I always had the micro mold short. The only difference is that the audiologist picked 2.4mm vent and I measured my vent and it is only 1.4mm. So I selected 1.4mm for my fitting. Also no change in receiver size.
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What is your receiver size, by the way? You didn't say.
Also, I still don't understand the correlation between the pre-REM and post-REM gain curves you showed in the beginning of this thread, and the timing when your HCP set the vent hole to 2.4mm and you changed it to 1.4mm.
Was the pre-REM gain curves vs the post-REM gain curves when the vent hole size was set exactly the same pre and post? Meaning, so your HCP set it to 2.4mm, and you captured the actual gain curves data and stored it, then your HCP did REM (with nothing else changed, the vent hole size was still set to 2.4mm when REM was done? Then you captured the post-REM gain curves data right afterward and plotted both of them and showed them as is at 2.4mm setting here in this thread?
Or do any of the gain curves data have anything to do with your vent hole size reset to 1.4 mm?
What I'm trying to say is that if the pre-gain curves data was for 1.4 mm and post REM gain curves data for for when 2.4 mm was set, then you're not comparing apple to apple anymore.
Also, I still don't understand the correlation between the pre-REM and post-REM gain curves you showed in the beginning of this thread, and the timing when your HCP set the vent hole to 2.4mm and you changed it to 1.4mm.
Was the pre-REM gain curves vs the post-REM gain curves when the vent hole size was set exactly the same pre and post? Meaning, so your HCP set it to 2.4mm, and you captured the actual gain curves data and stored it, then your HCP did REM (with nothing else changed, the vent hole size was still set to 2.4mm when REM was done? Then you captured the post-REM gain curves data right afterward and plotted both of them and showed them as is at 2.4mm setting here in this thread?
Or do any of the gain curves data have anything to do with your vent hole size reset to 1.4 mm?
What I'm trying to say is that if the pre-gain curves data was for 1.4 mm and post REM gain curves data for for when 2.4 mm was set, then you're not comparing apple to apple anymore.
The Pre-REM curve was the original gain curve I got from the audiologist for my on trial Phonak Audeo. It assumed the double cup rubber tip (forgot the proper term for it). Post-REM is after the audiologist did the REM testing with my on trial Phonak Aideo hearing aids with the mini molds. The vent hole in this mold was large, bigger than 2.4mm.
Sorry I got you confused with my Audiograms and various gain curve posts. The grey lines in the Audiogram I have posted in my signature link are from my audiologist done the standard way with headphones and that was used by her to calculate the gain curve for both my old Oticon OPNs and the on trial Phonak Audeos. The color lines in my Audiogram was done DIY In-Situ using my Oticon OPNs that has the mini-molds at 1.4mm vent hole size.
The gain curve curves I posted on the thread "Change in gain settings on first connect to Genie2" on Aug 23, 2023 is comparing the gain curves on my old Oticon OPN mimiRites with mini-molds. Here the original gain curve was from the audiologist. She assumed a 2.4mm vent hole in the mold. I changed the vent size to 1.4mm when I did the in-situ fitting since I measured the hold size to be 1.4mm. The gain curves here show how my DIY In-Situ fitting changed the gain curves from what the audiologist had originally. This is all on the Oticon OPN.
On the Oticon OPNs, I can see a 3 on the receiver. Maybe there is an M to the right of it, but it is under a blue tape and inside the dome. So hard to read. On the Phonak Audeos, the receiver has 3M on it. Is that the receiver size? What is the significance of it?
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Since it looks like you use different fittings between your pre-REM curves and post-REM curves, there's probably really no point in trying to analyze the differences between them anyway since they're not apple to apple with the only difference being pre to post REM.
Wouldn't it be fairly simple to go back to the settings of the pre-REM gain values and simply change the ear piece to the same mold and recalculate the gain values to compare to the post-REM ones?
Yeah, but that would still just be theoretically calculated/prescribed gain curve. It's not necessarily going to match exactly with what you will measure it to be pre-REM. The pre-REM gain curve is the ACTUAL measurement made during the REM process before any adjustment is made to it to get it to match the target curve. Then the post-REM gain curve is another set of actual measurements made during the REM process to confirm that the adjustment now has gotten it to match with the target curve now.
Both the pre and post REM data must be the actual measured data during the REM process in order for any analytic on the comparison to be worthwhile.
Both the pre and post REM data must be the actual measured data during the REM process in order for any analytic on the comparison to be worthwhile.
I am confused. What is pre-REM for you? It is measured? How?
