Hearing Aid Fitting
The fitting appointment for a Hearing Aid case — the patient comes back wearing the aid and says what you tick (nothing, by default), and the learner asks how it sounds and fine-tunes it until they're happy.
The Hearing Aid element is where a case is built, the aid chosen (Selection) and verified against the prescription (Verification). A Hearing Aid Fitting is the fitting appointment for that case: the patient comes in wearing the aid as the learner left it after Verification, saying what they think of it — the complaints you tick, such as "It sounds tinny and sharp, almost robotic." — and the learner asks how it sounds and fine-tunes the aid until they're happy. The two stay separate elements, so verification and the appointment are graded (and reported) on their own.
In the designer both sit in the Amplification group, under More elements, with a one-click Hearing Aid + fitting appointment that adds both, linked.
One case, two elements
A Hearing Aid Fitting doesn't design the case again. It names the Hearing Aid element it follows, and:
- the Hearing Aid element supplies the patient, the loss and the prescription, the aid, and the tolerance and step size;
- it supplies where the appointment starts too: the aid as the learner left it there after Verification, in the same attempt;
- the appointment itself says what the patient comes in saying, per ear — and, for combinations the built-in complaints don't name, in what words.
In an attempt, the aid is the one the learner chose in the Hearing Aid element in the same attempt, and an ear they didn't aid there stays closed here too.
Adding a fitting appointment
- Hearing Aid Fitting links itself to the lesson's latest Hearing Aid element.
- In a lesson with no Hearing Aid element it offers to add one too (Add a Hearing Aid too? → Add both), linked.
- Hearing Aid + fitting appointment adds a Hearing Aid element and an appointment for it.
The link is mandatory: the lesson won't save while an appointment isn't linked to a Hearing Aid element. Deleting a Hearing Aid element that an appointment follows asks first — the appointment goes with it, or nothing is deleted.
An appointment is a template exactly when its case is: a Hearing Aid element that follows a template audiogram gives every attempt its own loss and prescription, and the appointment picks that up. Its card shows Template (from Hearing Aid); there's no toggle of its own.
Design tab
- Fitting for — the Hearing Aid element this appointment follows: any Hearing Aid element above it in the lesson. An appointment always follows a Hearing Aid element, never another appointment. Open … jumps to it. An appointment that ends up above the element it follows (a drag can do it) keeps its link, and its card and Design tab warn: This fitting appointment comes before the Hearing Aid element it follows — move it below. The lesson still saves: learners meet it first, and it waits until that element is finished (see Visits happen in order). With no Hearing Aid element above it, the tab says to drag it below one — or, in a lesson with none, to add one with Hearing Aid + fitting appointment.
- Name (optional) — what the learner's tab, the appointment's own page and notices, the results and the report call it: "2-week fitting", say. Blank reads Fitting; two unnamed appointments read "Fitting 1" and "Fitting 2".
- How the appointment opens — per ear the case aids: the gain curves the console draws, what the patient says as it opens, and the starting numbers — for a learner who brought the aid to target in Verification (each learner starts from their own aid; see below). It's shown on the recommended aid, its feedback manager run. When the patient would say nothing there, an amber note says so: only what a learner left off in Verification would be a complaint, and "sounds good" is theirs for leaving the aid alone.
Where the appointment starts
From the aid as the learner left it after Verification, in the same attempt — exactly as the Hearing Aid element grades it, mistakes and all. The patient judges it against a good fit moved by what you ticked, so a box they left more than the tolerance off a good fit is a complaint here too, beside what the patient comes in saying — unless it happens to land where this patient likes it (highs left too quiet, for a patient who finds full highs tinny).
| The Hearing Aid element | The appointment starts from |
|---|---|
| Has a Verification step | The aid as the learner left it after Verification (the designed starting fit, if they never adjusted it) |
| Has no Verification step (Selection only), or is hidden from learners | The aid brought to target: the prescription as the aid in the ear can deliver it, with the MPO on the patient's loudness tolerance |
Either way it's held to the aid now in the ear — the learner's own choice when the Hearing Aid element has a Selection step — and the aid counts as feedback-managed (the manager is run in Verification), so it's held to its feedback-safe limit. An ear the learner left without an aid there gets no start of theirs: it stays closed (see below).
