Exactly. It’s not worth the REM if they aren’t experts. Then it just ends up a big mess. Good luck!
Thanks Blacky for all the info! I really appreciate your time:)
You really do need to work with someone that really knows what they are doing. With my Paradise aids we were unable to get the gain set to my prescription without a lot of feedback when using domes. Reducing the feedback dropped me well below target. My audi recommended that I go with custom molds and now I am at my prescription and speech is much clearer!
This might be the answer here too. I’m surprised how low that target was within the dynamic range.
It seems a really conservative estimate of what’s needed. NAL NL2 should be pushing the HF more than that. That looks like a dodgy implementation of the formula within the Aurical SW.
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That does not surprise me unfortunately. I really wanted this audiologist to work, but it’s time to try someone new. Thanks again for the feedback.
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Or the fitter didn’t enter all the data and/or did the preparation work.
My does a thing or two before we start with fitting where I have to be quiet.
After my brain short circuit last time I was thinking about it. Targets are definitely off, I completely agree with you.
Since aurical definitely does its job well, I’m also inclined to the opinion that fitter didn’t learn the process correctly. Maybe they slept during the training 
It’s not a rocket science but you have to know what are you doing.
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Good Morning, I can’t speak to the actual programing changes you might need, but I can tell you that my audi knows factory settings are not adequate at least for me. I go to University of Colorado Audiologist who are very experienced in all sorts of hearing loss profiles, I ask a lot of questions and she gives a lot of answers. Often she has students with her and they are learning themselves. About 1.5 years ago I got a new pair of hearing aids and my audi had me try them with factory settings while in the office. There was no way that those setting would work for me. With out her input and knowledge, I would still be hearing impaired even with brand new top of the line aids that were set to my audiogram at the factory. I would run from that audiologist and find yourself some one better. Part of your interview would be to ask about factory settings and REM adjustments. Best of luck!
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Do you know where I could find some information about this type of fitting. TIA for your help.
Is that even YOU?
Usually the bottom line in the fitting software is your audiogram, but this one does not look like the one posted behind your forum-name.
The way the screen was grabbed is revealing some names. “Mail -” is probably the machine’s owner, the audiologist. I do not use Noah, but the other name MAY be The Client. Which is not much like the real-looking name you use here.
Interestingly the Oticon REM Cookbook is open. This could be routine, or a search for help with a puzzle.
We just have to remember that audiometry dBs are HL and REM are SPL. And that one thing is matching the REM targets of NAL2 and other is using the Live Speech Mapping.
There are different fitting formulas NAL2, DSLv5, APD etc.
I would verify that your audiometry has the bone conduction and discomfort thresholds (UCLs).
Between target formulas can vary a good amount of decibels, especially in high frequency regions.
What people above suggested is trying to match the targets of REM combined with having your amplification in a good position within your dynamic range.
I found really useful LSM plus some minor compression and slight frequency changes based on the patient’s subjective response, of course, verifying that he has a good response with that fitting.
The program which is opened is the last one, otosuite.
Target is also openend.
I’m not familiar with that icon where another name is shown, but it looks like maybe some chat app?
It has two people for the icon.
Ok, found, it is Microsoft teams icon. Whatever that is
But the other thing you notice is really important - audiograms aren’t even close in form.
If this is the reason, I’d very much like to know more?
I mean, how can from audiogram there she hears tone at 0-10db, now automagically for the same frequency 30 be shown, and from almost linear shape get to very curvy one?
Thanks anyone who can explain this 
Edit, found this, I think I understand now where the curve comes from
And this source covers a bunch of terminology, excellent!
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I ask out of curiosity: is it necessary to make additional adjustments in REM due to single-side deafness?
Yes and no.
Are we talking about aiding the worst or best ear or both?
Strictly speaking the level of your prescription IS your prescription, however there are a couple of caveats.
- The loss of your stereo summation which is worth 3dB ‘extra’ gain. This means you generally need more power.
- The directional field is effectively halved.
- Any monaural fitting must also consider the processing delay and the effect on the phase of the signal and further collapse of the directional field at particular frequencies.
Personally, in any binaural fitting, my preference is to slightly under amplify the worst ear, slightly over amplify the best ear, at least at the beginning and then head towards a more significant amount of gain in the worst ear over time. This ‘shows’ the brain how both ears via the hearing aids, eliminating processing delay issues and may go some way to walking back long term auditory processing disorder.
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Thanks for reply, very interesting!
Only best. My left ear is unaidable (apart CROS system - not released yet or cochlear implant which is very hard to accustom, maybe only for me because of 20 year of no using left nerve).
This is the issue I have considered. Practically it is enough simply add 1 step up on volume button?
As you’re probably aware, louder isn’t necessarily clearer, but it may help under certain conditions.
Single hearing aid noise processing is difficult, whether you respond to more or less aggressive noise management is debatable. You might need to evaluate this to get the best fit.
You’re probably the kind of person who would benefit most from a device like the Resound Multi-Mic too.
Also, don’t discount CROS simply because you have no history of using one side, you’re already headed down the path with your main aid, adding a transmitter aid to the other side of your head isn’t such a huge step. Also, the CROS attempts to better utilise your better ear anyway, so the lack of a contra-lateral input shouldn’t have a bearing.
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You’re right. It gives more effect in silent environment than in loud.
I have Phonak Roger Select. Sometimes it gives strong SNR and the ambient noise is decreased, more often I didn’t see much difference.