Pre-REM is when after they hook up microphones inside your ear canals with you wearing your hearing aids being turned on and everything. Then they play a bunch of sounds on the speakers in front of you to replicate environmental sounds, like for example replicate speech and noise inside of a restaurant or in a public place. While the sounds are played on the speakers, the mics inside your ear canals pick up the amplified sounds and record them into the REM system to map into the actually produced gain curves across the frequency range.
Then the HCP will observe this actually measured gain curve against the theoretical target gain curve that is calculated by the REM system for a particular fitting rationale. If the actual measured gain curve (the pre-REM data) is not up to par or above par to the target data, then the HCP is adjust it up (or down) to match with the target data at each of the frequency point. This adjustment is done to your hearing aids directly by the REM system, but is manually done by the HCP, unless the REM system is connected directly to Genie 2 and REM Autofit (a Genie 2 feature() is used, in which case Genie 2 will make the adjustment automatically and the HCP doesn't have to do any manual adjustment.
The post-REM gain curve will be the post adjusted but still actually measured gain curve as recorded by the REM system recording the new sounds as amplified by the hearing aid which now is amplifying based on a new prescription that is the adjusted post-REM prescription. The post-REM gain curve may not match the target gain curve 100%, but it should be a close enough match.
Then the HCP will observe this actually measured gain curve against the theoretical target gain curve that is calculated by the REM system for a particular fitting rationale. If the actual measured gain curve (the pre-REM data) is not up to par or above par to the target data, then the HCP is adjust it up (or down) to match with the target data at each of the frequency point. This adjustment is done to your hearing aids directly by the REM system, but is manually done by the HCP, unless the REM system is connected directly to Genie 2 and REM Autofit (a Genie 2 feature() is used, in which case Genie 2 will make the adjustment automatically and the HCP doesn't have to do any manual adjustment.
The post-REM gain curve will be the post adjusted but still actually measured gain curve as recorded by the REM system recording the new sounds as amplified by the hearing aid which now is amplifying based on a new prescription that is the adjusted post-REM prescription. The post-REM gain curve may not match the target gain curve 100%, but it should be a close enough match.
Thank you for your detailed explanation. Sorry that I am still struggling to comprehend. Let me playback what I understand. What you call pre and post REM gain are both measured gains using a mic inside the ear canal. Pre is before adjustments are made to the hearing aids and post is after the adjustments. Am I getting it correctly?
The comparison chart I posted are not the measured gains. It is simply the insert gain values programmed into my hearing aids before and after the AUD ran a REM fitting for me. She did not make any adjustments manually, guess it must have been an autofit REM.
pvc
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Here's how I think it works (not autofit), but close.
Watch your Audi carefully; When your Audi runs the REM measurement it only takes a few seconds of gobbledygook sounds for the REM system to measure the sound at-your-eardrums.
After those few seconds, REM may be done and over with. If your Audi thinks the measurement is close enough, then the REM adjustments may be accepted, applied, and therefore change (your-previous-hearing-aid-settings) at a machine-controlled speed equivalent to the blink-of-an-eye.
If not, then your Audi may fiddle around with the REM system by (mouse dragging and mouse clicking), and perhaps rerunning the gobbledygook sounds one, or a few more times before the REM adjustments are accepted, applied, and therefore change (your-previous-hearing-aid-settings).
I don't think there are any instances where the REM adjustments would be discarded and not applied to your hearing aids. Though, I could be wrong. I never went to REM School.
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pvc
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Well that would be results/(Rx/Prescription) calculated by Genie 2 once all the variables have been specified and you proceed to the "Fitting" step of Genie 2. Here's a clip from a DIY School Hearing Aids PDF File named (What to Expect for your First Fit);
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That's what I thought too, but Volusiano seems to think otherwise, that's why I am confused. He pointed out that my original fitting assumed a double cup rubber tip and the Post-REM used my new mini-mold. I can understand that. But if I take my original setting and do a recalculation after changing the tip to the same mini-mold, wouldn't that make it an apple to apple comparison pre and post REM?
pvc
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As per my VA Audiologist: A small change in Acoustics does not always result in a recalculation of the Rx/Prescription.
Though I am going out on a limb here, I believe that a new Rx/Prescription from Genie 2 (if and when it does occur) will overwrite your REM adjustments.
Though I am going out on a limb here, I believe that a new Rx/Prescription from Genie 2 (if and when it does occur) will overwrite your REM adjustments.
The calculated prescribed gain curve is just that, CALCULATED based on ideal conditions with audiogram info, fitting info, and hearing aid model info taken into account. And no ear canal irregularities are taken into account because they vary and they're unknown.
