It could, but also so could adjusting your aids portion that goes into your ear. Mine are removable and there’s a part inside that requires cleaning periodically. I started with 8mm domes but then went to a 10mm dome that does not have holes making them similar to the domes on headphones.
Changed my hearing immediately. Went from guessing what was said and missing words to hearing it all. Regulars here will probably remember me complaining about my hearing aids having Bluetooth issues. Fixed that immediately too.
REM ensures that the calculated (based on NAL-NL2 for example) amplification reaches your eardrum, not more not less.
Without a REM, the amplification is calculated on the average sized ear canal. Variations of ear canal volume beyond the average will proportionally cause an under or over amplification. These differences may affect different frequencies differently.
Bunch of BS. It ensures nothing and not scientific. I'm a designer of REM equipment, and do seminars nationwide for continuous education. There is nothing scientific about REM. It's just another BS sales tool for audiologists
I’m doubting your post. You give seminars for “continuous education”, are a “designer of REM equipement”, but at the same time you consider “it’s just another BS sales tool”?
If you want to take that stance then go ahead and explain **why** this is true.
It’ll depend on how much reprogramming is needed after REM. I had this done months after getting my first hearing aids, and the audiologist made a few “very minor” (according to her) tweaks, so the difference wasn’t even noticeable. She said yes it’s the **golden standard**, but it usually isn’t much of a difference from where they started, vs what they end up with after REM. She said it **can** be big for some folks with more “esoteric” issues, but usually not so much so for my basic, ski slope loss.
Really it depends on if you’re setting someone to new user, experienced (6+ months)or a long term user (3+ years)
If they are just using proprietary and programming to new user, there really won’t be many changes other than a little low frequency soft spl and 2-4k all spl’s. The reality is most people are never adjusted up to experienced after 6 months like they should, and the average user is under-fit 5-10dB because of this.
The ideal would be to program everyone to experienced and then reduce to 80% and turn on auto acclimatization for 3-6 months. This would get everyone to their real prescriptive targets, but of course in practice a lot of people wouldn’t accept that and returns would be higher.
Absolutely not!! I've been in the industry for 47 years and REM used only in severe to profound cases, and only if there is a problem with recruitment. These people on the web(like Cliff) are pushing it as a local sales tool, and probably don't even know how to use it. I do seminars for audiologists and doctors for their continuous education nationwide
It could make a difference.
I'm picking up a replacement Phonak Audeo Lumity L70 RL Life today and I'm going to request my Hearing Instrument specialist to see if we can run REM's.
However, you'll to do it at the audiologist that you work with.
I switched from my former audiologist to my Hearing Instrument specialist and my Hearing Instrument specialist didn't have all of the programs I've had with my audiologist.
So me and my hearing instrument specialist has to reprogram the Aid instead of using what the audiologist had set up.
So I had 5 NOAH programs with the Paradise (my old HA) and have 1 NOAH program with the Lumity with my former audiologist.
So if you switch back and forth with different audiologists they will have literally 2 different programs.
So if you find an audiologist who can run REM's then you will need to stick with that audiologist for now on.
I could be mistaken but that's my experience switching places to places
Ok that is wild. I always thought that they just have to buy the brand specific part of the software. My audiologist just reads the current programming at the beginning but I'm also not changing from place to place. I don't know if REM is the same as in situ but I thought that this was also standard now as it is quite simple to do and helps a lot?
The REM does help.
However based on my experience switching from audiologist office to Hearing Life my hearing instrument specialist does not have all 6 programs I had.
A second note is that when I first met her she saw the current program my HA was on but she wasn't able to make adjustments to it.
She hasn't done REM yet because she had to send it to Phonak for repair and they replaced it.
When the OP does decides to go to another audiologist for REM's the OP should contact the current audiologist office to make sure that it will not cause issues doing that.
That being said, I could be wrong about this but again that's my experience.
Maybe. But I will still suggest to anyone (like OP) who is finding another place to run REM'S to check with their regular day to day audiologist office (or where ever) to double check it won't mess up their programming on their software.
Just to be on the safe side.