So, based on your experience, the CROS doesn’t give much benefits, even in situation, when four mics may be used? I mean 2 from CROS and 2 from HA linked by system such as auto StereoZoom, to make more focused directionality than from 2 mics only.
I thought it isn’t helpful in some situations because I had to work hard. Then the battery died. Then I’ve realised how much it really helped. Yes, I had to work hard but without it, battle was just lost.
In short - turn it off and see if its helping if you haven’t done that already. I was really surprised.
About crosses…
I have one bad ear and one normal ear. First few years I wore aid only on bad ear. People talking from my bad side had to walk over to my normal side.
This year I’ve started with 2 aids, and results are awesome. Paradises 90.
The other day, shopping mall, echoey, slow day so no many people around, my husband on my bad side, wearing mask and speaking normally, we could normally converse. No mics needed.
Paradises and marvels transfer sounds between the aids in various modes. Not loud, but it’s there.
There’s also 360 mode which I’m currently looking into which should maybe be louder.
So basically I’m utilising all 4 mics.
Prior to this, fitters would use acoustic phone program and tweak it for everyday usage. Such solution is called amp cross or tricross.
So it aids bad ear AND transfers the signal to good ear (and aids it if needed).
For phonak, there’s this 360 program that should work better since you don’t have to pick side master-slave, it should detect automatically from which to which it should transfer.
Regular cross solutions just pick sounds from bad side, discarding it completely.
Check dr cliff’s video on the topic of single sided deafness / ampcross, forgot the exact title.
However if you’re totally deaf on bad side, then bicross is the term you need.
Cross only transfers the sound to the normal ear from bad side.
Bicross transfers to the good ear and helps it as well (so it’s also an aid).
Those two are devices under such name.
Ampcross solution (no device exists) is with 2 aids, aiding each ear and transferring the signal between them. Needs a fitter who knows how to make it work, and aids that aloow it.
Maybe you’re right. I rarely participate in social events, so I had only several occassions to use it. My experience with Roger Select is with Phonak Bolero V70-P (I haven’t transferred RogerX license to my Audeo P90-RT yet), so maybe with new HA (bought them 6th Nov) it will works better…
Yes, saying “CROS” I meaned “BiCROS”, because I am completely deaf on left side. However, AmpCROS definitely isn’t for me because I could loss e.g. AutoSense features and more. I am much interested in 360 mode. Thank you for much infos.
I expected some benefits from Binaural Voice Stream from CROS e.g. Speech in 360, Speech in very loud noise or Auto StereoZoom. This is one of many things why I have bough P90-RT version, not P70.
I am very glad you have reached so many benefits only thank to aiding second ear!
For me, I don’t hear many benefits with Paradise compared to previous aids (Venture) in situation apart streaming. Perhaps because I have it very briefly, maybe its no REM (only APD 2.0 + louder adjustments), maybe too small vent with regard to my good hearing in lows. Many things to consider!
I bought my top of the line Resound hearing aids, new on eBay for half the price of $6000 quoted by my Audi. I sent copy of my hearing test to the vendor and they were programmed by them. I then made an appointment with an Audi for a REM test. I got her name from a Dr Cliff video on YouTube. She charged me $160 to perform the REM test. So for an incredibly low price I have the latest Resound hearing aids fitted by an Audi using REM testing.
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Here’s one video that explains a bit how Aurical’s OnTarget tool works: https://youtu.be/bnAeKm1ObsM
Should REM show readings that are at or above target unless there’s a specific issue at that level (e.g., feedback)? Some of mine are below target (especially 55dB stimuli) and the lower SII percentage seems to indicate that could be improved. This was just a temporary programming, but I want to understand to get this programmed better when returning.
Also, REM readings should not go into the grey shaded area? To avoid this, those frequencies need to be increased more to make better use of the dynamic range, even if it exceeds target? Do you just increase the lowest stimuli curve or should the higher stimuli curves also be increased so one can better differentiate loudness? You say it should be in the middle of the dynamic range all the way across, but how does one determine the adjustment levels for each stimuli level as those would then be adjusted without being fit to target? For my loss, there is a lot of dynamic range not being used and the target curves in one ear are struggling to fit my loss (crossing into the grey area) so something seems off.
As a test to see if I understand, I used the half gain rule, reduced to a one third gain rule. Is that gain value in dB HL or dB SPL?
When using X/3 to be conservative, although it looks good using the Aurical OnTarget chart and value, the db SPL levels are significantly under this computed value. Is this disparity due to the conversion from dB HL back to dB SPL? I don’t think one can just subtract the hearing threshold sensitivity values at page 1 to convert: https://web.archive.org/web/20201111162603/http://www.thieme.com/media/samples/pubid1260387312.pdf but when attempting that it does provide values which are closer to what Aurical is displaying. Without knowing what reference value Aurical uses to convert dB HL to dB SPL it might not be possible to compute things in an exact manner. Plus I’d have to account for any RECD for my ears?
Edit: Costco HIS says they aim to keep the numbers in the On Target table to be less than 5 (250-2k) and less than 8 (3k-6k). The graph of REM accounts for the personal ear acoustics and thus it is ok for the measurement to cross into the grey shaded area of the audiogram. This person is conservative on the 55dB stimulus to avoid causing compression of the three fitting curves. Is that a good approach? Seems it may be just underfitting softer sounds where many HOH people struggle. They also say they don’t have enough handles to get more precision, but I don’t think that’s accurate these days, with some hearing aids having up to 24 bands. I watched her adjust and she mostly grouped 2-3 bands at a time. They seem over-reliant on REM fit to guide what they are doing so that a future autofit protocol can probably do a better job.