Real Ear Measurement - Why Is It Important?

[Music] hi there welcome back to value hearings youtube channel i'm emma i'm a clinical audiologist and in today's video i'm going to touch on the topic of real ear measurement or rem which is a topic that comes up a lot in forums and it comes up a lot on questions on our website we hear it a lot from our clients what is it and why do we need it so it was mostly this video the inspiration for it came from just last week when i had a client tell me that they'd heard from another provider near my clinic that rem was no longer needed wheeler measurement was out of date and we didn't need it anymore and he wanted to know because he'd been watching our youtube videos he'd been reading our website and also he's a big fan of dr cliff who's got the most successful audiology youtube channel in the world and he talks a lot an awful lot about really measurement and how important it is so this person you know he wanted to know well why did they say it was out of date is it out of date what's the story here so we had a chat and i explained to him that no it's definitely not out of date at all perhaps what this audiologist is thinking is that years ago one of the significant reasons for doing real ear measurement was to make sure the hearing aids were actually doing what they said they were doing on screen and yes the technology has improved so we've been able to trust that the hearing aids are doing what they say they're doing on screen more than ever but that's not really what it's about so what a real ear measurement as the name suggests is taking your ear into consideration when we're fitting the hearing aid so when we're actually fitting a hearing aid we use these prescription formula there's quite a few to choose from the majority of audiologists use either what we call the now nl1 or nl2 prescription formula or the dsl version 5 formula and then also a lot of them will use the proprietary prescription formulas from hearing aid manufacturers as well but all of them are pretty similar to the now nl2 they prescription formula are not necessarily better than the ones the hearing aid manufacturers are using but they're the ones that have the most data behind them and the most evidence behind them so that's generally globally the prescription formula that's used that formula is used then to calculate based on your audiogram what kind of levels of gain you're going to need to get you up to a more normal hearing level okay so we're trying to get the signs more audible and normal levels for you but keep it nice and comfortable as well so when we do that that calculation is based on the assumption that you have an average adult ear so the average adult ear is kind of a thing but everyone's ears are so different like one ear to the next on one person can be so dramatically different and the other thing that can be so different is also the impact that the hearing aid coupling so whatever dome or mold we've chosen has on your ear canal acoustics so we've all got different lengths of ear canals different widths different curvatures so the actual shape of the ear canal can vary a lot and this can actually even change over time obviously when we're fitting children their ears are constantly changing but even in the elderly we see some changes as well and then us guys in between the acoustics don't necessarily change that much um but like i said our ears can be so unique and depending on what hearing aid we're using if we change the dome size the dome type or we go for an ear mold or a dome all the acoustics have changed again so we really need to check that so the real your measurement is us being able to use this amazing prescription formula that has had a lot of research go into it but apply it even more accurately for you and your ear and i guess why i get really passionate about this is that there is so much evidence to show that this works this relates to better outcomes this leads to happier clients it even leads to less adjustment appointments leads to less returns of hearing aids less hearing aids ending up in the drawers so yes you can put a hearing aid in and just pre-program it based on the software and the calculations that the hearing aid manufacturers made and that person will most likely have an improvement and will notice that their quality of life is better but it will almost definitely not be as good as if we do a real ear measurement where we're actually incorporating their personal ear canal acoustics so it is incredibly important you can't just take a hearing aid from one person's ear and put it in another person's ear and expect it to sound the same the sound that leaves the hearing aid changes quite a lot before it reaches the eardrum and we need to measure that another obvious thing about relay measurements other than that they're very evidence-based is that they're objective so most of the rest of our testing which is really important is subjective mostly we do obviously do some speech and noise testing in the clinic we get we use questionnaires to get feedback from our clients we don't just fit them to prescription and send them out the door and say this is what it's going to sound like we'll make sure that it's comfortable for them because everyone is a little bit different but the only way to objectively test that the hearing aid is made in the target that we want it to mate is using this verification method of real ear measurement so it's really important even as the hearing aids age you know you've got a one two three four five year old hearing aid parts have changed perhaps that person's hearing loss has changed a little bit we need to recheck that we need to do the real ear measurements so that we know that all the components of the hearing aid are working as well as they could be so the relay measurement is really powerful tool in an older hearing aid to figure out if something isn't working quite right because you as a client can't always tell these changes can be so gradual so it's really important that we actually do an objective test to see well are they reaching target and if not can we get them to reach target and if not why so how is the really measurement actually performed well it varies from clinic to clinic and even audiology to audiologists as to what protocols they use but generally what you'll find is they place a little probe tube in the ear when you do not have anything else in the ear that little probe tube acts like a little microphone and it becomes acoustically transparent once we calibrate it so it doesn't have an impact on the ear canal acoustics very very clever stuff and then we're actually able to measure your personal ear canal acoustics without having any hearing aid in there it's also really important that we make sure that probe tube is in the correct position so it needs to be in a very specific position not too close but not too far away from the eardrum for us to get the best reading and fitting off the hearing aids then we put the hearing aids in switched off and that gives us an idea of your occluded response so when we put the hearing aid in what kind of hearing loss are we giving you when it's switched off then we can take that into account then we switch the hearing aids on and we will usually just check what the automatic fit from the hearing aid manufacturer looks like and take a bit of a recording of that to see how close or how far it is away from the actual target we're trying to achieve and generally we'll play average speech at 65 db spl and then we'll play very large speech at 80 db spl and we'll play very soft speech at 50 db spl and that is us just trying to see how the hearing aid responds to the different levels and volumes of speech we will then try to match target as best as we can so we use the hearing aid software to manipulate the gain handles in order to match that target that's being generated by the prescription formula as close as possible obviously we then ask you how you feel how do you feel about that volume and the sound quality and we will potentially make adjustments based on your feedback but this is a good starting formula for us so there you go any questions about the real ear measurement please please leave them in the comments below if there's any other videos you'd like us to make about real ear measurement or any other topic for that matter definitely leave a comment please like and share this content if you did enjoy it and please please subscribe to the value hearing youtube channel it really helps increase our reach thank you so much for watching

Channel: Value Hearing

Views: 1,432

Rating: 5 out of 5

Keywords: hearing aids, real ear measurement, REM, is REM important, hearing aid verification

Id: kdtUyYAltoM

Length: 9min 0sec (540 seconds)

Published: Tue Feb 16 2021