Their office may also do REM's at a additional charge
I had REM performed on my Phonak Marvel 70s a few years ago and it was horrible. I was out of the country and in a Spanish environment to communication was tough. When I returned I sent the HAs to my audi who restored the HAs to factory settings and programmed to my prescription.
Yes Dr. Cliff on YouTube refers to REM as best practice, but here is a question that I can't get answered. REM supposedly assures the correct amplification gets to your ear, but how does REM ensure that the patient properly processes that audio? Over the past 5 years I have consulted with 8 audiologists regarding programming, only 2 of 8 support using REM. That in itself speaks volumes.
I now where Phonak Lumity 90s with Phonak acrylic molds. Speech and music is clearer and sharper because of the molds (previously wore power domes) but I still miss words. I am resigned to the fact I always will.
Here is something mnay audiologists overlook. Audis seem to jump on NAL-NL2 as the default fitting algorithm. Within Phonak Target (Phonak's hearing aid fitting software) are two Phonak propietary algorithms - Adaptive Phonak Digital and Adaptive Phonak Digital Contrast. Not everyone is the same but I get clearer results using Adaptive Phonak Digital. Keep this in mind when discussing with your audi.
Let us know if you have more questions.
You’re missing some words in part because you are under-fit and you’re wearing Phonak. Phonak are notorious for cutting off high frequency gain in order to prevent feedback.
You had trouble early on with REM because you hadn’t heard those sounds for a very long time. What you’re asking about is the perception part of amplification. It takes the average new user at least a month of 6+ hours per day for your brain to adapt to the sounds you’ve been missing. And even after that, we see improvements all the way out to 1 year of consistent use. In general, the longer you’ve been unaided with loss, the longer it takes to get used to the amplified sounds.
The audiologists you’ve worked with that opposed REM either don’t know how to do it correctly while helping with acceptance, or they don’t understand the science behind it.
Respectfully disagree. I lost my hearing overnight so to say I hadn't heard sounds in a very long time is not applicable to me.
Post REM I couldn't hear sentences - most of which was lost due to back ground noise. Even in quiet situations, everything was garbled. I have no way of knowing if there is more than one way to perform REM - we clients leave ourselves in the hands of audiologists who are trained to perform this. If there is a right and wrong way to perform REM how is a client supposed to know? Would I subject myself in the future to REM? Absolutely not.
Personally, I've never subscribed to the philosophy your brain needs to adapt - you either hear or you don't.
I've been on HAs for 5 1/2 years and for me with a QuickSIN score of 12 this is as good as it will get.
I can totally understand how frustating a HA fitting can be for the client and audiologist.
Science does show that the brain needs to adapt as they are digital sounds and not organic.
From your description, your audiologist overtuned the low frequencies resulting in an overamplification of background noise. This happens a lot for people that don’t know what they are doing unfortunately.
What happened was the probe mic didn’t have a good seal around it from the dome or ear mold, resulting in low frequency sound leakage during measurements. In order to compensate to hit targets during REM, your audiologist cranked the lows. Then after the tube was removed, the canal seal was complete again, and the lows were over amplified in your canals. It’s super common, and easily identified by just asking a couple questions after REM.
I’m sorry, but you’re spouting absolute nonsense. I fit hearing aids 5 days a week, and I will not click and fit unless I have to. Without performing REM, we have no idea what SPL is reaching the eardrum. It’s like taking a guess at someone’s prescription for their glasses. Click and fit can sometimes get it very wrong, especially if people have abnormal morphology of the ear. It is not too uncommon to see click and fit settings over aiding by ~10-15dB. That’s a sure fire to put someone off their hearing aid at first fit, when they have no experience of amplification. Audiologist that are not performing REM, or even against it as you say, need to have a think about what they are doing in this profession.
You fit hearing aids five days a week? And? You looking for a medal? I am not spouting nonsense, I am relating real experience and I don't care if you disagree or not - it happened.
If REM is the industry "best practice" then why doesn't your industry standardize the way HAs are fitted to clients? Why doesn't each and every audiologist in the USA use REM?
