What would be the optimal method, a helper where one can’t see the key press triggering the tone, and then a hand signal or verbal acknowledgement.
Yes, someone else presenting the tones non rhythmically so you aren’t necessarily expecting them and accepting the threshold as where you detect 50% of the time on upwards runs. An auto one is a cool idea, but I agree probably not something the manufacturers are prioritizing.
is preferred practice, but it’s one of many. A clinician who doesn’t do it is a “bad" convivial in the same way that they would be a “bad" clinician of they didn’t to , audiometry, speech in noise testing, offer appropriate acoustic coupling, educate, counsel and listen to the patient, and on and on. REM get inexplicably argued about, whereas no is arguing that we don’t need appropriate acoustic coupling. (Even though, sadly, that is ALSO apparently a big issue.)
Recruitment is widely misunderstood and misused including by professionals and therefore , but the person having loudness tolerance issues should probably have their measured and use a prescriptive target that accounts for them, and then possibly think about hyperacusis protocols if it’s a big issue.
So, as a rule of thumb, if I perform an in-situ test on myself and get 80 at 2 kHz, I should assume that I would hear that at 85 if someone else performs an in-situ test and I would be “blinded” in that test?
If R.E.M. is the gold standard then why isn’t it a mandated industry standard? If performing R.E.M. guaranteed a perfect fitting, why would we need volume control on our hearing aids?
Too oversimplified issue in that question. Do you take into account that some performing are not knowledgeable what they are doing? Buying REM equipment and doing it isn’t sufficient. You also need to know what you are doing and how to interpret verification at the eardrum and concurrently take into account all background concerning the patient.
In summary, in my opinion R.E.M. is over rated and I personally would never seek another R.E.M. fitting
This is classic example of anecdotal evidence, while there is evidence-based scientifically proved that in general REM is very useful tool to provide better audibility in population.
I had applied for early replacement. I was taken aback by the WSIB letter of response. Perhaps I’m just paranoid. I’m very lucky for what I’ve received so far.
I’ve had health issues that lead to my concerns. I’m feeling better since I retired. But I’ve got a way to go.
How is the new setup program working out? I’m still on NL2. I hope NL3 is better.
If performing R.E.M. guaranteed a perfect fitting, why would we need volume control on our hearing aids?
doesn’t guarantee a perfect fitting, it’s one step in the fitting process that may help get you to a good fitting faster, with fewer appointments and trips.
Here’s an analogy: You need to go on a long-term medicine for some condition, and the medicine happens to be in liquid form. The doctor is going choose a starting dose based on your weight, age, etc., and then adjust according to your body’s reaction. Your starting dose is 5 ml. You might decide, what the heck, I’ll just eyeball the dose since it may not be right for me anyway. Or you might measure the dose. Measuring it is like using REM. Not a perfect analogy but useful, IMO.
I don’t think REM is worth hundreds of dollars and a visit to another provider. It’s certainly worth the time that it takes a skilled provider to perform REM as part of the routine fitting process.
By the way, volume control has its uses even with well-fitted aids. For example, I turn down my aids’ volume when I watch TV with my wife, because otherwise a TV volume that’s comfortable for her would be too loud for me.
appropriate random ascending staircase method, you’re generally going to mark your thresholds a little bit better than they really are. You could boost them 5 dB and probably be closer.
This is a great advice! Many Thanks !
When doing my fittings, I’ve found that the softest tones levels can vary depending on how quiet it is (quiet vs ultra quiet at 1am). What I’ve done is to select the level above the quietest sound which I’ve found “consistent” . I think this aligns with your pro recommendation of increasing the gains by 5dB.
I’m planning to experiment with the random ascending staircase, but I’m uncertain about the level of randomness I can achieve since I’ll be able to see the frequency of the selected tone in the software.
How does one different actual loudness tolerance issues from normal variances such as a more sensitive patient or someone who just doesn’t like loud noise or avoids it to preserve hearing?