The learner's page and the grade read the start the same way, from the attempt's saved work; and since the Hearing Aid element is read-only once the appointment starts (below), the start can't move under the learner. The designer can't know a learner's own fit, so How the appointment opens, and the words under each ear on the Settings tab, show a learner who brought the aid to target. When the Hearing Aid element has no Verification step, or is hidden from learners, that is every learner's start, and the Design and Settings tabs say so. The learner's own page then says the patient is wearing the aid they chose (or just "their aid"), not the aid "as you left it".
Visits happen in order
The appointment starts from the aid as the learner left it in the Hearing Aid element, so that element has to be finished before the appointment opens — and has to stay as it was once the appointment starts:
- It waits. Until the learner has reached the Hearing Aid element's last step (Verification — or Selection, in a Selection-only case), the appointment's tab says Finish … first — It opens once you've reached Verification in Hearing Aid — with a button that opens it. No console, no numbers.
- The learner starts it. The first time it opens ready, the learner is asked "Start the fitting appointment? … closes when you start. To change it after this, you'd reopen it — and that resets this appointment." Cancel leaves it unstarted, with a Start the appointment button on the page.
- Starting closes the Hearing Aid element. From then on its Selection and Verification are read-only, with a note saying which appointment the learner has moved on to. They can still look back through it — both steps, the speech maps, the grid — but nothing there can be changed or run: no new device, no REM run or MPO check, no adjustment, no feedback manager. An ear left there without an aid says so, and that the visit is closed.
- Going back on purpose resets the appointment. If the learner realizes during the appointment that the aid or its verification was wrong, the closed Hearing Aid element's note has a Change the aid or verification button. It asks first, naming every appointment it would reset — "Reset …? Changing the aid or its verification starts … over: everything you've done there is cleared … Your instructor will see that you restarted it." Confirmed, the appointment's work is cleared and the Hearing Aid element opens again on the step the learner was looking at; once they're done there, the appointment asks to start again, on the aid as they now leave it. If the reset can't be saved (a dropped connection), the page says so and the element stays closed — they can try again. The results screen, the report and the replay show each restart (Restarted the fitting appointment 1×); it's never scored. Not on a submitted attempt.
A Hearing Aid element hidden from learners keeps no one waiting: the appointment starts as it opens, and closes nothing.
Settings tab
The case
What comes from the Hearing Aid element, listed under one Given line: the patient, their loss and the prescription; the aid in each ear (the learner's own choice when that element has a Selection step); and how close counts — the tolerance and the step size. Tested in … opens that element's Settings tab, where they're set — it keeps the prescription, tolerance and step size on show while an appointment follows it, whatever its steps. An ear the learner declined — or left undecided or unfinished — at the Hearing Aid element stays closed here too, and still counts (see Scoring & Report tab).
What the patient comes in saying
Per ear, tick what the patient says about the aid, in their own words. Each row is one part of the fit — the whole aid, each input level, each region, and the loudness limit (MPO) — with the too little complaint on one side and the too much one on the other (one or neither per row), each showing its fix underneath, so which way a complaint points is never a guess:
| Row | Too little → the fix | Too much → the fix |
|---|---|---|
| Everything | "I can barely tell the hearing aid is on." → increase overall gain | "Everything is just too loud." → reduce overall gain |
| Soft sounds | "I can't hear soft or quiet voices." → increase gain for soft inputs | "Little noises — the fridge, paper rustling — are way too noticeable." → reduce gain for soft inputs |
| Average sounds | "Normal conversation still sounds too quiet." → increase gain for average inputs | "Ordinary conversation sounds like people are shouting." → reduce gain for average inputs |
| Loud sounds | "Loud sounds don't sound loud — music and raised voices sound flat." → increase gain for loud inputs (less compression) | "Loud sounds are way too loud — they make me jump." → reduce gain for loud inputs (more compression) |
| Lows | "Voices sound thin — no body or warmth." → increase low-frequency gain | "Everything sounds boomy and hollow — like I'm talking in a barrel." → reduce low-frequency gain |
| Mids | "Voices just aren't clear enough." → increase mid-frequency gain | "Voices sound harsh and honky, a bit nasal." → reduce mid-frequency gain |
| Highs | "Speech sounds muffled and unclear." → increase high-frequency gain | "It sounds tinny and sharp, almost robotic." → reduce high-frequency gain |
| Loudness limit (MPO) | "Loud voices and music sound squashed and distorted." → raise the MPO to the patient's loudness tolerance | "Sudden loud sounds — a door slamming, dishes clattering — actually hurt." → lower the MPO to the patient's loudness tolerance |
Below the rows are your own complaints, under This patient's own words (see How this patient puts combinations).