Don't forget what REM means -> REAL EAR MEASUREMENT. Real measurement, not calculated prescription. That's why a microphone is inserted into each ear canal -> to MEASURE the sound level from the speakers.
If you can plot out your "prescribed" theoretically calculated gain curve, and map it against the pre-REM measured gain curves, they don't necessarily match 100%. Usually the measured gain curve will tend to (but not always) underperform when mapped against the calculated/prescribed gain curve. The calculated/prescribed gain curve in theory should match more closely to the target, but not necessarily exactly either. That's because the target curve takes your audiogram info and run the calculation through the fitting rationale of choice to arrive at what the amplification level should be according to/as dictated by that fitting rationale. But the prescribed/calculated gain curve may or may not be able to achieve that goal, depending on whether the receiver is up-to-size or not, or whether the hearing aid has strong enough amplification for the hearing loss or not, or whether the dome is sealed tight enough, or whether your ear canal is too irregularly shaped or not, or whether the vent hole is too big or too small or no vent hole can affect it differently, too.
Anyway, as far as the clinician is concerned, they look at what their inserted microphone measures, and they see if that is at target yet or not, and if not, they adjust the gain one way or another to get as close to the target as possible, all the while looking at the measured gain curve on their REM equipment. For the clinician, the pre-REM curve is what was measured by the mics inside the ear canals before they change anything. And post-REM is the what the curve looks like after they change everything, and post-REM gain curve should match as closely to the target curve as possible. They don't look at or care about the calculated/prescribed gain when they do REM.
If the clinician doesn't take any of these snapshots of the actual real ear measurements (that make up the pre and post gain curves, and also the target gain curves) and/or share this information with you, then you wouldn't have it. All you would have then is the originally calculated/prescribed gain curve, and what the adjusted gain curve looks like on paper as required to match up the target. So in this case, your pre-REM data which YOU have is the calculated/prescribed gain, but it's not the pre-REM gain curve that the clinician was looking at during the REM process, because yours is the calculated one, his/hers is the MEASURED one.
As for post REM, same thing. What you have in YOUR record is what it took the clinician to adjust ON PAPER as a matter of record in order to see what is MEASURED on his/her REM screen. For example, on the measurement screen, at a particular frequency, the calculated/prescribed pre-REM gain is 5 dB. But because of under performance by your hearing aid, and maybe due to leaks from your bad fitting seal, the measure gain is actually measured at only 3 dB. And let's say that target is 6 dB. So the clinician would keep increase the gain 1 dB at a time until it matches the target. On paper, he/she should only click up 3 dB to go from the measured 3 dB to the target 6 dB. But because of the underperformance and leak, maybe the clinician actually has to click 4 dB up before the measured adjusted gain shows to be at 6 dB like where the target is.
So what you have for pre-REM is the calculated/prescribed gain of 5 dB. But what the clinician has for his/her pre_REM measured is 3 dB only.
As for post REM, the clinician had to do 4 clicks of 1 dB each to arrive at 6 dB target, so the clinician's post-REM gain is 6 dB as measured. But your recorded on paper post-REM gain is 5 dB (original pre REM), plus 4 dB upward clicks by the clinician to arrive at the target, so your post-REM on paper for the record is 5 + 4 = 9 dB post-REM.
So now you see why you're seeing 5 pre and 9 post on paper as calculated and recorded in actually adjustment in # of dB clicks (4), while the clinician is seeing 3 pre and 6 post, are all different? And that's why I wouldn't want to try to explain and over analyze why the pre and post numbers are different the way they are, because what you're looking at on paper in Genie 2 is not necessarily the same as what the clinician sees on the measured REM screen. So there's a lot of apples and oranges in the mix here. Why bother explain and analyze scientifically when it's actually too complicated due to many factors involved?
Even if I don't have the clinician REM measured pre and post gain curve, and I only have the original calculated prescribe gain curve and the final adjusted gain curve as what the clinician had to do to match target, I'll just take the final post-REM adjusted curve as recorded by the number of clicks done by the physician as a post-REM starting point to work off of. It doesn't pay to try to analyze so you can understand why the differences are what they are, because there are way too many factors and apples and oranges and cherries and vanilla all mixed up together.
Don't forget what REM means -> REAL EAR MEASUREMENT. Real measurement, not calculated prescription. That's why a microphone is inserted into each ear canal -> to MEASURE the sound level from the speakers.
