Real Ear Measurement - Why Is It Important?

In this video, Emma discusses Real Ear Measurement (REM) - what it is, why it's important for a hearing aid fitting, and how it's performed. REM is a crucial step of a hearing aid fitting, but can be often overlooked. Having REM performed can often improve hearing aid benefit as it allows for the hearing aid to be programmed for your individual ear shape and size.
Value Hearing strongly advocates REM for all hearing aid fittings and as part of an ongoing hearing aid maintenance program.
www.valuehearing.com.au

[@eckhardbrunkhorst7468]

I use REM every day here in Germany. Its the best training for the ears hearing Performance imo. Thanks for the great Video!

[@richardseewald4739]

Many thanks for this Emma. Beautifully done!

[@watermain48]

Your videos are so, so helpful to so many of us. Thank you Emma.

[@JRock-vf4fw]

Thank you for the perfect information.

[@jlingo8977]

I already asked my dad to go visit Value Hearing Melbourne CBD for REM. Thank you for the video

[@pinepienaar3401]

Dear Emma, thank you for your task of educating the deaf fraternity. As a deaf person in need of new aids, your blogs are greatly appreciated. I am writing to you as I am concerned about the use of the REM procedure as a fitment confirmation test. During my stay at the NASA satellite tracking station at Hartebeesthoek, I was tasked to verify the dependability of calibration procedures for its transmission systems. By being in the marked for hearing aids and having experience with calibration procedures, I evaluated the REM fitment measurement. My findings and a recommendation are set out below:- As far as dependability is concerned, the REM test does not meet the requirement of a verification test, as it does not consider what the client actually hears. It does not measure the response of the ear, but rather the response of the hearing aid. A prescription audiogram measurement procedure on the other hand embraces what the client hears, thereby making at an inclusive test. The REM test in contrast ends in the space between the proposed hearing aid receiver and ear drum. This makes it a blind and incomplete test, as it assumes that the output signal of the hearing aid is what the client will actually hear with the hearing aids. As such, its description is a misnomer as it does not measure the response of the ear but rather the response of the hearing aid. A more fitting description would therefore be HAM for Hearing Aid Measurement! In addition, REM positioning of the microphone can cause perturbations and variations. REM results are therefore at best a guestimate, and even more so when the test microphone must somehow be positioned beyond and in front of an ear mould! As a means of determining how well a hearing aid corrects impaired hearing, the REM is a shot in the dark and may as well be performed on a test bench with the use of a dummy ear canal, as it only tests the output signal of the hearing aid when positioned in an ear canal. It therefore comes short as a true confirmation test, as it does not test how the deaf person hears the signal from the hearing aid. Confirmation Test (CT) :- An alternative test is proposed that includes the response of what the client actually hears when using the proposed hearing aids. It culminates with a confirmation audiogram that is used to confirm that the choice of a hearing aid and its consequent programming complies with the prescription audiogram. Instead of an in-ear microphone, it uses a loudspeaker calibrated at a prescribed test distance. Earphones may be used as a poor second choice, but perturbations may result when positioned over fitted hearing aids. Magnetic fields from the earphone may also have an effect. At its conclusion, any differences between the prescription and confirmation audiograms may be used to fine tune the programming of the hearing aid being fitted. As is the case with a prescription audiogram, the confirmation audiogram relies on what the client actually hears when using the proposed hearing aids. Polar Diagram:- In addition and as a bonus, the CT may be used to demonstrate and quantify the much mooted directional ability of hearing aids. Adventurous practitioners may also use it to produce a polar diagram of the hearing aid's directional response or what it ‘hears’ by the expedient of adding a swivel chair equipped with an azimuth (directional) indicator to the test booth. By rotating the client (and hearing aid) to face various directions, it becomes possible to produce a directional response polar diagram of a fitted hearing aid. Such a polar diagram has three variables namely direction, intensity and frequencies and can be represented as a three-dimensional graphic that can be plotted with one of the many available plotting apps. As my professor would say: "QED" Kind regards, Pine Pienaar

[@pericobilbao]

VERY GOOD EXPLANATION. I WISH YOU OR CLIFF HAD A CENTER OF AUDIOLOGY HERE IN MADRID, SPAIN.

[@cindytrotter776]

Very clear presentation, thank you.

[@ValueHearing]

Glad it was helpful!

[@twelveytwelve]

Everything I've seen and read about Value sounds positive. Can't wait to give you guys a try in a month or two. 👂🏻👂🏻

[@ValueHearing]

That's wonderful Bono. We look forward to assisting where we can.

[@arlynsmith9196]

Thank you so much. You have provided a ton of info to me. I am am 71 (and in the US) and new to this as I just woke up deaf in one ear one morning for unknown reason. ENT was unable to recover anything so I got a phoneak cros-p from the Dr. of Audiology in the ENT office. I have only had them for 10 days but I am really thinking of returning them (I have 30 days to return for full refund). I did not know about this test but will ask and if it can be shown to me that the hearing aids are providing value I will keep them, but so far it seems they are not. I pull one or the other out in various environments to see if I can detect any difference and so far I cannot. Thank you again!

[@user-gr1th4tm7k]

I am stuck here. In my region we have only one REM-apparatus and it is currently in repair. Thank you for your explanation!

