Individualizing Hearing Aid Fittings:
Advancing to the REAR
Presenter:
Michael L. Poe, AS
Inventor/Designer of Live
Speech Mapping
Primus North America
From the
desk of
our
Attorney
The views expressed in presentations made at
International Hearing Society (IHS) educational
events are those of the speaker and not
necessarily of IHS. Presentations at IHS events,
or the presence of a speaker at an IHS event,
does not constitute an endorsement of the
speaker's views.
Download the slides at www.ihsinfo.org/convention
Agenda
Historical Overview Of Real Ear Measurements
Best Fit Is Not A Button
Why Verify?
Live Verification REAR LSM
Demonstrating Hearing Aid
Advance Features
Historic overview of REM
The Year was
1982
Events of 1982
Events of 1982
The Advances in technology that began in previous years
continue to gain speed in 1982 with the release of the:
Commodore 64 computer
The first CD player by Sony.
The shift is so significant that Time Magazine names The
Computer as the person of year in 1982.
ET won the Academy Award for Best Picture
Historic overview of REM
Other Big News Items
Epcot Center Opens in Orlando
The Tylenol Scare
The Opening of the Vietnam Veterans Memorial
Death of John Belushi, Henry Fonda, Grace Kelley
Birth of Prince William
Olivia Newton John had us getting Physical
Joan Jett had us loving Rock and Roll
Michael Jackson ruled the music scene and the
airwaves with Thriller, which became the best selling
album of all in time. 1982
The 3rd most Popular song In the USA
Historic overview of REM
H. Gustav Mueller, PhD
January 13, 2014
From the Desk of Gus Mueller
Michael Jackson had just released Thriller, Chariots of Fire was
showing at the theaters, a college quarterback named John Elway
was making news at Stanford, and I was attending the ASHA
convention in Toronto. It was November 1982. I recall walking
down the aisle in the exhibit hall and hearing my name called. I
was being summoned to the Bernafon booth, where they had on
display a new probe-tube microphone real-ear system. It was a
prototype of what would soon become the Rastronics CCI-10,
named after the developer Steen Rasmussen
Historic overview of REM
Historic overview of REM
What are Real Ear Measurements?
Real Ear Measurements are an objective,
computerized method of measuring sound
pressure level in the proximity of the eardrum.
The system uses a probe-tube connected to an
ear level microphone and establishes hearing aid
performance in-situ, allowing critical real ear
factors to be considered in each hearing aid
fitting.
Waveform Identification
Does it end in R or G
Waveform Identification
REAR/AG
Real Ear Aided Response
The sound pressure levels measured in the ear canal with
a real ear measurement system when the operating
hearing aid is in the ear.
The measurement should approximate the most
comfortable loudness level. It is also used for soft and
loud input levels for audibility and tolerance checks.
Terminology & Waveform Identification
REUR/UG
REAL EAR UNAIDED RESPONSE
The sound pressure levels measured in the open ear
canal with a real ear measurement system
The REUR represents the boost in sound pressure level
resulting from the collection and shaping of sounds by
the head, external ear and ear canal.
Waveform Identification
REIR/UG
Real Ear Insertion Response
The measurement difference in gain between the REAR
and REUR
ie. REIR = REAR - REUR
The measurement should approximate the prescription
target gain curve.
It correlates to soundfield functional gain
Wavefrom Identification
REOR/OG
Real Ear Occluded Response
The sound pressure levels measured in the ear canal with
a real ear measurement system when a non-operating
hearing aid is in the ear.
The measurement represents the attennuation and new
resonances created by a hearing aid shell when placed
into the ear canal.
Waveform Identification
RESR
Real Ear Saturation Response
The maximum sound pressure level a hearing aid can
produce measured in the canal by a real ear measurement
system.
The measurement should approximate the uncomfortable
loudness level.
Advancing to the REAR (again)
LIVE SPEECH MAPPING DEFINED
The sound pressure levels measured in the ear canal with a
real ear measurement system when the
operating hearing aid is in the ear.
It is the REAR measurement using live speech as the
stimulus and the patient’s dynamic range as the target.
Relationship Among The Real Ear Responses
Why Best Fit Is Not A Button
Best Fit is Simply a prediction of the gain and
output.
Best Fit uses the Kemar (Knowles Electronic
Manikin For Acoustic Research
Does not account for individual tolerances in
microphones and receivers
Programmer must Program to nominal values
Why Best Fit Is Not A Button
Why Verify?
There are many reasons why one should
verify using probe microphone
measurements, but perhaps the most
compelling case is why we are in the
profession of hearing healthcare – to
Significantly improve someone’s quality of
life.
Ryan Bullock, Au.D
December 22, 2012
Why Verify?
Figure 2. Differences in measured insertion gain and software-simulated insertion gain for 12 patients. Negative values
indicate that the software-simulated insertion gain is less than the measured insertion gain.
Hawkins and Cook 2003
Why Verify?
FITTINGGOAL
(the first time)
Get your ACT together to achieve optimum
communicative performance and listener
comfort in their Top Listening Situations and
as many listening conditions as possible.
Why Verify?
Use of
LSM
reduces
follow-up
visits
AND
saves
$$$
…a study in the
Hearing Journal
February 2002
David R. Cunningham, Roberto
G Lao-Davila, Barbara A
Eisenmenger, and Richard W.
Lazich
CONSUMER REPORTS July 2009
Followed 12 patients for 6 months (shopped and used hearing aids)
National survey of 1,100 who purchased in last 3 years
Lab-tested features of 44 hearing aids
LACK OF INFORMATION
one-fourth of the respondents said style and features
were not discussed.
HIGH PRICES
MEDIOCRE FITTING
$1,800 - $6,800 per pair
two-thirds were misfit
What the Big Retailers are Saying
Primus Real Ear Case Study
Primus
Make the
Complicated
Easy!
Live Verification
LET’S DO SOME VERIFICATION MEASURMENTS
AND DEMONSTRATE THE ADVANCED FEATURES OF SOME GREAT
HEARING AIDS
Questions?
Contact Michael Poe
888-335-1241
[email protected]
www.auditdata.com