- I often talk about how critical Real Ear Measurement
is to ensure that your hearing aids are programmed properly.
But there are some situations where
Real Ear Measurement won't give you that perfect fitting.
So in this video, I'm gonna cover a few situations
where Real Ear Measurement doesn't work
as well as it should.
Coming up.
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Hi guys, Cliff Olson, Doctor of Audiology
and founder of Applied Hearing Solutions
in Anthem, Arizona, and on this channel,
I cover a bunch of hearing-related information
to help make you a better informed consumer.
So if you're into that, consider hitting
the subscribe button.
Real Ear Measurement is the only way to ensure
that your hearing aids are programmed appropriately
to your hearing loss prescription,
and if you don't have Real Ear Measurement performed
at your fitting appointment, essentially,
programming the hearing aid is complete guess work.
And if you are anything like me,
you would much prefer to know rather than to guess.
If you aren't yet familiar with Real Ear Measurement
and what it is and how it works,
I highly recommend you watch my video that I will link
in the card up here and in the description below,
because it's the single most important thing
that you need to understand when being fit
with your hearing aids.
As important as Real Ear Measurement is,
there are situations where Real Ear Measurement alone
won't get you that perfect fitting,
and I wanna share a quick story with you
about when I was an audiology extern.
There was a patient who called up the clinic
and wanted some adjustments done on his hearing aids.
When he came in, I was the only one available to see him,
and when I hooked him up to the equipment,
I noticed that he wasn't meeting his prescriptive target,
so I was thinking, well, this is easy.
I'm just gonna increase the amplification
in his right eat that was significantly below
his prescriptive targets.
He'll be hearing better.
He'll be on his way,
He'll be extremely happy.
Well, that's not exactly how it occurred.
It had turned out that this patient had a mastoidectomy
done on his right ear.
As I proceeded to increase the amount of amplification
in the right ear, he actually told me
that he was feeling a little sick to his stomach,
so I continued to make some more adjustments
to get him up to his prescription,
and he stopped me again, saying he really needed
to go to the restroom.
So I got up and I started to unhook him
from the Real Ear Measurement equipment
and he ended up throwing up all over the office.
You see, what had actually happened
was I was increasing the volume too much on his ear
that he had surgery on, and it actually created a situation
where he got a vestibular reaction that made him
instantly dizzy and nauseous.
Obviously, in this scenario, using Real Ear Measuremnt
to hit his prescriptive targets was a bad idea.
While getting to those targets might have given him
more audibility and better speech understanding,
if it causes someone to get dizzy and sick
and to throw up when they start hearing sound at that level,
you can't keep them at that their prescription.
But a mastoidectomy isn't the only situation
where Real Ear Measurement might not achieve
the best results.
A lot of different conductive hearing losses
can actually make these targets unreachable.
Some of these are, of course, including mastoidectomies,
which I talked about before, but ossicular chain
discontinuity, otosclerosis, ruptured eardrums,
or even a cholesteatoma.
Here is an actual screenshot of an audiogram
for a patient with otosclerosis.
The gap that you see a conductive hearing loss.
This is a screenshot of Real Ear Measurement
done on this patient.
The purple hash mark line is the NAL-NL2 prescription
for this individual's hearing loss.
The solid purple line is the amplification
coming out of the hearing aid
Ideally, these lines would overlap, indicating that
the prescription for amplification has been met
by the hearing aid.
As we can see, these lines are not overlapping.
This was as close as I could reach the targets
and still have the volume be comfortable for this patient.
If I were to force the solid line to overlap
with the prescriptive hash mark line,
it would have been intolerable by the patient.
This patient may adapt to more amplification over time,
but will likely never achieve the full prescription
for their hearing loss.
Not being able to reach prescriptive targets
is a common occurrence for individuals
with a conductive hearing loss,
but it can also occur in individuals who have hyperacusis.
Individuals with hyperacusis are overly sensitive
to certain sounds, typically sounds that aren't loud
to individuals with normal hearing,
but they find them to be uncomfortable,
and what happens in this situation is that
you might have certain targets that you need to reach
in order to give them full audibility to sound,
but by getting them all the way up to that target,
it's completely intolerable to them as well.
You would essentially have no choice but to reduce
the amplification away from the prescriptive target line
and send them home without this full audibility.
Essentially, there's a trade off that happens
where you're trying to give them as much audibility
as possible, but you're also trying to keep it
comfortable for them.
Another situation that can cause the inability
to reach a prescriptive target is a first-time
hearing aid user.
First-time hearing aid users have typically
come from a long period of time of auditory deprivation,
where their auditory nerve and auditory cortex
are not perceiving at the full level,
and when you start giving them amplification back,
all the way up to their prescriptive targets,
they might not be able to handle that amount of volume.
The best approach to handle this situation
is to actually get them all the way up to
their prescriptive target, then back down the amplification
away from that prescriptive target.
This was you know that the hearing aids have
the capability of reaching that prescription,
but you don't wanna give it all to them
at the very first fitting.
When will essentially happen is as time goes by
and they adapt to that level of sound,
you can kind of baby step that amplification
back up into their prescription, and by the time
you're done with that fitting process,
you typically have that individual all the way up
to their prescription, so they have full audibility,
and they still have comfort.
Now, I wanna make something's really clear.
Just because there are certain situations
where Real Ear Measurement and reaching prescriptive targets
isn't possible, it doesn't mean that Real Ear Measurement
shouldn't be completed.
Real Ear Measurement will still give you an idea
of where the amplification is inside of your ears
to see how far away you are from your prescription.
If you're away from your prescription,
you know you're not gonna be hearing your best.
If you're on your prescription, you know you are
gonna be hearing your best.
But unless you perform it you have no clue
where your hearing aids are actually programmed at.
That's it for this video.
If you have any questions, leave them in
the comments section below.
If you liked the video, please share it.
If you wanna see other videos just like this one,
make sure you hit that subscribe button.
I'll see you next time.
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