I’ve been struggling for so long with with speech recognition. At no time has anybody recommended Real Ear Measurement. I was so frustrated that I was going to fly out to Phoenix to see you until I found your list of Dr Cliff approved hearing professionals. I believe we are on the road to better hearing. Many Thanks
Wow! Although not an audiologist I am a physicist and a musician and I pride myself on knowing a LOT about sound, acoustics, and psychoacoustics. I also suffer from moderate high frequency hearing loss and have been thinking about a new pair of hearing aids and stumbled across your video collection in the course of my research. I've now been binging on your videos for a couple of hours and am simply blown away by how much I've learned. I swear, you ALMOST make me wish I lived in Phoenix. ;-) THANK you!
Wouldn't it make sense, if you are trying to get the curves as accurate as possible, to make sure to start with a curve that represents the patient's hearing loss as accurately as possible? By this, I mean performing an audiogram with more than 6-7 data points? If the hearing aid I use has a capacity of 15 channels (frequency bands of the Widex Moment 440 for example), then wouldn't it make sense to measure at 15 different frequencies from perhaps 250Hz to 10kHz or so? As an audiophile, I would cringe at taking only 6-7 frequency response measurements of my loudspeakers in my listening room, and then adjusting them. I would want to measure more frequencies to make sure all the dips and peaks are as accurate as possible. Doing the REM is analogous to what an audiophile does with Room Compensation Equalization (Audyssey is the industry leader) to make their audio system as accurate as possible. Not being limited by processor power, Room Equalization curves such as Audyssey use FIR filters that could essentially have several tens of thousands of frequency points, each individually adjustable for level and Q, etc. I know we can't do that with the limited processing power that can be stuffed into a small HA, but if we have the potential for adjusting 15 separate channels (frequency bands) in a HA, then shouldn't we be measuring at least 15 frequency test points in the audiogram? I have a feeling that the average Audiologist, even if they DO REM, is only using 6-7 frequencies to measure, although they may have 15 possible points of adjustment. I assume this would increase the time spent on the audiogram significantly as well as the REM.
@@davidcrandon2329 The most frequencies I ever measure is 10, but I usually measure 8. I agree with you, it will be more accurate the more data points you have as a reference. It's scary to see some people fit aids with only 4 frequencies tested.
I like how you adjust the loud, average and soft sounds separately. I was trained to adjust all of them at the same time and I always feel like I go back and forth so many times to get things just right between the levels. Thanks for sharing!
Your site has cleared up a lot of what I didn't know, I didn't know four years ago. Now I'm really, really pissed about what I didn't know four years ago. An insurance company referral to a third party to cover most of the cost. Now it's clearly the reason why they were the cheapest. Thanks for your time you have spent on your site. Cheers Jack
I've watched about ten videos so far and this is the BEST yet. So important to be able to fine tune my device so that it is accurately matching my prescriptive targets. Thanks!!
Thank you for putting these videos on UA-cam. I was tested last Monday 5.23.22 with 20% hearing loss and white noise at 3000db. My husband knows sound from being the sound guy. He has helped me understand some things. Your videos explains what he was testing me for in the sound booth and the real ear testing he did with and without the hearing aid. Fascinating. He tested speech sounds in a variety of settings. Sometimes I didn't hear at all and some I did. Quite interesting watching these videos after the test.
Dr, thank you for sharing your knowledge concerning our profession and helping us to give our patients the ability to get the most out of the equipment that we have chosen for them to use. I know that i will be applying some of that which you have shared and that what i do not use will always be in the back of my mind, ready for the time its applicable. I realise that most of your content is geared towards the end consumer but i know for a fact that there are a lot of hearing care professionals out there looking at your videos because they are definitely helpfull. Since i introduced your channel to my partners, I know that my whole group keep a close eye on your channel for these and many more reasons as we are all passionate about giving our patients the best care out there. Would it be possible to make a few more videos specifically aimed at we professionals. I appreciate your consideration. TGC Blessings in abundance :)
Thank you very much for sharing your knowledge! I tried several hear caring professional and found the best one because of you! It‘s a life changing difference now
I thank you so much. I just made an appointment with a company that has REM and more of your big 5. You’re a like saver. There are no hearing up providers in the Bay Area or I would have chosen one. I
Just formed an opinion after watching several videos discussing hearing aid fitting and adjustment: Your's is the best! I am a retired engineer and your video here has had value to me, another offeror on the same topic served three videos which seemed like "word salad", I didn't learn nearly as much there as I did watching your video here. In particular, the adjustment of variable levels of compression was interesting.
I am thinking of purchasing new hearing aids and have subscribed to your channel. I take down notes and try to learn as much as possible to make a well informed decision on what I need. Thank you so much for your helpful and knowledge information.
Thanks so much! Great information for me, I’ve been wearing hearing aids for 11 years now and I find this so helpful. I’m not an audiologist, just a 71 year old geek with a professional background in broadcast audio who knows what sound should sound like.
Wow, in all my hearing test and hearing aid fittings I have never been offered REM as part of the service! Thank you for the information in helping me understand I should demand a better service from my hearing care professionals!
Thanks for the videos you have put out about REM and the hearing aids. I have learned a lot this afternoon and it is helping me to make a wise decision on my choice. God bless and have a great day.
I am confirmed VA eligible. Outstanding guidance from the two videos I watched--VA and Costco. Much thanks!!!! Any suggestions re: Indianapolis VA still has no system for on-line appointments, yet the NEVER answer their appointment request calls, and rarely answer the voice mails that follow. Any "secrets" as to how to actually speak with a human at Indianapolis VA., or is my 29 years as a Navy pilot without any benefits?
Hey Bob, glad you enjoyed the videos. Unfortunately, I have no insight or influence inside the VA system. I might be able to pull some strings for the Phoenix VA with some audiologists I know, but wouldn't be much help in the Indianapolis area.
Hi! Im a hearing Aid specialist in germany and i also prefer the freefit:) i always use the dsl v5 an i tune the 65db curve slightly over the hearing treshold at fequencies from 4 to 8 khz too. Then i let the pacients perform a training phase for some weeks before i reduce the adjustment if its too intense. Im also glad that most of my customers accept custom made earmoulds so i can bring the horsepower on the road:) Greetings Eckhard
Hey Dr Cliff. I know you probably don't cycle back through videos like this, but I really dig the real ear measurement software. Think you could do another video once you've figured everything out? Would love to see another one of these from start to finish.
Dear Doctor Cliff, I am an an audiologist from Holland. Like your video about REM, doing this for a couple of years now and the results are great. The last 6 months i have been practicing RECD with my clients. Can u tell me something more about RECD. What's the added value of this measurement can be and what to watch out for? Thank u in advance.
You're awesome, Dr. Cliff. This is very helpful. May I know what would be the curve if the eardrum is perforated? What do you do for those types of loss in regards to real esr measurement?
Well done. Watching your videos convinced me to pursue treatment. Question: Have you seen some videos in Spanish or a guide to the vocabulary of Audiologists in Spanish? I live in Guaymas, Sonora, Mexico half the year (Seattle the other half) and if I need hearing aid service I need to be able to understand the specialized vocabulary of the industry. My native language is English.
