Question On REM

@user490 said:

. If you do not measure you have no way to verify that the aids are delivering amplification close to target

What about my case where amplification is not needed? What my devices do is to adjust frequencies to those which my brain can understand. (Filling in the gaps from dead nerves, I suppose is a way to explain)

I’m going to go with what the doctors of audiology and the neurotologist told me. They are the ones live-and-in-person with me.
No offense is intended at all to those who are proponents of REM. It’s just that sometimes REM is not necessary of helpful. Other times, as explained by the same audiologists, it is critical to study REM and adjust accordingly.

So, if one’s fitter or audiologist declines REM, it may be for a legitimate reason.

I’m not sure how REM handles frequency shifts at normal thresholds. @Neville seemed to indicate REM would be even more important if thresholds are normal so perhaps he can add some details. One wants to account for the accoustic coupling selected. One also want to be certain the gain is not excessive especially with good thresholds. Without REM it is a guess.

You can trust your providers but that does not make their claims correct. Medical providers in the US have to provide the lowest standard of care only to avoid malpractice. Rarely does one provider practice the best level of care in all respects. Rarely are they fully up to date. For audiology the risk of harm with adult patients is low so the care can be poor. They can, for example, blame the patient for not complaining. Any harm would likely happen over years and be hard to establish. Dr. Cliff mentioned that in Oregon if REM is not performed a patient can return hearing aids without a time limit. I’ve not verified this but it is one more data point to support that the standard of care has shifted.

REM takes a short time and has no meaningful costs other than time and the equipment. There’s no reason not to do it even if it happened to confirm it added nothing at all which would be rare. The endless debate is pointless because people who know way more than us have already determined using it is best practice.

@PJB12 said:

What about my case where amplification is not needed?

If you have normal hearing thresholds, then NAL-NL3 normal hearing module is probably a good option to show targets gains. Without REM it isn’t possible.

@PJB12 said:

It’s just that sometimes REM is not necessary of helpful.

That situation is when the patient has ear canal almost ideally similar to average. How they measure it? Another situation is when patient want to try HAs when there is busy day in audiology practice; he/she loan it just to check sound.

Indeed, it either acoustic neuroma or hearing loss greater than 60-70 dB in which is increased risk of dead regions in the cochlea (risk, but not certainty).

@Neville said:

In what situation would you have an intact inner ear and dead nerves?

The troubled or non-functional nerves are in the brain, not the ear.

In my situation the cause is three-fold:
A) Physical injury to the brain in the past.
B) A non-resolved demyelinating disease
C) Chronic inflammatory demyelinating polyneuropathy (Similar to “B”, but different cause)

These items also cause non-hearing deficits & challenges.

In the post quoted above, “medical simplification” was mentioned. I absolutely disagree. I have been well educated by the medical professionals about the A, B and C pathologies. The education continues as the challenges progress and/or manifestations change.

Bonus:
One of my brothers is board certified neurologist and board certified neuro-psychiatrist. He is considered by medical professionals to be the top in his field. He is an excellent impartial resource to review what I have been told and to review diagnostic testing and imaging. Plus, he has access to other professionals who are able to review.

My trust is in him, as well as the other physicians & audiologists.

That’s a very particular case so you cannot extrapolate REM is not needed or useful for you to just about anyone else. Even in that case I would think they would want to know what signal is being sent to the ear by the hearing aid. Maybe they think it does not matter due to those issues but it is not a good broadly applicable opinion.

Can you describe what you can hear unaided and aided?

What diagnostics are used in your case? Specific imaging (ear and brain MRI), ABR, other? You seem to say some frequencies still get processed. How did they determine that?

@Neville said:

But people are absolutely using hearing aids with normal thresholds to try to overcome auditory processing issues–the extra gain helps with temporal asynchrony in the nerve and the extra features may also support. I would still REM it.

Exactly. REM is just for particular cases, like middle ear or sinuses open to ear canal.

NAL-NL3 has “normal hearing module”, which probably could help with APD. There is MedRx simulator software, in which someone can enter their normal or near normal threshold and then choose that module.

I have no time for checking papers and don’t know which particular disease it is, but eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) seems pretty reasonable to be supplemented as well as vit. D due its immunomodulation effect. At least they shouldn’t harm in reasonable doses.

@user490 said:

That’s a very particular case so you cannot extrapolate REM is not needed or useful for you to just about anyone else

I mentioned what I was told by the medical professionals who know my physiology about REM & me.
I never “extrapolated” that is was not useful to others, If my words appear that way, I apologize.
I also mentioned REM for others.

@user490 said:

Even in that case I would think they would want to know what signal is being sent to the ear by the hearing aid.

Explained to me was that their computer can pick up what the speaker is providing to the ear. Maybe they have this because it is a medical practice?

@user490 said:

Can you describe what you can hear unaided and aided?

The simplest description would be that certain ranges of frequencies, or a certain single frequency, will provide me with garbled sound, muffled sound, stacatto sound, quiet sound or no sound at all.
Tonal gaps are quite prevalent.

@user490 said:

You seem to say some frequencies still get processed. How did they determine that?

Common hearing testing without hearing aid devices was Step One.

@PJB12 said:

Explained to me was that their computer can pick up what the speaker is providing to the ear. Maybe they have this because it is a medical practice?

What I see in the Target software in real time is only what microphones pick up, not what particular SPL is provided near your eardrum after mic pickup and processing the sound by the HA. Still insufficient and shouldn’t be medical practice, it’s rather rule of thumb assessment.

@PJB12 said:

So I should quit going to these people? Not likely.

I didn’t write that, I wrote that measuring microphone pickup is insufficient. You can discuss that with your HCP.

That’s where I’m confused about how the testing works.
The person’s instrument can “hear” what the speaker in my ear is delivering to the ear. I have no idea how.

Perhaps the computer knows what the microphones on the devices are picking up and applies the programming of the hearing aid to artificially “hear” what is being delivered to the ear. I don’t know the science behind it.

I understand this is more appropriate than REM for me because the concern has little or nothing to do with volume in the ear.

The only reason I initially replied to this thread was because a poster had concerns about not having REM testing. I simply wanted to explain that sometimes REM testing is either not useful or inappropriate. I’m not involved here to defend the clinicians.

There are only a few studies that have actually been done and off the top of my head they recommend about 10dB soft gain, 5dB moderate length gain and minimal loud gain, so fairly compressed. Open fit. I have yet to get a good look at what NL3 is suggesting. Practically, clinicians are a all over the map. I haven’t heard reports of volume junkies. Most of this stuff does seem to focus on just giving a bit of a boost to softer speech.

The research supporting remote mics is a lot more robust. But remote mics just aren’t quite as flexible in terms of use situations.

The compression doesn’t bother these patients?

Could a similar approach be used in the highs and lows for cookie bite to overcome some of the loss from the hearing aid itself or do the fitting prescriptions account for this? NAL-NL3 seems to boost the curve a little versus NAL-NL2 possibly to get at some of this.