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Getting new Phonak infinio Sphere 90's w c-shells. How important is digital 3D ear scanning (Otoscan)?

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Dear all, I will be getting new Phonak infinio Sphere 90’s w c-shells in the next 2 weeks. How important is digital 3D ear scanning (Otoscan) for getting the best fit on these c-shells?
(I am a first time user of c-shells, always used power domes previously. See my for why I now need c-shells.) (Also I need to get an excellent fit on the first attempt with the c-shells since I spend much of my time in Mexico (retired) and would have to fly back and forth to the US for appointments if the c-shell fit is not good.)

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If your audiologist can take a good canal impression with a low viscosity/low hardened modulus impression material, then a 3D scan offers relatively little other than generating the flat file from the gun rather than a scan of your impression in the factory. It removes the first few days of the order process and the risk of a lost delivery too.

I have had both impressions and the scan. I wear acrylic full skeleton ear molds and I find for my comfort the impressions make a more comfortable custom ear molds.

I just got my Phonak Spheres with acrylic full skeleton ear molds made by impressions and they are extremely comfortable and no feedback either. But I agree not everyone can do the impressions correctly. What has always worked for me was moving my jaw like I was eating and talking while the impressions are setting up. Yes I know some say that your mouth should remain closed. Well that makes a very uncomfortable ear molds in my experience.

thanks to the 4 of you for your fast and useful input. Does anyone else have experience with traditional impression material method vs. the newer (8 year old now) digital 3D method that just produces a .stl file?

(I understand that this file is then sent by the audiologist to the Phonak Otocloud so they can physically make the c-shells and send them back to my audiologist. Is that understanding correct?)

Just a caveat: the actual manufacture of the molds are just as important as the scans being done to create the molds.

My audi’s experience is that the old-fashioned impressions taken with the putty seem to deliver a better fit for patients than the laser-scanned one. I have no idea if the molds are made in the same factory no matter if laser or physical impression is sent in.

They will be made in the same factory by the same stereo lithography machines.

The ‘problem’ I’ve seen illustrated with the 3d scanner approach, is that if there’s a fault in the process or a poor scan, is that it doesn’t get found out until the first fit. Whereas even with a ‘bad’ impression, you are unlikely to end up with an oversized product, simply because you can’t make an oversized impression (without damaging the ear) and then you can do a side by side final scan (or just make a ‘negative’) in casting silicone and see if it hits the right spots. The product never leaves the factory if it’s not right.

It’s one of those processes where the inherent strength of the analogue approach means that the digital approach needs to better by a significant degree to justify moving that way. Or it serves a market with greater distance or time pressures better.

Personally I’d prefer if the manufacturers collectively offered high-res table-top or spindle scanners, which are way cheaper. These would allow in-clinic scanning of moulds to begin the manufacturing process/asses suitability for Canal/Cic/iic solutions and better product choices. Send the flat file through, get the manufacturer started, also send the the impressions by post to ensure final shell shape is good and looks right in the ear, before the aid ships.

@Um_bongo said:

It’s one of those processes where the inherent strength of the analogue approach means that the digital approach needs to better by a significant degree to justify moving that way.

YES! That’s a great explanation of the PROS of old-fashioned impressions vs CONS of scanning the ear canal!

Your solution calls for some redundancy, which can save time, stress and money in the long-run, by using both technologies. My audi’s clinic stopped doing laser scan images a few years ago, cuz they kept having to REDO and REDO the final mold.

Edited
@1Bluejay said:

My audi’s experience is that the old-fashioned impressions taken with the putty seem to deliver a better fit for patients than the laser-scanned one.

My impression, and I could be wrong, is that is one of the many scams that some audiologists do. I believe that the audiologists that say that are ones that do not have, or know how to use, the laser equipment. So, they sell what they do have or know what to do. There, unfortunately, is a lot of sleeze in some audiology practice.

@Psych2 said:

There, unfortunately, is a lot of sleeze in some audiology practice.

I can’t say if that is the case outside of my audi’s practice, but I’ve been SUPER lucky. Both my current audi (of 4+ years) and my previous audi (15+ years) have been amazing people, their practices supportive and professional.

