Of course, some clinicians argue that simply acquiring and hitting the target does not guarantee a successful fitting-and we agree. Given the introduction of any fixed sound (speech, background noise, pure tones) into any ear canal, the acoustic result at the eardrum may be significantly different for each individual ear canal, even within the same patient. Just as one cannot accurately guess the type and degree of hearing loss, one cannot guess the ear canal size or ear canal resonance characteristics. For those who do incorporate conventional REM routinely into their hearing aid fitting protocol, the 10 to 15 minutes spent acquiring REM, documenting, and using the information is time well spent. Some clinicians occasionally use REM, perhaps for more challenging fittings and troubleshooting. An unverified first fitting is really an unknown starting point. A REM-verified first fitting is an evidence-based and well-informed starting point for accommodating the patient’s subjective feedback. Specifically, REM and patient preferences are not mutually exclusive indeed, it’s quite the opposite. Of course, there is also the assertion that the patient’s feedback and preferences take priority over objective measurements of sound-although that isn’t actually a cogent argument, as the use of REM does not preclude or argue against the patient’s subjective response. Chief among them: lack of time, lack of equipment, a seemingly cumbersome process, and expensive equipment. There are wide-ranging reasons cited for the low usage of conventional REM. Mueller 1 estimated that 20-30% of all fittings involve REM the first author (DLB) estimates the actual number may be closer to 10-15%. Although REM is undoubtedly important, objective, facilitative, and worthwhile, very few clinicians employ these measures in their daily hearing aid dispensing routine. Beck, AuD, and Nicholas Crowe, MScĪdmittedly, conventional real ear measures (REM) are-and have always been-a hard sell. Tech Topic | April 2017 Hearing Reviewīy Douglas L. Oticon has revisited the existing REM AutoFit to provide an improved, intuitive tool integrated in its fitting software utilizing this new IMC 2 protocol. There is now a standard, cross-manufacturer protocol developed through HIMSA, referred to as IMC 2 (Inter Module Communication – Protocol 2).
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