Hearing Aids

Hearing Aid is the amplification element a case is built in. It holds one case — the patient, their loss, the aid — and the learner works through it in up to two steps:

Use either step or both — you choose them first, at the top of the Design tab, and the learner always does them in this order. Everything is always designed; the steps only decide what the learner does. A step you leave off is given to them from your design: without Selection they work on the recommended aid. The starting fit you design is what Verification opens on — someone else's first fit, which the learner measures and brings to target. So you can teach selection alone, verification alone, or choose-then-verify — all from the same case. Turning a step off never loses its design or its scoring: turn it back on and it's as you left it.

Fitting the aid to the patient — asking how it sounds, and fine-tuning it until their complaints are gone — is its own element, the Hearing Aid Fitting: the fitting appointment, linked to this one, which picks the aid up as the learner left it here.

On the learner's page the steps sit behind a step bar. They unlock in order (Next), and the learner can always go back. On a narrow phone the step names scroll sideways on their own, so Next always stays in view.

With Selection on, REM always shows both ears, and the learner's own decisions open them — never your answer. An ear they choose to aid that your case doesn't is theirs to verify (its loss, aid and prescription are yours too: the Design and Settings tabs show both ears), but it isn't graded; the fit decision is where that choice is marked. The steps don't say which ears the case aids. What can still hint at it is an ear whose aid differs on something the learner doesn't choose — its technology tier above all, which sets how many frequencies it tunes — so the Design tab warns when the two ears' aids differ that way.

The element has the usual three designer tabs, and each holds one kind of decision:

• Design — the steps the learner does (a new element opens here, on them), then the case itself, in the order the learner meets it: the aid, then the starting fit.
• Settings — the patient (ears, loss, UCL, prescription), then one section per step: Selection and REM (and Fitting appointments, when only a Hearing Aid Fitting uses the tolerance and step size).
• Scoring & Report — what counts in each step the learner does.

The Settings and Scoring & Report tabs open on one line naming the steps — In this case: Selection → Verification — with a Change link that opens the Design tab, where they're chosen.

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Design tab

Steps the learner does

The tab opens on the steps, as tiles numbered in the order the learner does them (side by side on a tablet or wider, stacked on a phone): Selection (choose the ears and the aid) and Verification (prep the aid, then measure it in the ear). Tap a tile to turn that step on or off — either or both, always in that order. At least one step stays on: tapping the last one says so rather than turning it off. Verifying needs an ear to work on, so on a choose-only case that recommends no aid, turning Verification on fits the right ear (the tab says so). An organization's element preset sets the steps a new element starts with (both, by default). Turning a step on brings back the element's Review scoring badge, because that step has its own section on the Scoring & Report tab for you to check. Turning a step off doesn't bring the badge back.

Only the steps you choose are in focus below:

• Given — a part the learner is handed stays on the tab, editable, and its section says so in one plain line — never a badge on every option. The aid when there's no Selection step (The learner doesn't choose the aid); with Selection on, the options the learner isn't asked to choose, and the series when it's Fixed, named in one line (The learner doesn't choose the series and retention). The starting fit is never the learner's to set: its line says Verification opens on it.
• Hidden — a part that only serves a step that's off: the accepted alternatives and the series warnings without Selection. Without Verification, the starting fit folds to one line, Not in this case.

Nothing hidden is cleared: turn its step back on and it's there as you left it.

The aid

Suggest an aid sits at the top: pick a loss scenario and Fill in the aid puts a typical aid on each fitted ear (with Selection on, on both ears) — plus a sensible set of accepted alternatives when the learner chooses:

It's a transparent starting point, not a fitting formula — override anything afterwards.

Below it, each fitted ear has its aid, built across six options. With Selection on, so does an ear the case doesn't aid — marked not graded: it's the aid the learner works on if they choose to fit that ear anyway. The tab warns when it differs from the aided ear's on an option the learner doesn't choose (or the technology tier), since the difference would show in REM and hint at the answer; Copy aid lines them up.

Some options constrain others, and the designer enforces it as you build: a custom in-ear style (ITE, CIC) is its own mold, so it can't take a dome; retention follows the coupling. Switch to an ITE with a dome selected and the coupling flips to an earmold automatically. With both ears showing an aid, Copy aid to left / right copies one ear's aid — and its accepted alternatives — to the other. Only the aid: each ear's patient (its loss, UCL and starting problems) stays its own.