If you can plot out your "prescribed" theoretically calculated gain curve, and map it against the pre-REM measured gain curves, they don't necessarily match 100%. Usually the measured gain curve will tend to (but not always) underperform when mapped against the calculated/prescribed gain curve. The calculated/prescribed gain curve in theory should match more closely to the target, but not necessarily exactly either. That's because the target curve takes your audiogram info and run the calculation through the fitting rationale of choice to arrive at what the amplification level should be according to/as dictated by that fitting rationale. But the prescribed/calculated gain curve may or may not be able to achieve that goal, depending on whether the receiver is up-to-size or not, or whether the hearing aid has strong enough amplification for the hearing loss or not, or whether the dome is sealed tight enough, or whether your ear canal is too irregularly shaped or not, or whether the vent hole is too big or too small or no vent hole can affect it differently, too.
Anyway, as far as the clinician is concerned, they look at what their inserted microphone measures, and they see if that is at target yet or not, and if not, they adjust the gain one way or another to get as close to the target as possible, all the while looking at the measured gain curve on their REM equipment. For the clinician, the pre-REM curve is what was measured by the mics inside the ear canals before they change anything. And post-REM is the what the curve looks like after they change everything, and post-REM gain curve should match as closely to the target curve as possible. They don't look at or care about the calculated/prescribed gain when they do REM.
If the clinician doesn't take any of these snapshots of the actual real ear measurements (that make up the pre and post gain curves, and also the target gain curves) and/or share this information with you, then you wouldn't have it. All you would have then is the originally calculated/prescribed gain curve, and what the adjusted gain curve looks like on paper as required to match up the target. So in this case, your pre-REM data which YOU have is the calculated/prescribed gain, but it's not the pre-REM gain curve that the clinician was looking at during the REM process, because yours is the calculated one, his/hers is the MEASURED one.
As for post REM, same thing. What you have in YOUR record is what it took the clinician to adjust ON PAPER as a matter of record in order to see what is MEASURED on his/her REM screen. For example, on the measurement screen, at a particular frequency, the calculated/prescribed pre-REM gain is 5 dB. But because of under performance by your hearing aid, and maybe due to leaks from your bad fitting seal, the measure gain is actually measured at only 3 dB. And let's say that target is 6 dB. So the clinician would keep increase the gain 1 dB at a time until it matches the target. On paper, he/she should only click up 3 dB to go from the measured 3 dB to the target 6 dB. But because of the underperformance and leak, maybe the clinician actually has to click 4 dB up before the measured adjusted gain shows to be at 6 dB like where the target is.
So what you have for pre-REM is the calculated/prescribed gain of 5 dB. But what the clinician has for his/her pre_REM measured is 3 dB only.
As for post REM, the clinician had to do 4 clicks of 1 dB each to arrive at 6 dB target, so the clinician's post-REM gain is 6 dB as measured. But your recorded on paper post-REM gain is 5 dB (original pre REM), plus 4 dB upward clicks by the clinician to arrive at the target, so your post-REM on paper for the record is 5 + 4 = 9 dB post-REM.
So now you see why you're seeing 5 pre and 9 post on paper as calculated and recorded in actually adjustment in # of dB clicks (4), while the clinician is seeing 3 pre and 6 post, are all different? And that's why I wouldn't want to try to explain and over analyze why the pre and post numbers are different the way they are, because what you're looking at on paper in Genie 2 is not necessarily the same as what the clinician sees on the measured REM screen. So there's a lot of apples and oranges in the mix here. Why bother explain and analyze scientifically when it's actually too complicated due to many factors involved?
Even if I don't have the clinician REM measured pre and post gain curve, and I only have the original calculated prescribe gain curve and the final adjusted gain curve as what the clinician had to do to match target, I'll just take the final post-REM adjusted curve as recorded by the number of clicks done by the physician as a post-REM starting point to work off of. It doesn't pay to try to analyze so you can understand why the differences are what they are, because there are way too many factors and apples and oranges and cherries and vanilla all mixed up together.
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pvc
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My curiosity about REM and its nomenclature ended a long time ago when I learned how expensive these REM systems are! 
So I just recommend saving the original professional settings during your very first DIY fitting session so that you can revert back to to the original professional settings if necessary. This becomes even more important when the saved settings include REM.
So I just recommend saving the original professional settings during your very first DIY fitting session so that you can revert back to to the original professional settings if necessary. This becomes even more important when the saved settings include REM.
Amen to this! I totally agree with this 100%. It's really not worth the time and effort to over-analyze pre and post REM data because there are just too many variables in the mix. As researchers or clinicians or HA mfgs, I'm sure it's worthwhile doing for the sake of learning, and also worthwhile doing because you can control many variables for the sake of experimenting. As simple users, it's really beyond our means to control much of this process in the first place anyway. So the best approach is to pick a starting point as DIY'ers and just go from there.