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Custom Ear Molds, Which Type?

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I’m a relatively new hearing aid () user, having used my professionally fitted Phonak Audeo Sphere I90s for about three months now, following a year with AirPods Pro in HA mode and then All-Day Clear hearing aids for a month.

I initially used open domes, but after discussing custom ear molds, I tried vented domes to get used to the increased occlusion. I’ve found that I can adapt to them, and the sound quality of my hearing aids has significantly improved. This was a pleasant surprise, as my low-frequency hearing is fine, and I previously thought open domes were a better fit hearing wise.

Now I’m considering custom ear molds and need advice on the best type and appropriate level of venting. With the vented domes and open domes, I’m finding that I’m between a small and a medium size—the small moves a bit, and the medium is too uncomfortable for extended wear. I’m hoping custom molds will resolve this fit issue.

I’m currently leaning towards either the Phonak titanium cShell or an acrylic mold. Could you please offer some advice on these options and any potential downsides, aside from the cost?

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Titanium is tougher. Less likely to break. Thinner walls allow bigger receivers in smaller ear canals. Titanium is supposed to be non-allergenic. Acrylic can be modified by audiologists in the office for some problems.

WH

Have you checked the costs already? I checked with my audiologist, expecting to hear anything between “okay” and “horrifying” but was told that there is no charge for custom molds during my 3-year warranty period! I’m still trying to decide before I ask her to start the process, because the reason isn’t bad sound quality. It’s just that every dome I’ve tried so far backs out of my ears, even with retention “tails”/concha locks. Right is worse for this issue, since that ear canal is smaller and shorter. I do like a deeper placement of the speakers for the best sound quality and comfort, though.

I have been wearing aids for 20 years and always acrylic custom ear molds. The titanium molds sound great but not supported for my Oticon power receivers. There are newer custom mold that while actually clear like acrylic that will form to the ear canals due to body heat. My audiologist tried to get it for my aids but my receivers being power receivers it isn’t available for them only the acrylic.

Edited

I had a similar problem with my Infinio domes: The medium was too big and the small was too small (vented domes). I also found the “light bulb” shape of the Phonak dome uncomfortable.
The solution I found: Oticon domes (in my case, I use Oticon’s 8mm openBass). This option is cheaper than getting titanium cShells. The Oticon fits the Phonak receiver perfectly. Based on what you said, you can try Oticons double-vent bass or the OpenBass
Worth the try, they are very cheap @ Amazon.

In reply to @AttilaDaPun

I had to go to a full skeleton ear mold because of the issue you have. But my ear canals are quite large and I had issues not finding domes that woud stay put. I have an appointment in about 10 days and I am hoping to get impressions done to get new ear molds as my ear molds aren’t staying in place anymore.

Your hearing loss is similar to mine and when I had ric phonak slims I had acrylic c shells. I had ordered slim tips, but my small ear canals ment that I ended up with the c shells. They were infinitely more comfortable than the open domes which drove me bonkers with itching. If they are properly vented you should be fine with them. Mine were free.

In reply to @AttilaDaPun

I did check the cost and will have to pay $225 out of pocket. If they are more comfortable and stay put, I will consider it money well spent. I am leaning toward the titanium as I have some skin allergies and don’t want to chance the acrylic causing irritation.

Agree. I think one of the issues is that the SW recommendation is based on the default values of the manufacturer’s fitting model. I’ve also seen different recommendations in different softwares for the same .

I wear Oticon INTENT aids with power receivers, 105db, but the fitting software says that 85db receivers are needed. Well the 85db receivers wasn’t powerful enough for me to understand speech. And the feedback was terrible because the aids had to be pushed to the absolute maximum of the receivers for me to start to understand speech. With the 105db receivers I fully understand speech and also have absolutely no feedback issues.

With an like yours, I will stick to domes. I do not know your age; however, I will get into custom mold now, only for future changes in my audiogram, a way to be ready.

I use Microsonic17

It is hard to get to them; it must be through an audiologist who does business with them. And for some, it might not be affordable. My things with them are about the acoustic, the durability, and the good-looking.