Under What this aid can do (tap to open), each ear shows the max gain and the OSPL90 (the receiver's output limit) per region — the same limits Verification enforces. This is where you check that the aid can actually do the job. Venting: Open has a limit of its own in the ear: an open fit lets the low frequencies leak back out, so REM measures little or none of the low-frequency gain (see Open fits leak the lows below).

Also accept (shown when the learner chooses the aid) marks other options that are defensible too. With Accept clinically-equivalent alternatives on in the Scoring & Report tab (the default), any marked option scores correct — so a case where either a RIC or a BTE is reasonable doesn't punish the learner for choosing the one you didn't. An aid built from accepted choices also counts as a right aid in Verification (see Only targets the right aid can reach are scored).

Manufacturer series

Every aid belongs to a series — a manufacturer's line ("Oticon Intent", "Phonak Audéo") laid over the six generic options. A series:

• labels the options the way the brand does — Premium can display as "Intent 1", RIC as "miniRITE" — and can drop options the line doesn't make;
• carries the line's gain characteristics: each receiver class has its own per-frequency max-gain and OSPL90 curves (the two a technical data sheet publishes), and each coupling and venting option can adjust them. Those ceilings are what Verification enforces.

Sheet values are 2cc-coupler measurements; Theta works in ear-canal SPL, so a receiver entered from a sheet has an average adult RECD added. The device data is real; the fitting rationale, the patient and the target rule are Theta's teaching-grade models. The platform admin manages the series under Admin → Hearing aids. Scoring always compares the generic values, so a learner in the wrong series can still be right about every other option.

Each ear's Series picker sets the series the recommended aid is designed in. How much say the learner has is on the Settings tab (Selection → Series the learner can choose from). The learner sees the same series tiles on both ears: every active series in scope, plus the recommended series of each ear the case aids. Both tabs warn when the pick can't be a real choice:

• only one series tile would be offered — the recommended one — so picking it is a free point (a manufacturer with a single active line, say, or a library with only Generic);
• One manufacturer with no manufacturer chosen (the same free point);
• One manufacturer whose brand has no active series left — none of its series are offered but the recommended one;
• One manufacturer with a recommended series from another brand — it's still offered, as the one odd tile, which gives the answer away.

The starting fit

Each fitted ear shows its starting fit — what the aid is set to when the learner first gets it. Verification opens on it: someone else's first fit, which the learner preps, measures and brings to target. Without Verification nothing programs the aid, so the section folds to Not in this case (kept as you designed it, for when Verification is back on).

You tick the problems it opens with, on a grid of everything / each input level / each region, too quiet or too loud — plus whether the MPO starts too low, too high or on target. A new element's starting fit has nothing ticked: it opens on target, and each problem you tick is built relative to that good fit. (On an open fit — the new element's aid — a problem in the lows can't show in REM: the lows leak out of the vent, so the card warns if you tick one.) Theta builds the starting numbers from those choices, onto the prescription — the full prescription, held only where the aid can't reach it, so a start with nothing ticked sits on every target REM scores — and rebuilds them whenever the target moves: a different aid, an edited audiogram, or a per-attempt template roll. That's why the numbers (Starting numbers, under the grid) are a read-only preview — typed numbers would be thrown away the next time the target moved.

If a ticked problem can't be in the start, the card says why and what to change:

The problems are always built against the prescription — that's what REM measures them against. What the patient says about the aid is the Hearing Aid Fitting's: this element has no patient to ask.