Excellent information and feedback! I am shopping for my second set of hearing aids and on my next visit I will be asking about REM. I have a request. I am trying various brands with one the goals being quality of sound for music listening. Yes, I am an audiophile and I still want to get the wow while listening to my stereo. Have you produced any videos discusing about hearing aides and music enjoyment?
I have hearing aids and real ear measurements were not done at the fitting. The last time I was in for the 6 month cleaning I mentioned real ear measurements to my HIS and she actually discouraged it saying it would make them too loud. So now I’m wondering what I’m missing out on since I do still have some problems with missing words and sounds. Much much better but no where near 100% happy by any means.
I really enjoyed watching this video but there is one thing I didn't understand: How do you create the NAL-NL2 Prescriptive method for each patient. I understand the process of adjusting the hearing aid to the prescriptive method but not how to design the prescriptive method for the patient. Marcel Koppel
Dr. Cliff, what assurance does a consumer have that the audiologist has used the REM correctly and fine tuned the hearing aids for maximum benefit? My audiologist makes adjustments based on REM but I always feel the hearing aid performance decreases rather than increases but the audiologist says “it takes the brain time to adjust”. I’ve lost confidence in my audiologist ability to fine tune my Phonak Audeo L90 but as a consumer have no way to verify my concerns. Oh and by-the-way, just try to get another audiologist to verify the programming on hearing aides they didn’t sell..
So, I was using my hearing aids wrong for my last 12 years, but I have a question, I am a native Spanish language, My hearing aids configuration may affect to learn another language like English? Your videos make a lot of sense, Its why I never understand other people in English unless has subtitles. Thanks for knowledge. Hugs from Colombia
Mr. CliffAud, I have a question for you. When we go to examine hearing, we enter a cabin that is soundproofed from outside sounds. We put on the headphones that are inside and raise our hand when we hear the slightest tone. And the audiologist records this on a chart we call an audiogram. The question is, why don't we do it with hearing aids? Let’s say we walk into a booth, hearing aids are connected to software, and we raise our hand when we hear the slightest tone. So we can bypass the hearing measurement (rem) and we have immediately measured the exact hearing for those hearing aids we have chosen. Could this be more accurate than the previous method?
Answer came there none! Anyway, my audiologist used desktop controls to do 'aid-in' tests as part of the fitting process for my Oticon Opn1s nearly four years ago, and showed me afterwards how close the aid-in performance is compared to my prescription. I would have thought that this is a different means to the same end.
This is essentially what REM is. The reason it can't be done with only one measurement is that HA's are not standardized, and each one will produce different responses under different circumstances with different patients. Think of wanting to make the frequency response in your music room at home as flat as possible. You have to measure its frequency response, then apply correction, then measure to make sure you got the correction right, and fine-tune it.
REM's features use the audiogram, but if your hearing is measured by headphones, without a RECD measure, it is not accurate at all... Do you use insert earphones ?
Really informative video! This gives great insight into what an audiologist should be doing. How would this process change when calibrating for a patient with single sided deafness?
Thank you doctor for such a great explanation... I have a question is there for any chance that that procedure can make online... I am writing from Bolivia and my father has a loss hearing so can you help please, He had a device but the doctor and it was one of the best didn´t do anything what you taught us... and now he does not use the device because it can´t hear properly... I hope you can help us
Thank you for all the great info. What are your thoughts on same day fits, and what would you consider to be the appropriate time to test, demo and program the instruments using best practices?
I thoroughly enjoyed the videos I watched. I've had several Cros hearing aids and am getting ready to purchase a new one. Leaning towards Phonak BR, but want more details that I can probably get from their site, however do you know of an audiologist you recommend that is in the Pueblo or southern Colorado area. Hopefully they would also bill insurance companies like UHC. Wish I lived closer to get the hearing aids from you following your REM technique.
I’m being fitted for hearing aids on December 21 what can I expect and can you help me on what happens at the appointment many thanks dr cliff and I am watching a lot of your video’s
Dear Dr. Cliff, I am your fans from Taiwan. Wish I can some of your advise for brand of REM. My question is have you every used Trumpet REM from Inventis company? Is that a common REM brand in your country? Asked this is because we are going to open a new hearing aids company in TW and now searching for REM product with high C/P value. If I decide to buy this one, my store is going to be the first one to use this REM in TW. BTW, most common brands in TW are GSI/AudioScan. Thank you!
Thanks again for a very informative video! I am back in to my ENT on the 29th to recheck my hearing loss/change since finishing chemo. The Tinnitus is loud and constant, has not changed and my asymmetrical cookie bite hearing loss is still with me. So it is looking like I will be in the market for a set of hearing aids.
Gary I ended chemo 3 months ago without hearing aid. I have had tinnitus too. My oncologist put me on adult dose Aspirin 325 mg that raises it. consume tree nuts, help combat cancer. Fortunately I'm using Dr Cliff's video to my advantage just in the nick of time. Good luck on your journey, and Thanks Doc!
Thanks, great videos. They have definitely made me a better-informed consumer. My audiologist (or here in France we don't call them audiolgists) tells me that REM is not very effective with an open dome because sound comes in from outside and not just from the hearing aid and that this doesn't make the measurements very accurate. Do you agree with this or should I insist on him doing REM?
LOL, I've heard some BS excuses before, but that might be the best one. 😂😂😂 Basically he/she is full of crap and you should go somewhere else because they are either unskilled enough to believe that, or they are literally lying to your face.
I wondered if the REM should be done each time you get a new hearing aid or is this only done in such detail the first time you start wearing a hearing aid? My daughter has unilateral hearing loss and just swithed to her second hearing aid after having her very first hearing aid for 5 years. I did not see such an extensive real ear measurement performed. It appeared that the hearing aid came set and a little adjustment was done. My daughter has issues with noise and I actually have never seen her "uncomfortable" measurement done ever. Thanks for all your great videos, they truly answer so many questions I ask and never seem to get an answer about.
I went to an audiologist and was tested and handed a prescription but was never offered a "fitting". The hearing aids began at $4,500 and increased to $7,500 for the Cadillac version. Adjusting the the settings from the manufacturer's standard was never offered... I did not purchase any at that time. How do I find an audiologist who will perform the adjustments to the software to maximize my hearing benefits?
Great video, answers lots of my continuing questions about hearing issues. My last REM was done about 9 months ago. I have not had the time to get back for second REM and I'm beginning to feel the need for an adjustment. How often should an REM be done?
Typically any time your hearing changes, you ear canal changes significantly (surgery or weight gain/loss) or you change some physical feature, like an earmold, on the devices. There is a chance that you "feel like you need an adjustment" because the devices need some preventative maintenance and cleaning.
This is probably a silly question but do you recommend other hearing institutes out of Arizona (like Southern Nevada)? I am impressed at how thorough you are in your testing and have been watching your videos. I am trying to find a good local place verses having to travel. I will travel, but I want to check closer to home.
Hey Dr. Cliff, I wanted to know if doing REM in patients using trimmer hearing aids could be beneficial, and if adjustments made using the trimmer can result in better sound quality for the client.
