct insertion of a probe microphone tube. Any hearing aid programming is guesswork until this is done because of the very large variations from the average RECD (used in all verification work if unmeasured) with surgical ears.
It is not difficult for an experienced clinician to correctly place a probe tube in a surgically modified ear. I frequently had to do with children who weren't particularly good at staying still (as young as 5 months old).
Your is not the specialist in aural rehabilitation: an audiologist/hearing care professional is. Audiologists are well aware of when a procedure is contraindicated and shouldn't be performed. If your ear isn't actively discharging infection and you don't have any other medical contraindications that rule the procedure out (historical surgery isn't a criterion, very recent corrective surgery may be for a limited time window), then you should attempt to get this measurement at least once.
You will probably find your audiologist can fit your aids in a test box once this measurement is done and so on-ear measurement won't be required unless your ear canals change through subsequent surgery or soft tissue shrinkage with aging.
You will more than likely achieve a more natural sound quality and better overall performance with your hearing aids by performing this measurement which takes less than a minute per ear.
If this happens immediately tell your audiologist. They need to note this in their clinical notes and examine your eardrum. It may be a sign of poor practice and if people don't complain they may not be aware it is happening. If they don't know, they cannot adjust their practice. No clinician ever wants to hurt their client.
Probe tubes can be very slippery and challenging to control, especially when multiple items are being placed inside the ear at once. Clinicians don't always get the placement right. This is why the probe guide assistants have been helpful, but even then I still use otoscopy to check for correct placement as there is always a margin of error with these.
I've mentioned this before. On my last REM my audiologist stick the probe in my ear too deep.
It freaken out right hurt. I'm taking pain.
I was getting ready to tell her when she moved it. The pain went away.
Here's a little drama: customer goes into Costco to trial a new aid.
--"Hi! I'm your new tech. I''m just going to stick this probe into your ear and test ".
--customer: but...I''ve had a lot of surgeries and all of my have warned me against this sort of thing
Tech: Oh, bother!! ENTs don't know about how great we non-medical techs are with these intrusive probes, and how to use them! Why, they're recommended on Hearing Tracker! All of us are 100% to be trusted...well, 85%...well, fifty percent. Speaking personally, I'm brilliant? Hey wanna go out for coffee some time?
customer: I dunno...
Tech: Who are you going to believe, your ENT or me?
My advice: believe your ENT. Your tech has limited credentials. Even an audi has limited credentials. Someone who posts on the internet has unverified credentials. Trust your ENT.
My advice: believe your ENT. Your tech has limited credentials. Even an audi has limited credentials. Someone who posts on the internet has unverified credentials. Trust your ENT.
All good points but remember, this forum has a bunch of members who are doctors, nurses, lawyers, ect. and of course a few self righteous smarter than everyone else members.
Those helping others just might be very qualified to say what they do. You can do the research to verify which type member you are dealing with.
My advice: believe your ENT. Your tech has limited credentials. Even an audi has limited credentials. Someone who posts on the internet has unverified credentials. Trust your ENT.
Well @jeffrey, in my instance, my Head of Department, at my general hospital, was absolutely useless, and I basically told him what I thought of him, he was ignorant and totally arrogant individual, I treated him with the contempt he deserved…Because we had a bit of bad blood between us, I thought, maybe I had a prejudiced opinion of Mr L, so I asked the Head of Audiology, strait out, what she thought of him, she said “Not a lot, but we have to try and work with him”! An ignoramus he might have been, but I trusted that ENT about as far as I could throw him, which wasn’t very far…
I have always found @Bimodal_user very helpful and informative, I believe he lives in Poland? I don’t know if he uses a translator? Sometimes translations come across in a slightly more aggressive tone, than they were intended… Suffice to say, if not, his English is extremely good, but it’s probably not his first language? For our sins, most of us regulars on here, try to help, okay some folks may feel that some of that advice is counterproductive, others might find it very helpful, it takes all kinds to make this world, only the reader can decide, what is useful information, and what is not!
In truth, I have only ever had done the once (2022 I believe) most private audiologists here in the UK don’t use REM, the NHS do use REM… If memory serves me correctly, Greg my NHS Audiologist used a white silicon probe, very flimsy and soft as I recall… Lastly, if you would please @jeffrey, perhaps you could tone down your replies ever so slightly, we are here to try and help, if we can?
@jeffrey there is massive variability in the understanding of the areas of expertise that an audiologist has amongst specialists. The best Otolaryngologists I know also trained as audiologists because that is also part of their role in some European countries.
Most ENTs have very little understanding of acoustics, psychoacoustics, signal processing or speech itself. They are limited to interpreting a diagnostic according to classifications that they often don't understand the practical significance of and determining whether someone meets surgical criteria or if a surgical treatment improves hearing. That's all their role actually requires.
Taking advice about aural rehabilitation from many ENT specialists is taking it from someone who is more poorly informed on this topic than many of the forum users here who have well-researched opinions based on actual experience.
I wasn’t aware @Hearing_Potential until I met that , how poorly educated he was towards hearing impaired… He had little or no communication tactics, he couldn’t hold eye contact, no concept of how to effectively communicate with me, he basically faced away from me, or buried his head in my file whilst talking! He did everything humanly possible to stop me from getting Cochlear Implants, basically he rigged a assessment, that was doomed for failure, so I wouldn’t be sent to Kilmarnock… There excuse was, I didn’t need CI’s because I was an excellent “Lip Reader” !!! Strangely, a couple of weeks after he retired, that department offered me to go to Kilmarnock for a full CI assessment, but by then, I had given up, and I was due to retire myself… Personally, I rarely if ever fall out with professional people, it doesn’t help your case to do so, but with some people it’s unavoidable, they think they are gods gift to humanity, oblivious to what fellow staff and patients think of them, they live in their own little bubble, and everything they do is correct, their vision is blinkered by their egos, listening to others, isn’t in their remit… Cheers Kev👍😉
Poland
Scottish Highlands