Why is an audiogram not repeated with hearing aids in?

This can be done but I’m not sure whether there is a validated method. Recently I had this using a speaker in the room and letting the aids do their job as we tested each frequency of an audiogram. Now I’m testing the aids with a few frequencies being overdriven above REM. They also wanted to underdrive some others but we’re testing one approach at a time. I might try it all underdriven next to compare.

Surely the REM only measures the sound output into the ear. It does not give a measurement of what the user can hear. Only the user can judge the actual sound quality ?

The HIS didn’t make those changes when running the test. Does that make the process less valid? She wasn’t entirely sure what to make of the result as in many frequencies I tested normal which is the best she has seen (my unaided hearing is normal to mild loss in those frequencies).

The programming software offers suggestions such as reduce fit levels by 2dB? Why is that still a valid tool but functional gain is not? Is this because the software accounts for the non-linear aspects that functional gain struggles too account for? She increased all three fit levels to try to account for this.

But it is a very important part of the adjustments. As it also measures the acoustics of the hearing aid domes or ear molds and the ear canals. To be absolutely honest only you knoe what you hear. And the audiogram only is a tool that represents what you say you hear. And if you always indicate a guess of what you hear it isn’t a honest measurement. I learned years ago to indicate I hear a tone when I truly hear the tone and ever since then I have gotten better adjusted hearing aids

Hearing aids don’t work by ‘insert pure-tone X level and get result Y level’.

So if you repeat a test you won’t get the actual functional gain result.

Mainly because tones aren’t recognised as speech AND feedback managers are specifically designed to remove pure-tone signals from the output.

Repeating the test through the aids will likely give a worse result than listening directly to the tones without the aids in.

Does that answer the question?

something that should be added, is that generally aided gain are done with speakers
with certain distance with an array of speakers at 45degrees and 1meter (some one correct me please). That would require a very big sound booth.

often time pediatric practices would have that set up.

Yes, I found the word recognition to be a very useful reference. I was amazed at the difference my HAS made in this respect. My biggest issue at the moment is if someone drops a knife or fork on the stone bench top it’s like sticking a skewer into my ear. Or if someone drops metal pipe or bar at work !

All I really know is that the Oticon INTENT1 aids with my VA audiologist, a professor of audiology, adjustments has changed my life. I don’t have anything now but the default program and I don’t need any other programs. My INTENT1 aids are so well fitted that I don’t even need the TV adapter or t-coils. I do have to have my calls streamed to my aids, and I enjoy music and audiobooks streamed to my aids. I have even been able to enjoy going to concerts and lectures. I use to shy away from meetings that had more than a couple of people in them, now I am comfortable in meets of 10 or more people.
It isn’t just that the INTENT1 aids are that good it is that I have an awesome audiologist that has made many hours of commitment to getting my aids adjusted for my needs. This has been a process over the last 6 years, a journey of wearing Oticon’s last 5 generations of aids and countless number of appointments and adjustments to find what works. Yes I fully understood that if it wasn’t for me being a veteran with a hearing loss disability I wouldn’t ever have been able to afford the aids and care that it took to reach this level of fitting.

Aided threshold testing is still used in cases where REM cannot be used, such as for cochlear implants and non-implanted bone conduction hearing aids (or, for many places that work with implanted bone conduction hearing aids and don’t yet have the testbox adaptor, which is newish, or if a patient has a device that isn’t yet compatible with it). But as above, REM is a better measure. It’s faster, it gives you more information, it’s more precise. But if a clinic doesn’t have/do REM then I do think that they should do aided testing for verification of fit.

@Gordz said:

Surely the REM only measures the sound output into the ear. It does not give a measurement of what the user can hear.

Other people have said this, but I don’t really understand how they are thinking about it. We already know what the hearing loss is and we know how the hearing aid is behaving on the ear. REM tells us very precisely whether something is audible for the user or not. Certainly I agree that only the user can judge the sound quality as it sounds to them**, but aided booth testing doesn’t tell you anything about the sound quality either.

**I’ll typically throw on a headset while performing REM so that I can also listen to the quality of the sound–I don’t have experience with all REM systems so I don’t know whether they all offer this option, but I find it very valuable. There are ways in which sound quality can be poor that is audible to anyone, and listening along helps me catch that and adjust it out. There are ways in which sound quality can be poor specifically because of how it is interacting with the specific user’s ears/hearing damage, and I of course cannot hear that.

Gordz offers another creative idea that might take a while to be tried!
I once sought the view of an audio clinician: “Could you try listening through my HAs, fed with audio degraded to what your measurements have shown I hear, and then use your listening judgment to adjust EQ etc in real time for good hearing?”
Well, it raised a smile. Years later, at last, I am blessed with an NHS (UK) audiologist who has real empathy, asks investigative questions, adjusts her software with subtlety (still seeking my live feedback) …and has transformed what I hear, speech and music. Achieved, and quickly, with obsolete Phonaks, too. Traditional tone-testing can not take us far: ask any hi-fi enthusiast!

It is clear to me that the first requirement for a good fit is an Audiologist with a desire to achieve a optimum outcome and not just a satisfactory one. Of course being able to afford multiple visits ( both in time an money ) is a requirement too. I am hoping that when my Noahlink arrives I will be able to invest the time and effort to achieve optimum. If a REM was so good a single visit would be sufficient, maybe two. However that is not the case.
@Neville I assume that other have said this because that has been their experience. In my simple way of thinking someone who is not struggling with speech recognition simply cannot appreciate what it is like. Something I have learned in over 50 years of electronics, many of those in R&D is this :-
In theory there is no difference between practical and theory. In practice, there is.
Read that again