Dr. Cliff, how to keep the average speech level 65dB within the prescriptive target once the loud and soft level speech are subsequently adjusted? I noticed that any adjustment on the loud or soft level speech gain will change the average 65dB as well. This is what I noticed in the Target fitting software.
Hi Cliff, Thank you for this wonderful informative video. I am venkat from India, Tamilnadu, Chennai and my son aged 4 is having hearing loss of moderaely severe in right and severe to profound in left ... i am having signia motion charge and go sp x hearing aid... can you make measurements for him remotely like a telecare...I ask you because you show these technical care analysis of real ear measurement so if you can check his audiogram and see if the hearing aid is properly calibrated as per the report..
i always wondered, if my parents payed so much for hearing aids, i always feel it could be better. so why not have the software downloaded to my computer to adjust my hearing aids over time, of course its not possible since i am not an audiologist. but this video makes me feel like audiologist can actually help me. i always felt hearing aids is ok. i just have to wait for the next hearing aid to improve just a little(that what it feels like) but this video feels like it fills a gap i have been missing my whole life(im 23, deaf since birth, and even considered cochlear multiple times, never did the work to get evualted). i will try to find an audiologist that have this
Thank you for your well-explained videos. I don’t know if I had a REM test, but I’ll find out ! My first hearing aids were Resound. I’m on my 2nd pair which are Starkey. I’m actually having better luck with Starkey, but still have clarity issues. My hearing loss is in the low tones so I always thought that is the reason for clarity programming issues. Most times I can hear a person or theTV, but I won’t understand certain words-infuriating. Would you recommend certain hearing aids for my type loss?
I've just had my first hearing aids fitted, and the audiologist didn't do anything like this to do a fitting, so no feedback microphone, or testing different speech patterns and decibels...none of it! So now I'm worried that what I'm getting is a bit of a feel in the dark rather than a correctly measured fitting.
same here, when i got my c&G 7ax, they didnt do this... it is here in Ottawa. I have my next appointment after 2 weeks, i will ask them about this test.
I do a great amount of yard work. Due to the usually high temperature and humidity here in Florida, my over the ear hearing aid is quite veritable to my head sweat. I also have found, since I cannot feel the aid after I get used to wearing it, I make the mistake of getting into my shower. Ouch! Any suggestions for me? Would an in-the-ear type of aid be a better choice for me? Could you cover the topic of hearing aids and ear wax? My ears produce a large amount of this wax.
Thank you for your very informative podcasts. perhaps you can help me with a dilemna. I have been wearing Resound Linx Quattro aids for 2 years and like them mostly. I still have problems from time to time with feedback and whistling and feel as though I still have problems with discrimination of words, so says my wife. (I am 80 yrs old but in excellent health and very active.) Another hearing specialist wants me to try the Phonak Audeo Paradise risk free for 30 days. Should I do this, or should I look into the Resound One with my former audiologist? Cost is not an issue. Thank you very much.
Excellent and extremely useful information!!! Thanks!!! Can you please indicate if there are any hearing providers that do these type of measures in the Southeast US since I do not live in your area?
@@DrCliffAuD I need a hearing aid, but want to wait until I am in NC. Once I make an appointment , I will make sure to tell her that you recommended her. Thanks much Dr. Cliff! I've learned a lot from your videos!!! Be safe!!
M Clark. OMG - amazing!!! I just saw Dr.Karp in Charlotte based on Dr. Cliff’s provider recommendations (he has a list if you haven’t seen it), and Dr. Karp was AWESOME. Thorough and careful - and a great “bedside manner.”
Quick question for you Dr Cliff. If a receiver is replaced would you do a repeat to verify the REM? How about going from open to tulip domes? I'm thinking the latter case would change the REM. They made both changes at CostCo my last visit but did not repeat the REM but will bring that up on the next visit. Thanks
Hello dr Cliff, I would like to ask you about delta values that are found in the Interacoustics Affinity system. They are used to precisely match the prescriptive target curve with the hearing aid output curve during REM measurement fitting. Do you prefer using them, are they really useful??
Can you please elaborate on whether or not you run an unaided test, followed by an occluded test when the hearing aid is inserted? Do you compensate for insertion loss particularly with a tight fitting dome or earmold?
What you are referring to is the Real Ear Unaided Response. I run this test if I am looking to see what their ear canal resonance is, and if that resonance is impacted by a dome or earmold. Insertion loss is usually accounted for by programming to prescriptive targets, but not always, which is why the measurement can be useful.
I think I'm ready for my first pair of hearing aids. Do you have any recommendations for Audiologists/Hearing aid providers in Northern Utah (SLC or Provo area) who use best comprehensive practices such as those I have learned about thru your videos? I receive so many ads from different providers and I have no idea who to select or what questions to ask while investigating who to go to. Thank you!
Great video. How do you save so many REM test responses in the Noah file from that day? In the software you are able to run 5 curves. When I save them and then run another type of test it saves over it.
Some of the measures aren't as critical to save, therefore, you can run a different curve in their "slot" and save over it. Otherwise, you can save and start a new session if you really want to record the results in Noah.
You can use the freestyle section to run the things that don't require a target and record the response of the hearing aids. Also, you can play things like a Scene -Party instead of Rainbow passage. I often run Scene - Party once muted and once unmuted and record the response so that I can see the difference. Also, run an occluded response with the hearing aids muted to get an idea of the effect of the acoustic coupling on sound for the person. You can also record the response of their prior aids, and then record the response of the new aids and it will tell you the dB difference, which could also be used to "import" a fit from a prior aid.
My HCP just fitted me with a Widex Smartric 440. They performed a situ and then REM afterwards and used autorem for various loudness levels. It showed lines from the insitu and then the rem adjustment lines above, which provided more amplification. They then set to inexperienced user to reduce amplification for a couple of weeks while I get aclimatised. Is this correct? They used an Aurical machine.
I am beginning to work out which hearing aids to purchase. So far it look's like the Phonak Avedo Paradise P-RT would be best for me. I also want to go to someone that performs REM. Can you recommend someone in Manhattan, New York?
As with your other infodeos, excellent information! Specific and actionable! Actionable in that we (hearing aid current and prospective users) are able to recognize true professional Audiologist by their "Actions" prior to and during evaluation and post fitting.
This was a very interesting video, this test came up on this Facebook forum today and thought to check it out: Hearing Aid Forum: Hearing Loss, Hearing Aids, and Cochlear Implants. It looks like a REM is something you go through after the hearinng aid purchase or before ?
How do I find someone near me who does this? I picked an audiologist because they said they did Real Ear Measurement on their site, but when I got their, they said they didn't and preferred to just tweak it over 4-6 weekly visits. It appears that this is very difficult to find. Any recommendations would be great.
Dr Cliff, HELP !!! I am in Naples Florida, where you can find a Hearing Aid store or Audiologist on almost every corner... and yes, we also have Costco. My head is spinning trying to choose a qualified person or place I can trust. Any recommendations would be greatly appreciated. Many Thank CJ
That's a tough one. Closest provider that I'm aware of that follows Best Practices is all the way up in Sarasota. Perhaps got to DrCliffAuD.com and print the Best Practice Checklist and start looking for a provider who follows as many Best Practices as possible.