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Settings tab

The patient

• Ears that should get an aid — per ear, the answer to the fit decision when the learner chooses the aid (an ear with no aid is a correct answer in its own right), or simply the ears being fitted. Only a choose-only case can recommend no aid at all.
• Hearing loss from — a linked audiogram (the loss is sampled from it frequency by frequency, and the case follows its template status), or Type it in for each ear, which opens the thresholds right below at the frequencies the aid tunes. With Selection on, both ears' tables show even when the case aids one: the learner decides which ears to aid, and an ear they aid that the case doesn't still needs its real loss to verify.
• The patient's UCL — their loudness-discomfort level, which sets the MPO the aid should be programmed to and how loud the loudest speech may be. With a linked audiogram it's the audiogram's UCLs (its Comfort Levels) only when that audiogram tests UCL (Require UCL testing in its Settings). Every audiogram carries comfort levels, but with UCL testing off they're never shown or graded, so the aid estimates the UCL from the loss instead — and the typed UCL row isn't used while an audiogram is linked. Typing the loss in, each ear's table has an optional UCL row under its Threshold row (the two ears sit side by side on a wide screen). Any frequency without one is estimated from the loss (the greyed placeholder), and a UCL less than 5 dB above the threshold is raised to 5 dB above it (its cell turns amber). This UCL is the patient's own — it decides what's too loud in REM's MPO check and in the grade. The UCL drawn on the learner's speech map can be the learner's own instead (see The speech map's upper limit).
• Prescription the case intends — the formula behind the targets REM grades against: THETA-1 (Theta's own rule, the default) or DSL v5. A Hearing Aid Fitting works from it too, so it shows whenever one follows the case — even without Verification.

Selection

Shown when the learner chooses the aid.

• Options the learner chooses — the rest are given, set to the recommended aid. Every option but retention is on for a new case — most cases don't turn on retention; add it when yours does. An option you turn off keeps its accepted alternatives — hidden, and never graded while it's given — so turning it back on brings them back as they were. Both ears are always presented, so the fit / no-fit decision is asked even with none chosen — and so is the series, unless it's Fixed: with no options asked it's the only device question, and the learner picks it for each ear they fit. For a case that asks only which ears to fit, set the series to Fixed (the tab says so when no options are chosen).
• Series the learner can choose from — Any manufacturer (the default: every series is on the table, so the learner has to find the right manufacturer and series), One manufacturer (one brand's active series), or Fixed (they see the recommended series only; never a scored row). With a choice, the learner picks the series first and the option tiles then show that series' names and options. Switching to One manufacturer takes the brand from the recommended aid's series; an aid still in Generic leaves the brand to you, and a brand whose series have all been retired stays listed, marked (inactive). The tab warns when the series can't be a real choice — a single tile, no manufacturer, a manufacturer with no active series left, or a recommended series from another brand (see Manufacturer series above).
• Ask for a written rationale — asks the learner why they chose the aid: one note per ear by default, or one note for both if they switch. It appears on the report and the results screen, but is never scored.

REM

Shown when the learner verifies with REM — the step after Selection. It holds the one tolerance and step size the case uses:

• Tolerance — the ± dB window counted as right. It also decides which targets are in the right aid's reach (one it can bring within the tolerance is). The one tolerance serves REM and any Hearing Aid Fitting for the case — there it's how far off something has to be before the patient notices.

• Step size — dB per tap in the console.

• The probe tube — whose problem the probe is:

  Placement	Behaviour
  The learner places it	A real task with a real window — scoreable (the default)
  Assume it's well seated	No probe step
  Assume it's too shallow / too deep	No probe step; the measurements are degraded the way a bad probe degrades them, so the learner has to recognise it

• Probe-tube window — the insertion depths (mm) that count as well seated. Outside it the probe under-reads the mids and highs — by a lot, on purpose, so a bad placement is unmistakable on the speech map — and too deep touches the eardrum: the patient winces. When the learner places the probe, a run taken outside the window doesn't compete for the graded best (see Verification under the Scoring & Report tab).

• Speech range on the speech map — Full (the default), Half or Off: how wide the shading around each level's average line is drawn — speech's peaks and dips. Narrow it, or turn it off to show the average lines alone, so the three levels overlap less.

• Receivers roll off above 4 kHz (on by default) — as in the clinic, where 6–8 kHz targets are rarely reachable. Above 4 kHz the ear gets less and less of the gain programmed there — about half at 6 kHz and a quarter at 8 kHz on a standard receiver, less on bigger ones — so turning it up barely moves the measurement: the soft, average and loud curves sink toward the unaided ear, and the MPO falls away too. The targets there stay drawn, out of reach, and they're reported but not scored (with the Gain builder on, in practice mode, the chart shades them "not scored"). The fitting software still shows the gain as programmed.

Fitting appointments

Without Verification — a choose-only case, say — a case that a Hearing Aid Fitting follows shows the tolerance and step size in a section of their own: how far off something has to be before the patient at the appointment notices it (back within it, the problem counts as fixed), and the dB each tap moves the aid there.