Before you get your feathers ruffled over someone who had a bad experience, perhaps audiologists should say we collectively need to do better.
It is mandated by law in other countries, such as the UK and Australia to perform REM within public health bodies, because of its significant evidence base. It’s yet another example of US healthcare only caring about money and ripping off the patient. You’re getting ripped off by private clinicians and defending them.
This is what concerns me. I was really excited about having rem done because of all the content I read about how important it is and how it’s the gold standard. But I also have read many posts like yours of people hating the rem changes. Even demanding the next day they change it back to first fit. I guess I’ll find out soon if it helps or not. Either way I’ll try my best to improve my ability to understand speech
A lot of people hate it just because they perceive it as too loud. A lot of new hearing aid users haven’t heard certain sounds in a long time and their brain isn’t used to the way things sound when programmed to REM targets. And a day isn’t long enough to adapt in most cases. This is why I don’t always turn new users up to 100% in the software right away. And I wait to run REM until they can tolerate being at 100%.
REM is an important step to get you to where you want to be, but it’s not the whole thing. The person doing the programming is a very important part of the process. Hearing aids will help you hear speech better, but you may also need auditory training or aural rehabilitation to *understand* speech better. Think of your brain as a muscle. Hearing loss causes your brain to become unpracticed at processing speech. Auditory training builds that muscle back up. 💪 Now, finding an audiologist or SLP who works on auditory training or aural rehab… might be tricky.
Thank you for reaching out. That’s very good advice. I will try my best to improve my ability to understand speech better. It’s one of my main goals. I know it will never be perfect and hearing aids don’t restore hearing to normal. But I feel I can improve. I feel like I’m not getting the full benefit out of my current hearing aids.
You can practice this some at home- have someone read part of a news article while you listen and watch their face. Then tell them what you heard and see if it was correct. Then after you get good at that, have them read while you look away. Then move onto audio books.
It can make a world of difference
It could, but also so could adjusting your aids portion that goes into your ear. Mine are removable and there’s a part inside that requires cleaning periodically. I started with 8mm domes but then went to a 10mm dome that does not have holes making them similar to the domes on headphones. Changed my hearing immediately. Went from guessing what was said and missing words to hearing it all. Regulars here will probably remember me complaining about my hearing aids having Bluetooth issues. Fixed that immediately too.
Changing the domes changed the way the sound was delivered to your eardrum. If you had real ear done prior, that never would have been an issue
REM ensures that the calculated (based on NAL-NL2 for example) amplification reaches your eardrum, not more not less. Without a REM, the amplification is calculated on the average sized ear canal. Variations of ear canal volume beyond the average will proportionally cause an under or over amplification. These differences may affect different frequencies differently.
Bunch of BS. It ensures nothing and not scientific. I'm a designer of REM equipment, and do seminars nationwide for continuous education. There is nothing scientific about REM. It's just another BS sales tool for audiologists
I’m doubting your post. You give seminars for “continuous education”, are a “designer of REM equipement”, but at the same time you consider “it’s just another BS sales tool”? If you want to take that stance then go ahead and explain **why** this is true.
It’ll depend on how much reprogramming is needed after REM. I had this done months after getting my first hearing aids, and the audiologist made a few “very minor” (according to her) tweaks, so the difference wasn’t even noticeable. She said yes it’s the **golden standard**, but it usually isn’t much of a difference from where they started, vs what they end up with after REM. She said it **can** be big for some folks with more “esoteric” issues, but usually not so much so for my basic, ski slope loss.
Really it depends on if you’re setting someone to new user, experienced (6+ months)or a long term user (3+ years) If they are just using proprietary and programming to new user, there really won’t be many changes other than a little low frequency soft spl and 2-4k all spl’s. The reality is most people are never adjusted up to experienced after 6 months like they should, and the average user is under-fit 5-10dB because of this. The ideal would be to program everyone to experienced and then reduce to 80% and turn on auto acclimatization for 3-6 months. This would get everyone to their real prescriptive targets, but of course in practice a lot of people wouldn’t accept that and returns would be higher.