I have had real air measurement performed a few times and it has never seemed to improve hearing over standard fit adjustment. And each time I've had to go get numerous adjustments to bring it into adequate levels. Is that just the audiologist doing poor rem fitting or do some people just not benefit from rem, because I'm not impressed at all. Tnx
My closest audiologist is using the manufacturers sensogram instead of Real Ear Measurement. Is that a viable alternative, or should I look for a different audiologist? TIA
Dr. Cliff, Is there anyone in Southern California that uses your methods? I have a pretty profound hearing loss and am trying to be realistic about what hearing aids can do. But my current hearing care provider really doesn’t do much in terms of what you are discussing here. Thx, Linda
If a patient requests to lower the volume, why keep increasing it until it meets their prescription? Doesn't more amplification mean more damage in the long run? Is there a benefit in intelligibility?
If a patient is requesting lower volume you don't increase it. You only make incremental increases towards the full prescription once they've adapted. For some, you stop below the prescription. For others, you need to exceed the prescription.
Wouldn't it make sense, if you are trying to get the curves as accurate as possible, to make sure to start with a curve that represents the patient's hearing loss as accurately as possible? By this, I mean performing an audiogram with more than 6-7 data points? If the hearing aid I use has a capacity of 15 channels (frequency bands of the Widex Moment 440 for example), then wouldn't it make sense to measure at 15 different frequencies from perhaps 250Hz to 10kHz or so? As an audiophile, I would cringe at taking only 6-7 frequency response measurements of my loudspeakers in my listening room, and then adjusting them. I would want to measure more frequencies to make sure all the dips and peaks are as accurate as possible. Doing the REM is analogous to what an audiophile does with Room Compensation Equalization (Audyssey is the industry leader) to make their audio system as accurate as possible. Not being limited by processor power, Room Equalization curves such as Audyssey use FIR filters that could essentially have several tens of thousands of frequency points, each individually adjustable for level and Q, etc. I know we can't do that with the limited processing power that can be stuffed into a small HA, but if we have the potential for adjusting 15 separate channels (frequency bands) in a HA, then shouldn't we be measuring at least 15 frequency test points in the audiogram? I have a feeling that the average Audiologist, even if they DO REM, is only using 6-7 frequencies to measure, although they may have 15 possible points of adjustment. I assume this would increase the time spent on the audiogram significantly as well as the REM.
Would any hearing care professional be able to have access to the ISTS plugin for the REM test and how common is it? I've think I've only ever heard the frequency sweeps and static sounds during my REM tests. Is the ISTS a more effective way to maximise HA performance or is it more to do with personal preference of the audiologist?
I just went to get hearing test. After the hearing test She did the adjustments. She did a calibration. I ask if that was real ear measurements. She said yes. She didn't put a probe along with the hearing aides at all. Not real ear measurements at all.
Dr. Cliff my audiologist was going to have me try out new hearing aids and I havent had a hearing test for 10 years. My hearing aids are close to that age. Should they have performed that test? It was in a booth with me pushing buttons. Is that test viable? I can live without the aids in a quiet setting not not in a noisy environment. Thank you
So - let me make sure I understand how this process works: A prescription is written by my hearing exam, and then I can purchase my desired Hearing Aid online, and provide them with my prescription, and they in-turn make all these adjustments? And then send me the Hearing Aid(s)? This is a very confusing process; one that I think ought to be talked about. Thank you.
Nope. While a hearing loss prescription is based on your hearing test, it is impossible to ensure you are actually receiving the correct amount amplification if that prescription is only uploaded into a set of hearing aids. Real Ear Measurement is a prescription verification procedure that ensures you are receiving the correct amount of amplification. This procedure must be performed by taking measurements inside of your ear canal using probe microphones inside of a Hearing Clinic. It is not possible to send your hearing test to a hearing aid company and have them "pre-load" your prescription and have it be accurate. Everyone's ear canal sizes and shapes are different which is not taken into account when a hearing test is uploaded into a hearing aid. This is why Real Ear Measurement is so critical to make further adjustments to the hearing aid programming to ensure your prescription is being met.
@@DrCliffAuD Thank you, Dr. Cliff. I just had an exam with Miracle Ear. They showed me that I have hearing loss, which I already knew. I've never been down this rabbit hole of considering a Hearing Aid before. Miracle Ear's Hearing Aids are very expensive (Premium) and I need to know that I'm getting the care, and product, that I'm paying for. The problem is... I get little to No information out of Miracle Ear. They only talk about their testing. I get better information from watching your youtube videos. I'm just not comfortable using Miracle Ear. Do you have any suggestion of what other facility I might want to use here in the K.C., MO. area? Thanks for your help and all that you do.
Ask. If they give you a look that indicates they don't know what it is, move on. There is NO excuse not to do REM in today's world. For a professional office, the equipment is in no way cost prohibitive. I have been lucky with my providers always being up to the latest standards. Both of them also were/are able to discern between substantive improvements and sales BS both in testing equipment and in hearing aids.
I’ve been struggling for so long with with speech recognition. At no time has anybody recommended Real Ear Measurement. I was so frustrated that I was going to fly out to Phoenix to see you until I found your list of Dr Cliff approved hearing professionals. I believe we are on the road to better hearing. Many Thanks
Wow! Although not an audiologist I am a physicist and a musician and I pride myself on knowing a LOT about sound, acoustics, and psychoacoustics. I also suffer from moderate high frequency hearing loss and have been thinking about a new pair of hearing aids and stumbled across your video collection in the course of my research. I've now been binging on your videos for a couple of hours and am simply blown away by how much I've learned. I swear, you ALMOST make me wish I lived in Phoenix. ;-) THANK you!
Wax filter
Wouldn't it make sense, if you are trying to get the curves as accurate as possible, to make sure to start with a curve that represents the patient's hearing loss as accurately as possible? By this, I mean performing an audiogram with more than 6-7 data points? If the hearing aid I use has a capacity of 15 channels (frequency bands of the Widex Moment 440 for example), then wouldn't it make sense to measure at 15 different frequencies from perhaps 250Hz to 10kHz or so? As an audiophile, I would cringe at taking only 6-7 frequency response measurements of my loudspeakers in my listening room, and then adjusting them. I would want to measure more frequencies to make sure all the dips and peaks are as accurate as possible. Doing the REM is analogous to what an audiophile does with Room Compensation Equalization (Audyssey is the industry leader) to make their audio system as accurate as possible. Not being limited by processor power, Room Equalization curves such as Audyssey use FIR filters that could essentially have several tens of thousands of frequency points, each individually adjustable for level and Q, etc. I know we can't do that with the limited processing power that can be stuffed into a small HA, but if we have the potential for adjusting 15 separate channels (frequency bands) in a HA, then shouldn't we be measuring at least 15 frequency test points in the audiogram? I have a feeling that the average Audiologist, even if they DO REM, is only using 6-7 frequencies to measure, although they may have 15 possible points of adjustment. I assume this would increase the time spent on the audiogram significantly as well as the REM.