Do lower tested mean anything or is that just conscious/subconscious selection of a level a bit below true discomfort? What does the normative data show?
These posts have been interesting and informative. Thanks to all. I was interested in the Summary feature of our forum that draws a conclusion, relating to . However, after I tried a few times, the summary would not reach a verdict. So here is my take: (not to infer that I am better than AI)
It seems that the majority do not think it to be absolutely necessary, especially if the fitter is not experienced in the feature. One poster, wtolkien, raised the question of the “percentage of fittings that were very different when comparing ‘first fit’ to ‘after REM’ “ Research published in the American Journal of Audiology found that 71% of hearing aids failed to hit their prescribed targets at one or more frequencies when using the manufacturer’s default settings alone.
Given this data there’s a reasonable chance your hearing aids could be performing better. However, many persons feel that if the cost is more than about $300, it is not worth it because the aids can be adjusted with situ fittings ensuring that the hearing aid is tailored to the individual’s unique ear shape and allows for real-time adjustments to fit the user’s specific needs.
To borrow a phrase from the next to last verse in the last chapter of Ecclesiastes: “here is the conclusion of the matter…..” Ask your audiologist is he/she does it, but do not pay (much) for it.
Dave, WSIB will keep giving you new hearing aids every five years even in retirement.
IIRC, This year it will be 5 years since you bought your last hearing aid? If so, that’s great, you’ll probably be able to have the latest Phonak hearing aid coming out in a few months, or maybe as early as August?
American Journal of Audiology found that 71% of hearing aids failed to hit their prescribed targets
Before I retired, my company developed close to 200 new products, about a third of which used chips of 22 bits or more. So I know the good, the bad and the limits of DSP chips, and I also understand analogue-to-digital conversion and back. ADC DAC
Before I would approve a new product, it had to meet the “just noticeable difference” threshold. In other words, would a customer be able to see a noticeable benefit to buying our new product over what they were using before? Forget technical specs. Could the customer definitely see the difference and was the difference worth the price? The hearing aid business has a major problem with that threshold, and they depend on the placebo effect of new technology and glossy marketing words between new generations of hearing aids to sell them. They don’t depend on the user hearing better from one incremental generation to another. ( is going to change that!)
That aside, in terms of and the 71% of failing to hit their prescribed targets. They are talking about precise technical theory and not what a hearing aid wearer can actually hear. Even if they say they can hear the difference, once they relax their focus and concentration and return to the chaos of daily life, most of them can no longer identify what the adjustment actually did for them.
If an REM is available, go ahead and do it. But it’s not hearing aid magic.
So, as a rule of thumb, if I perform an in-situ test on myself and get 80 dB HL at 2 kHz, I should assume that I would hear that at 85 dB if someone else performs an in-situ test and I would be “blinded” in that test?
Eh, “on average”. I actually probably wouldn’t put the boost on above a 65 loss because at that point, when the outter hair cells are pretty much dead, the difference between hearing it and not hearing it are much bigger. But Ocram makes a good point:
I’ve found that the softest tones levels can vary depending on how quiet it is (quiet vs ultra quiet at 1am)
The other big difference is that this isn’t being conducted in a sound booth. Again, that matters less if your thresholds are higher, but more if you have close to normal hearing.
But it can all get a bit semantic. There are no “true” thresholds. Neural perception is stochastic and at the threshold level for a normal hearing listener there is a range of volumes between “hear it 100% of the time” and “never hear it”. Prescriptive targets are based on a particular definition of threshold established in the field, which is 50% detection on ascending runs (going from quiet to loud) in a situation where the listener is not in control of the tone presentation and doesn’t know exactly when to expect it. If you break these rules, you’re adding in more variance. However, much to my dismay and probably many people here who are like me and want precision, there is fuzziness in audiology. I try to minimize it wherever possible but realistically if your thresholds are 5 dB off and you’re DIYing does it matter? It’s going to be a pretty small gain difference and you’re adjusting the gain to preference anyway, aren’t you?
