When Real Ear Measurement FAILS! | Hearing Aid Programming
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- Опубликовано: 17 окт 2024
- When Real Ear Measurement FAILS! Dr. Cliff Olson, Audiologist and founder of Applied Hearing Solutions in Anthem AZ, discusses situations when Real Ear Measurement may not result in the perfect hearing aid fitting.
Website: www.AppliedHear...
Real Ear Measurement is the only way to verify if your hearing aids are meeting your hearing loss prescription. REM Video: • The Most Important HEA...
However, there are some conditions where Real Ear Measurement will not get you that perfect hearing aid fitting.
In my last year as an audiology student, I attempted to reach hearing aid amplification prescriptive targets using Real Ear Measurement. However, the patient had a mastoidectomy on his right ear. Upon programming him up to targets, he proceeded to vomit all over my office. This is when I first realized you can't just force everyone to hear at their prescription.
There are several other conditions where you may not be able to rely on Real Ear Measurement 100%. The following conditions may not allow you to reach prescriptive targets:
1. Mastoidectomies
2. Otosclerosis
3. Ruptured Eardrums
4. Choleseatomas
5. Ossicular Chain Discontinuity
Not being able to reach prescriptive targets using Real Ear Measurement is common in individuals who have a conductive hearing loss. However, just because you have a condition where you may not be able to reach your prescription, it doesn't mean that Real Ear Measurement shouldn't be done. It is still the only way to know where you are at in relation to your hearing loss prescription.
So the next time your hearing care provider says that Real Ear Measurement isn't necessary, just smile and say "Yes I know, but I still want to see how close I am to my prescription".
I am about to go for a fitting of my first hearing aids. These videos have been immensely helpful to prepare me, from a position where I knew almost nothing to one where I feel confident that I know what to expect and how to be an intelligent consumer. Your presentations are clear, precise, and to the point. I recommend them highly and appreciate what a great service you offer. Thank you very much!
Thanks Elliot. This is exactly what I am trying to accomplish with my videos. I wish you the best!
When he had the procedure done, was his hearing not retested?
As someone who has encountered a couple of the ear concerns mentioned here this was very helpful, thank you.
In summary, the following conditions may not benefit optimally from programming hearing aid thresholds to prescription targets:
-phonophobia
-mixed or conductive hearing losses (especially with perforated ear drums)
-hyperacusis
-first-time hearing aid users
I will add another situation...we often see that the loud input levels are significantly louder than NAL-NL2 prescription targets for open hearing aid fittings of mild SNHL. In the field, we know that matching these to targets would cause unnecessary compression and negative effects of sound quality.
It shouldn't.. It should be measuring how your hearing aid is amplifying loud sound, but if its uncomfortable you can lower it.. It should show the target as being louder than others.. im so confused,. You need to have the right ear piece when performing the REM
Hi Dr. Cliff. Recently found your videos and can't thank you enough. I have two questions which I hope you can answer. My hearing has recently diminished and on testing my WRS in one ear decreased in one ear from 92% to 68% over a 3 year period. An MRI of my IACs showed no pathology. Given that I likely have a significant sensorineural component contributing to my hearing problems, how important are REM? Also how likely is it that ANY hearing aid will help me with my word recognition? Thanks for your help.
My first hearing aids were set at 75% for several weeks, then brought up to full rx...even at 75% it was amazing to me how much hearing I had been missing...
My wife is in her 40's and a stroke survior from a brain injury as an adult who had a cholestoma when she was younger. Her hearing is 80% in right and 32% in left ear. We are debating on whether to go with a different audiologist who has the capability of real ear measurements. First of all we going with a Phonak M70-mid level and if her left ear doesn't respond well (within the 45-day trial) back down to the B70-right and B Cros on left. What are you thoughts on the value of real ear measurements for her?
Massive benefit. If she were my wife, I wouldn't even walk into a clinic that didn't do REMs. That being said, AmpCROS with the Marvel would be better than just a single aid in the left ear, because unless you CROS that sound over, the left ear likely wouldn't do well.
Hi Dr.Cliff, Can the REM test be applied to all kinds of hearing aids including the IIC (ex.Starkey soundlens) considering a small probe has to be inserted inside the ear canal together with the hearing aid. Will the process and equipment be the same as other kinds of HA?
Yes, REM can and should be used with all hearing aids (possibly excluding Lyric). The process is and equipment is the same no matter what hearing aid you have from BTE to IIC.
