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Why should you perform real-ear measurement (REM)?

Hearing aid fitting can be a difficult area to navigate; should you focus solely on the client’s feedback? Should you focus on making a good target match? Or should you just rely on the hearing aid manufacturer’s ‘first fit’? Ultimately you need to apply a combination of these actions and at the same time apply counseling.

Real-ear measurement (REM)

The above can be simplified with the use of real-ear measurement (REM). REM can help you to focus on objective information whilst taking in your client’s feedback that forms the subjective aspect of the fitting. These must be in equal balance with a good dose of counseling to help your client to understand her hearing loss, manage her expectations of the hearing aid’s function and also assign a good expectation of its limitations. All of these things combined allow you to give the client the best hearing aid fitting and preparation for her rehabilitation possible.

The issues with solely relying on real-ear measurement (REM)

Let’s say you ignored this and focused solely on a 100% REM target match, focusing on the objective fitting and ignoring your client’s input. She would have a well-fitted device, which would follow guidelines and best practices specifying the correct stimulation for audibility, but she will find this jump overwhelming. She will experience discomfort and a heightened sensitivity to sounds, which her hearing loss had led her to leave behind. This is not ideal, and it is very likely your client will stop using the device and possibly come back for a re-fitting or return the device completely.

The issues with a purely subjective hearing aid fitting

Now let’s consider the other side of the coin, a purely subjective fitting following the client’s input and desires concerning how the hearing aid should sound. To begin with, the client will steer to the side of comfort, which reduces loudness and in turn reduces audibility. This may not seem to be an issue at first; but once the client leaves and begins to use the device in the scenarios she expected her hearing aid to help her in, she will soon realize it is not benefitting where she thought it would. Again, the patient will return to have her hearing aid re-fitted, but as we’re relying on subjective input this will lead you to blindly turn the hearing aid up and the same circle happens again. After time, the client will tire of this and ask to return her device or stop using it completely.

The two examples given explain why there needs to be an equal mix of objective and subjective input. Yes, you want the client to be comfortable and yes, you want your client to hear but this can be a balancing act.

How to include your client in their hearing rehabilitation

REM and visible speech mapping allow you to show and provide the evidence of what the client’s hearing aid is doing and compare this to target algorithms, which have been formed from lots of investigations and studies. This helps you to explain what prescription your client needs, but also forms a talking point about what is comfortable and preferred. It can also show space for progression should the client wish to begin acclimatizing to her hearing aid slowly. Tools like these also help to involve and include the client’s loved ones so the rehabilitation process is shared.

Hearing rehabilitation is a two-way partnership between the clinician and the client. Although the hearing aid analyzer is a central part of this, it should not be an obstacle to the objective of helping your clients.

Related resources

About the author

Dennis Mistry, BSc (Hons) Audiology, graduated from Aston University in 2011. Since November 2013, Dennis has served as a Clinical Product Manager at Interacoustics, as part of its Hearing Aid Fitting product management team.
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