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Scoring & Report tab

A line at the top names the steps the learner does (Change opens the Design tab, where they're chosen). Below it is one section per step the learner does; a step given by the design isn't graded. A step you turn off keeps its scoring settings for when it's back.

Changing the steps, or a step's scoring, never breaks an attempt already made: each attempt keeps the steps it started with. An edit to the scoring of a step an attempt didn't do doesn't mark it settings changed, and Re-score keeps an attempt's own settings for a step the lesson no longer has.

Verification is graded on what the learner's page let them do:

• The aid as they last saw it. Settings made on a stronger aid and left in place after switching to a weaker one are graded as that aid holds them — the numbers REM showed — not as they were stored.
• A closed ear counts as never touched. An ear the learner declines, leaves undecided or leaves with an unfinished aid grades as if nothing had been done on it — even if they verified it first. Its rows still count: the design sets the total.
• Only the case's ears are graded. An ear the learner chose to aid that the case doesn't is theirs to work, but only the fit decision marks it.

Selection

Three blocks, each with the standard Off / Scored / Report-only control:

• Fit decision — per ear, independent of the aid.
• Manufacturer series — only when the learner may choose one.
• Device configuration — per option, applied to both ears.

Accept clinically-equivalent alternatives (on by default) lets an option marked Also accept score correct. It also decides whether the learner's aid counts as one the case accepts in Verification (below).

The total is set by the design, not by what the learner does: every ear the case recommends fitting contributes its scored options whether or not the learner chose to fit it. An ear the case leaves unaided contributes only its fit decision.

Verification

Off / Scored / Report-only over the probe placement (inert unless the probe is the learner's task), the prescriptive formula choice, the speech-map gain cells (input level × region) and the MPO bands. MPO bands are scored on matching target and on not exceeding the patient's UCL.

Ran the feedback manager is part of prepping the aid, so it's here whenever the case has Verification: Off / Scored / Report-only — report-only by default. The report says, per ear, whether it was run on the aid in the ear; scored, it's a point per ear.

Only targets the right aid can reach are scored

The speech-map targets are the full prescription for the patient — the case's intended formula, from their loss and loudness tolerance, not from the aid — the way a verification system prescribes. Not every target is reachable: an aid can only add so much. So a target is scored only when the recommended aid can bring that level to within the tolerance of it. What an aid can reach is decided by:

• its gain limit — the most it can add there before it feeds back;
• its output — no output may pass the MPO the patient's tolerance asks for on that aid;
• an open fit's leaking lows — below 1 kHz an open fit keeps little or none of its gain in the ear (see Open fits leak the lows).

So a learner who picks a weaker aid than the case calls for loses exactly the targets the right aid would have reached: choosing an open dome where a closed fit was needed costs the lows, because the recommended closed fit reaches them and the open dome leaks them. A learner who picks an aid the case accepts is never asked for more than that aid can do. An aid "the case accepts" is the recommended aid, or one built only from accepted alternatives (with Accept clinically-equivalent alternatives on), series included when the learner chooses it. Without a Selection step the aid in the ear is the recommended one.

A target out of reach is no part of its region's point (below): the region is graded on its other frequencies. The results screen and the PDF list it with its target, marked out of reach.

The MPO target is the patient's UCL less 6 dB, as a receiver can program it — capped by the OSPL90 of the learner's aid when the case accepts it. On any other aid it's the higher of the recommended aid's and the learner's own: a weaker receiver than the case calls for can't reach it and loses that band, while a stronger one is graded on the patient's own tolerance — where its start opens, where the patient flinches in the MPO check, and what the Fitting appointment's patient judges. MPO bands are never left out as out of reach.

Either way, REM draws the full prescription — a severe loss on a standard receiver with an open dome shows soft speech falling well short of the high-frequency targets, the lows sitting on the unaided ear, and loud targets above what the MPO allows, however hard the learner pushes.

