REM test results...please help!

Just as a FWIW, Med-Rx are based in Pinellas County, which might be a million miles from you, BUT, they sometimes need people as training subjects, to show REM tuning in-house. This could provide you with a tuning solution that doesn’t cost a packet. (Pending Covid restrictions)

If you go, make sure you get a beer in ‘Gators

What a terrible experience! Good luck at your next appointment. Hope it goes well. I am still in my trial period and may return these and try someone new. I had the original first fit manufacturer settings reloaded last night and it is so much better. And yet, I think that it can be even better and that is what I want this time. I think doing a REM test correctly takes a lot of training and knowledge and if it’s not done correctly it doesn’t work. Most audiologists just don’t know how to do it.

Luckily I’m still in the trial period. The audiologists that I have called will program, but it is very expensive. My hearing aids were less expensive than their prices where I purchased, but it sounds like its worth it to pay more and then have unlimited programming and service during warranty period.

Thanks for all the useful info! I asked him about this last night but he said that we were already at the top of the level for feedback, so I had them re-programmed with manufacturer setting and its much better. I will probably return and purchase from one of Dr. Cliff’s networks.

You really do need to work with someone that really knows what they are doing. With my Paradise aids we were unable to get the gain set to my prescription without a lot of feedback when using domes. Reducing the feedback dropped me well below target. My audi recommended that I go with custom molds and now I am at my prescription and speech is much clearer!

This might be the answer here too. I’m surprised how low that target was within the dynamic range.

It seems a really conservative estimate of what’s needed. NAL NL2 should be pushing the HF more than that. That looks like a dodgy implementation of the formula within the Aurical SW.

That does not surprise me unfortunately. I really wanted this audiologist to work, but it’s time to try someone new. Thanks again for the feedback.

@Blacky said:

I’m also inclined to the opinion that fitter didn’t learn the process correctly

Do you know where I could find some information about this type of fitting. TIA for your help.

@julieMK said:

looks off to me.

Is that even YOU?

Usually the bottom line in the fitting software is your audiogram, but this one does not look like the one posted behind your forum-name.

The way the screen was grabbed is revealing some names. “Mail -” is probably the machine’s owner, the audiologist. I do not use Noah, but the other name MAY be The Client. Which is not much like the real-looking name you use here.

Interestingly the Oticon REM Cookbook10 is open. This could be routine, or a search for help with a puzzle.

We just have to remember that audiometry dBs are HL and REM are SPL. And that one thing is matching the REM targets of NAL2 and other is using the Live Speech Mapping.

There are different fitting formulas NAL2, DSLv5, APD etc.

I would verify that your audiometry has the bone conduction and discomfort thresholds (UCLs).

Between target formulas can vary a good amount of decibels, especially in high frequency regions.

What people above suggested is trying to match the targets of REM combined with having your amplification in a good position within your dynamic range.

I found really useful LSM plus some minor compression and slight frequency changes based on the patient’s subjective response, of course, verifying that he has a good response with that fitting.

Yes and no.

Are we talking about aiding the worst or best ear or both?

Strictly speaking the level of your prescription IS your prescription, however there are a couple of caveats.

1. The loss of your stereo summation which is worth 3dB ‘extra’ gain. This means you generally need more power.
2. The directional field is effectively halved.
3. Any monaural fitting must also consider the processing delay and the effect on the phase of the signal and further collapse of the directional field at particular frequencies.

Personally, in any binaural fitting, my preference is to slightly under amplify the worst ear, slightly over amplify the best ear, at least at the beginning and then head towards a more significant amount of gain in the worst ear over time. This ‘shows’ the brain how both ears via the hearing aids, eliminating processing delay issues and may go some way to walking back long term auditory processing disorder.

Thanks for reply, very interesting!

@Um_bongo said:

Are we talking about aiding the worst or best ear or both?

Only best. My left ear is unaidable (apart CROS system - not released yet or cochlear implant which is very hard to accustom, maybe only for me because of 20 year of no using left nerve).

@Um_bongo said:

The loss of your stereo summation which is worth 3dB ‘extra’ gain. This means you generally need more power.

This is the issue I have considered. Practically it is enough simply add 1 step up on volume button?

As you’re probably aware, louder isn’t necessarily clearer, but it may help under certain conditions.

Single hearing aid noise processing is difficult, whether you respond to more or less aggressive noise management is debatable. You might need to evaluate this to get the best fit.

You’re probably the kind of person who would benefit most from a device like the Resound Multi-Mic too.

Also, don’t discount CROS simply because you have no history of using one side, you’re already headed down the path with your main aid, adding a transmitter aid to the other side of your head isn’t such a huge step. Also, the CROS attempts to better utilise your better ear anyway, so the lack of a contra-lateral input shouldn’t have a bearing.

@Um_bongo said:

As you’re probably aware, louder isn’t necessarily clearer, but it may help under certain conditions.

You’re right. It gives more effect in silent environment than in loud.

@Um_bongo said:

You’re probably the kind of person who would benefit most from a device like the Resound Multi-Mic too.

I have Phonak Roger Select. Sometimes it gives strong SNR and the ambient noise is decreased, more often I didn’t see much difference.

@Um_bongo said:

Also, don’t discount CROS simply because you have no history of using one side, you’re already headed down the path with your main aid, adding a transmitter aid to the other side of your head isn’t such a huge step. Also, the CROS attempts to better utilise your better ear anyway, so the lack of a contra-lateral input shouldn’t have a bearing.

So, based on your experience, the CROS doesn’t give much benefits, even in situation, when four mics may be used? I mean 2 from CROS and 2 from HA linked by system such as auto StereoZoom, to make more focused directionality than from 2 mics only.