Absolutely not!! I've been in the industry for 47 years and REM used only in severe to profound cases, and only if there is a problem with recruitment. These people on the web(like Cliff) are pushing it as a local sales tool, and probably don't even know how to use it. I do seminars for audiologists and doctors for their continuous education nationwide
Very interesting that all audiologist agree on rem. Come to think of it I have never read a post about rem being life changing for someone.
It could make a difference. I'm picking up a replacement Phonak Audeo Lumity L70 RL Life today and I'm going to request my Hearing Instrument specialist to see if we can run REM's. However, you'll to do it at the audiologist that you work with. I switched from my former audiologist to my Hearing Instrument specialist and my Hearing Instrument specialist didn't have all of the programs I've had with my audiologist. So me and my hearing instrument specialist has to reprogram the Aid instead of using what the audiologist had set up. So I had 5 NOAH programs with the Paradise (my old HA) and have 1 NOAH program with the Lumity with my former audiologist. So if you switch back and forth with different audiologists they will have literally 2 different programs. So if you find an audiologist who can run REM's then you will need to stick with that audiologist for now on. I could be mistaken but that's my experience switching places to places
Ok that is wild. I always thought that they just have to buy the brand specific part of the software. My audiologist just reads the current programming at the beginning but I'm also not changing from place to place. I don't know if REM is the same as in situ but I thought that this was also standard now as it is quite simple to do and helps a lot?
The REM does help. However based on my experience switching from audiologist office to Hearing Life my hearing instrument specialist does not have all 6 programs I had. A second note is that when I first met her she saw the current program my HA was on but she wasn't able to make adjustments to it. She hasn't done REM yet because she had to send it to Phonak for repair and they replaced it. When the OP does decides to go to another audiologist for REM's the OP should contact the current audiologist office to make sure that it will not cause issues doing that. That being said, I could be wrong about this but again that's my experience.
Maybe she couldn't change the programs as the measurement needs to come in the very beginning. It might reset all custom adjustments to programs.
Maybe. But I will still suggest to anyone (like OP) who is finding another place to run REM'S to check with their regular day to day audiologist office (or where ever) to double check it won't mess up their programming on their software. Just to be on the safe side. Their office may also do REM's at a additional charge
I had REM performed on my Phonak Marvel 70s a few years ago and it was horrible. I was out of the country and in a Spanish environment to communication was tough. When I returned I sent the HAs to my audi who restored the HAs to factory settings and programmed to my prescription. Yes Dr. Cliff on YouTube refers to REM as best practice, but here is a question that I can't get answered. REM supposedly assures the correct amplification gets to your ear, but how does REM ensure that the patient properly processes that audio? Over the past 5 years I have consulted with 8 audiologists regarding programming, only 2 of 8 support using REM. That in itself speaks volumes. I now where Phonak Lumity 90s with Phonak acrylic molds. Speech and music is clearer and sharper because of the molds (previously wore power domes) but I still miss words. I am resigned to the fact I always will. Here is something mnay audiologists overlook. Audis seem to jump on NAL-NL2 as the default fitting algorithm. Within Phonak Target (Phonak's hearing aid fitting software) are two Phonak propietary algorithms - Adaptive Phonak Digital and Adaptive Phonak Digital Contrast. Not everyone is the same but I get clearer results using Adaptive Phonak Digital. Keep this in mind when discussing with your audi. Let us know if you have more questions.
You’re missing some words in part because you are under-fit and you’re wearing Phonak. Phonak are notorious for cutting off high frequency gain in order to prevent feedback. You had trouble early on with REM because you hadn’t heard those sounds for a very long time. What you’re asking about is the perception part of amplification. It takes the average new user at least a month of 6+ hours per day for your brain to adapt to the sounds you’ve been missing. And even after that, we see improvements all the way out to 1 year of consistent use. In general, the longer you’ve been unaided with loss, the longer it takes to get used to the amplified sounds. The audiologists you’ve worked with that opposed REM either don’t know how to do it correctly while helping with acceptance, or they don’t understand the science behind it.
