In-Situ Audiometry: Is It the Same as Real Ear Measurement?

What is in-situ audiometry and how is it different than REM?
Dr. Rachael Cook, audiologist at Applied Hearing Solutions in Phoenix, Arizona, talks about in-situ audiometry and how it cannot be used as a substitute for real ear measurement (REM).
What is Real Ear Measurement? • The Most Important HEA...
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[@templateremix]

I’m curious about the follow up of this video. I’ve been using both REM and in-situ and found similar results in most case, and significant results with speech tests and speech in noise tests. To me if the in-situ audiometry is done properly with the earmold or dome that is gonna be used, the calculation of the gains should be approximately similar to REM. Let’s not forget that REM shows a full continued gain curve on all the frequencies, but in reality we just had a few key frequencies tested and everything else is pure guesses. Still curious, maybe the next video will change my mind on this.

[@dameionnotte286]

Most of my clients hate the REM settings. Or come back and tell me they can’t hear well. Why is that if it’s best practice? I don’t understand why some people hear better with some manufacturers first fit. And the proprietary fit meets test box targets. Please educate me

[@user-gr1th4tm7k]

Thank you, Dr Cook! Congratulations on your great improvements in the way that you deliver the information. Now you sound very confident and you have mastered speech in public skills brilliantly! It pains me, that I cannot perform REM, because Signia does not provide this service in Kazakhstan.

[@chandebrec5856]

Apart from the REM-substitute issue, in-situ in a quiet environment does seem like a superior hearing loss -- audiogram generation -- test for a given hearing aid and coupler setup.

[@nnnnnn5719]

Why do the frequencies tested with in-situ audiometry, in all the hearing aids on the market, not match the centered frequencies that can be tuned in each of the adjustment channels? I mean, if there are 20 of them, why do we not have 20 (or more) tested frequencies in situ? Thus, we have to deal with a curve. And we can form it more precisely with REM than with in situ audiometry…

[@Globulov]

Hi, I am a French audiologist and biomedical engineer I often follow your videos with interest. I see some problematic points. I don't see In situ audiometry as a replacement to real ear measurement. It allows to have more measurement point and therefore it allows a better calculation of hearing aid methodology. It's especially true when compared with headphone audiometry, it's less true with insert earphone. Real Ear Measurement is a good tool, it's not a magical tool. Even with a patient with a perfect standard ear there can be a certain variability of results depending on the probe insertion even with the 5mm rule. Kundt tube model explains that simply. Moreover in some case a blindly trust to insertion gain can be a catastrophic. For example the patient who have very small ear canal. In those case the probe insertion and the event either closed or created induce some measurement mistakes. Some pathologies like important tympanic perforation or ossicular chain ankylosis may change drastically the (middle ear/headphone ear) impedance ratio. It mays invalidate the hypothesis that the sound pressure level at the probe can be easily compared to what is perceived by the patient. It the first case with the large tympanic perforation the ossicular chain can't do it's job properly. And in the second case we may imagine a solid wall and the sound won't pass as easily as expected. To be clear I think the real ear measurement is a good tool that I use daily and as an old experimented audiologist now the gold standard remains the freefield audiometry with appropriated stimuli coupled with loudness growth assessment. Nevertheless this test has it's limitations but this post is already far too long. Here is a potato to redeems the time you spent to read this. Sincerely

[@gbkworf]

I have a close friend and his AUD gave him excuse #3. He was told In-situ is better than REM. When I told the 2 Hearing Up AUD's at my last visit what my friend was told they both just shook their heads in disbelief.

[@rachaelcookaud2695]

My next video on this topic I'm going to prove it. I tested the REM results on our assistant Bri using her own in-situ audiometry programming and it was AWFUL.

[@gbkworf]

My buddy is bringing your video to his next AUD appointment. That should be interesting. @@rachaelcookaud2695

[@chandebrec5856]

@@rachaelcookaud2695 Maybe you could also explain the rationale of those who say that in-situ can replace REM? Saying that it can replace conventional audiogram measuring I can understand, but all that in-situ provides is ... an audiogram! Do REM-replacement proponents say the in-situ audiogram is so much more accurate than traditional sound booth ones that the fitting software will generate better gain levels so that REM in unnecessary? Or do they say something else?

[@parthpandya5631]

Is audiomwtry and insitu audiometry same? And if not how it will differ

[@newengland8126]

Are the Hearing Aid Fitting Standard 15 steps the same as your Best Practices?

[@chrischiba3027]

I received my Hearing Aids from the VA, and don't recall them performing this test. So who does REM audiometry testing in the Phoenix Metro area? Or does REM have to be done by the issuing audiologist?

[@gbkworf]

REM is better and the science proves it. Simple as that. @@chandebrec5856

[@user-sv2mg8yg7n]

I had a provider put a Mic. In like rem. But it wasn't the test it only showed one thing volume. He could have done it. I asked for it, and he said he did the test, but it wasn't that test. Funny, I could see how that would help people like that have noise sensitivity. I had 2 things on time. 1 is it takes less time to do it than fix the person not happy with the fitting 2nd. Is it can be done when asking and training on fixes and why doing them. So less time is needed, I think, to cut time down combing the test with asking how it sounds and if it worked. Even for people like cook or cliff. So I'm saying I need more money to do the time i not sure if that is all true. Yes, it takes time but multi-tasking and combining things together. Less time spent. So, DO REM AND DONT get to say give money for doing the job right. YES ABOUT ONE NEEDED. but some will be less time than others and some more law of averages

[@user-sv2mg8yg7n]

One last thing right live in Montana. Less than a 20 percent do the real ear measures. Fact