Your Audiologist is Wrong: Real Ear Measurements are ESSENTIAL for Your Hearing Aids to Work Well

@jeffrey said:

My ears have been heavily reconstructed by surgeries in my youth. Apparently, I barely have an ear drum in my right ear. My excellent audi pointed out that REM requires a mic be poked up against the ear drum. again, my ears canals are bizarre. my audi does REM on request but advised against it for me. I agree. He also thinks that it’s over rated. He relies on adjusting aids to fit the real world experience of the user, which can’t be replicated in office but only aimed at

After reading this, I feel ambivalent. If you have undergone multiple surgeries that have altered the shape of your ear canal, REM is especially important for accounting for your ear canal’s unique features! Additionally, he could insert a probe microphone under eye control during simultaneous otoscopy. Furthermore, I doubt that carefully introducing the probe millimeter by millimeter would be dangerous.

Regarding soft spoken people. It really depends. You might get lucky and be able to but I wouldn’t expect it. Ideally use a remote microphone. If your hearing aids have a special feature for soft spoken people (like Phonak’s Speech Enhancer), odds are better. Having your Audi add extra gain to 50dB sounds can possibly help.

I think you missed the part about the fragility of my right ear drum.

People on the internet are often sure that they could perform micro-technical procedures, even without any experience or training.

Highs help with soft spoken people. Appropriately acoustic coupling to support gain around 1khz also helps if you’re in an open fit and shouldn’t be. What happens when you just turn the volume up?

When folks turn up the volume does that often indicate a less than optimal acoustic coupling? More at the highs or 1K?

@user490 said:

What do each of the other brands do? Can one force Oticon not to gain average?

The dynamic (AI) sensing feeding into dynamic gain algorithms in modern aids means that it’s often difficult to ‘see’ the specific response out of the box.

There’ll be an engineering group in Oticon who will ‘absolutely’ believe their processing strategy represents the best levels of gain vs. loudness vs daily auditory fatigue and they will have a study to prove their position. Or at least they did one two/three years ago in the development of the Intent.

Other manufacturers will be doing their own thing.

I might have the wrong end of the stick here, but Oticon broke their own product release cycle (12 months early iirc) when the Intent came out, this might be evidence that (with the best ‘Intent’) in the World the AI rules could be set to give users the type of sounds they like rather than the ones they need for absolute speech clarity.

Perhaps they’re going to sort it out in next month’s release. The difficulty as an Audiologist is that it’s a bit like Formula 1, but where you only have one manufacturer on their own test track ‘proving’ the performance of their car. I like what this site is trying to do in terms of comparison, but I think they are struggling to show like for like comparisons simply, because people can’t wear two different hearing systems at one time and habituation issues.

The Oticon release could be a power aid too, but I’ve heard nothing to confirm that.

We have just tried boosting only soft mode a couple of weeks ago. I am going in today, to reverse that change because all it has done is made speech blend in more with background noise. Even in quiet environments I am mishearing things a lot more - so much so, that even my sister asked me if my hearing aids were working. Unfortunately boosting soft mode boosts all frequencies, but the lower frequencies overwhelm the higher frequencies with the end result that I am currently hearing worse than I did two weeks ago. So, yes we have to reverse that.

I am going to ask if him if I can have one program with Vac+ and a second program with Nal-NL2 configured and compare how well I hear with both. It will answer for once and for all whether the missing high frequencies are the problem or not.

I had two programs a while ago, just out of curiosity, one with VAC+, the other with Nal-NL2. No dramatic difference in my case, but I definitely prefer the VAC+.

@Roberto said:

So, it’s not just marketing fluff.

I’d absolutely agree with that too. We’ve fitted a lot of DeMant product over the years.

Again (to labour the car analogy) picking a car just on it’s 0-60mph time isn’t a reliable metric for real World use. It IS an indicative performance level though.

@user490 said:

What do each of the other brands do? Can one force Oticon not to gain average?

Each manufacturer has their own systematic divergence from prescription targets and it will differ from generation to generation. But they also cannot account for the degree to which your individual ear shape differs from average.

@user490 said:

When folks turn up the volume does that often indicate a less than optimal acoustic coupling? More at the highs or 1K?

No not necessarily, but sometimes knowing what a user’s experience is with turning up the volume helps identify problems. If the acoustic coupling is too open the low/low-mid frequencies will still not be there when you turn up the volume and speech will get sharper but soft speech might still be lost.

@Roberto said:

I am going to ask if him if I can have one program with Vac+ and a second program with Nal-NL2 configured and compare how well I hear with both.

I mean, if he’s not doing REM anyway then you might as well ask for a 3rd DSL Adult program if you are chasing the highs, which will only take him an extra few seconds to add.

@Bimodal_user said:

Wow, so even diagnostic tonal audiometry testing can be biased?

I’m not sure biased is quite the right word. But yes, audiometers are calibrated to assume an average ear canal size and if there are significant variations then the RECD will correct for that for the calculation of prescription targets. If someone has a perforation, for example, the audiogram if done with custom tips can show a low frequency loss which isn’t really there but it’s just an artifact of the ear canal volume being much larger (because the middle ear is included). RECD will correct this, but if not RECD is available then testing should be done with circumaural phones because the ratio of the increase will be smaller relative to the much larger calibrated ear canal size for circumaural (because it’s over the ear).

Sorry I’m stuck on my mobile right now, but what jumps out at me is…is your RECD sitting that it was measured with an earmold? Aren’t you in RICs? It would have been measured with a foam tip, unless that’s an old RECD taken at a time when you were in a BTE.

No, there are DSL adult targets. NAL and DSL have been converging over time–I’ll be interested to see what changes happen with NL3–but DSL adult targets still tend to have a bit more high frequency emphasis and are a bit less compressed. Most manufacturer proprietary targets are based on NL2.

My hearing loss is in the 1500 to 5000 range and to get me to be able understand speech my aids had to have more powerful receivers than the fitting software said. And the aids adjusted far above the fitting software recommendation. Which was the cause of so much time and effort and the therapy I had so I could hear the sounds loud enough to understand what people were saying. In most cases aids regardless of manufacturer are set for comfort and not for optimal hearing, meaning they are set lower than needed

I have just come back from my current audio. He has added an extra program for NAL-NL2.

I noticed a change immediately upon switching to that program. He voice was definitely more clear with NAL-NL2, although he never sounded indistinct with the Oticon Vac+ profile. But I can definitely hear a difference for the better with NAL-NL2. I was not expecting to actually hear the difference! Interesting.

I will update once I have trialed NAL-NL2 for a week or so and see which environments each program works best in.