As Receiver in the Canal (RIC) hearing aid fittings become increasingly popular, there seems to be a large number of hearing healthcare providers who wonder whether or not they should make earmolds for their patients as well. Earmolds are standard and necessary for Behind the Ear (BTE) hearing aids, but RIC instruments come with a kit of domes of different shapes and sizes. How does a provider choose when to use the domes and when to select earmolds instead?
The answer is based on a number of factors, all of which are dependent on the patient who is being fit. Several things must be considered before making a decision to order the custom fit earmolds. Perhaps it is too obvious, but the first thing a provider will do is to try the different shapes and sizes of domes available for the RIC receivers. Many of the domes are now crafted 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? Your provider will keep in mind that all ear canals are created differently, so what works for a patient’s left ear might not be the same size or shape for what works in the right ear.
If a patient reports discomfort with the standard domes, a custom mold may be necessary. We look at the patient’s ear canal; if it curves severely or is very narrow, it might not be possible to get a good fit unless he/she gets a custom made product. We also note the texture of the canal; if it is soft or flaccid, utilize a mold of a harder material (like acrylic), as soft material will be difficult to seat properly against a soft canal and there will be risk of sores, pain, and infection. If the canal is very rigid, consider using a softer material (like silicone) that will seal more easily against the canal. Does the patient complain of occlusion with the stock dome? If so, a custom mold with venting (even just a pressure vent) can make all the different in the world for the patient.
As stated above, ear canals are not all created equal, so there is not a clear cut answer…the most important thing, as always, is to listen to your patient and couple their complaints or issues with your objective data. This valuable information will help you make an informed decision on their behalf and bring you success in your RIC hearing aid fittings.
Until next time,
Dr. Kristin
