Custom EarMolds versus hearing aid Domes
OPEN FIT and Receiver in the Canal (RIC) hearing aid users almost always begin with a fitting of DOMES (tube tips). Earmolds are standard and necessary for Behind the Ear (BTE) hearing aids, but RIC / OPEN FIT hearing aids come with a kit of domes of different shapes and sizes to try. How does a provider or consumer decide when to use the domes and when to select earmolds (Ear Molds) instead?
The answer is based on a number of factors, all of which are dependent on the patient. Several things should be considered before making a decision to purchase the custom fit earmolds. The first thing a hearing aid provider will do is to try the different shapes and sizes of domes available for the OPEN FIT or RIC receivers. Many of the domes are now made to work with different sized ear canals and to prevent feedback for even severe and profound losses.
Is the fit is comfortable? Is there occlusion? Is there feedback? Does it slip out of ear? The provider knows that all ear canals are created differently, so what works for a patient’s left ear might not be the same size or shape that works in the right ear.
If a patient experiences discomfort, or sore ears, trouble in noisy locations, slipping out of ear when using the standard domes, a custom mold may be necessary. If the patient’s ear canal; curves severely, has had surgery, or is very narrow, is a child, it might not be possible to get a good fit unless he/she gets a custom made ear mold If the texture of the ear canal is soft or flaccid, a mold of a harder material (like acrylic) is normally purchased. If the canal is very rigid, they will usually select a softer material (like silicone rubber) that will seal more easily against the canal. Does the patient complain of occlusion (hollow sound) with the stock domes? If so, a custom earmold with venting will solve the problem, or a deeper earmold that exits very close to the ear drum. Another very common problem is ear wax plugging the sound opening. An earmold can solve this problem when using OPEN FIT which have very small sound Slim tubes and openings.
I have experienced and solved these problems, personally as a hearing aid user, during the last 50 years. I also have been a hearing aid provider, manufacturer and earmold lab owner. I was the first to invent/produce soft SILICONE RUBBER earmolds in 1965, because of my dissatisfaction with hard earmolds. So my experience is not just learned in school, but also in the REAL WORLD. I have worn flexible, comfortable silicone rubber earmolds ever since.
So when is the right time to choose an earmold? Because ear canals are not all created equal, so there is not a clear cut answer. Do you have any problems with discomfort, hearing in noisy locations, or does the dome/ tube slip out of position? A well fitted earmold can solve all of these problems.
DISCOMFORT: ear canals are not round and vary in shape from the outside (tragus) to the ear drum (tympanic membrane). So when you place a round Dome in the canal, it presses against the narrow width area and makes little or no contact in the vertical area. Studies have shown there is better hearing when the tip is very close to the ear drum and yet most of the fittings are shallow. There is also better fidelity, volume and reduction in the occlusion effect (hollow sound). You can generally go deeper with an OPEN FIT than with RIC hearing aids, because of the larger diameter of the Receiver on the end of the RIC Slim Tube. A well fitting Silicone Rubber earmold provides comfort and solves the other problems.
TROUBLE HEARING IN NOISY LOCATIONS: When the Dome allows background noise to leak past the Dome, the hearing aid cannot control that un-amplified sound. The solution is a sealed earmold with deep penetration that prevents the leakage and occlusion, so there is no need for a vent. The best hearing aid cannot control that noise that leaks in. The important thing is to place the tip of the mold close to the ear drum, as shown in studies.
DOME SLIPPING OUT OF THE EAR: This is a very common problem. Manufacturers have tried to prevent this problem with several domes in a row, with limited success. Ear discomfort and problems in noise can still persist. An underlying problem is the movement of the jaw (mandibular motion) which pressing up under the canal pushing the domes out of their normal position. Another dangerous problem is the hearing aid falling off the ear and getting damaged.
HEARING AID FEEDBACK (whistling): If you have persistent or intermittent FEEDBACK and you have tried all the usual domes, then a custom earmold is the logical solution. I have been able to fit all my patients with a flexible silicone rubber earmold. Not all silicone molds work as well. Some are too soft and are very difficult to insert in the ear. I have severe hearing los and very thin, soft ear canals, so I apply a thin film of non allergic face cream to the earmold, avoiding the tip opening. This not only eases insertion and removal, but it also helps prevent feedback.
You don’t need to put up with these problems if you take advantage of the modern solutions of HCPB CUSTOM, LOWEST COST, MEDICAL GRADE SILICONE RUBBER EARMOLDS, which are available on this site..
The most important thing is to achieve hearing success with your OPEN FIT/RIC and BTE hearing aid fittings.