Very good question. Is the 15 point, or higher, calibration used after a set adaptation period?
@doctorem - What devices do you use?
@@davidcrandon2329 The most frequencies I ever measure is 10, but I usually measure 8. I agree with you, it will be more accurate the more data points you have as a reference. It's scary to see some people fit aids with only 4 frequencies tested.
I like how you adjust the loud, average and soft sounds separately. I was trained to adjust all of them at the same time and I always feel like I go back and forth so many times to get things just right between the levels. Thanks for sharing!
Your site has cleared up a lot of what I didn't know, I didn't know four years ago. Now I'm really, really pissed about what I didn't know four years ago. An insurance company referral to a third party to cover most of the cost. Now it's clearly the reason why they were the cheapest.
Thanks for your time you have spent on your site. Cheers Jack
I've watched about ten videos so far and this is the BEST yet. So important to be able to fine tune my device so that it is accurately matching my prescriptive targets. Thanks!!
Thank you for putting these videos on UA-cam. I was tested last Monday 5.23.22 with 20% hearing loss and white noise at 3000db. My husband knows sound from being the sound guy. He has helped me understand some things. Your videos explains what he was testing me for in the sound booth and the real ear testing he did with and without the hearing aid. Fascinating. He tested speech sounds in a variety of settings. Sometimes I didn't hear at all and some I did. Quite interesting watching these videos after the test.
You are wonderful. This is a very high quality informative video that you have shared with us for FREE. Thank-you doctor!
You are so welcome!
Dr Cliff, you are amazing!
Thank you for sharing this online
Dr, thank you for sharing your knowledge concerning our profession and helping us to give our patients the ability to get the most out of the equipment that we have chosen for them to use.
I know that i will be applying some of that which you have shared and that what i do not use will always be in the back of my mind, ready for the time its applicable.
I realise that most of your content is geared towards the end consumer but i know for a fact that there are a lot of hearing care professionals out there looking at your videos because they are definitely helpfull. Since i introduced your channel to my partners, I know that my whole group keep a close eye on your channel for these and many more reasons as we are all passionate about giving our patients the best care out there.
Would it be possible to make a few more videos specifically aimed at we professionals. I appreciate your consideration.
TGC
Blessings in abundance :)
Thank you very much for sharing your knowledge! I tried several hear caring professional and found the best one because of you! It‘s a life changing difference now
I thank you so much. I just made an appointment with a company that has REM and more of your big 5. You’re a like saver. There are no hearing up providers in the Bay Area or I would have chosen one. I
Just formed an opinion after watching several videos discussing hearing aid fitting and adjustment: Your's is the best! I am a retired engineer and your video here has had value to me, another offeror on the same topic served three videos which seemed like "word salad", I didn't learn nearly as much there as I did watching your video here. In particular, the adjustment of variable levels of compression was interesting.
I am thinking of purchasing new hearing aids and have subscribed to your channel. I take down notes and try to learn as much as possible to make a well informed decision on what I need. Thank you so much for your helpful and knowledge information.
Thanks so much! Great information for me, I’ve been wearing hearing aids for 11 years now and I find this so helpful. I’m not an audiologist, just a 71 year old geek with a professional background in broadcast audio who knows what sound should sound like.
Thanks for the information, Dr. Cliff. This answered several questions about REM and what the procedure is meant to do. You are the best!
Glad it was helpful!
Inning is
One l,
I really enjoyed this video! I love learning about why things are done the way they are & understanding the process as a patient. Thank you!
Glad you enjoyed it Natalia. Out of my 200+ videos, this one is my favorite!
Wow, in all my hearing test and hearing aid fittings I have never been offered REM as part of the service! Thank you for the information in helping me understand I should demand a better service from my hearing care professionals!
Thanks for the videos you have put out about REM and the hearing aids. I have learned a lot this afternoon and it is helping me to make a wise decision on my choice. God bless and have a great day.
Thanks Dr.Cliff! You are always giving us the accurate information!
I am confirmed VA eligible. Outstanding guidance from the two videos I watched--VA and Costco. Much thanks!!!! Any suggestions re: Indianapolis VA still has no system for on-line appointments, yet the NEVER answer their appointment request calls, and rarely answer the voice mails that follow. Any "secrets" as to how to actually speak with a human at Indianapolis VA., or is my 29 years as a Navy pilot without any benefits?
Hey Bob, glad you enjoyed the videos. Unfortunately, I have no insight or influence inside the VA system. I might be able to pull some strings for the Phoenix VA with some audiologists I know, but wouldn't be much help in the Indianapolis area.
Hi! Im a hearing Aid specialist in germany and i also prefer the freefit:) i always use the dsl v5 an i tune the 65db curve slightly over the hearing treshold at fequencies from 4 to 8 khz too. Then i let the pacients perform a training phase for some weeks before i reduce the adjustment if its too intense. Im also glad that most of my customers accept custom made earmoulds so i can bring the horsepower on the road:) Greetings Eckhard
Hey can you teach me how to do REM fittings? there are no rems in our whole country, i can be the first one
@@iffatmkhattak2566 what Hardware for doing REM do you have?
Hey Dr Cliff. I know you probably don't cycle back through videos like this, but I really dig the real ear measurement software. Think you could do another video once you've figured everything out? Would love to see another one of these from start to finish.
Dear Doctor Cliff, I am an an audiologist from Holland. Like your video about REM, doing this for a couple of years now and the results are great. The last 6 months i have been practicing RECD with my clients. Can u tell me something more about RECD. What's the added value of this measurement can be and what to watch out for? Thank u in advance.
good way to do it, I would additionally recommend the "open rem" feature 😊👍
You're awesome, Dr. Cliff. This is very helpful. May I know what would be the curve if the eardrum is perforated? What do you do for those types of loss in regards to real esr measurement?
This is very interesting and addresses my fear of hearing aids amplifying the many sounds that are already normally too loud for me!
Well done. Watching your videos convinced me to pursue treatment. Question: Have you seen some videos in Spanish or a guide to the vocabulary of Audiologists in Spanish? I live in Guaymas, Sonora, Mexico half the year (Seattle the other half) and if I need hearing aid service I need to be able to understand the specialized vocabulary of the industry. My native language is English.
Excellent information and feedback! I am shopping for my second set of hearing aids and on my next visit I will be asking about REM. I have a request. I am trying various brands with one the goals being quality of sound for music listening. Yes, I am an audiophile and I still want to get the wow while listening to my stereo. Have you produced any videos discusing about hearing aides and music enjoyment?
I have hearing aids and real ear measurements were not done at the fitting. The last time I was in for the 6 month cleaning I mentioned real ear measurements to my HIS and she actually discouraged it saying it would make them too loud. So now I’m wondering what I’m missing out on since I do still have some problems with missing words and sounds. Much much better but no where near 100% happy by any means.
Thanks Dr. Cliff for that informative video.
