So, last night, it was Denzel Washington in some sort of audiology sequel [The Equalizer 2] … good stuff, but MrsSpud and I were tired, and the wind was howling outside. Under those conditions, afforded me easier comprehension, but I could have easily gotten by comfortably with my VAC+ program.
As @Volusiano has pointed out articulately in several prior posts: one doesn’t want to dilute the brain’s mastery of one’s preferred fitting rationale by frequently switching, but it’s nice to have the option (especially in my case where there’s such a subtle difference between VAC+ and NAL-NL2, comparatively speaking).
31 March '21: Another Tiny Tidbit of Totally Titillating Technical Trivia
I was streaming NPR while baking bread. HerSelf®️was watching TV, and the dogs were chewing NylaBones and making a good deal of clatter.
In this situation, I had better speech comprehension and clarity using my program than I did with VAC+ during a talk segment about Amazon.
When the next segment on a Baltimore jazz/blues pianist aired, VAC+ was my regime of choice.
My point: having access to the two fitting rationales is working for me. I use NAL-NL2 judiciously, but the extra “sharpness” (to use @Volusiano’s word) is definitely advantageous in certain situations.
I don’t think I will be giving it up; in fact, I may have my audiologist delete the existing music program in order to put DSLv5.0 into my machines
Keep in mind that unless you’ve been fit to target with , you are comparing VAC+ with what I might call for this purpose Oticon- rather than true NAL-NL2. It’s not uncommon to require quiet significant changes to what the manufacturers are calling a prescriptive target to actually fit to target. Conversely, if you’ve had REM on both, then you are comparing a VAC+/NL2 hybrid to NL2 because there are no external targets for VAC+ and it typically gets fit to NL2 targets, although I’ve seen it fit to . It is also possible that a clinician adjusted to mid-level gain targets without adjusting compression when doing REM, which leaves you at something in between.
A quick look at the VAC and Oticon NL2 first fits suggests the biggest difference is more gain for soft high frequency sounds for NL2, which is consistent with a lot of things you are reporting. Any music program is going to tilt towards more low frequency gain and less compression, so your preference for VAC also makes sense, although I would expect an adjusted dedicated music program to be better.
Remember, too, that your brain adapts, particularly to mid-level gain. With consistent wear, something that sounds a bit loud will come to sound more natural. Typically, manufacturer proprietary rationales are interested in comfort and acceptance. If you are willing to chase audibility, you will generally have more success in the long run.
Just for your interest–when I do REM, the huge majority of the time I have to turn everything UP to meet prescriptive targets, often in the highs but regularly across the board. There are certainly cases where things need to come down, particularly on a small ear, although often it just needs to come down to smooth out a peak. That gain above 4 kHz that lots of adults don’t like is also what clears up confusion between s,f,t,k,z,v.
Thus far in my (short) journey with Oticon More3s, I have come to a few conclusions:
VAC+ fitting rationale gives me very good comprehension and comfort in 80-85% of situations. For reasons I can’t explain, the fitting regime brightens things up and helps my comprehension when I’m tired;
“More Sound Booster” (an ON app feature) doesn’t do much except attenuate background noise… I even suspect that it may increase the forward directionality of the ;
My More3s have such a blazing fast chipset that the devices give me better quality music sound than the Music program added by my audi. (We’re going to delete that and put DSLv5.0(adult) into them and see how useful it will be,) and;
I still only have had one occasion to try out More3 in a noisy restaurant setting, so I feel unqualified to offer any comments on whether the tier3 technology is adequate for my needs. [In the restaurant foray, I was having lunch with a close friend whom I hadn’t seen in months. We had a lot to catch up on, and I didn’t want to miss anything, so I toggled my ConnectClip into external mic mode and clipped it onto my friend. … I don’t think I missed a sentence!]
So, I think my experience validates @Volusiano’s advice: used judiciously, the availability of an alternative fitting rationale can definitely enhance the versatility of my devices, with and without the presence of speech.
[PS: The little Oticon Remote Control 3.0 permits me to switch programs and adjust the volume more quickly and discretely than using the ON app. I keep it in my pocket and can make changes on the go without drawing attention to myself.]
@Neville: Thank you for putting your oar into this discussion, Neville.
To the best of my knowledge, my Audi performs on whatever changes such as adding NL2 are made. He definitely did have to turn some things up to match my prescriptive targets. I suspect that he may have to do some further tweaking, since it sounds as though everyone has a lisp. I’m hearing “sh” when only “s” is being said.
Although my music is a central aspect of my life, understanding my wife and students, as well as being able to hear sounds our critters are making are my most important criteria driving changes to my settings. My audiologist and I are on the same page, and I know for certain that he’s committed to best practices. Lazy he is not!
Since getting my More3s on March 2nd, I have been wearing the devices for 16 hours a day, on average. I wore my previous Unitron North Moxi Fit 800s far less than that - to be honest, on many days, the devices sat, unused, in their case (because they were useless to me, given their poor fit). I’m not sure whether 30 days suffices to refresh my heretofore unstimulated auditory cortex, but I’m certain that changes for the good are occurring.