[@stanbain3430]

Please advise if an audiometer is as good as the probe tube that you mentioned. Also is it possible to make an appointment with Emma. Thank you so much for your very informative Videos. Cheers Stan. Brisbane.

[@ValueHearing]

Hi Stan, Emma is based in the Bondi, NSW clinic. We do have a clinic in Brisbane (Indooroopilly) where another of our excellent audiologists is based. We can also offer phone consults as part of our process too. Please call us on 1800 157 429 to discuss your options further if you're interested. In answer to your question: An audiometer is used to test your actual hearing levels (the hearing test/audiogram); whereas a probe tube is part of performing the real ear measurements (REM). For REM to be accurate, you need an accurate audiogram.

[@louierichards3302]

Great information. I have a question about aids. They amplify sound and they are set at volume levels, will this still progress with loss? Keep adjusting to louder volume levels?

[@ValueHearing]

Hi @louierichards3302. Hearing care providers will typically ensure that there is enough 'reserve gain' when fitting a hearing aid, i.e. they plan to ensure that there is adequate room to continue to adjust the hearing aid even if your hearing deteriorates (within reason). The great thing about a receiver-in-canal (RIC) style of hearing aid though, is that the receiver itself is where the power of the hearing aid is, and this part is detachable in the clinic. So even if your hearing were to deteriorate to a point where the current receiver is no longer suitable, your audiologist will be able to change the receiver to something more powerful. This only applies to the RIC style though, not your standard behind-the-ear and in-the-ear styles.

[@ynotjf]

Emma, 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”. To me, REM programming is as much of a crapshoot as ear difference variation from manufacturer programming.

[@kaylasmusic]

It verifies that its meeting your target and that its working

[@blainefrank9243]

Is it difficult to setup REM correctly and do you think some audiologist are better at it than others?

[@ValueHearing]

It's certainly a lot easier to set up REM these days, with automated options on offer (although some auto options are much better than others). It does take skill to set up REM well, so, yes, some audiologists are more skilled at this than others. REM is important, but it's just one of the steps we do when fitting a hearing aid. How the end-user thinks it sounds is more important!

[@vicksybaby]

You mentioned after you have done the occluded response you switch the hearing on doesn’t that depend whether the aid it’s a closed no vented mould or double dome or an open dome, I thought you leave the aid off until you do the one REM Calibration especially if you are using the Otometrics Aurical, then turn the aid and run your responses at 65dB, 50db and then 80dB, matching as close to target as much as you can focusing mainly on 65 as that’s mainly speech

[@reneemeyer6297]

I am two days into Oticon More hearing aid trial. REM has not been done. Is that something that is done when you purchase? At this point I am definitely not getting enough improvement in hearing to warrant $4800 for these HAs. These are the level two model. I am considering trying the highest level which are $6200 hoping that they will be better but I can’t pay that much money for something that is not properly fit. Hoping someone can answer this question for me.

[@ValueHearing]

Thank you for the comment Renee, short term trial as not always ideal as you can read about in this article: www.valuehearing.com.au/news/hearing-aid-trials-and-tribulations. Another issues is that your hearing loss might not require a More 2, which would limit the value of the benefit vs price for you. You can read about it in detail here: www.valuehearing.com.au/news/do-i-really-need-expensive-hearing-aid Not having REM could definitely limit the benefit as well. So as you can see your experience may be about more than just a lack of REM. If you can see if they offer a full money back guarantee if you do proceed and then make sure REM is included in the fitting. I hope this helps.

[@kaylasmusic]

My AUD did a real ear test on my new devices, but im switching to molds, so she did the real ear to coupler test to place the programming with the new molds. Is it the right thing to do? or should I have her all re do the actual test with my aids in once my molds come in?

[@ValueHearing]

Rea ear to coupler difference (RECD) can be a good starting point to take ear canal acoustics into account, but REM is still the best way to ensure that your hearing aid settings match your hearing needs.

[@kaylasmusic]

@@ValueHearing Right, but cant you match the target with the RECD?

[@CreaseysWorkshop]

Hi Emma, When I was fitted with my hearing aids I was initially tested to create an audiogram. Then they played a series of words which I was asked to repeat. After being fitted with my hearing aids this spoken word test was not repeated. Wouldn't it have been a useful test to see if there was an improvement? Is that normally done to verify the configuration? I guess the same thing applies to the audiogram. Why doesn't the audiologist repeat the audiogram after the hearing aids have been fitted to quantify any improvement?

[@ValueHearing]

Hi @Creasey's Workshop! Great question. We do the hearing test so that we know the severity of your hearing loss, and word tests so that we can gauge how you might do with amplification. While some clinics are set up to do an aided hearing test (similar to the one you do under headphones), most clinics aren't (you need a specific set up for this). Instead, we can verify the hearing aid fitting by doing Real Ear Measurements and aided speech testing (which is often different to the speech testing you did prior to getting the hearing aid). We also verify it with your reports on the improvements you've noticed.

[@CreaseysWorkshop]

@@ValueHearing oh yes, of course, the headphones would interfere with the hearing aids. I had not considered that. Thanks for your reply.

[@dannwing4224]

I have the same question and asked a few audiologists, but never get a clear answer. It's like doing an eyesight test wearing your newly fitted glasses. The optometrists never did that. I don't know why. Wouldn't that test result give u a clear idea of what your eyesight is when wearing the glasses???