How a tick builds the patient. Each ticked complaint puts the patient 10 dB the other way from the prescription in every box it covers. "Tinny and sharp" — the highs are too much — means the patient wants the highs 10 dB softer than prescribed, so on an aid brought to target they say it, and turning the highs down fixes it. Ticks that cover the same box add up ("everything too loud" with "highs too loud" puts the highs 20 dB softer), opposite ones cancel, and no box moves more than 20 dB. The MPO pair moves the patient's loudness tolerance instead: "loud sounds hurt" makes it 10 dB lower than the case's, "squashed and distorted" 10 dB higher (as far as the receiver allows). A lower tolerance caps loud speech too, so ticking only "loud sounds hurt" can also have the patient say "Loud sounds are way too loud — they make me jump." — lowering the MPO in the console fixes both.
A new appointment comes in with nothing ticked — Theta's starting point (on a good fit the patient says "Sounds good."); tick what they should come in saying. An organization's element preset can change the default.
Under each ear, as you tick, the tab shows what the patient says on an aid brought to target ("Sounds good." when nothing is off). If a ticked complaint won't be said there, an amber warning lists it with why:
| Why the patient won't say it | What to change |
|---|---|
| Another tick asks for the opposite in the same sounds, so the two cancel | Uncheck one |
| A too much complaint where the prescription is already close to no gain — the patient can't want much less | Check another complaint, or make the loss there greater in the Hearing Aid element |
| A too little complaint where the aid can't give this patient more — it's at its gain limit, or loud sounds already reach their loudness tolerance | Choose a more powerful aid (or a closed fit) in the Hearing Aid element, or make the loss milder |
| Both MPO complaints are checked, so they cancel | Uncheck one |
| "Squashed and distorted" where the receiver can't produce more output, so the patient's higher tolerance never shows | Choose a more powerful aid in the Hearing Aid element |
A ticked complaint the patient voices in broader words isn't listed: "highs too loud" can come out as "Everything is just too loud." when that's what the fit has, and that's the complaint said.
- Custom shape (optional, folded under each ear) — where the patient likes it on top of the ticked complaints, in dB from the prescription for each input level × region: negative means they want it softer there. Its summary names what it moves.
- Same in the left / right ear → copies one ear's ticks and custom shape to the other.
How this patient puts combinations
Your own complaints, in the patient's own words, for combinations the built-ins don't name: type what they say, the fix (shown to you, not the learner), and tap cells in a Soft / Avg / Loud × Low / Mid / High grid to mark where the fit is wrong — too loud or too quiet. A complaint can mix both: "quiet things vanish and loud things hurt" is soft-too-quiet plus loud-too-loud.
Whenever the aid has the pattern a custom complaint describes, the patient says it in your words instead of the plain ones — whether or not you ticked it — and says it once. Tick it under an ear to have the patient come in saying it. It counts as fixed once every marked box is within the case's tolerance; a mixed complaint keeps being said until both halves are fixed. Removing a custom complaint un-ticks it wherever it was used. An organization can keep a shared list in its element preset; every new appointment in the org starts with those complaints available.
Asking the patient
A cap on "How does it sound?" at this appointment (Unlimited by default). A cap makes the learner reason from what the patient said rather than asking after every tap.