VAC+ has , right off the bat, provided me with levels of perception and comprehension that are orders of magnitude greater than anything I realized with my Moxi Fit 800s. What a joy it has been for me, and for MrsSpudGunner! My audi and I agreed to install the stock More Music program at the first fitting, but to use our time getting VAC+ to work for me. Speech comprehension is what I need more of to improve my quality of life.
After reading numerous posts by @Volusiano and others, like yourself, whose familiarity with these rationales eclipses my own, I made notes and communicated them to my audi, along with an expression of my need to be able to perceive soft, non-speech sounds in a quiet setting. He had no objection to adding a properly-fitted program to my machines, with the caveat that I not spoil my brain-learning of the VAC+ neural signals giving me such success as I was experiencing, 3 weeks after first fitting.
My existing narrative documents the advantages that I’ve gained from having access to NL2, as well as the fact that I’m not likely to demote VAC+ from its current status as my go-to main program.
I’m interested in pursuing your suggestion that tweaking might improve the music program, however, I’d like to maintain our prioritization of speech, for the time being, and continue with an A/B/C comparison of the three fitting rationales. After a few weeks of habituation, my plan is to cull out either NAL=NL2 or DSLv5.0, (as long as my functionality in speech is not impaired), at which point, we can tweak the music program.
That, at any rate, is the plan, and I’m genuinely grateful for the information that you’re sharing with me to inform my decisions in this regard.
I believe this would also be the case with the autofit, yes, but I am not 100% sure. I’ve only run it a few times interfaced with the Verifit 2. The Verifit doesn’t have VAC+ targets (they are proprietary, we don’t know what they are or why) and so it is verifying against, well, whatever you set it to. I am not familiar with how it might work with other systems, or whether it has some internal autofit as I would never use that.
As for “best” in the long run. . . . There’s no research to speak to that, as the VAC targets are proprietary. NL2 and have been compared a few times and come out pretty close, although there is some hint that DSL does better in noise (further, there are now also DSL noise targets). In any case, the one that is going to win is the one that gives you the best undistorted audibility, since you cannot hear what you cannot hear. There is certainly evidence that children whose fitting falls below targets have poorer language outcomes.
If you take a VAC+ prescription and use to fit it very carefully to NL2 targets, and then do the same with an NL2 prescription, then yes you will more or less have two NL2 programs. It used to be the case that some things were active in a proprietary prescription that were not active in an open academic one, but this isn’t as often the case anymore although it still happens. If anything, you tend to see differences in how compression speed is managed. I’d have to go digging again with VAC+ to see if there’s anything subtle like that. Oticon’s floating linear window used to only be active in VAC, but I’m not sure whether that’s the case anymore or not. I fit a lot of Opns a few years ago, but haven’t done much Oticon lately.
I guess another way to ask @Neville is whether it makes sense to not do on a VAC+ based program that is targeted to NL2 IF your goal is to adhere to the authentic VAC+ rationale 100%, since one does not know what the VAC+ target would be because it’s proprietary in the first place. Granted, it’s not optimal to not do REM to begin with, but it now sounds like a VAC+ targeted REM is really not possible due to proprietary reasons, and an NL2 targeted REM basically negates the differences and turns the VAC+ program basically into an NL2 based program.
A follow-on question is that if Oticon develops VAC+ and keeps it proprietary, surely they must be aware that any REM done on it can only be based on one of the non-proprietary standards. So aren’t they worried that any REM performed will dilute the value/differentiation of their VAC+ rationale into a standard rationale more or less? Why wouldn’t they want to address this issue by providing some kind of VAC+ REM target for audis to perform REM on? Would that spill the secret of their VAC+ rationale? Surely, they can work with Verifit to incorporate the VAC+ target into the REM and still keep it a secret somehow?
And the question expands beyond Oticon as well. How do other manufacturers who have their own proprietary rationales deal with this? I think most of the major mfgs have their own proprietary rationales as well, no?
I think we should wait to hear from @Neville first before you plan to do that, but I don’t see how it’d hurt, if your audi is game to accommodate your requests. We’re learning a lot from Neville here about this topic.
To tell you the truth, my audi never did any on my OPN 1 (and I didn’t even know what REM was at the time to ask), but I was happy enough with my results (although maybe I could have been even happier if REM were done) so I didn’t push her to do REM later on for me, because I was already well on my way with programming so I would rather not use her programming service anymore, even at the expense of not having REM done for me. Before when I used the standard to drive the prescription, I had to fine tune my gains a little bit to be happy. But later with the in-situ audiometry, I was able to just prescribe to the in-situ result and would be happy right away without any fine-tuning.
Anyway, long story short, my VAC+ and and NL2 programs never have REM adjustment to color toward a biased target in the first place, so I’m able to tell the differences between them quite clearly.