The best measurement

Each speech level, and the MPO, is graded on the learner's best measurement — not their last — so re-measuring on the same aid never lowers the grade. The latest run counts only where no run competes (none seated in the probe window, or the aid whistling on every seated one) and for the MPO's comfort — both below. Every run's inputs are kept with the attempt (the aid's settings, the probe depth, the aid in the ear), and the grade re-measures each one the way REM measured it; the page's own figures are never taken on trust. The best run of a level is the one with the most scored regions on target, then the smallest average distance from target (the latest wins a tie); the MPO's best check is picked the same way, leaving out any region where the latest MPO check is over the patient's UCL (that region can't earn its point whichever check is shown).

Not every run competes for the best:

• Only runs on the aid now in the ear. A level measured only before the learner changed the dome, receiver or style counts as not measured, and the report says other aid.
• Only runs with the probe seated. When the learner places the probe, only runs taken with it inside the probe-tube window count — a mis-seated probe under-reads the mids and highs, so a fit that's over target can read on target through it. When the case assumes the placement, the case sets the depth, so every run competes.
• Only runs measured with the aid quiet. Until the feedback manager runs on the aid in the ear, its gain can go past the feedback-safe limit — and the aid whistles (the ear shows Whistling). A speech run measured while any of the aid's gain was past that limit — at any input level, not only the level measured — was measured while the aid whistled, a reading no clinician would keep, so it's never the best. So Run all on a whistling aid takes every level out of the running, not only the level whose gain is too high. (Running the manager holds the aid to the limit, so a run after it is always quiet. The MPO check measures the output ceiling, not the gain, so whistling never takes a check out of the running.)

A level with no run that competes is graded on its latest run on the aid in the ear, and the results and the report mark what was wrong with that run (the column reads Graded there, not Best): unseated when that run was taken with the probe outside the window, whistled ("measured while the aid whistled") when the aid whistled as it was measured. A mark describes the run graded, not every run of the level: a level whose seated run whistled and whose latest run was quiet through a short probe is marked unseated only.

The MPO's comfort is judged on its latest check. Its match to target comes from the best check, but over the patient's UCL is judged on the latest MPO check on the aid in the ear. If that check is over the UCL, the MPO's point is lost there even when an earlier check was safe, and Advanced Analytics' MPO above the UCL counts those bands. An MPO changed after its latest check isn't judged until it's checked again — REM marks the check for re-running — and an MPO never checked on the aid in the ear is judged on the aid as it was left.

Up to 20 different runs of each level (and of the MPO) are kept per ear. Past that, a run goes that the grade on the aid in the ear can't need, whichever regions are scored, and whether or not the case accepts the aid — first one that can't compete (a mis-seated probe, or the aid whistling), never its best, and never its latest — so re-measuring on the same aid never lowers the grade. Switching aids is different: a run on another aid can't be graded on the aid in the ear, so when none on it can go, the oldest run on another aid goes — and an aid the learner puts back in the ear may have lost its best run.

The probe placement is graded where the learner left the probe.

Points are per region

REM awards points per region, not per frequency. A premium aid programs three frequencies inside a region where a basic one programs one; a ticked region is one point and needs every scored frequency inside it right, so the same scoring carries the same weight whichever aid the case uses. A frequency that's out of reach, or above 4 kHz with the roll-off on, isn't part of its region's point. The report still lists each frequency.

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The learner's steps in detail

The screens: a stage over a console

Each step is laid out like the other simulations: what the learner looks at on top, and the controls in a console tray pinned along the bottom. Choosing the device, the option tiles are on top and the tray holds each ear's aid as chosen so far and the rationale. In REM, the prep panel (Before you measure) and the speech maps are on top — the patient's MPO verdict floats over the top of the plot, so the speech map never changes size as it comes and goes — and the tray holds each ear's grid with its Run menu (Run all, each speech level, and the MPO check) beside the − / + adjuster. The tray always has a spot for both ears; an ear with no aid keeps its spot, greyed out, with the reason. On a narrow screen the tray shows one ear at a time, with a Right / Left switch that opens on the first ear there is to work on. Phones and tablets keep full-size grid cells for touch; the cells tighten on a desktop.

On a desktop, the charts fill the height above the tray. On a screen under about 820px tall (a short laptop, a landscape iPad) that left them a sliver, so there the charts keep their own proportions and the stage scrolls instead.

Verifying: REM

REM comes right after Selection, and starts by prepping the aid — the Before you measure panel above the speech maps, one numbered step each, the next one highlighted:

1. Seat the probe — when that's the learner's task (the case can place it instead, and then the step isn't there).
2. Choose the prescription to verify against.
3. Run the feedback manager, per ear.

