Phonak Audeo P90-R Programming

Thank you for getting back to me. I am so glad I found this forum as I have to say I have been getting very frustrated after reading such good things about these new HA but having such a bad experience.

So my audiologist has not done an REM. What is that? He just did the test from within HA.

So the main differences:

1. When the new HA were turned on there was lots of white noise that was there all the time. He has cured that for the most part in the Autosense prog but others still have it. Even in Auto I can still hear it at the edges so it means its not as comfortable when just sitting in the quiet.
2. any sharp sound is VERY sharp so any clatter from the kitchen feels painful. Even seems an echo.
3. I can’t hear my wife (some might say a feature!) - or for that matter any voice in the house very well. it sounds like its coming from a tinny little speaker.
4. The other programs still have white noise and so any time I use my phone on Facebook or whatever my HA switch to the link to my phone and Woooooshhhh!

So I have tried wearing the new HA for the past 48hrs to see if I adjust. But its just causing me stress. I have now gone back to my old HA and I can feel my stress levels from noise drop dramatically.

Now I am not saying my old HA are perfect - I was hoping through reading reviews that the new HAs would give me a better hearing experience with voices plus all the extra tech of connecting to phone, TV etc.

Rgds Nick

REM = Real Ear Measurement where a machine which measures sound has a fine tube inserted close to your ear drum and your HA placed back into your ears. Sounds are made speech, etc thru your HA where it is measured at the ear drum and compared to hearing loss target. Adjustments will then be made to HA to compensate where it hasn’t reached the required target level. If your HA are giving you grief then they must not be set correctly.

Thank you so much for the response. I will push for REM.

Rem in hands of person who doesn’t understand it is useless.

I wouldn’t push for them doing the proper job, I’d push for money back and finding a fitter who knows what they’re doing. It’s not our job to teach them their job. We have the money, we choose.

So this was the response from my Audiologist.

Yes REM measures the sound pressure level in the ear when wearing a hearing aid. What we have done is AudiogramDirect. In-situ audiometry, such as Phonak AudiogramDirect, allows clinicians to measure hearing thresholds directly through a client’s hearing aids. It also takes into account of the unique patients clear canal during the measurement.

I think the challenge I have is that Singapore being a small island means I have a limited choice of practitioners. And this guy is “well” recommended. I have been with him through 4 generations of aids. But we are just not getting these ones right.

REM based live speech mapping used for fitting has nothing similar. Because this method sends speech through the speaker in front of you, and measuring tube checks what came near your eardrum (4mm away) afer your HAs processed the sound.

First step of that process is indeed white noise sound made for pure calibration of instruments and your canal.

In situ audiogram is just that, audiogram. Beeps.
Yes, it does implicitly take into the account your ear canal, but how well you hear beeps unfortunately isn’t the same as how well HA process speech and if thing that comes to your drum is even comprehensible for the machine, let alone your brain.

Yes, your fitter has no clue what’s the purpose of it. And is seller.

You can be without equipment and still know what you’re talking about or what the equipment is really used for.

Also, WRS measuring doesn’t ask for REM equipment, just a speaker and sw with prerecorded words. And if fitted aids on 65db sound from speaker cannot deliver wrs that was measured with headphones (to see what db you need to get the best score, so, amount of amplification), then they’re not fitted properly.

Word lists are especially made to cover all types of vocals and hearing issues, so from listening 20 words, and repeating them back, it’s easy to both asses the progress and see where aids need tweaking eg which sounds you don’t hear but you should since you heard them during initial wrs with headphones and those words on blastingly loud.

Rem based live speech mapping makes process easier and faster for them. Gives good baseline and comprehension for you in just a few minutes of doing it.
So basically, it’s beneficial for fitter since it saves time enormously. One fitting session of 10-15 minutes and you immediately have the best speech comprehension in quiet.

However, it isn’t necessary. Unfortunately, people who don’t do that, also don’t do anything else. So ‘do you do REM’ is simple question to filter out good fiter.

However wrs with headphones to see how much help you actually can get from ampflication and then tweaking aids until you can get at least the same wrs using them on normal loud sounds (65db), is a bare minimum!!

In situ audiogram has nothing to do with how well you understand speech with aids.

Aids are just amplifiers. So if your initial wrs test showed that you need 100db input and you understand 80% of words, then well fitted aids should give you 80% of the same words on all sounds.

So, if I speak to you on 65db, aids should boost that to give 100db your ear need.

But if you heard wood correctly but not house during initial wrs, and with aids you don’t hear any, aids aren’t fitted properly, no matter the fitting process (rem is that, fitting process). However, no aid in the world will give you back house if your cochlea is that damaged and just cannot hear those sounds.