Granted, my understanding of adjustment of proprietary vs population averaging rationales is FAR from being as nuanced as yours and @Neville’s, but I think I have the general gist of it.
My Audiologist is great - I’ve confessed that after 6 years of hopelessness and despondency, that I’m like a kid in a candy store with him and my new machines.
He’s happy to partner with me in my quest to become a knowledgeable patient, with whom he can communicate unambiguously, and is chuffed that my Oticon More3s are putting some joy back in my life. He wants to provide me with the comparative experiences that were denied to me by my previous (horrid) audiologist.
He believes that there should be a compendium of industry best practices, however, I don’t think he’s exactly a rabid proponent of REM. It is a tool to obtain a better outcome for his clients, if I have understood him correctly. He performs REM, but I think he exercises some judgment as to how tightly to ride the curve.
*Therefore - I’m sure that he won’t have any issues with providing me with non-REM-diddled versions of the three fitting rationales for my edification and appreciation.
You can understand from his degree of understanding and cooperation with my heuristics why I think he’s a “keeper”.
Oh, no, not necessarily. It takes a bit of effort to really match two programs perfectly together, and different clinicians use differently (e.g. are more or less fussy about paying attention to precise target matching rather than overall audibility and general “in-the-ballpark-ness”), so I’d expect differences between your programs. It’s also common for clinicians to adjust mid-level gain to target without touching compression. I mean, there clearly ARE differences between your programs, based on your report. has its own targets and will be different still. I’m sure if you asked your audiologist whether he could force the two to sound more similar, his answer would be yes, but what would be the point? I do think it makes more sense to contrast NL2 and DSL (or, say, CAMFIT), but I have an academic bias.
So aren’t they worried that any REM performed will dilute the value/differentiation of their VAC+ rationale into a standard rationale more or less?
No? It’s not really up to them how we fit hearing aids. If they can develop a rationale that will provide better outcomes, then they need to show us how and why this is the case. Honestly, this isn’t something that they market to us. To the contrary, I’ve seen them market ‘better first fit to target’ (e.g. they have adjusted their gain to make the hearing aids more likely to hit targets more closely from a first fit in order to save us time). I have never gotten the impression that any manufacturer cares which rationale we fit, and I’ve seen rationales converging over time, which makes sense if the entire industry is trying to figure out what works best for the most people. It tends to be other features that they woo us with–better feedback management, better noise reduction, better connectivity options, and so on.
There are still a huge number of dispensers throughout the world who do not use REM and just first-fit to manufacturer rationale. But manufacturers tend to support REM, which reduces follow-up appointments and increases patient outcomes and therefore makes both their direct client (clinicians) and indirect clients (hearing aid users) happy. Most, not all, manufacturers have their own proprietary rationales. Most say, “It’s based on NAL, just fit to NL2”.
@Neville: Thanks for your reply. I agree that contrasting NL2 and DSVv5.0(adult) would be useful.
Once I have tried both of them in the scenarios in which NL2 has shone, I’ll be in a position to decide whether to keep all 3 rationales or ditch one and focus on building a better music program.
[I’m actually quite surprised that neither of the two fitting rationales I’ve been using for music has exhibited any severe phasing effects due to .
I use a lot of altered chords and even tritone substitutions: I’m impressed with the way the More3s mics and chipset handle the complex acoustic geometry without blinking an eye (or warbling).]
[I’m actually quite surprised that neither of the two fitting rationales I’ve been using for music has exhibited any severe phasing effects due to frequency lowering.
I use a lot of altered chords and even tritone substitutions: I’m impressed with the way the More3s mics and chipset handle the complex acoustic geometry without blinking an eye (or warbling).]
I think maybe the way is done by Oticon, via frequency transposition and composition, instead of via frequency compression (as done by other brands like Phonak), might have helped make music sound not as distorted as it might have been. I’m music oriented as well and I never feel like the music I hear is off tune by one bit, even though my built-in Music program (based on VAC+) has Speech Rescue turned on.
As for the lack of warbling, it’s possible that the feedback prevention technology (MoreSound Optimizer) from the More lets you get away with having to use the tradition feedback management at all, which is prone to cause warbling due to its 10 Hz frequency shift strategy.
We still need that average. I agree that it would be nice over time if subsets types of hearing loss with different etiologies would be differentiated, but think about drugs–you need to know the average effect to get anywhere. Individualizing afterwards is the art of the clinician, but hopefully over time it will also move towards science. But it wasn’t that long ago that all hearing aids were were amplifiers.
Oticonian/Disposablyte
Thus far in my (short) journey with Oticon More3s, I have come to a few conclusions:
. There’s no research to speak to that, as the VAC targets are proprietary. NL2 and have been compared a few times and come out pretty close, although there is some hint that DSL does better in noise (further, there are now also DSL noise targets). In any case, the one that is going to win is the one that gives you the best undistorted audibility, since you cannot hear what you cannot hear. There is certainly evidence that children whose fitting falls below targets have poorer language outcomes.