Also, my audi wasn’t charging patients for the multiple molds being made when the laser impression was manufactured with a defect. It was the clinic that ate the cost.

I can also vouch that the titanium molds she had made using the old-fashioned putty-in-ear impression came out PHENOMENAL - no pain from the fit as of Day 1. No remake or altering the mold at all.

:four_leaf_clover:

Thanks to all this is now clear to me. Two follow on questions are these:

(I have just updated my see above. (In both my ears my levels are approximately: 35dB at 250 Hz, 45dB at 500 Hz, 55 at 750 Hz, 70 dB at 1000 Hz, 90 dB at 1500 Hz, 110 dB at 2000 Hz, 110 dB at 3000 Hz, and 110 dB at 4000 Hz, and 110 dB at 6000 Hz.))

  1. I have been doing some research and it seems with my 35dB at 250 Hz and the profound loss above 2000 Hz, I am candidate for UP (Ultra Power) receiver instead of the P (Power) receiver I have been using. Is this your thought also?
  2. And in my research I also came on the suggestion that I need the Encased c-Shell for this UltraPower / UP receiver. What do you think?

thanks for your input on these 2 questions. It will be much appreciated so I can get the most benefit from the Infinio Sphere Ultra 90’s I will soon be purchasing. KR, Dennis

Not an audiologist, but my take is that P receiver would be fine. I’d be curious what your word recognition scores are. I don’t think you’re going to hear anything above 1500 Hz without .

I do use and it is maxed out on my Phonak Lumity 90s. It does help a lot: for example I can hear a bit of F’s and male S’s which would not be possible without frequency lowering.

I don’t quote any others here in that I can’t really contribute, I don’t think, to their comments.

I did my research before purchasing my Phonak Sphere Infinio I70 (90 wasn’t covered by my insurance), and specified the titanium molds based on all the material available here - never having anything else.

I’d previously had Beltone soft molds; it took 3 times to get it right - but that did eventually happen. My loss level is such that without a PERFECT insertion of solid domes, I’d get horrendous feedback. The final set had Beltone’s HighPower receivers - which, fortunately for me, happened to be the same size as the 3P of my Phonaks.

So, while we waited for the titanium molds to arrive, I stuck Phonak 3P receivers into the Beltone molds.

And when the titanium molds arrrived, and the left ear proved painful, did it again for that ear. And when sending it off for some chiseling or other material removal didn’t resolve the issue, got a new impression - but while I waited, again used that Beltone soft mold.

And, furthermore, while the left mold is now comfortable, it tends toward migration out of my canal - so, just to see how we diid, I’m alternating between the (newly made because my previous Beltones were still under warranty but had splitting occurring due to all the in-out of the receivers) (new - which aren’t a comfortable as the others; they seem harder Beltones) and the Titanium molds.

I still have tweaking to do about my prescription but so far my speech recognition is pretty good, my ‘Spheric speech in loud noise’ setting on MyPhonak seems to help for those circumstances, and, ironically, the new Beltones are less comfortable than the Phonak, which is a reversal. I presume that to be a stiffer flexible material than my prior Beltone molds. Worse, my left ear migrates a bit - not working entirely out as my Titanium used to do, but not sealing perfectly, either. As the soft molds have a notably larger vent than the Phonak Titanium, that migration can lead to some feedback in close circumstance, though none is present otherwise.

My loss, VERY oddly, somehow reduced (got better) in the lower frequencies, after years of steady decline. Yet, my middle volume setting is nearly always quite sufficient.

Artificial hearing is a black science!

As to one commenter’s view of molds and perfection, I wasn’t charged for a remake, nor the attempt at making the left mold comfortable; I think that was on Phonak. And my Beltones had a year warranty (though I did have to pay for them due to the previous molds’ warrantees having exceeded their 1-year coverage); but replacements were not under warranty, Beltone’s position being that the replacements were only covered under the original warranty period. So, those will be solely a backup should my P molds ever have a failure. Given that the receiver is molded into the shell, if that should fail, I’ll want/use those Beltones, anyway!

Finally, for what it’s worth, your audio is far better than mine until you get into the much-higher frequencies; the P is quite sufficient for me…

Good luck with your journey!

