Real ear measurement vs. in-situ audiometry

Also glad OP is happy.

The main difference is the right aid is about 7.5 db louder in the high end. The main problems that I had were the left aid was too loud in the high end and the right aid was too soft overall. With the Costco fitting the overall effect was that I had to run my TV about 5db louder than with my old aids. I was also getting feedback on the right side as well as the right being too soft. And the size 1 wires from Costco were too short and were irritating my ears. So along with the AD fitting I changed to size 2 from size 1 and made silicone molds. Costco had used an M receiver on the right and P on the left. When I bought new receivers I had to get the same power on both so both are P’s now. I’m sure all this is more than most end users would be willing to do but it’s fun to me.

Widex user here who requested REM and it gave me the best hearing I’ve had.

And yet many “professionals” say it is not needed. They are just lazy or too cheap to buy the equipment. I started using it in the mid 80s and never stopped until I sold the practice.

If you perform the in-situ audiometry and choose to re-prescribe your hearing aids to the in-situ results, then your original audiogram is no longer taken into account and the in-situ data is taken into account instead.

For the Oticon Genie 2 in-situ, the original audiogram is shown as a reference when you perform the in-situ test so you can have an idea of how far off (or close) the 2 results are. For me personally, I prefer to re-prescribe my hearing aids to the in-situ results because to me, that would be a more accurate assessment of my hearing loss as it is by default calibrated to the actual hearing aids I’m wearing.

So to me it’s actually both an enhancement and replacement to my audi’s audiometry. The Genie 2 in-situ also gives me a test at 125 Hz while my audi’s audiogram only starts out at 250 Hz.

Here’s an article from Phonak AudiogramDirect with Remote Support | Audiology Blog16 They seem to consider audiogram direct a reasonable substitute for audiogram when only remote fittings are available. They seem to consider audiogram preferable. I found interesting the wide variance range for both (15 dB)

Thank you @Volusiano, @MDB,

I expected that in-situ would improve the fitting formula, since there’s more data involved.

I trust my in-situ, but this doesn’t work very well with pandemic, so I returned to my audi

@MDB said:

Here’s another take on this. Seems to be specifically from a Widex perspective: In-situ Thresholds for Hearing Aid Fittings | The Hearing Review

Of note, it seems to claim that for fitting hearing aids that in-situ is better than audiogram but for diagnostics, audiogram is better.

It does make a lot of sense that in-situ is better for fitting, but audiogram is better for diagnostics.

For fitting, every hearing aid may amplify differently and its physical fitting (via dome or custom mold) also has a more unique response, also depending on the unique ear canal shape as well. All this is taken into consideration with the in-situ audiometry and the result is customized with all these factors taken into account.

For general diagnostic, none of the factors above come into play except for the ear canal shape. So a calibrated standard would give you a common reference point to base on in determining the result. After all, you don’t want to do a hearing test based on an uncalibrated amplification device if you end up wearing a different hearing device that has a very different response altogether.

@tinkyp said:

By taking the acoustic fit of the aid into consideration it fine tunes it all automatically rather than needing to do it manually which is very much trial and error.

I guess I’m confused . Doesn’t REM do this? That the test with your hearing aids are seeing how your ears are working with the hearing aid based on what the Audi adjusted them to you. TIA.

Rem verifies the fit.

In situ audiogram is used to produce fit. By manufacturer formula.

If aids have isn’t aligned with what nal-nl2 wants for example, then you tweak the aid and rerun rem live speech mapping. And again, and again. Until what qids produce really is aligned nal-nl2 fitting formula. Which is independent formula.

@Sequoia_Woman said:

I guess I’m confused . Doesn’t REM do this?

Yes.

…

As a regular hearing aid user with no technical knowledge of Audiology I can only recount my personal experience of using several aids and visiting a large number of audiologists in UK and in Turkey where I live! In UK I have had government provided Phonak programmes by Health Service providers. The only time that REMs were used (later appointment) resulted in an immediate improvement in speech clarity but still unsatisfactory for TV and films!
I also visited a superb Audiologist to trial a pair of premium Resound aids (2017 model) REMs were used and approx three adjustment visits were made! These resulted in clear speech, decent TV and good speech in noise but I felt that the sound stage was overwhelming in intensity!
I then commenced a search in Turkey for a non premium model that would give a decent performance! I discovered that hardly any practitioners have the knowledge and/or equipment to use REMs instead they totally rely on a “How does that sound” approach and expect to finish the job in 30 minutes! Finally I decided that the Oticon OPN S3 should give me reasonable speech clarity and bought a pair from this type of practitioner! I am still not getting the clarity that I need and the volume settings are wrong! I also visited an Oticon owned company where a newly qualified Audiologist (in Turkey most are Audiometrists) tried to do REMs but obviously was struggling as she asked for assistance! The result was that I was there three hours while further tweaking was done! Eventually I returned to the original dealer for a reset but I know that in late Spring I will need to get professional REMs possibly with further tweaking in the UK before I am ever happy with these Oticons!

This argument will run-and-run.

A bit of anecdotal feedback. In the UK the NHS (National Health Service) fitters are REQUIRED to do REMs.

I have spoken to several NHS staff. They generally seem to regard REMs as a legal/contractual requirement.

Once they have ticked the REM box, the fitters start again from scratch with fine-tuning as the REM derived settings are generally useless.

@Blacky said:

n situ audiogram is only an audiogram, pure tones. I agree that it’s fairly accurate, but it’s purpose is only measuring pure tones.

But that is precisely how the whole show starts - with the pure tone test and audiogram which is just a few points.
So it should also finish with the same test. And more if desirable.

The same with speech test. Why have all these expensive machines? Why not an audio file on the PC with difficult words, and the patient listening and repeating them. Depending what type of words they hear wrong, the appropriate frequency gain can be tweaked.

I found this topic by googling for something else.

Congrats True Brit for clearing this for me.
People get sucked into complexities when things can be done simply.

I like this - the only thing missing in the REM is the ear.
But the ear is what this is all about, not algorithms.