Measuring needs a prescription chosen and, when placing the probe is the learner's task, the probe placed. Any depth lets them measure, but a run taken outside the probe-tube window doesn't compete for the graded best (see Verification under the Scoring & Report tab). The feedback manager is the learner's call (it's graded — "Ran the feedback manager" — and until it runs the aid can whistle). Once every step is done the panel steps out of the way, into a round hearing-aid button in the bottom-right corner of the speech maps: it opens the same steps over the stage, to re-place the probe (when that's the learner's task), switch the prescription, or re-run the manager after a new dome. Then the learner measures, and adjusts the aid to target.

REM verifies the fit in the ear, on a speech map: the output at the eardrum against the prescriptive target for soft / average / loud inputs, plus an MPO run. At each frequency that's

speech level in that band + the open ear's own resonance (REUG) + the aid's insertion gain

The speech level is the band's share of the overall 50 / 65 / 80 dB SPL — speech is loudest around 500 Hz and falls away above it, so soft speech is about 43 dB SPL at 250 Hz but only about 18 at 8 kHz. The REUG is an average adult ear's (small in the lows, peaking around 3 kHz). A badly placed probe under-reads everything it measures in the mids and highs — the speech map, the MPO and the unaided REUG alike. The grid in the console is the fitting software, on the same aid, and adjusting it adjusts the aid. A measurement is a snapshot — once the aid's settings or the probe move on, or the learner changes the aid itself (another dome, receiver or style in Selection), the ear's Run button gets a gold dot and its menu marks which levels to re-run — and marks the MPO check when the MPO wants checking again. The probe depth each level and the MPO were measured at is kept with the attempt, so a measurement taken at the wrong depth stays marked when the learner leaves the step and comes back. The speech map always shows the latest measurement; the grade takes the best one — of those taken with the probe seated, when seating it is the learner's task (see Verification under the Scoring & Report tab) — so a learner can keep adjusting and re-measuring on the same aid without losing a good run, though the MPO's comfort is judged on its latest check.

The learner chooses the prescriptive formula to verify against in the prep panel — nothing measures until it's made. The crosses are that formula's full prescription for this patient; they don't bend to the aid, so an aid too weak for the loss shows as a shortfall. The default prescription is THETA-1, Theta's own teaching rule (DSL v5 prescribes more gain at every input level). The Hearing thresholds overlay (in the gear) plots the thresholds the learner has: with a linked audiogram, their own (from the Audiometry step) — never the case's true loss, which the lesson may ask them to measure; with thresholds typed into the case, those, since they're given. An audiogram is in dB HL, so it's converted to dB SPL frequency by frequency with the RETSPLs for TDH-39 supra-aural headphones (ANSI S3.6) — the same conversion the prescription and the patient's discomfort levels use.

The speech map's upper limit

The speech map follows the convention of a Verifit 2 SPL-o-gram: the UCL is the limit, and the MPO is a measurement.

• The UCL — the patient's loudness-discomfort level, in ear-canal dB SPL — is drawn as a dotted line with gray shading above it: the limit an MPO may come close to but shouldn't cross. It runs on, level, to both edges of the plot.
• The MPO is drawn as an asterisk at each band, with no connecting line — only once the MPO check has run on that ear, and then it's the measurement, moving only with a new check. Before then nothing of the MPO is drawn, though the aid's MPO still caps the speech curves, as the aid holds its output. Where the patient said the check was too loud, that band's asterisk is red — their report, not a comparison with the UCL drawn.
• Which UCL is drawn gives nothing away. With a linked audiogram it's the learner's own: the UCLs they measured on their audiogram, and where they didn't, predicted from their own thresholds — the same rule as the thresholds overlay. With the loss typed into the case it's the case's UCL, since that's given.

Whether a sound is actually too loud is the patient's to say. During the MPO check, beeps above the patient's real UCL make them flinch — "too loud" — and the grade judges the MPO against that real UCL too (on its target ± the tolerance, and not above the UCL), so a learner's own UCL measured or predicted differently from the patient's may not match where the patient flinches. The legend reads UCL — the limit (gray above) beside a dotted line and ✱ MPO (once checked).