The learner's appointment
Once the appointment has started (see Visits happen in order), a strip at the top says the patient is back, wearing the aid as the learner left it, and asks the learner to find out how it sounds and fine-tune it until they're happy. Below it is the fitting console, on the appointment's own copy of the aid — opening on the aid as they left it in Verification; the Hearing Aid element's aid never changes. The patient's opening words are saved as the appointment opens, so leaving and coming back isn't a free re-check. An ear the learner declined, left undecided or didn't finish choosing an aid for in the Hearing Aid element stays closed — that element is closed by now, so the ear can only be opened by reopening it (see Going back on purpose above, which resets this appointment; never on a submitted attempt) — and its notice says the ear still counts toward this appointment. An appointment whose link didn't resolve when the attempt began shows a notice instead of a console.
The console
Each ear has a How does it sound? button (with the asks left, when there's a cap), the patient's last words, and a gain chart; the console tray along the bottom holds each ear's grid. The grid is input level × frequency: soft (50 dB SPL), average (65) and loud (80) inputs against the aid's tunable frequencies — 3, 6 or 9 of them depending on the technology tier. The grid and the chart show the insertion gain — what the aid adds over the open ear, which is what fitting software is programmed in. The chart's dashed line is the most this aid can add (Max gain (this aid)). Soft input gets the most gain, so the rows run Soft, Avg, Loud from the top — the gain shrinking down each column is the compression — with the MPO row beneath them: an output ceiling, so it stays in dB SPL.
The learner selects cells — by dragging, or by tapping a frequency, row or region header —
and one − / + moves the whole selection. Selecting a frequency or a region picks the
gain rows only; the MPO row has its own header, because changing the patient's tolerance
ceiling should always be deliberate. The two read-only CR rows (⚙ → Compression
ratios) work as they do in REM.
The prescriptive target is hidden. The patient is the learner's guide.
The feedback manager was run in Verification, so the grid says so, and the aid stays at or under its feedback-safe limit. The chart shows what it holds back in the highs only with Device limitations on (below).
Device limitations (practice mode)
Device limitations, in the Display (gear) menu, takes the aid's gain limit apart — on the gain chart and in a small table under it. From the top: what the receiver alone could add (a thin line); what the dome + vent cost (hatched — an open fit leaks the lows out); any series adjustments a brand's series makes on its options; and, in the highs, what the feedback manager holds back. Every column adds up: receiver + dome and vent + series = the aid's limit; less the feedback share = the feedback-safe limit (shaded on the chart, Held back for feedback). Off, the chart shows the aid's limit alone. It's a teaching view: offered in practice mode, never shown in exam mode.
Gain | Output (practice mode)
The gain chart is the console's main view: compression reads as the loud curve getting less gain than the soft one. In practice mode the Display (gear) menu's Chart switch — Gain | Output — swaps it for REM's speech map of what the aid puts in the ear, in dB SPL: the speech level, plus the open ear's own resonance, plus the gain — less whatever stops it reaching the eardrum. An open fit's lows leak out of the vent (no gain below 1 kHz), a receiver rolls off above 4 kHz when the Hearing Aid has Receivers roll off above 4 kHz on, and the MPO (asterisks) caps every curve. It's REM's arithmetic without the probe, so a later REM run on the same aid reads the same, give or take the probe's placement. Loud 80 sits on top and Soft 50 at the bottom, the curves drawing closer together as compression gives the louder inputs less gain. It's kept plain: no speech ranges, and no target, UCL or thresholds — the patient stays the guide.
On Output, the same menu offers Show components, which takes one curve apart (REM's gain builder): pick Soft 50, Avg 65 or Loud 80 and that curve is drawn as layers — the speech coming in, the ear canal's boost (REUG), the aid's gain as set, then what leaks out of an open fit (shaded), what the receiver's roll-off loses and what the MPO cuts off — with a table under the stage giving each layer per frequency. Every column adds up to the point on the chart (In the ear (dB SPL)).
Both are teaching views: offered in practice mode, never shown in exam mode, and remembered in that browser (Show components is the same setting as REM's gain builder). The grid stays in gain either way.
The patient
The patient compares the fit with where they think it sounds right, box by box: soft / average / loud input against the low / mid / high regions — the prescription, moved by what you ticked and any custom shape. Any box more than the tolerance away is a problem, and the patient mentions every problem — including ones the learner creates along the way. Push the highs too far while fixing "muffled" and the patient starts saying it sounds tinny.
