Dr Cliff. It takes how long to program hearing aids?

I don’t DIY and don’t believe in it. But many do and I understand why. I am a retired communications electronic technician/engineer/IT professional and I believe that while i could DIY that I don’t believe it is wise. And I have 9 hours of audiology training at the State medical school. My audiologist is a professor of audiology and I have set in on his classes, all graduate doctorate level. Yes I have had a lot of influence in how my aids are adjusted but always under the supervision of my audiologist.

@DamonHill said:

I wanted to know if there are common symptoms (like headache, nausea)

No, just hearing loss over time. Which might happen anyway depending on one’s genetics, so it could be hard to even tell.

@Raudrive said:

Are you saying it takes a REM machine to verify this?
Are the odds on our side to not hurt our hearing by following the software properly?

REM to be sure, yes.
Yes, the odds are on your side if you are not exceeding the settings target suggests, but while manufacturer first fits tend to be underfit it is also not THAT uncommon for them to be peaky and over target in certain places. There are certain venting effects where in addition to losing gain at lows you are also increasing gain at mids. Anyone with smaller ear canals is also likely to be getting more than what the software is predicting.

My preference for DIYer would be for them to go get an upper limit measured, which I’ve said to others is DSL child targets. That’s not because we know that fitting over those targets WILL cause damage, its because we have good evidence that those targest WON’T cause damage and they tend to be on the loud side of more adult users anyway, so then the DIYer can fiddle around under that level all they like with the caution that changes to the acoustic coupling on the ear will change things in ways they cannot neessarily predict.

UNDERfitting is arguably also a risk of DIY, but a different kind of risk.

@Neville said:

Yes, the odds are on your side if you are not exceeding the settings target suggests

#1 benefit of DIY for me is being able to make simple changes without an appointment or humping an hour to Costco. Happy to not be in the majority which seems to prefer waiting to get waited on for so many things that their lifestyle must decline dramatically in retirement unless they’re wealthy. I encourage DIY for everything possible, especially to young people at risk of missing the opportunity to build on basic skills over a lifetime. At the very least DIY of hearing aids will improve the user’s ability to communicate effectively with their provider.

It’s been 1.5 years since I started wearing HA’s and 5 different models/brands, 5 audiologists, 3 REM fitting sessions and numerous followup sessions with my last audiologist, nada. Not even close…

Found that, like what has been mentioned in this thread, I have resisted turning up the volume. Been living with bad hearing for a long time; maybe 35 years and the sounds that I hear today really don’t coincide with my memory. I’m getting used to the sounds, but not all of them.

Even after beginning to understand Target, the changes I made seemed to be limited by the implementations of the software.

It wasn’t until I fed target with a straight line hearing loss audiogram (read that as about 40db at all frequencies) that I began to get close. So close that now I haven’t tweaked the settings for months, but I have noticed that I am not able to adjust certain frequencies without affecting a whole range. There go those implementations of the software again, getting in the way. :0(

The main issue is that if you allow Target to use your audiogram as the basis for the settings, those settings don’t come close to providing an inverse picture of your audiogram. I’m sure there’s a valid explanation for that, but I find it an anomaly.

BTW, been programming computers, networking, repairing for more that 40 years. Reviewing software is very straight forward to me and Target seem like it’s OK, sans some deficiencies, or maybe I should call them shortcomings/capabilities.

Nick

This was the main reason I went DIY, (5 yrs now). Everytime I needed small adjustments it was a 30 minute drive, one way. More often than not what seemed like a perfect adjustment in the audi office was less than that in the “real world”. Now I just go into MY office make a minor adjustment. Best decision I ever made was to go DIY.

Gain levels at DSL pediatric targets. And then you have a record and just make sure you don’t exceed those.

Not the uncomfortable level, the average level. The average, day after day exposure to too much sound is what you’re trying to avoid. Of course damaging sound situations should be avoided too, but people already know about using HPD with power tools, etc.

I see benefit in having the software and seeing how it works but think people tend to push DIY on others more than is warranted. There are some people who really don’t seem to have a clue who really shouldn’t mess around with DIY. On the good side they often have enough problems trying to get the equipment and software set up that they self filter.

Why would it be standard practice? Clinicians don’t have to use REM to check that you are not exceeding DSL child targets because they know that you are meeting whatever targets they have set you to.

No, you misunderstand. Absolutely congenital hearing loss can be made worse with noise exposure–there is no assumption that it cannot be. But we have good evidence that DSL child targets do not make hearing worse. So as long as you are fit below them you’re fine, and above them is a mystery danger zone. DSL child targets are above adult targets, yes. I’m not saying fit to DSL child, I’m saying don’t fit beyond DSL child. And I’m saying that without REM you do not know to what degree you are or are not approaching them, regardless of the software first fit.

@william50 said:

But I find that the REM levels to be far too high and uncomfortable.

So here’s a good example of the OTHER risk of DIY. Chronic underfit. But no risk of causing more damage as he’s just turning things down.