The patient's spoken verdict — a gold-outlined line over the top of the speech map — shows for 5 seconds once the sweep has played, then goes. The result stays in the grid's ok / too loud under each MPO band and in the red asterisks. The check is taken the moment it starts — leaving the step mid-sweep keeps it, and the grid's ok / too loud is there when the learner comes back — but a result about an MPO changed since is cleared: check it again. An MPO never checked is judged for comfort on the aid as it was left; one checked, on its latest check on the aid in the ear.

Open fits leak the lows

An open fit — Venting: Open, on a dome or an earmold — leaves the ear canal open, so the low-frequency sound the aid adds runs straight back out through the vent. On the speech map the aided curve sits on the unaided ear below 1 kHz however far the low gain is turned up: none of the gain stays in the ear at 500 Hz and below, all of it from 1 kHz, and a rising share in between. Like the roll-off above 4 kHz it's a share of the gain, not a fixed loss, so turning the gain up can't make it back. The fitting software (the grid) still shows the gain as programmed — only the measurement in the ear loses it — and the MPO check isn't affected.

What the aid can't reach is part of what the learner is working out, so the speech map doesn't point it out on its own. Only with the Gain builder on — practice mode only (below) — does it show:

• the open fit's leaking lows, shaded open fit: lows leak out;
• above 4 kHz with the roll-off on, the targets that aren't scored, shaded not scored;
• a target the learner's own aid can't bring within the tolerance — its gain limit, its output, or an open fit's leak — drawn as an open (hollow) cross, fainter than the others (Out of reach for this aid). Only the learner's own aid is judged here, never the recommended one: which targets the right aid reaches is the answer to Selection.

With the Gain builder off, and always in exam mode, every target is a plain cross and nothing is shaded but the UCL. The grading is the same either way.

The console

The console grid is a grid of 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. It shows the insertion gain — what the aid adds over the open ear, which is what fitting software is programmed in; the speech map is where the total output in the ear (dB SPL) is shown. 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 learner can turn on two read-only CR rows under the MPO from the gear (⚙ → Compression ratios; off by default, remembered in their browser, the same setting in REM and in a Hearing Aid Fitting). They show the compression ratio each column makes, soft → average and average → loud, worked out from the gains as the learner adjusts. The input rises 15 dB from one level to the next, so a column that gives the louder sound 5 dB less gain lifts the output 10 dB: a ratio of 1.5. Equal gains read 1.0, and an output that doesn't rise at all reads ∞ (limiting) in amber. They're there to teach — never set directly, never scored.

The feedback manager

A dome or vent gives up high-frequency gain to feedback. The feedback manager is part of prepping the aid: it's the last step of Verification's prep panel, per ear. Until it runs, the gain can go up to the aid's own limit — but past the feedback-safe point the aid whistles: a red Whistling badge on the ear, and the whistling cells in red. Running it measures the feedback path and holds the aid to its feedback-safe limit, bringing anything whistling down. Any change to the chosen aid on an ear — its series, receiver, dome or vent, or the decision to fit it — resets the manager there, even a change back. A case without Verification has no manager to run — its aid is taken as already managed — and so does a Hearing Aid Fitting: the aid was prepped here.

MPO is the patient's tolerance, not the receiver's limit

OSPL90 only caps the MPO: an under-powered receiver on a patient with a high tolerance can't have its MPO programmed where it belongs — exactly the consequence a wrong choice should have. No output may exceed the MPO.

REM doesn't show the patient's comments, on screen or on the report — asking the patient is the Hearing Aid Fitting's job, and REM verifies against the prescription.

The gain builder (practice mode)

Gain builder, in the Display (gear) menu, takes a measured speech curve apart, one level at a time (Soft 50 / Avg 65 / Loud 80): the speech arriving in each band, plus the ear canal's boost (REUG), plus the aid's gain as it was set for that run, less what an open fit leaks out of the vent below 1 kHz (a Leaks out (open fit) row, shown only for an open fit), less what the receiver's roll-off loses above 4 kHz, less what a badly placed probe misses, less what the MPO cuts off. The layers are drawn on the speech map under that curve (the other levels fade), and a table under the chart gives the numbers — each column adds up to the point on the chart. It explains the curve on screen, so it uses the aid's settings and the probe depth of that run; if either has moved since, it says so. While it's on, the speech map also marks what the aid can't reach and what isn't scored (see Open fits leak the lows). It's offered in practice mode and never shown in exam mode.