My audiologist did a REM, turning the screen so I could see it. It was not a match at all, but she didn't do any adjustments. She explained that she had found I like the sound louder than the result recommended and if she set it that low it would be back at the level I had previously rejected. Yes, I had earlier found that I was constantly turning the sound up. She said she found that REM doesn't factor in the patient's preferences. So is it reasonable to do the REM and ignore the results?
Doing REMs and not factoring the results is not acceptable in my book. You don't have to match prescriptive targets every time. However, unless you perform REMs, you have no idea how much amplification you are receiving. Now she knows exactly how much you prefer so it can be referenced in the future. The biggest benefit of REMs is that you dont HAVE to rely on patient description of the sound. That is why it is so important!
Just wondering, for the patient with the maistoidectomy how did you end up verifying his hearing aid then? Using a coupler test?
Still verified using REM. It is just that i verified that we were as close to her prescription as possible without any major peaks or valleys in the programming.
@@DrCliffAuD cheers! I'm an audiologist in Australia and fitting a client this week and was wondering about this issue !
Or reverse slope. Low freq loss rising to normal. Especially the worse those lows are... I still use it, I just play with low freqs.
Lauren or Dr Cliff can you tell me more about REM and fitting for someone with Reverse Slope loss (brought about recently by auto immune--so I haven't 'adapted' much and haven't noted unusually good hearing in high frequencies).
I'm a long-time hearing aid user (started in my early 20's, now in my mid-50's). I first had a real ear measurement done...last year. The programming it suggested made hearing absolutely awful for me. Now we're trying new hearing aids, along with a new real ear measure test, and I'm going bonkers. It feels like I'm in a huge gymnasium, and nothing is clear, except that this is not working. Any suggestions?
Based on the output measured in your ears, your provider should be able to identify where to make additional adjustments off of your prescription. They should never adopt a "take it or leave it approach" when programming to prescriptive targets. That is why programming is an Art and Science.
About REM, I heard people that when they go to an audiologist they turn up the volume to 110 decibels and now their Tinnitus is screaming. That's is my concern for my daughter, Is this really necessary? And what to do before and after a test like this one. Thank you so much Doc. :)
REM doesn't have to go that loud and usually wouldn't be 110 dB (SPL or HL) unless the patient has really poor hearing. The loudest I usually present sound with my REM system is loud speech at an average of 80 dB SPL at the reference microphone hanging on the patient's ear, and the prescriptive target for that speech still has an amplified envelope usually averaging between 80-100 dB SPL at the eardrum after the hearing aid has turned it up to target. Again, unless one of my patients has a severe to profound hearing loss, real ear measures are almost always well below 110 dB. I honestly spend most of my time adjusting the soft (50 dB input) and medium (65 dB input) responses of a hearing aid and usually only run the loud speech for 12-14 seconds twice in the visit. Of course, if someone tells me their tinnitus is getting worse during measures, I'll ask them if they want me to stop altogether or if they want me to keep going for a couple more minutes until the adjustments are done and let them decide. I'm sure Dr. Cliff does the same, as will most of us. Dr. Sarah Chipman, audiologist.
Ooh so my ruptured eardrum that I’ve had surgeries on is why I felt sick when I turned my hearing aid up to 6 the first day just to see how it was 😅 lol. I got it a week ago and I have been keeping it at a 3 or 4 currently. I’ve tried it at 5 a few times briefly but I felt a tiny bit sick after a little bit and turn it back down.
That is why you wait til your surgery site has healed, then get a new hearing test, then have your hearing aids reprogrammed.. I have had a tympanoplasy done but never had any issues with that because ai didn't get new hearing aids until almost a year after surgery..
I have the ReSound LNX 3D hearing aids and the first time i had them on, the volume was so loud they had to be turned down. The problem I'm having now is some sounds are soooo loud when voices sound normal. Like ice droping into a bowl, I have to take them out because it so loud. Any suggestions what can be done?
ReSounds are the best when it comes to impact noise reduction. Have your hearing care provider lower the MPO a little bit.
Hey Doc,
Have you encountered Liam Boehm videos for tinnitus treatment?
If yes then what do you think it is scam or what?
Tinnitus can not be cured. His "FREE E-Book" states that "Tinnitus is Curable". The information he shares is not backed by science and is comical at best. His testimonials are either fabricated, or the placebo effect is alive and well. If he tries to get you to buy something, save your money.