@Skip thanks for your indepth comment. Useful to me.
One last question: i am planning to get my c-shells in acrylic. Do you have any idea how acrylic compares to titanium in: durability, cost, and as a tool to hear better ( equivalent I guess to if it is a good fit)?

Two things about Acrylic:

I’m not a good source; my only acrylic experience was in the horrible chase to get the Beltones properly adjusted; Miracle ear STARTED with that. They were very comfortable.

My sense of things is that acrylic and titanium, mold for mold, will feel about the same, other than that titanium can be made either smooth or ‘rough’ - the texture to help keep it in place.

In the case of Phonak molds, they look like a human heart, rather than my acrylic and soft molds’ more rectangular shape, with the ear curve resulting in a rectangle sticking into my ear. Some reading suggests that this (Phonak’s receivers) shape is to put the speaker closer to the ear, though I don’t see how that’s possible.

The English guy who does vids on this forum, I think, did a side-by-side abuse of a Titanium and an acrylic mold, with a hammer. The acrylic was dust; the titanium unaffected. I don’t know that you’d put your molds through that level of abuse, but it does suggest that you don’t have to worry about breaking an acrylic mold!

Costwise, I expect the titanium is much more expensive, from both a material and manufacture-challenges standpoint. But absolutely, molds will enhance the hearing, whether soft, acrylic or titanium. There’s a good piece about titanium molds here (can’t point you at the moment but search for posts about titanium molds and you’d find it) which may help you make up your mind.

Be aware that you may need to do it more than once; my first left ear mold was extremely painful, and while the second adjustment (new mold impression on the second) is comfortable, it wants to migrate out, so it’s a bit of a dark science to get it right (recall the 3x times to get the Beltone soft molds right.

But once you get it right, if you’ve used domes before, you’ll never go back…

Hope that helped…

In reply to @dennis.hurley8

PS you may find this useful; I couldn’t find the hammering-on acrylic vs titanium post (yet):slight_smile:

Advices before purchasing titanium cShells / titanium earmolds
EDIT: This is continuation of my topic about my experiences with titanium cShells: END OF EDIT DISCLAIMER: Titanium cShells are not a cure for anything. Please have mercy on your HCPs and don’t insist on titanium if you don’t have experience with acrylic earmolds/cShells (you used domes only) and you don’t have an allergy or a narrow ear canal, because in case of discomfort the waiting period for remake will be too long. Make sure you’re comfortable with acrylic/silicone ones previously. I…
Edited

In reply to @dennis.hurley8

@dennis.hurley8 said:

I have been doing some research and it seems with my 35dB at 250 Hz and the profound loss above 2000 Hz, I am candidate for UP (Ultra Power) receiver instead of the P (Power) receiver I have been using. Is this your thought also?

It’s a bit equivocal. That’s maybe not useful to you but true. Some users do find a bit of benefit from gain up at the very edge of their profound hearing loss, but for others that area is just too damaged. The sonova receivers are pretty quite, so you would probably not have chip noise problems with the UP. But the UP is also a lot bigger and might give you a less appealing physical fit unless you know you have big canals. The venting required for your loss might limit the potential benefit of the highs on the UP anyway. So: trial and error, which isn’t great when you’re traveling for it. I might lean towards the P.

(Where I am you’d be a possible candidate because of your missing highs.)

We have the otoscan and I still do traditional impressions, maybe 50/50 leaving out pediatrics that cannot use the scanner. The otoscan is safer and more comfortable, but still takes some skill so if someone sucks at taking earmolds they aren’t necessarily going to do better with the scanner. There are some ears that I just can’t scan well depending on the anatomy and if someone has a lot of movement in their canal I still prefer a traditional impression. It’s easier to go deeper with the otoscan. There are horror stories about things that CAN happen with traditional impressions and those things are impossible with the otoscan, but in my entire career I’ve never had one of those horror stories happen. If someone came in with mastoid cavities or some other hard to pack situation I’d absolutely default to scanning.

And yes, labs also differ–there’s skill required from the individuals on that end too. Maybe ask the clinician to have phonak audiology double check the mould before it leaves the lab because there won’t be an opportunity for remakes.

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