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Reports, results, analytics and replay

• Results screen and PDF — one section per step the learner did, in their order, each with its breakdown and table: the chosen aid against the recommended one (with the rationale), and the verified speech map (with the feedback manager's rows). The PDF's REM grid reads every cell from the grade: the target the learner was graded against, a dash for a level (or MPO) never run, and the MPO's "!" only where its latest MPO check on the aid in the ear passed the patient's UCL (never checked on it: the aid as it was left), even beside a value from an earlier, safe check. A target the grade left out shows its value marked out of reach, with a line under the table saying why — the recommended aid (or the learner's accepted aid) can't bring it within the tolerance — and its result is report-only. REM's values are the best measurement of each level and of the MPO — the table's column says Best — a level measured only on an aid no longer in the ear says other aid, and a level with no run that competed is graded on its latest run, with the column reading Graded, and marked with why: unseated (the probe outside the window — the PDF's grid marks that level's row with an asterisk too) or whistled ("measured while the aid whistled" — a dagger in the PDF's grid). Above each ear's grid, the probe caption says where the learner left the probe — in or outside the window, which is what the probe point grades — and, when every level was graded on its best run, that the graded measurements were taken with the probe seated. It never calls the measurements unreliable because of where the probe ended up.
• Advanced Analytics — the hearing-aid analysis points read the step they belong to: Selection's Device configuration, Fit decision and Manufacturer series; and Verification's Real-ear speech map on target, Real-ear output ceiling on target, Average distance from real-ear target, Prescriptive formula, Probe placement, MPO above the UCL, Speech levels measured, Output ceiling measured, Re-verified after adjusting (counted only in an ear whose aid changed after it was first measured — a nudge, a feedback manager that lowered the gain, or a new choice in Selection — and only the levels measured again after the last change; not applicable when nothing needed re-verifying, as on a case that opens on target), and the feedback manager's two — Feedback manager run on the aid in the ear (per ear, as graded) and Feedback manager runs (how many times it was run in Verification). A step the lesson leaves out shows as not in this lesson rather than a fail. REM's points read the measurement the grade took — the best one on the aid in the ear (with the probe seated, when that's the learner's task) — so a level measured only on another aid counts as not measured, and a target out of reach, like any report-only row, isn't counted. MPO above the UCL counts the bands its latest MPO check on the aid in the ear puts over the patient's UCL (never checked on it, the aid as it was left), each reported at the output that reaches the ear — what was compared with the UCL, not the probe's reading. An item-tolerance override on a hearing-aid point can't go below ±1 dB — the case grades nothing tighter — so an older ±0 override grades, and says, ±1 dB. Moving between the steps isn't work: a learner who only clicks Next through them hasn't attempted the element. The patient's points — complaints resolved, patient satisfied, asking the patient — are the Hearing Aid Fitting's.
• Attempt replay — steps through the whole element, showing whichever step the learner was on — the device as chosen in Selection; the probe and the runs in Verification — with a jump point for each step they opened, in the order they worked them. Running the feedback manager is narrated in Verification. Pushing the probe into the eardrum shows as a fault.

The fitting appointment

Fitting the aid to the patient is its own element: a Hearing Aid Fitting follows this one, picks up its patient, loss, prescription and aid (the one the learner chose here, in the same attempt), and has the patient come in saying what you tick on its Settings tab (nothing, by default) for the learner to fine-tune away. It starts from the aid as the learner left it here after Verification — mistakes and all. Deleting this element asks whether its fitting appointments go too. The Hearing Aid + fitting appointment button in the Amplification group adds both, linked.

The two happen in order: the appointment opens once the learner has reached this element's last step, and once they start it, this element is read-only — so the aid the appointment starts from can't change under it. Its Selection and Verification screens stay open to look back through, with a note that the learner has moved on; nothing on them can be changed or run. If the learner realizes at the appointment that the aid or its verification was wrong, the note's Change the aid or verification button reopens this element — after a confirm that it resets the appointment (their work there is cleared, and the restart is shown to you, never scored). See Visits happen in order. An ear left without an aid then says why and that the visit is closed, instead of pointing back to Selection.