I had applied for early replacement. I was taken aback by the WSIB letter of response.
They’ve gotten harder on early replacement since the program change. Stick with the five years if you can. We’re throwing people into loaners to avoid early replacement because it actually limits their choices now.
How is the new setup program working out? I’m still on NL2. I hope NL3 is better.
Not many providers HAVE NL3 yet, including us. The National Acoustics Lab released it, but it will take time for 1) manufacturers to add it to their software and more importantly, 2) systems to add it to their software. I think the MedRx device has it. I lean towards so I don’t know how meaningful NL3 will be to me. I’ll be interested to see what the changes are and what their new prescriptions for normal hearing people with noise trouble are.
How does one different actual loudness tolerance issues from normal variances such as a more sensitive patient or someone who just doesn’t like loud noise or avoids it to preserve hearing?
Do lower tested UCL mean anything or is that just conscious/subconscious selection of a level a bit below true discomfort? What does the normative data show?
Interesting question and possibly an area of some ongoing conversation in the field. But I would say that pure tone loudness discomfort levels () under 80 are generally considered abnormal. Normal hearing individuals generally have LDLs quite a bit higher than that. I wouldn’t refer to low LDLs as recruitment. Recruitment is an abnormal growth of loudness (you find that things seem louder faster than someone else does) and is present in all cases of hearing loss and to a greater degree as hearing loss gets more severe simply because of the reduced dynamic range that results from the sensorineural hearing loss. So I prefer hyperacusis for abnormally low LDLs.
Low LDLs make hearing aids harder; you have to compress more and that sounds worse. Loud perception is flexible to a certain degree, however, and people who are motivated to do so can often push their LDLs up.
That aside, in terms of REM and the 71% of HAs failing to hit their prescribed targets. They are talking about precise technical theory and not what a hearing aid wearer can actually hear. Even if they say they can hear the difference, once they relax their focus and concentration and return to the chaos of daily life, most of them can no longer identify what the adjustment actually did for them.
I would dispute this a bit. A lot of what REM is doing is taking sounds that are otherwise inaudible to a patient and making them audible. So it is indeed what a hearing aid wearer can actually hear. In one of the worst cases I’ve seen a patient came in with brand new hearing aids that were giving him less than 10% audibility, and in this patient’s case they couldn’t advocate for themself and their caregiver was counselled on realistic expectations. Most cases are not going to be like that. But the brain can’t use what it can’t hear, and most new hearing aid users have no idea what they should be able to hear or what things should sound like because they have been living with hearing loss for over a decade.
There are hearing aid users who don’t want to optimize things or don’t want to hear things. If their hearing aids are doing 80% of what they can for them and they are happy, that’s good enough. But that should be their choice, not their provider’s choice.
Fingers crossed. I tried to talk to the audiologist after submitting a claim for early replacement. My claim was for loss due to noise exposure. It was accepted over 20 years ago.
My specialist suggested my hearing is much worse since I had a heart procedure. It was denied. The letter from WSIB was upsetting to me. I’ve had no contact from that person at WSIB.
You and Neville have good memories. Thanks to you both.
Patients with ~105-115dB who report not liking loud sounds are just aware they don’t like what normal hearing folks would also consider loud and not pleasant but perhaps some may be willing to tolerate potentially due to hearing loss?
It depends. I lot of the time patients with severe loss and hearing aids complaining that things are loud are actually complaining about soft sounds that sound louder than they remember, and this is legitimate and often not something that can be resolved. Moderate and loud sound perception is flexible in a way that soft sounds perception isn’t. There is a sense of “softness" that is lost with hearing loss such that when you replace those sounds they will always sounds louder than you remember them and you have to make a choice between getting used to (not adapting so much in this case, really just getting used to) hearing them a bit louder versus simply not hearing them at all. But if you choose not to hear them at all then you also lose the soft sounds in speech in that frequency range. So it depends on what the bothersome sounds are, really.