I really enjoyed watching this video but there is one thing I didn't understand: How do you create the NAL-NL2 Prescriptive method for each patient. I understand the process of adjusting the hearing aid to the prescriptive method but not how to design the prescriptive method for the patient. Marcel Koppel
My audiologist does not do REM! I just got new hearing aids Phonak Paradise P90. Where can I get tested properly. My zip is 10547.Thx
Dr. Cliff, what assurance does a consumer have that the audiologist has used the REM correctly and fine tuned the hearing aids for maximum benefit? My audiologist makes adjustments based on REM but I always feel the hearing aid performance decreases rather than increases but the audiologist says “it takes the brain time to adjust”. I’ve lost confidence in my audiologist ability to fine tune my Phonak Audeo L90 but as a consumer have no way to verify my concerns. Oh and by-the-way, just try to get another audiologist to verify the programming on hearing aides they didn’t sell..
So, I was using my hearing aids wrong for my last 12 years, but I have a question, I am a native Spanish language, My hearing aids configuration may affect to learn another language like English? Your videos make a lot of sense, Its why I never understand other people in English unless has subtitles. Thanks for knowledge. Hugs from Colombia
Mr. CliffAud, I have a question for you.
When we go to examine hearing, we enter a cabin that is soundproofed from outside sounds. We put on the headphones that are inside and raise our hand when we hear the slightest tone. And the audiologist records this on a chart we call an audiogram.
The question is, why don't we do it with hearing aids? Let’s say we walk into a booth, hearing aids are connected to software, and we raise our hand when we hear the slightest tone. So we can bypass the hearing measurement (rem) and we have immediately measured the exact hearing for those hearing aids we have chosen.
Could this be more accurate than the previous method?
Answer came there none!
Anyway, my audiologist used desktop controls to do 'aid-in' tests as part of the fitting process for my Oticon Opn1s nearly four years ago, and showed me afterwards how close the aid-in performance is compared to my prescription. I would have thought that this is a different means to the same end.
This is essentially what REM is. The reason it can't be done with only one measurement is that HA's are not standardized, and each one will produce different responses under different circumstances with different patients. Think of wanting to make the frequency response in your music room at home as flat as possible. You have to measure its frequency response, then apply correction, then measure to make sure you got the correction right, and fine-tune it.
REM's features use the audiogram, but if your hearing is measured by headphones, without a RECD measure, it is not accurate at all... Do you use insert earphones ?
Really informative video! This gives great insight into what an audiologist should be doing. How would this process change when calibrating for a patient with single sided deafness?
This is awesome. I had no idea it was so involved.
Thank you doctor for such a great explanation... I have a question is there for any chance that that procedure can make online... I am writing from Bolivia and my father has a loss hearing so can you help please, He had a device but the doctor and it was one of the best didn´t do anything what you taught us... and now he does not use the device because it can´t hear properly... I hope you can help us
Wow, that's really thorough.
Thank you for all the great info. What are your thoughts on same day fits, and what would you consider to be the appropriate time to test, demo and program the instruments using best practices?
Good video, thanks for posting. Makes a lot of sense.
I thoroughly enjoyed the videos I watched. I've had several Cros hearing aids and am getting ready to purchase a new one. Leaning towards Phonak BR, but want more details that I can probably get from their site, however do you know of an audiologist you recommend that is in the Pueblo or southern Colorado area. Hopefully they would also bill insurance companies like UHC. Wish I lived closer to get the hearing aids from you following your REM technique.
I’m being fitted for hearing aids on December 21 what can I expect and can you help me on what happens at the appointment many thanks dr cliff and I am watching a lot of your video’s
Dear Dr. Cliff, I am your fans from Taiwan. Wish I can some of your advise for brand of REM. My question is have you every used Trumpet REM from Inventis company? Is that a common REM brand in your country? Asked this is because we are going to open a new hearing aids company in TW and now searching for REM product with high C/P value. If I decide to buy this one, my store is going to be the first one to use this REM in TW. BTW, most common brands in TW are GSI/AudioScan.
Thank you!
Really nice video Doctor Cliff- thank you..
Thanks again for a very informative video! I am back in to my ENT on the 29th to recheck my hearing loss/change since finishing chemo. The Tinnitus is loud and constant, has not changed and my asymmetrical cookie bite hearing loss is still with me. So it is looking like I will be in the market for a set of hearing aids.
Well Gary, I wish you the best of luck. After watching this video you are definitely better informed on what to expect!
Gary I ended chemo 3 months ago without hearing aid. I have had tinnitus too. My oncologist put me on adult dose Aspirin 325 mg that raises it. consume tree nuts, help combat cancer. Fortunately I'm using Dr Cliff's video to my advantage just in the nick of time. Good luck on your journey, and Thanks Doc!
Is REM performed by placing the hearing aid in a box with a probe as well?? I think this is how my professionals do it
Thanks, great videos. They have definitely made me a better-informed consumer. My audiologist (or here in France we don't call them audiolgists) tells me that REM is not very effective with an open dome because sound comes in from outside and not just from the hearing aid and that this doesn't make the measurements very accurate. Do you agree with this or should I insist on him doing REM?
LOL, I've heard some BS excuses before, but that might be the best one. 😂😂😂 Basically he/she is full of crap and you should go somewhere else because they are either unskilled enough to believe that, or they are literally lying to your face.
I go in to pickup and get fitted for both ears next week. I will ask about the REM test if they don't offer it. Thanks
Doctor Olson, thanks for the very comprehensive info. How do I find someone in my area (Ft Myers Fl) that does a comprehensive fitting?
Kristin at Coastal Hearing in Bradenton is part of the hearing up network.
Thank you. Very helpful information and video.
I wondered if the REM should be done each time you get a new hearing aid or is this only done in such detail the first time you start wearing a hearing aid? My daughter has unilateral hearing loss and just swithed to her second hearing aid after having her very first hearing aid for 5 years. I did not see such an extensive real ear measurement performed. It appeared that the hearing aid came set and a little adjustment was done. My daughter has issues with noise and I actually have never seen her "uncomfortable" measurement done ever. Thanks for all your great videos, they truly answer so many questions I ask and never seem to get an answer about.
Every new hearing aid and after any change in hearing.
I went to an audiologist and was tested and handed a prescription but was never offered a "fitting". The hearing aids began at $4,500 and increased to $7,500 for the Cadillac version. Adjusting the the settings from the manufacturer's standard was never offered... I did not purchase any at that time. How do I find an audiologist who will perform the adjustments to the software to maximize my hearing benefits?
Great video, answers lots of my continuing questions about hearing issues. My last REM was done about 9 months ago. I have not had the time to get back for second REM and I'm beginning to feel the need for an adjustment. How often should an REM be done?
Typically any time your hearing changes, you ear canal changes significantly (surgery or weight gain/loss) or you change some physical feature, like an earmold, on the devices. There is a chance that you "feel like you need an adjustment" because the devices need some preventative maintenance and cleaning.
This is probably a silly question but do you recommend other hearing institutes out of Arizona (like Southern Nevada)? I am impressed at how thorough you are in your testing and have been watching your videos. I am trying to find a good local place verses having to travel. I will travel, but I want to check closer to home.
Dr. Nancy Campbell in Carson City.
This is my favorite REMs equipment 😁 - Abram
I've use a number of different units and the Aurical PMM is by far my personal favorite.