@william50 said:

I also question why we have to assume that high tech expensive hearing aids and fitting software is so out of whack that it needs an REM to perform at its designed parameters.

We don’t have to question. We are well aware of how manufacturer fitting rationales diverge from prescriptive targets both in how they are set up and in how they are impacted by individual anatomy and acoustic coupling to the ear. As I’ve said elsewhere, manufacturer first fits meeting targets appropriately is so uncommon that when it happens I send a photo to my colleagues so that we can all say, “Wow! Nice!”

You’re an engineer, so you know how sound behaves in a small space with no venting versus a big space with lots of venting.

@Neville said:

As I’ve said elsewhere, manufacturer first fits meeting targets appropriately is so uncommon that when it happens I send a photo to my colleagues so that we can all say, “Wow! Nice!”

That happened to me for the first time ever @Neville, with no REM… First fit, was my last fit, from November 2023… My A.uD set up the Naida Lumity 90 UP BTE’s, before I got there, she did a very extensive hearing test (3 weeks prior) way longer than normal, the aids went strait in my ears, she ran the feedback management, “how does that sound”, switch to NAL NL2 please, says I… Bingo, we are good to go, and off I went I did have several follow up appointments, but these were questions & answers sessions, Boots Hearing Care wanted me to review these aids for them, so the follow ups didn’t have any adjustments, just question after question with my A.uD taking notes, I was asked if I needed any adjustments, but I said no thanks! I did ask my A.uD, if there was any particular reason why no adjustments were deemed necessary, she said, it was quite common, in her experience, for many clients, first fit was there last fit, especially with Phonak Lumitys… IMO, that’s either lucky, or the aids themselves are easy to fit, or she is an exceptional Audiologist, perhaps a combination of all 3? These aids, have never been adjusted since day one, not even the slightest tweak, and I have no intention of getting Noahlink Wireless out of its box, and firing up Target, I don’t believe, I could set them up better, perhaps, I could get sounding slightly better, but that would be minimal, and I am delighted the way they are set up, so I leave them well alone… As the old adage goes “if it’s not broken, don’t try to fix it”… Cheers Kev

I mean, that’s excellent that you are happy with your hearing aids, but without REM we don’t know that they are hitting prescriptive targets. Though it’s more common in men with BTEs and earmolds or ITEs than other fits.

Thanks for your post

You’ve helped a lot!
I’ll message you tomorrow. It’s late.

I’ve made progress in the last year. Efore that it was terrible.

I appreciate the pros here who use their skill to help.

DaveL

I had the same experience. Hospital ward. Lying down. Cardiologist at foot of the gurney. I couldn’t understand a word. Yet I could hear every word a nurse spoke to a patient 25 feet behind me. Then they wheeled me away for my surgery.

@orgullodemexico said:

I’ve often wondered is there a standardization of equipment & procedures for performing REM? Does every audi that performs REM use identical procedure & equipment that Dr. Cliff has?

Yes and no. The REM equipment measures the output of the hearing aid at the eardrum against a variety of prescriptive targets. There are many different REM machines with different extra features that might make things easier or quicker, but they all do the basic thing they need to do. Cliff uses the Natus. There are some benefits to the Natus in terms of computer integration and portability. I prefer the Verifit, but I think Cliff started out as a young provider with the Natus back in ~2017 and as an early practitioner the Verifit would have been an expensive choice for him.

The procedures are all basically the same. But that being said, there is some skill involved in using REM and if you’re not very comfortable with it there are a few ways to really mess things up. I think that for an independent provider practicing in a vaccuum (single-person practice), it would be very difficult to implement without a mentor. And having trained a pile of audiologists and HISs one thing I’ve noticed. . . I always hesitate to say anything like this because I really value my HISs colleagues, but I think sometimes we forget that a university degree does, in fact, teach some very important skills. In my direct experience, audiologists are faster to pick up on the trouble-shooting skills required whereas HISs are a little bit more likely to want to do things by rote and maybe don’t have some of the theoretical scaffolding that allows for a quick analysis of what could be going wrong. Again, many HISs are fabulous and bright. However, on average, it takes more to get them to a place of competance with REM which suggests it would probably be extra hard for them if they were all alone in a clinic. On average.

@orgullodemexico said:

I was very bewildered afterwards as to why that happened. I suppose with the large room, tall ceilings, the attorney’s voice was going everywhere except to my HAs.

Yes, you’re right. Reverberant environments can be very difficult, even when quiet. I’ve had normal hearing people show up in my clinic complaining about hearing loss and it just turns out that they’ve done a recent renovation, knocked down some walls, put in hardwood floors and marble counter tops and now the acoustics of their home are just brutal even though the new “great room” is bright and airy and beautiful.

@Neville said:

However, on average, it takes more to get them to a place of competance with REM which suggests it would probably be extra hard for them if they were all alone in a clinic.

I’d agree with that here too: If I’d not been working for the U.K. distributor of a REM system, there’s no way I’d have the degree of background competence to confidently run the tests. Then again my route in to the industry was fairly unusual.