im sorry but everyone saying “didn’t work” for them or it’s not necessary is misunderstanding what REM is. it gives the audiologist a visible representation of what the hearing aids can do, can’t do and what they are doing in your ears. using myself as an example i have one baby sized ear canal and one average sized ear canal. the REMs will balance the sound without so much trial and error.
if you prefer your settings as they are if they not hitting the target then your audiologist doesn’t have to match it. it’s still information which is useful and really is their ethical duty to collect. they’re putting something in your ear that creates pressure waves.
and saying things like the audiologist has to be good at their job to do it accurately and tiny movements can make a huge difference therefore it’s not accurate anyway and so it’s not worth doing is like saying it’s not worth servicing your car because the mechanic has to be good at their job. obviously! but you unfortunately it’s on us to find the good mechanic/audiologist.
or if they’re not misunderstanding, it’s simply what they want to be true because their audiologist doesn’t do REMs and they refuse to believe they’re being cheated (because they are). and by the way, I’ve been DIYing since you needed a hi pro box with the old USB A and those flimsy cables that always broke. I still think REMs are a necessary and valuable step on the fitting process
There’s one of the issues….I have tried a longer wire. With another smaller dome, which was different than the current smaller one I have on, but as this is the 4th dome I have tried, I can no longer remember. I tried that dome with the longer wire alone, and then after that didn’t work, the attachment that holds it in place. The issue is it held it in the wrong place for my ear! I had to try and move it around, but could not get it to stay where it needed to.
What you say makes sense about every time I change the dome and finding the correct dome first, but that could take a lot longer. My current audi said she had A LOT of molds to try, so I feel like she’s going to keep trying molds with no end in sight, and keep putting me through this over and over again. Honestly, I am at my wits end with it. To your point, it would have been better to go to a place that does REM regularly and includes that testing in the price while fitting domes. I think I found with the longer wire it has a tendency to come out more - hence the little whip attachment to keep it in place. Yes I realize I might need molds, but my audi doesn’t seem to think I need to do that (at least not yet). I will email my audi and ask her if I can either get a smaller dome or longer wire or both and see if that works better, but I am not very confident.
I have experienced provincial government cutbacks before.
I’m grateful I have my hearing aids. I’m grateful that Hearing Well Matters took me on when I needed a new audiologist or hearing instrument specialist.
The coworkers still working at the school board say I’m lucky I retired. A lot of people there have been released. I spent time training an incredible young man hoping it would help him.
That’s a decent -like summary, which I mean as a back-handled compliment, sorry. As AI might, you’ve captured the overall gist of the discussion, but ignored a smaller volume of more authoritative posts like @Neville’s.
Search engines and AI see this forum as a valuable source. But the vast majority of users and would-be HA users, who just want to cough up the price and get help with their hearing, don’t recognize that threads like this one end up being oriented toward the informed few. The pros like @Neville, along with a few non-pros, know and say that is a necessity for fitting that vast majority of users. But their voices can get lost among the users who’ve dived deeply into this stuff, including ’ers whose experience is pretty much irrelevant to regular hearing aid clients.
I kind of regret saying that REM isn’t worth a few hundred dollars extra. No one should have to pay that on top of regular fitting and dispensing fees, but maybe it is worth it for a typical inexperienced client if it’s the only way to get fitted properly (if that’s the actual result). Also, a few hundred dollars means nothing to some people and a whole lot to others, so it’s hard to generalize.
Well I don’t know where this is all gonna lead, but my In-situ has always been pretty spot on to my over multiple brands and models over the years, sooo I can summarise another dead end thread, is just another tool in the tool box, it’s not ever gonna magically restore your hearing, you can do cheaper at a fraction of the cost that any clinic can offer and still hear better!
One thing tho, is that the manufacturers are getting very good with QC, it won’t be long before REM will be done exclusively by the next generation of receiver
(xMEMS) making all this nonsense of what’s better redundant
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