@@DrCliffAuD - Is the Avant Arc any good?? It has the audiometry and the REM in one machine.
Hey Dr. Cliff, I wanted to know if doing REM in patients using trimmer hearing aids could be beneficial, and if adjustments made using the trimmer can result in better sound quality for the client.
Dr. Cliff, how to keep the average speech level 65dB within the prescriptive target once the loud and soft level speech are subsequently adjusted? I noticed that any adjustment on the loud or soft level speech gain will change the average 65dB as well. This is what I noticed in the Target fitting software.
Hi Cliff, Thank you for this wonderful informative video. I am venkat from India, Tamilnadu, Chennai and my son aged 4 is having hearing loss of moderaely severe in right and severe to profound in left ... i am having signia motion charge and go sp x hearing aid... can you make measurements for him remotely like a telecare...I ask you because you show these technical care analysis of real ear measurement so if you can check his audiogram and see if the hearing aid is properly calibrated as per the report..
i always wondered, if my parents payed so much for hearing aids, i always feel it could be better. so why not have the software downloaded to my computer to adjust my hearing aids over time, of course its not possible since i am not an audiologist. but this video makes me feel like audiologist can actually help me. i always felt hearing aids is ok. i just have to wait for the next hearing aid to improve just a little(that what it feels like) but this video feels like it fills a gap i have been missing my whole life(im 23, deaf since birth, and even considered cochlear multiple times, never did the work to get evualted). i will try to find an audiologist that have this
Is it possible to perform the test in the presence of fluid in the ear?
in a type B ?
THANK YOU
Thank you for your well-explained videos. I don’t know if I had a REM test, but I’ll find out ! My first hearing aids were Resound. I’m on my 2nd pair which are Starkey. I’m actually having better luck with Starkey, but still have clarity issues. My hearing loss is in the low tones so I always thought that is the reason for clarity programming issues. Most times I can hear a person or theTV, but I won’t understand certain words-infuriating. Would you recommend certain hearing aids for my type loss?
I've just had my first hearing aids fitted, and the audiologist didn't do anything like this to do a fitting, so no feedback microphone, or testing different speech patterns and decibels...none of it! So now I'm worried that what I'm getting is a bit of a feel in the dark rather than a correctly measured fitting.
same here, when i got my c&G 7ax, they didnt do this... it is here in Ottawa. I have my next appointment after 2 weeks, i will ask them about this test.
Any suggestions as to how often should the instruments be calibrated Dr. Cliff?
I do a great amount of yard work. Due to the usually high temperature and humidity here in Florida, my over the ear hearing aid is quite veritable to my head sweat. I also have found, since I cannot feel the aid after I get used to wearing it, I make the mistake of getting into my shower. Ouch! Any suggestions for me? Would an in-the-ear type of aid be a better choice for me? Could you cover the topic of hearing aids and ear wax? My ears produce a large amount of this wax.
Thank you for your very informative podcasts. perhaps you can help me with a dilemna.
I have been wearing Resound Linx Quattro aids for 2 years and like them mostly. I still have problems from time to time with feedback and whistling and feel as though I still have problems with discrimination of words, so says my wife. (I am 80 yrs old but in excellent health and very active.) Another hearing specialist wants me to try the Phonak Audeo Paradise risk free for 30 days. Should I do this, or should I look into the Resound One with my former audiologist? Cost is not an issue. Thank you very much.
Excellent and extremely useful information!!! Thanks!!! Can you please indicate if there are any hearing providers that do these type of measures in the Southeast US since I do not live in your area?
What state do you live in?
@@DrCliffAuD Atlanta currently, but moving to NC near Charlotte in a couple of months. Much appreciated!!!
@@mclark8522 You'll want to see Dr. Melissa Karp. drcliffaud.com/providers/melissa-karp
@@DrCliffAuD I need a hearing aid, but want to wait until I am in NC. Once I make an appointment , I will make sure to tell her that you recommended her. Thanks much Dr. Cliff! I've learned a lot from your videos!!! Be safe!!
M Clark. OMG - amazing!!! I just saw Dr.Karp in Charlotte based on Dr. Cliff’s provider recommendations (he has a list if you haven’t seen it), and Dr. Karp was AWESOME. Thorough and careful - and a great “bedside manner.”
Quick question for you Dr Cliff. If a receiver is replaced would you do a repeat to verify the REM? How about going from open to tulip domes? I'm thinking the latter case would change the REM. They made both changes at CostCo my last visit but did not repeat the REM but will bring that up on the next visit. Thanks
Love this, thank you!!
Hello dr Cliff, I would like to ask you about delta values that are found in the Interacoustics Affinity system. They are used to precisely match the prescriptive target curve with the hearing aid output curve during REM measurement fitting. Do you prefer using them, are they really useful??
Is there a phonak dealer in Las Vegas NV that uses best practices??
Can you please elaborate on whether or not you run an unaided test, followed by an occluded test when the hearing aid is inserted? Do you compensate for insertion loss particularly with a tight fitting dome or earmold?
What you are referring to is the Real Ear Unaided Response. I run this test if I am looking to see what their ear canal resonance is, and if that resonance is impacted by a dome or earmold. Insertion loss is usually accounted for by programming to prescriptive targets, but not always, which is why the measurement can be useful.
I think I'm ready for my first pair of hearing aids. Do you have any recommendations for Audiologists/Hearing aid providers in Northern Utah (SLC or Provo area) who use best comprehensive practices such as those I have learned about thru your videos? I receive so many ads from different providers and I have no idea who to select or what questions to ask while investigating who to go to. Thank you!
He has a Resources tab on his web site where you can find a provider in your area. I tried it an there werent any in my area.
Great video. How do you save so many REM test responses in the Noah file from that day? In the software you are able to run 5 curves. When I save them and then run another type of test it saves over it.
Some of the measures aren't as critical to save, therefore, you can run a different curve in their "slot" and save over it. Otherwise, you can save and start a new session if you really want to record the results in Noah.
You can use the freestyle section to run the things that don't require a target and record the response of the hearing aids. Also, you can play things like a Scene -Party instead of Rainbow passage. I often run Scene - Party once muted and once unmuted and record the response so that I can see the difference. Also, run an occluded response with the hearing aids muted to get an idea of the effect of the acoustic coupling on sound for the person. You can also record the response of their prior aids, and then record the response of the new aids and it will tell you the dB difference, which could also be used to "import" a fit from a prior aid.
My HCP just fitted me with a Widex Smartric 440. They performed a situ and then REM afterwards and used autorem for various loudness levels. It showed lines from the insitu and then the rem adjustment lines above, which provided more amplification. They then set to inexperienced user to reduce amplification for a couple of weeks while I get aclimatised. Is this correct? They used an Aurical machine.
I am beginning to work out which hearing aids to purchase. So far it look's like the Phonak Avedo Paradise P-RT would be best for me. I also want to go to someone that performs REM. Can you recommend someone in Manhattan, New York?
How to go about fitting HA for patients with severe recruitment?
Great video but what does it cost to get this hearing test done if insurance won’t pay?
Entirely depends on where you go and if adjustments need to be made as well.
