Real Ear Measurement vs. Auto Hearing Aid Programming

This should be required listening for all members. I had my first real ear fitting at Costco recently. I feel I’ve been cheated prior to this last fitting!!! I would never allow a fitter to fit me without real ear from now on. Imagine I’ve been spending $200 for my fittings and no one did this. What a ripoff.

Seems to be saying Nal NL2 is the only effective prescription. All of the proprietary prescriptions reduce the gain in the higher frequencies to increase comfort to satisfy customers at the cost of effectiveness.? Maybe I misunderstood.

Thanks for your reply, @Sierra. Actually, I’m familiar with REM and all it does, etc, I was hoping that one of the audiologists who visit the forum could comment on the different methods/machines used and if one system is preferred over the other. Personally, I think the Verifit possibly allows for more accurate REM and tweaking, but I’m not an audiologist.

“Real Ear” such as VeriFit measures the “hardware”. Including your ear-hole, but nothing past eardrum. This won’t ever change, unless the HA’s program is changed (or something goes bad, or there are changes in the ear bore- both unlikely).

The “target” is a matter of opinion. The several academic studies have lofty goals for speech balance. I think the problem is these sound “harsh” and displease users. The HA companies take theory as a starting point but bend some “comfort” into the curves.

The “target” is somebody’s opinion on a good curve for an average user (of given HL and experience etc). The well-known targets are not “wrong”. But they are not perfect for everybody. Hearing and understanding is a very personal thing.

The VA clinic I go to does REM and they adjust to NAL-NL2. I asked about other formulas and they were quick to tell me that they only use NAL-NL2. I found out very quickly that aids programmed in such a manner wouldn’t work for me. When I got them hooked up at home, I tried DSL-5 adult, and it sounded better to me, so that is what I went with. I also want to try the Phonak formulas as well. One of my criticisms of the VA is that they seem to take a cookie cutter approach. They don’t activate SR, and once they complete the REM, you are out the door and good luck. Of course you can go back if not satisfied, and I intend to do just that at some point. But given the experiences I have had so far, I don’t have my hopes up. On the other hand, they do see an enormous number of people, and I don’t think they can reasonably be expected to spend a great deal of time on any one patient. My clinic seems to be pretty inflexible in a lot of areas, but others have posted that they got excellent treatment by the VA. I guess it varies according to which clinic you use. I do think REM is a valuable tool for the audiologist, and helps insure a more accurate fit. I don’t think it works in every case though.

Are these the proper steps to fitting using fitting formula and REM: 1) Try the different fitting formula available and chose the one that appears to help your hearing the most. 2) Use REM to fine tune the fitting of the formula.
Another question: Will the REM data change based on the fitting formula used? In other words, is only one REM measurement required until your HAs change or your hearing changes? TIA for your help.

Excellent answer.

Finally, someone else who realizes that REMs are NOT a magic bullet.

They DO detect broken hearing aids and cables/tubes … BUT … all this stuff should be working anyway for a new aid. Also, you don’t need this high tech system to detect a duff hearing aid!

The target volumes that REMs check for are just theoretical goals … and there are several versions of these goals so which is the RIGHT one?

Also, as noted above, the REM does NOT test any part of YOU!

IMHO, REMs are essentially marketing theatre for the audis.

The more flashing LEDs, color screens and tinkering with probes etc the audi does the more nurtured the client feels.

The used car business is the same - a very clean showroom plus highly waxed cars plus free coffee and friendly discussion mask the crap transmission or engine of the car you are looking at.

End users who INSIST on audis using REMs show that the ploy works.

It’s clearly worth it for an audi to spend $10,000 on a glitzy REM system to show his/her ‘expertise’ …

@TrueBrit said:

Also, as noted above, the REM does NOT test any part of YOU!

I outlined elsewhere why this argument makes no sense. You didn’t clarify what I might be missing.

REM may note be a silver bullet, but personally I would prefer to do business with an audi that chooses to have every available tool at their disposal to help me hear better.

REM test will make your hearing prescription closer to the gain targets. Most audiologist and HIS use manufacturer first fitting procedure which won’t be equal to REM. I asked my local audiologist for REM if not buying aids from her and she quoted 300 US dollars per ear!