Just released study finds no clear 3-month advantage for REM-based fitting in unilateral hearing aid users

@jeffrey said:

ALL of my ENTs/surgeons have warned me against letting GPs and HA techs poke around my ears. You've also suggested that my ENTs and audis don't know what they're talking about-with absolutely zero evidence. that's hardly a science based conclusion.

Such many words and you still think it's a problem to simply get silicone probe, show it to ENT and simply ask. That was what I have written.

Meanwhile

@jeffrey said:

What you mean above is, 'I don't know why you disregard my advice and listen to your licensed doctors rather than doing what I tell you?'.

folks, that's not good advice.

No, please stop insinuating what I didn't say. I haven't written "ENT is stupid, do what I said", I have written something like "ENT can't have knowledge about everything, please show him that delicate probe, which can't pierce even Kleenex tissue paper"

and I have written something like:

"REM is especially important for patients whose ear canal anatomy is particularly distorted, i.e., more deviated from the population average."

That's not the same comparing it to what you are insinuating to me.

@bradw said:

Is the end goal speech understanding in whatever the patient calls his world? Or is it something else?

Yes, I wonder about this too. I'm an optimiser, so I'm a good fit with patients who are optimisers. I'm a fine fit for patients who aren't optimisers too, because even though they aren't that concerned I will leave them in a solid spot. It's a harder emotional struggle for me to manage patients who come from a place of "I want to hear the bare minimum required to lightly interact with society". At the end of the day I belive in patient-centred care and I believe in personal choice, but yeah I'm going to push back with those ones.

@bradw said:

I reckon that a lot of one and done fittings are a result of a patient not knowing that it could be better....or a patient too lazy to call back...

Absolutely we get patients who show up three years later and are like "I hate these hearing aids" and we're like "Why didn't you call us? Why didn't you answer our regular calls? We can fix all of that!" But that being said, at least when these patients walk away after their initial follow-up we KNOW that they are getting good audibility because we measured it.

Part-time wearers typically do not do as well as full-time wearers. It's a failure of motivation, sure, but on the audiology side it is also a failure of education. You can be the clinician who is like "thanks for the easy money, good luck, on to the next" or you can be the one who is with them in year three when they finally make the transition to full-time wear after you've spent a lot of effort and time getting them there. Those patient may not be as financially valuable, but as much as possible I try to work for the intrinsic/moral value.

@bradw said:

So yeah, I agree that when a doctor goes against the suggested norms, it's worth questioning.... but it's not automatically wrong!

Hm. You need to be careful though because on the internet these days you can get sucked very quickly from nuanced questions about which particular patient cases are best for statins and how understanding has changed over time, to full quacky statin denialism. And from there, how many steps over into the increasing gravity of modern wellness RKF Jr style grifting? Overarching medical guidelines are there to protect the public. If an individual doctor disagrees about something, the proper pathway is to go back to their peers. If the evidence is on their side, practice recommendations will change. If a doctor cannot change the mind of a group of his educated peers, his basic premis should be pretty heavily scrutinized. If he's charming, all the worse--one can understand how someone shy or odd who is a poor communicator may fail to get their ideas across, but if someone is generally a smooth talker chances are their idea failed because it was bad. Or I guess because . . . conspiracy!

@Neville said:

Finally, I think this discussion should probably not veer sideways into known antivaxxers like Gotzshe.

I don't think you should be dismissing someone using labels because you don't like their views on one topic and to be blunt, if that's all you have to say then you should keep it to yourself because you haven't bothered to read what he wrote and if you had you would think differently. I have lost a lot of respect for you because you cannot see past your own biases and you don't want to, while at the same time accusing others of being biased. Peter founded the Cochrane Collaboration because he believes in science done well and has completed more collaborative systematic meta reviews of topics than you ever will. Disagree with him all you want, but keep your ad hominem to yourself. It's fallacious and lazy.

I resent being told to keep things "on topic" because something upsets you. This forum is filled with off-topic replies, and I actually asked Abram to change to the topic title because it was very misleading. I have also contributed more to this discussion than yourself. You're coming in at the end and dropping your opinion very late in the day.

@bradw said:

I agree that when a doctor goes against the suggested norms, it's worth questioning.... but it's not automatically wrong!

You are absolutely right to question whether something is based upon sound evidence. There are so many practices that aren't founded on solid science and have simply continued because "that's what's always been done" or that's what is profitable and pharmaceutical companies have been involved in designing guidelines. Statin medications are a good example of this.

If you've read the evidence presented, you would realize that real ear measurement has a solid evidence base behind it, with randomized control trials and better patient outcomes to prove it. But even then, audiologists consider it one tool in their selection of tools. Something better will come along to replace REM eventually and we'll embrace that too.

Did my immediate familiarity with Gotzsche lead you to believe that I *hadn't* read his stuff?

I remember now why you and I were at loggerheads. I'd forgotten before in the context of you seeming like a reasonable audiologist. But it was because you lean into anti-science conspiracy territory, right? For all your talk of EBP. You said homeopathy worked through the occult? Yeah. You and I will not agree on this. We have incompatible belief systems and I'm not interested in arguing it out.

So this is a report from one practitioner about 105 of their customers/patients? If so, it's more an anecdote than a 'study', IMO. How did this come to be publicized as a 'study'?

If only one practitioner is involved, isn't it about that practitioner's skill? Even if he's right, how useful is his report to HA users who live out of his geographical area? Or does he do remote adjustments for users?

Read the article linked where he details how the BMJ refused to publish analysis of a study promoting a particular antidepressant drug after it was discovered that the original authors hid two suicides and claimed 67% of their cohort showed improvement and a resolution of symptoms on the drug when only 3% did. This is not his study, this is him whistle-blowing. The original authors accepted this re-analysis was correct.

You aren't truly curious about the world and consider people who don't follow your own personal dogmatic beliefs to be beyond the pale. You treat us like crap and promulgate social stigmas against us. Stigmas that you have probably learnt from a society and never have actually rationally thought about. I know this will detract from you being a good audiologist every time you interact with someone who you disagree with. You should take at deeper look at yourself. It's your attitude that is rotten here.

I think you would very much appreciate the site Retraction Watch. The world of medical publishing is murky place and has been for a long time. There's so much you need to know before you can even consider reading a paper.

As far as I'm concerned, that discussion is over.

It seems to me that REM is a matter of Audiologists collecting more money for something that has doubtful benefits.

@Joey1 said:

It seems to me that REM is a matter of Audiologists collecting more money for something that has doubtful benefits.

Evidence says something different.

Your statement is also inconsistent. Audiologist have to invest into REM equipment (and annual calibration service), so I don't understand your comment about "collecting more money".