As with your other infodeos, excellent information! Specific and actionable! Actionable in that we (hearing aid current and prospective users) are able to recognize true professional Audiologist by their "Actions" prior to and during evaluation and post fitting.
Dr. Cliff really called some of us students out by saying "and performing it well". Lol
*takes notes*
😂
This was a very interesting video, this test came up on this Facebook forum today and thought to check it out: Hearing Aid Forum: Hearing Loss, Hearing Aids, and Cochlear Implants. It looks like a REM is something you go through after the hearinng aid purchase or before ?
REMs are done at the hearing aid fitting appointment.
How do I find someone near me who does this? I picked an audiologist because they said they did Real Ear Measurement on their site, but when I got their, they said they didn't and preferred to just tweak it over 4-6 weekly visits. It appears that this is very difficult to find. Any recommendations would be great.
Dr Cliff, HELP !!! I am in Naples Florida, where you can find a Hearing Aid store or Audiologist on almost every corner... and yes, we also have Costco. My head is spinning trying to choose a qualified person or place I can trust. Any recommendations would be greatly appreciated.
Many Thank
CJ
That's a tough one. Closest provider that I'm aware of that follows Best Practices is all the way up in Sarasota. Perhaps got to DrCliffAuD.com and print the Best Practice Checklist and start looking for a provider who follows as many Best Practices as possible.
How are skull simulators used for fitting?
How do you find an audiologist uses REM for correct fitting?
the best way is to go to my website HearingUp.com and use the provider locator.
Do all audiologys do this test? Im on my first week & I go back in a week. Should i ask for one, if they dont bring it up??
Can you recommend a few Audiologists in the Fayetteville, Bentonville Arkansas area?
I have had real air measurement performed a few times and it has never seemed to improve hearing over standard fit adjustment. And each time I've had to go get numerous adjustments to bring it into adequate levels. Is that just the audiologist doing poor rem fitting or do some people just not benefit from rem, because I'm not impressed at all. Tnx
My closest audiologist is using the manufacturers sensogram instead of Real Ear Measurement. Is that a viable alternative, or should I look for a different audiologist? TIA
Dr. Cliff, Is there anyone in Southern California that uses your methods? I have a pretty profound hearing loss and am trying to be realistic about what hearing aids can do. But my current hearing care provider really doesn’t do much in terms of what you are discussing here. Thx, Linda
Where in Southern California?
Doctor Cliff, AuD 90815 area code.
@@lcollins2731 Linda, I am very interested if you found an Audiologist you like. I live very near you.
If a patient requests to lower the volume, why keep increasing it until it meets their prescription? Doesn't more amplification mean more damage in the long run? Is there a benefit in intelligibility?
If a patient is requesting lower volume you don't increase it. You only make incremental increases towards the full prescription once they've adapted. For some, you stop below the prescription. For others, you need to exceed the prescription.
Wouldn't it make sense, if you are trying to get the curves as accurate as possible, to make sure to start with a curve that represents the patient's hearing loss as accurately as possible? By this, I mean performing an audiogram with more than 6-7 data points? If the hearing aid I use has a capacity of 15 channels (frequency bands of the Widex Moment 440 for example), then wouldn't it make sense to measure at 15 different frequencies from perhaps 250Hz to 10kHz or so? As an audiophile, I would cringe at taking only 6-7 frequency response measurements of my loudspeakers in my listening room, and then adjusting them. I would want to measure more frequencies to make sure all the dips and peaks are as accurate as possible. Doing the REM is analogous to what an audiophile does with Room Compensation Equalization (Audyssey is the industry leader) to make their audio system as accurate as possible. Not being limited by processor power, Room Equalization curves such as Audyssey use FIR filters that could essentially have several tens of thousands of frequency points, each individually adjustable for level and Q, etc. I know we can't do that with the limited processing power that can be stuffed into a small HA, but if we have the potential for adjusting 15 separate channels (frequency bands) in a HA, then shouldn't we be measuring at least 15 frequency test points in the audiogram? I have a feeling that the average Audiologist, even if they DO REM, is only using 6-7 frequencies to measure, although they may have 15 possible points of adjustment. I assume this would increase the time spent on the audiogram significantly as well as the REM.
Does REM work for profound hearing loss.
Would any hearing care professional be able to have access to the ISTS plugin for the REM test and how common is it? I've think I've only ever heard the frequency sweeps and static sounds during my REM tests. Is the ISTS a more effective way to maximise HA performance or is it more to do with personal preference of the audiologist?
It's personal preference. Both are speech weighted signals.
I just went to get hearing test. After the hearing test She did the adjustments. She did a calibration. I ask if that was real ear measurements. She said yes. She didn't put a probe along with the hearing aides at all. Not real ear measurements at all.
Dr. Cliff my audiologist was going to have me try out new hearing aids and I havent had a hearing test for 10 years. My hearing aids are close to that age. Should they have performed that test? It was in a booth with me pushing buttons. Is that test viable? I can live without the aids in a quiet setting not not in a noisy environment. Thank you
REMs are extremely important for hearing in background noise. You need the booth test first, then REMs.
@@DrCliffAuD thank you
What a sadness not to know in Mexico, who can carry out this study
So - let me make sure I understand how this process works: A prescription is written by my hearing exam, and then I can purchase my desired Hearing Aid online, and provide them with my prescription, and they in-turn make all these adjustments? And then send me the Hearing Aid(s)? This is a very confusing process; one that I think ought to be talked about. Thank you.
Nope. While a hearing loss prescription is based on your hearing test, it is impossible to ensure you are actually receiving the correct amount amplification if that prescription is only uploaded into a set of hearing aids. Real Ear Measurement is a prescription verification procedure that ensures you are receiving the correct amount of amplification. This procedure must be performed by taking measurements inside of your ear canal using probe microphones inside of a Hearing Clinic. It is not possible to send your hearing test to a hearing aid company and have them "pre-load" your prescription and have it be accurate. Everyone's ear canal sizes and shapes are different which is not taken into account when a hearing test is uploaded into a hearing aid. This is why Real Ear Measurement is so critical to make further adjustments to the hearing aid programming to ensure your prescription is being met.
@@DrCliffAuD Thank you, Dr. Cliff. I just had an exam with Miracle Ear. They showed me that I have hearing loss, which I already knew. I've never been down this rabbit hole of considering a Hearing Aid before. Miracle Ear's Hearing Aids are very expensive (Premium) and I need to know that I'm getting the care, and product, that I'm paying for. The problem is... I get little to No information out of Miracle Ear. They only talk about their testing. I get better information from watching your youtube videos. I'm just not comfortable using Miracle Ear. Do you have any suggestion of what other facility I might want to use here in the K.C., MO. area? Thanks for your help and all that you do.
Would you know if REM would be performed by an audiologist at Mass Eye and Ear?
I would be shocked if they didn't, but ultimately I do not know.
Ask. If they give you a look that indicates they don't know what it is, move on. There is NO excuse not to do REM in today's world. For a professional office, the equipment is in no way cost prohibitive. I have been lucky with my providers always being up to the latest standards. Both of them also were/are able to discern between substantive improvements and sales BS both in testing equipment and in hearing aids.