I realize that there are plenty of clinicians out there that perform REM on every client. That's great – hats off to you! However, I will be the first to admit that as an audiologist working in the clinic, I did not always perform REM. I know… you're shocked. We all work with the best intentions for the client, but in daily practice already tight schedules and additional unexpected time constraints such as walk-ins fill the day to the brim. Here at Bernafon REM is a regular part of our clinical trial protocols, and I have long since learned the advantages of performing REM on a regular basis. Once you're in the habit of performing it you become a REM advocate (I know I have).
“I will be the first to admit that as an audiologist working in the clinic, I did not always perform REM.
But now I’m a REM advocate.”
Understanding the time constraints that can impact a clinician's ability to perform REM, I'm pleased to introduce the new speech mapping option that we now offer for the REMfit™ feature in Oasisnxt with versions 19.2 and later. Speech mapping is much more relevant in the clinic for both the client and the clinician. For the clinician you can ensure that your client is hearing well enough at all speech levels. Using a signal based on the long-term average speech spectrum instead of an unmodulated signal will provide a more speech-focused fitting. While still measuring the maximum power output with a swept pure tone will safeguard against uncomfortably loud sounds.
The speech-based test signal can be used with the automatic features of hearing aids so that the verification will give a more realistic expectation of how the hearing aids should respond in real-life situations. The client gets a visual representation of what they can hear and what sounds they may still have difficulty hearing. In this sense, REM can be used for verification as well as a counseling tool.
In addition to offering these benefits, Bernafon has made the process so efficient that you'll wonder why you ever considered not performing REM. You are likely already familiar with Bernafon's feature, REMfit™, but it is now available with the speech mapping option. To make REM even more appealing there is a new REM module that works with Oasisnxt - the Verifit. Audioscan has created Verifit®LINK which allows Oasisnxt to communicate directly with the Verifit. The following screen shot is an example of what you will see in the Oasisnxt software when performing REM with the Verifit®LINK
To get started, go to Preferences under the Tools tab where you can select REMfit™ and enter the IP address or hostname to connect the Oasisnxt software with the Verifit. Make sure that the probe tube microphones are calibrated and then you're ready to run the entire fitting including verification and fine-tuning of the target match through the Oasisnxt software. Go to the Tools tab and select Verifit®LINK to run the measures. Make sure that the client is seated facing the speaker at 45 to 90 cm (18 to 36 in.) from the center of their head and place the probe tubes and then hearing aids in the ears. Once you've selected Verifit®LINK, the hearing aids will automatically be put into a test mode by the fitting software. The following settings are used:
- Adaptation: Target gain 100%
- Feedback Canceller: On
- Directionality setting: Omni
- Frequency Composition: Off
After the initial measurement Frequency Compositionnxt can be turned on to specifically test the frequency lowering feature, if necessary. Otherwise, when the measurements are finished and the Verifit®LINK module closes, the hearing aid settings will return to their previous state (i.e., if Adaptation was set to 80%, it will return to 80%).
Once you start the process a first measure will be made of the fitting, gain will then be automatically adjusted to match targets, and then another verification measurement will be made for the new gain settings. At the end, you can either accept the changes or reject them. Verification and match to target are all performed in one quick procedure without the clinician having to make any manual adjustments. There is, of course, a manual option which allows the clinician to make the changes themself. However, a study that compared three fitting methods: a manufacturer's first fit, a first fit with manual gain adjustments, and the Verifit®LINK automatic fitting found the automatic version to be accurate and the most efficient. Read the Topics in Amplification Speech Mapping for more details.
“Verification and match to target are all performed in one quick procedure without the clinician having to make any manual adjustments.”
This new feature has simplified the first fitting appointments for our clinical trials at Bernafon which the clinicians and our trial participants both appreciate. There is no need to take the time to manually match targets to the Verifit going back and forth between Oasisnxt and the Verifit screen. Make this feature part of your standard fitting procedure* and you'll experience the benefits of faster, accurate fittings and clients with more realistic expectations with their new hearing aids.
*Note: You may find yourself unconsciously chanting the ISTS speech signal after hearing it so often - this happens to us in the clinic at Bernafon.
References:
Folkeard, P., Pumford, J., Abbasalipour, P. Willis, N., and Scollie, S. (2018). A comparison of automated real-ear and traditional hearing aid fitting methods. Hearing Review, 25(11), 28-32.
Wolfe, J. and Neumann, S. (2014) Hearing Technology for Children In M.J. Metz (Ed.), Sandlin's Textbook of Hearing Aid Amplification Technical and Clinical Considerations 3rd Edition (p. 427-496). Sand Diego, CA: Plural Publishing, Inc.