Why are Audiograms not done with & without Aids?

[Squeezer53]

Just a general question for the Pros....

I have had a couple of AuDs and HA trials with each so far. But,

I am wondering why don't they do a repeat of the Audiogram with aids in place? Would that not be as beneficial (or even more) than doing REM?

Here's my understanding of the tests. Please correct me if I am wrong (entirely possible)

Audiogram:
Done in soundproof booth w/ headset (or plugs), controlled environment and controlled sound input levels re: volume, frequency, masking etc.
Measures, thru Pt response what is being percieved with un-aided hearing.
Provides the basis for HA need & selection (along with other factors of course)

REM:
Done on Pt w/ Aids in situ (programmed for the Pt's loss)
Measures what the aids are delivering to the Pt's ears and helps to diagnose the effect of the Pt's ear "architecture" on the Aids Output. Sound input is again (as in Audiogram) controlled via computer input to the HAs & REM mic records the results in situ. Eliminates the Pt's perception of what they are recieving and creates objective data to work from.

But... After this, all other measurement is done thru discussion and subjective evaluation by the Pt. in an uncontrolled environment with uncontrolled input. "Can you hear me now?", "How's This?".

Why are they not doing a repeat Audiogram in a controlled environment with controlled freq/vol input with Aids in place and include masking effect etc.. I would think there would be more informational benefit than even REM can provide. Plus the additional ability of the AuD to show the Pt before & after charts. Seems like it could be a good acceptance & sales tool as well as diagnostic. Be more objective but still contain the Pt's subjective perceptions in a way identical to the original test parameters.

I'm not complaining, I just want to understand. From a design of experiment, it seems like it would be a very quick & trouble/risk free way to do a quick eval of an HA's efficacy for any given Pt profile..

[Sylvester]

Squeezer. This is my first response on this site! I am an HOHer, not a professional, but am technically trained and have worn many HA's since2001.
I too have asked the same question of my Aud.
Basically to repeat the test in the soundproof room with HA's in would be of some value if all we listen to is pure tones.
The open room test when the Aud asks "how's this sound" is more like the real world sounds we experience, so the Aud can adjust those sounds to see if we discriminate better.
The REM test is valuable because it picks up the sounds from the HA direct in the ear chamber and shows how the eardrum is "hearing" while reverberating in that closed space.
But I find that describing sounds is very difficult-so it takes a long time & then I have to live with it for a few days to let my brain adjust. Patience is the key both for the HOHer & if you're lucky to have a skilled Aud that is patient too, that is the best of all things! Hope this helps.
Regards

[xbulder]

many of the current hearing aids, have a built in audiometer.
For example, the low cost Phonak Una have an audiometer to measure thersholds in Situ.
In fact, ever since the widex senso was introduce - widex had a tool call sensogram which helps to measure in situ thersholds.

Others, like Sonic Inv products (i think starkey as well) you can measure the
most confortable range in most if not all their products..

Regarding rem, the point is Verification verification verification. You are just checking tha the client is getting WHAT the software (fitting software) is saying you should get.. Verification should not be optional..

when you get your glasses, you need a machine (lensmeter) to check that the precription from the lab is what the Dr had prescribe. While it is true that
some people would argue, you try this HI if there are no commplains -here you go ,there is not need to verify- this is not really prof right?

[Squeezer53]

I agree that verification of delivery of sound is important (my AuD does REM as a rule). Ear architecture (& molds)changes the accoustics too much to simplt rely on what the computer screen says.

But it seems to me that if the Audiogram is the defining test (along with Pts subjective observation) to show need of an HA. Then it is the only objective measurement on which to create a baseline. After a week or two of wearing the HAs, It would make sense to me to repeat the Audiogram with Aids in place and use both it & Pt subjective observations to measure efficacy & improvement.

While they are mostly pure tone measurement it could show up dead zones, recruitment, masking etc. And you would of course repeat speech disc masked & unmasked in a controlled environment. Then compare the scores.

You could also get a more accurate "Level of comfort" (not clapping or banging a ring on a table.

When I trial aids, I try to get myself into repeat situations with each one for a better comparison, but having actual chart & scores in a repeatable controlled environment would give me less variable & subjectve basis to compare and would, I think give my AuD something "real" to point at re: % of improvement and could be used as a sales or pt acceptance tool.

I may be too much of an engineer type, but I like having measuable real numbers and a controlled design of experiment when choosing technology.
These things cost more than my 1st new car did. (Datsun B210). OOps, showing my age here:o

[Khenkels]

Get fitted with a Widex Passion, the fitting software is awesome - and she does this with the aids in. She then took that same fitting and applied it to my Unitron Next...

[xbulder]

widex had been doing ever since they introduce the senso,
the senso gram was introduce close to 10yrs ago...
Most of HI out there have something of this sort...