In other words, if your initial wrs is 90 or more, that means that aids can help you to understand almost everything.

If wrs is 50, aids won’t bring you up to 90, however, without them, you cannot hear even that 50, so they’re still useful to deliver that 50.

You only care about end results after all.

How can they know if you hear well if they don’t test and verify what they’re done?
‘how do you hear me now’ aren’t words from word list that addresses tricky sounds

Tell them you won’t need their services obviously, so, ask for unbundled price, just aid, without endless hours of pathetic work based on ‘how do you hear me now’. You can do better yourself, if nothing then from the sheer fact that you can directly test and tweak in your environment eg home, and not perfectly quiet office.
And from the fact that phonak programming software has a wizard which helps with fitting.

Like ‘problem with own voice’, then you click, and it adjust gains. Or ‘problem with female voices’. Or ‘problem with s, sh sound’ or many others.

You don’t need to be an expert to read that and click around.
It’s literally made in ‘for dummies’ approach.

Good fitter doesn’t use that since they now how sound behaves and they directly adjust gains when you tell them and describe your issue.
But sw is so good that you can pick an issue and it will do gain adjustment per frequency for you.

And I think we all are ‘smart’ enough to not click ‘problem with own voice’ if we have problems with sh sound.

And you can record your list, and put it on repeat and check which words you hear completely and which don’t.

It’s not even about perfect recording or calibration, it’s about being able to repeat the process in the same conditions and being able to compare before and after tweak.

And yes, sw has ‘undo’ and even direct comparison between two points in time/sessions.

It’s just that ‘how do you hear me now’ aren’t useful words for testing. Especially since you probably look at person.

So I have been silent for a while while I have been getting the bits and pieces together and doing more research. I now have the Noahlink wireless connected to my MacBook Pro running Windows on Parallels Desktop. All now working.

My Audiologist did come to my house with a Phonak Audiologist bringing their equipment and did some changes. The major difference being changing the fitting Formula to NAL-NL 2 and the improvement was very significant. That being said I still want to try some minor tweaks.

Although I have done a bunch or reading and going through the manual and videos I just want to check with folks on some simple basics. I have connected my Aids to the Target 7.1 software and saved the session to my notebook without making any changes. If I screw up when playing around - what is the easiest way to “reload” the saved settings as they are now. Simply put if I make changes how best to undo to what I have right now?

Hi @nick.evered
Reload an old setting is easy to do:
Before you start your session, select in Target the original customer/session you want to reload.
Select “connect”. After the connection is established, Target compares selected session’s data and the hearing aid data. If they are different, Target will ask you whether to use the sessions data or the hearing aids settings.
Select this time the sessions data.
Then leave the session.
You will be asked, where the data shall be saved: hearing aids and / or to the session. Select only the hearing aids, so your (prevously) saved session will be untouched.

To play around, choose another session to start your own setting. Best is to define even a new customer name for your own sessions. To keep your originals save. For example name it “nick selffitting”.
This time you can save in both, the hearing aids and the session data.

Hi All, so I have been playing around a bit wrapping my head around various options and each of the different programs. Thank you all so much with assistance on being able to keep original settings and reload when I screw up bit time - but mistakes seems to always be the best learnings!

So right now I am pursuit of good music streaming while I am cycling - Two pieces I would like advice on. 1) Trying to improve bass response so the music doesn’t sound too tinny - I know I cant expect Dr Beats quality but any kind of improvement would be good. 2). Wind Noise. It seems a big trade-off here. My first attempt played music well but the faster I peddled the quieter the hearing aids adjusted.

Any hints or experiences with Music adjustment well appreciated.

Hi Nick
I’m glad you get familiar with the programming. And yeah,it’s quite a learning procedure!
To improve the bass, you might try to use larger occluded domes. I changed to power domes instead of the custom made shells and got quite a good low frequency respond now.
I have the same issue with cycling. When I’m not streaming, I use a manual program with wind block set to the max. But it’s not satisfying…
For streaming, I set the mics to OFF, to have no environmental noise. There is a check box in the streaming options to do so. I know, it’s a bit dangerous when cycling, but I do it anyway only when I’m alone with low traffic…

Thanks for getting back to me - doesn’t switching of the mics in music also impact when you want to speak on the phone??

@nick.evered said:

doesn’t switching of the mics in music also impact when you want to speak on the phone??

I don’t think so, music streaming and phone calls are two different Bluetooth profiles, but I’m pretty sure in target you get 2 different programs to adjust, one for Bluetooth for calls and one for Bluetooth music streaming, you can adjust the mic mix, say - 10dB would be safer when out riding your bike then turning them off completely.