Why is an audiogram not repeated with hearing aids in?

What a wonderful post! Thank you.

20 yrs with hearing aids. I had an experience today. I wanted to cry.
My parents died in 93. My Brother and I are 70 and 78. He’s schizophrenic. I couldn’t understand a word he said in a restaurant. He’s so kind and gentle. He never used to repeat himself. I try to understand.

What you do is special and so important.

DaveL
Mississauga

Ps. Our Sister died in 2013. We are the last two members of our Family. Every word spoken is so important. Every word heard should be understood.

How is your sound field arranged? Do you find you more often have to increase gain above REM or reduce gain below REM? Or is there no pattern?

REM isn’t just a target. NAL NL 2 / DSL V5 are targets, and you can check that you’re there with REM. But you can see way more than that. Here you can see the audiogram, the “speech banana” etc. Going above “targets” is no problem.
There’s no pattern because every patient is different in what he can tolerate.

Well I agree and disagree. Yes it makes a difference but the goal is for verification of the fit not an exact this is what it will always do. Something is some times better than nothing and doing SF aided vs unaided warble tones and word recognition gives a basic idea of function. Then it is up to the professional to take this info vs what the patient is talking about and coming up with a good solution(s). Don’t throw the bathwater out with the baby. Its the best we have at present. The problem is many of the things we are talking about aren’t done by the majority. JMHO

Speech testing with hearing aids in free field is mandatory to me. REM with speech mapping helps you easily correct the right phonems.
Warble tones in free field one ear at a time can sometimes be useful for a binaural balance when the hearing loss is asymetric for exemple (well mastered REM makes it less useful)

Here is an example I just had. But let me go thru my process so it makes more sense. At the initial fit I fit using visible speech (RE) and make sure all results fit the hearing loss targets. Then I review handling and care and we practice inserting and removing and cleaning and even changing filters (and domes if applicable). I also dogear the troubleshooting guide plus a quick guide I print which has all necessary basic care and use guides. And this includes pairing phone and using it.
then I have them wear them for at least 2 weeks and bring them back in and chat with them about how its going what good as well as challenges they may have and address these.Then I put them in my sound field and do aided and unaided testing using warble tones and speech. this is my process every time.
On the post fit of a patient monday he complained about distortion and screechness. (some times this is normal when the loss is in the high frequencies.) When I did the warble tones aided and unaided there was 50 db gain @ 4k and 55 at 6k. But by RE he had 25 and 20 respectively. So with out having to just guess at what was going on I was able to see exactly and able to adjust exactly where the problem was located.
Hope this helps you see why I do this. As things advance in the hearing aids verifications fall behind which is always the case. But we still can can get good info from our old methods

First not sure what you mean by half verification see my last comments

Your post is excellent.

And it’s the fatal flaw.

I have myPhonak.

Could my practitioner set up my Paradise p90r hearing aids when I
Am in the environment I have trouble hearing in?

I volunteer to be in a test group to see how this goes.

How about it Phonak Canada! 78 and I’ve had 3 pairs of Phonaks

DaveL

REM did not show that much gain in those high frequencies. But because SF did I didn’t have to guess at where I needed to adjust to correct his complaint. When REM came out I was one that used both to compare SF we were doing to REM. Results are usually comparable to SF WT’s. Also, doing SF as well as REM is just a way to confirm results.

When I do testing I strive to find out what the patient’s best understanding is. And though I can’t be sure when its a high frequency loss I can get close by also paying attn to the sounds missed. So I run SF WR at 50 dB HL then under headset find MCL and get scores for each ear and binaural. This is then my target for understanding. And yes if high freq loss they usually do better but not worse. So with this info I can get verification of they are reaching WR target. And I often do will add aided SF QSIN.
Just because there are new things happening in our HA’s doesn’t been we should stop doing some older verification, it still has validity. And until new methods are found that can verify what we are striving for they should still be used.

@Dr_Palmer said:

REM did not show that much gain in those high frequencies.

Yeah, that’s interesting. So was your real-ear measure inaccurate or was your audiogram inaccurate?

in all honesty, we should be fitting to maximize SII, which we dont normally do. I still dont know why fitting software nor equipment uses artificial intelligence, why PC audiometers do not even have masking assistants…

we know have ACT, we can determine how much support you need in noise, furthermore, demand instruments, Oticon for example in case of more ACT values to change how more sound intelligence works. Its a good step forward.

most hight end fitting hearing aids have proprietary fitting formulas, so it is better to use Rem auto fit. After you might run speechmapping ( Verifit) to see your SII to check for audibility. That’s a much better approach

It’s a valid approach but absolutly not the better one.
But you do you.