They describe the problems in the fewest true sentences, using the built-in wording in the table above. "Everything" is only said when it's true at every input level and in every region; a row or region complaint when most of it is off; and a single wrong box is still mentioned, by the plain complaint closest to it — or in your words, if you wrote a custom complaint for it. The responses are deterministic, and the patient says "Sounds good" only when nothing is off. Leaving the appointment and coming back shows the last answer rather than a free re-check. The patient always reacts to the aid actually in their ear — its limits, and their own loudness tolerance as its receiver can program it — so a learner is never left with a complaint they have no physical way to clear.
The MPO is judged against the patient's tolerance on this aid: their UCL less 6 dB, capped by the receiver's OSPL90, moved by an MPO complaint you ticked. More than the tolerance above it, loud sounds hurt; more than the tolerance below, they're squashed. That's a different line from REM's MPO check in the Hearing Aid element, which calls a beep too loud only above the UCL itself — so an MPO set right at the UCL passes REM's beeps but gets "Sudden loud sounds … actually hurt." here.
Scoring & Report tab
The appointment grades the patient — there's no target to match here (the targets are graded in the Hearing Aid element's Verification). Two rows, each Off / Scored / Report-only (Scored by default); changes apply straight away:
| Row | Worth |
|---|---|
| Complaints resolved | One point per complaint the patient opens the appointment with — heard on the aid as the learner left it in Verification, so a mistake left there counts too — earned when that problem is gone from everywhere it covered; overshooting into the opposite problem ("too sharp" pushed through to "too dull") is not a fix |
| Patient says it sounds good | One point per ear for ending the appointment with a patient who has nothing left to say |
Under the rows, a note counts the complaints a learner who brought the aid to target finds the patient with (on the recommended aid). With both rows Off, a warning says the appointment isn't scored and the PDF leaves it out.
Only the case's ears are graded, and — as in the Hearing Aid element — the design sets the total. An ear with no aid from the Hearing Aid element (declined, undecided or unfinished) still counts: it's graded as never touched, so its opening complaints stay unresolved and "sounds good" is earned only when the patient had nothing to say about it. The learner's page says so on the closed ear, and the results screen and the PDF mark each of its rows no aid fitted at the Hearing Aid visit.
Results, report, analytics and replay
- Results screen — per ear, the breakdown of the complaints and the "sounds good" row; View data plots where the learner left the gain against where the patient likes it.
- PDF — the same per ear, with a closed ear saying why and each of its rows marked no aid fitted at the Hearing Aid visit. With both rows Off the appointment is left out of the report.
- Advanced Analytics — Fitting appointment: complaints resolved, Fitting appointment: patient satisfied and Fitting appointment: asked the patient, separate from the Hearing Aid element's own points. A lesson with no fitting appointment shows not in this lesson. A patient who comes in with nothing to fix reads not applicable — nothing recorded to grade on complaints resolved (not "not switched on"). Asked the patient counts only the asks after the appointment's last reset. Starting an appointment, or having it reset, isn't work: for Elements attempted, a learner who starts it and leaves without asking the patient or adjusting the aid has passed through it.
- Attempt replay — the fitting stage: the curve steps as the aid settles (the last change included, even when the learner moves straight on), and each visit to the element is one chapter. An ear with no aid shows Not fitted. Started the fitting appointment marks the moment the learner started it — drawing the aid the appointment starts from — and notes that the visit before is closed from there, when there was one they could open: an appointment following a Hearing Aid element hidden from learners starts as it opens and closes nothing. The fitting appointment was reset marks a reopen of the Hearing Aid element: the stage starts over from there (the Hearing Aid element's own replay says Reopened this visit to change the aid or its verification).
Organization defaults
An organization's element preset has a Hearing Aid Fitting section: what a new appointment's patient comes in saying (ticked in both ears of a new appointment — Theta's ticks nothing), your own complaint wording (How this patient puts combinations), and the ask cap. Only a starting point: an appointment keeps its own settings afterwards.