How To Perform Real Ear Measurement (REM) | Using Natus Aurical PMM 

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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?

You are so welcome!

Glad you enjoyed it Natalia. Out of my 200+ videos, this one is my favorite!

Glad it was helpful!

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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!

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 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.

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.

Dr. Nancy Campbell in Carson City.

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.

Kristin at Coastal Hearing in Bradenton is part of the hearing up network.

😂

REMs are done at the hearing aid fitting appointment.

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.

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.”

It's personal preference. Both are speech weighted signals.

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.

Every new hearing aid and after any change in hearing.

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.

Are you going to a Best Practice Pro in Ohio?

Hi Jay, I don't have any San Diego area providers in my Network so I can't confirm that any follow comprehensive Best Practices. However, there are several Audiologists in the Los Angeles area that fantastic.

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.

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.

Entirely depends on where you go and if adjustments need to be made as well.

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Hey Joe, I get hundreds of comments per day so I may have missed them. Feel free to keep asking. Just FYI, if they are complex treatment questions, I typically do not answer these in the comments and would require a full consultation.

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.

Insert eye roll

the best way is to go to my website HearingUp.com and use the provider locator.

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.