Time Saving Benefits of Real Ear Measurements

This is the third and final of three parts of the webinar “The advantages and benefits of performing Real Ear Measurements”. In this video Amanda Goodhew, International Clinical Trainer with the Interacoustics Academy, explores the time saving benefits of performing Real Ear Measurements during the hearing aid fitting and rehabilitation process.

You can read the full transcript below.

How REM can save time in the long run

One of the biggest barriers to clinicians adopting REM as part of their standard practice is time. And it's a valid concern. There is a lot to do in an audiology appointment:

• History taking
• Diagnostic assessment
• Explaining results
• Counseling to get buy in
• Programming a hearing aid
• Selecting the appropriate settings for the individual
• Instructing the patient or client on insertion
• Maybe some form of validation or evaluation
• And test box measurements

When you then add REM into the equation, it's another task that takes time within the appointment. But what I'd urge you to think about is not so much the time taken in appointments, although we will come to some time saving tips in a moment, but the number of appointments required in total.

The evidence base supporting the use of REM is extensive in terms of outcome measures, assessing benefits, and patient satisfaction. But another interesting finding has been about reducing the number of patient visits required.

This paper published in 2011 [1] looked at data from over 500 patients and found that performing verifications such as REM results in an average of 1.2 fewer visits. By combining REM with validation measures, this effect is even stronger. And that is how investing in performing REMs in the first place can save you more time in the long run.

How to speed up the REM procedure

There are some tools and suggestions which can help speed up the REM procedure.

Firstly, experience and practice. The more REMs you perform, the easier it becomes to be swift, accurate, and efficient. Inserting the probe tube is often mentioned as the biggest barrier to performing REM. The more you do it, the easier it becomes.

Binaural REM is hugely advantageous in allowing you to perform and adjust your real ear measurement on both ears at the same time, compared to performing each ear individually. This affords us a significant amount of time saving.

Many hearing aid manufacturers have developed an auto-fit tool which allows for fast automatic matching to target, affording significant time savings. Oticon for instance, have calculated that auto-fit REMs can be performed in under two minutes and 30 seconds. Interacoustics are working with all manufacturers on this functionality.

Delta Values

Delta Values is a calculation of how far from your target your hearing aid output is, which you can then use to inform your gain adjustments efficiently. I'll let Dennis Mistry, a former Clinical Product Manager for hearing aid fitting, explain how you can use this tool to both enhance the accuracy of your REM measurement and save valuable time.

Video transcript

This video explains how to find and use the Delta Values function in your Callisto™ and Affinity Suite software. You can enable and disable the Delta Values feature using this icon on the left-hand side of your home screen. You'll find your Delta Values at the bottom of your measurement graph. This feature can also be configured to always be on for your chosen protocol under your protocol settings.

The Delta Values feature has been created to help you get a better target match when fitting hearing aids. It does this by calculating the difference between your measured curve and your target curve at standard octave frequencies, therefore allowing you to quickly identify how much fine tuning is required to match target.

This works for all measurements in the REM software which are displayed against the target curve. Positive values indicate that your measurement is above target, and negative values indicate that your measurement is below target. 0 dB Delta Value means that you have an exact match to target. The values will only be shown once you have a complete measurement and will correspond to the selected curve in the software.

In this example, a measurement has been run and shows that the measurement does not meet the target. As the distance from the target can be read by the user, they can then make the required amendments to get a target match.

The second measurement shows the effect of these changes, and the Delta Values will then update to show the new measurement. An acceptable target match is usually determined to be within a range of the target curve. And this information is something which may be set for you by your national protocol, or through a local discussion with your peers.

Client satisfaction

Let's talk about patient satisfaction and why it matters. And not only are we providing a service and want the best outcomes for our patients so that they can improve their quality of life, but there are benefits to clinics and clinicians as well.

Patient satisfaction builds customer loyalty and increases the chance of repeat customers in the future. Positive reviews are incredibly important in this digital age of online ratings and trustworthiness assessments.

That said, despite all the online research available, word of mouth and personal recommendations are still valued highly between customers and patients and will be hugely beneficial in building business. And then there's something called willingness to pay, which I'd like to go into more detail in a moment.

Perceived benefit of REM

In 2000, as part of the findings of the MarkeTrak longitudinal study, this paper was published [2], which explored why people didn't use their hearing aids. The top reasons given were poor benefit from hearing aids and difficulty with background noise and noisy situations.

Nearly a third of respondents said they weren't using their hearing aids because they felt their benefit was minimal or non-existent, and over a quarter experienced their hearing aids didn't help in difficult listening situations, and in some cases, simply made things worse, not better.

Now, much has improved in technology since the year 2000. But this is an interesting insight. It wasn't the price or the cosmetics of the hearing aids that were off-putting, it was the sound quality and functionality or rather lack thereof.

Probe microphone measurements such as REM are not a guarantee of patient satisfaction. But remember, prescription targets such as NAL in DSL have been developed based on large amounts of data to meet patient's preferences and needs. And the evidence consistently suggests that hearing aid manufacturers first-fit algorithms often do not provide the required amount of gain. This effect is often noted in the crucial high frequencies and is typically noted to be an under amplification of the required sound.

Claire Henson and Pauline Smith published their research findings at the British Academy of Audiology conference, which showed an 18% decline in patient satisfaction ratings one year post fitting in those who did not have REMs performed, and this was significantly different from those who did have REMs performed.

Willingness to pay for hearing aids

As part of a study in 2016 [3], there was a very interesting analysis performed looking at end users’ willingness to pay for their hearing aids. The group was subdivided into experienced users, in-the-drawer users (those who weren't using their hearing aids), and first-time users who had no previous experience. Within each group, some were fitted to manufacturer settings, which we've called the first fit here, and some were fitted using REM.

The experienced group members who received REMs were willing to pay over $200 more for their hearing aid than those who had the first fit. The non-users were willing to pay $75 more for a REM'd hearing aid, and first timers were willing to pay $140 extra for having a REM procedure as part of their fitting protocol. In each group, those who received REMs were willing to pay statistically significantly more for their hearing aids than those who had the first fit.

Then, those who didn't receive REMs but only had a first fit were refitted using REMs, and each group was subsequently re-asked about their willingness to pay. And across all groups, there was an increase in how much they were willing to spend on their devices. And again, statistical significance was found here.

Interestingly, there wasn't statistical significance in the difference between those who were REM'd in the first place, and those who had REMs after their first fit, showing that there's no advantage not performing REMs at the initial fitting. I've heard some people say they prefer to reserve REMs as a follow-up tool. But this doesn't hold up against these findings here.

Summary

So, we've looked at some of the considerations when it comes to thinking about the time taken to perform REM, and some of the time savings that it affords in the long run, as well as some suggestions for how to reduce the amount of time it takes to perform the real ear measurement procedure itself.

We've also had a look at some of the important patient satisfaction outcomes and benefits of including REM in your fitting protocol, as well as the financial benefits with respect to the amount people are willing to pay for their hearing instrument. I hope this has given you a taste of the advantages that REM can bring to your patients and clients as well as you and your clinic.

References

[1] Kochkin, S. (2011). MarkeTrak VIII: Reducing patient visits through verification and validation. Hearing Review, 18(6), 10–12.

[2] Kochkin, S. (2000). MarkeTrak V: “Why my hearing aids are in the drawer”. The Hearing Journal, 53(2), 34, 36, 39–41.

[3] Amlani, A. M., Pumford, J., & Gessling, E. (2016). Improving patient perception of clinical services through real-ear measurements. Hearing Review, 23(12), 12.