I was using Phonak, but that SAV thing was falling every time.

Edited

In reply to @Adrian

@Adrian said:

Zebras are right, I think. For you, Bimodal_user, I think the software is taking into account your audiogram, which is not bad in the end; you are around 65 on the 8,000 Hz.

Without , Target software doesn’t take into account the size (volume) of the ear canal. Mine is large, like in @cvkemp case. That means, assuming the same gain set, lower near the eardrum than in situation when I would have average sized ear canal.
That’s because the sound energy is spreaded (“dissolved”) into larger volume of ear canal.

I tried M receiver and I am DIYer. It was simply too weak. The Sphere 90 with M receiver in power dome was much worse than my old Paradise 90 with P receiver in not-perfect-and-shallow-skeleton earmold with P receiver.

I’m 36.

@Bimodal_user said:

Without REM, Target software doesn’t take into account the size (volume) of the ear canal. Mine is large, like in @cvkemp case. That means, assuming the same gain set, lower SPL near the eardrum than in situation when I would have average sized ear canal.
That’s because the sound energy is spreaded (“dissolved”) into larger volume of ear canal.

Hello Bimodal_user, First of all, I offer my sincere apologies. I did not know your knowledge about HAIDs is so vast!

Second, I came here to obtrude on you with the only thing I have been using in the Target Phonak program, my “unschooled” knowledge about HAIDs.

I have to confess that I did not know you have to tell Target Phonak how long or large (in volume) my ear canal is.

Sincerely, I always order my earmolds “large” because I feel comfortable wearing HAIDs that way. But, remark, I did not have an idea it would impact the program’s performance; my mistake.

Third, I learned to listen to Target Phonak. For some time, I had a private debate about why Target Phonak told me I should use a 0.9-1.1 mm vent when my right ear was so bad and my left ear was in the severe range. It does not make sense to put both in the same vent mm. The day when I finally ordered, as software Target Phonak told me, Boom! a new beginning stepped into my life.

I was about to quit my job before they fired me because I have to pick up a landline phone some days during the week. My job is unattainable noisily, and my coworkers know I might miss a call from behind, but if they get a little closer, I will be there as usual.

Nope, it’s not going to happen because my friend’s software, Target Phonak, is in my homemade lab, in the most minimalist environment, helping me keep it afload.

That was the scenario that disturbed you.

Edited

I don’t think that’s what he is saying (at least, that was not my interpretation).

The software makes an initial recommendation based on the data it has and based on the manufacturers default model . But like any statistical model, there are variances and some members of the population align well with the model and some don’t (technical term: Outliers). It’s like taking the average weight of people in Houston and say "the recommended pant size is 32 (if you have been to Houston, you know how wrong this is)
So, in short, Target recommends but it is not a law
Also take into account that our experiences are different and may, or may not be applicable to you. It’s a forum, not a scientist PhD congress where every statement has to be proven.
@Bimodal_user : correct me if I am wrong please, you are a wise guy :slight_smile:

In reply to @Adrian

@Adrian said:

Hello Bimodal_user, First of all, I offer my sincere apologies. I did not know your knowledge about HAIDs is so vast!

No need to apologize. You had your experiences that are applicable to you. Regarding your and high-frequency loss, I am not surprised that you need more occluded earmolds like 0.9-1.1, although you have relatively good low-frequency hearing.
In tonal audiograms both your ears has relatively similar loss, so I am not surprised that the same vent size is applicable.

@Adrian said:

I have to confess that I did not know you have to tell Target Phonak how long or large (in volume) my ear canal is.

There isn’t any way to enter the ear canal volume, and I don’t know if choosing a larger size dome matters in the calculation. The only way to take that volume into account is Real Ear Measurement () with the TargetMatch module.

Sorry to hear about you job problems. I have similar, but I stood stubbornly for myself with quite good results.

I agree that getting knowledge and Noahlink Wireless 2 it’s great for me and I wish I had done it earlier.

@OcramSagev, your supposition about averages and variability/differences is definitely true. No one has the same ear canal. That’s why REM is so important.

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