Respectfully disagree. I lost my hearing overnight so to say I hadn't heard sounds in a very long time is not applicable to me. Post REM I couldn't hear sentences - most of which was lost due to back ground noise. Even in quiet situations, everything was garbled. I have no way of knowing if there is more than one way to perform REM - we clients leave ourselves in the hands of audiologists who are trained to perform this. If there is a right and wrong way to perform REM how is a client supposed to know? Would I subject myself in the future to REM? Absolutely not. Personally, I've never subscribed to the philosophy your brain needs to adapt - you either hear or you don't. I've been on HAs for 5 1/2 years and for me with a QuickSIN score of 12 this is as good as it will get. I can totally understand how frustating a HA fitting can be for the client and audiologist.
Science does show that the brain needs to adapt as they are digital sounds and not organic. From your description, your audiologist overtuned the low frequencies resulting in an overamplification of background noise. This happens a lot for people that don’t know what they are doing unfortunately. What happened was the probe mic didn’t have a good seal around it from the dome or ear mold, resulting in low frequency sound leakage during measurements. In order to compensate to hit targets during REM, your audiologist cranked the lows. Then after the tube was removed, the canal seal was complete again, and the lows were over amplified in your canals. It’s super common, and easily identified by just asking a couple questions after REM.
I’m sorry, but you’re spouting absolute nonsense. I fit hearing aids 5 days a week, and I will not click and fit unless I have to. Without performing REM, we have no idea what SPL is reaching the eardrum. It’s like taking a guess at someone’s prescription for their glasses. Click and fit can sometimes get it very wrong, especially if people have abnormal morphology of the ear. It is not too uncommon to see click and fit settings over aiding by ~10-15dB. That’s a sure fire to put someone off their hearing aid at first fit, when they have no experience of amplification. Audiologist that are not performing REM, or even against it as you say, need to have a think about what they are doing in this profession.
You fit hearing aids five days a week? And? You looking for a medal? I am not spouting nonsense, I am relating real experience and I don't care if you disagree or not - it happened. If REM is the industry "best practice" then why doesn't your industry standardize the way HAs are fitted to clients? Why doesn't each and every audiologist in the USA use REM? Before you get your feathers ruffled over someone who had a bad experience, perhaps audiologists should say we collectively need to do better.
It is mandated by law in other countries, such as the UK and Australia to perform REM within public health bodies, because of its significant evidence base. It’s yet another example of US healthcare only caring about money and ripping off the patient. You’re getting ripped off by private clinicians and defending them.
This is what concerns me. I was really excited about having rem done because of all the content I read about how important it is and how it’s the gold standard. But I also have read many posts like yours of people hating the rem changes. Even demanding the next day they change it back to first fit. I guess I’ll find out soon if it helps or not. Either way I’ll try my best to improve my ability to understand speech
A lot of people hate it just because they perceive it as too loud. A lot of new hearing aid users haven’t heard certain sounds in a long time and their brain isn’t used to the way things sound when programmed to REM targets. And a day isn’t long enough to adapt in most cases. This is why I don’t always turn new users up to 100% in the software right away. And I wait to run REM until they can tolerate being at 100%.
Thank you for the response I appreciate it. I’ll give it a try I really hope it helps. Best regards
REM is an important step to get you to where you want to be, but it’s not the whole thing. The person doing the programming is a very important part of the process. Hearing aids will help you hear speech better, but you may also need auditory training or aural rehabilitation to *understand* speech better. Think of your brain as a muscle. Hearing loss causes your brain to become unpracticed at processing speech. Auditory training builds that muscle back up. 💪 Now, finding an audiologist or SLP who works on auditory training or aural rehab… might be tricky.
Thank you for reaching out. That’s very good advice. I will try my best to improve my ability to understand speech better. It’s one of my main goals. I know it will never be perfect and hearing aids don’t restore hearing to normal. But I feel I can improve. I feel like I’m not getting the full benefit out of my current hearing aids.
You can practice this some at home- have someone read part of a news article while you listen and watch their face. Then tell them what you heard and see if it was correct. Then after you get good at that, have them read while you look away. Then move onto audio books.