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Please help me understand this change

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I’ve been wearing hearings for >15 years. Until 3 years ago Oticon. I’m currently using Resound 9 with ear molds. My left ear mold would shift in my ear during the day, I’m 79 years old but quite active, riding motorcycles and vigorous physical activities. I went back to my audio for new molds.

I was assigned a new tech, the former had departed. I had my hearing tested again, no significant change in the past year. The new audio recommended we go back to double domes. I have worn ear molds for almost all of my 15 years.

My hearing loss is significant, and my primary complaint is I’m not able to clearly hear my wife who always sounds muffled. I sensed some improvement with the double domes, however, streaming TV news and voices is worse. The biggest annoyance now is the double domes shift during the day, and I get serious feed back. I’m going back to see the audio first thing tomorrow morning.

Q: I do not understand the criteria for an audio to select molds or domes. Can someone help me understand why my audio might have suggested double domes. My audio appears to be a well run operation with 4 or 6 technicians in Southern California “desert cities”.

Thanks,
Dixter

DC Audio

10 people in this conversation8 min readJump to latest

That’s a pretty bad hearing loss and word understanding is suffering. Properly fit aids might get some of that back, maybe.

Do you know which receivers you have on your Resound 9 aids? I also believe molds are best for you.

Is feedback an issue often?
We’re the aids fit using ?

Are the aids set up using ? A little just might help you hear better.

Thank you for your quick reply.

My receivers are not The Marie. The feedback comes when the double domes begin to loosen up in the air canal. This will happen within an hour or two of pushing them back in firmly. A true nuisance.

Other than one of the molds coming loose, I had a few complaints.

My primary interest here today is knowing why might an audiologist switch from molds back to double domes?

What are the criteria for molds?

Thank you,
Dixter

@Raudrive said:

My understanding is hearing losses 40 db or worse in the lower frequencies. Yours is beyond 40 db less in the 1000 hertz area and higher.

It is as stated in the quote. However, it should not be treated strictly - it’s very individual.

I have good hearing in low frequencies and found an earmold with a small vent to be very beneficial for me. I’ll try even closed earmold in the future.

Retention and staying in place are also individual preferences.

Please allow me to clarify. Feedback was not a problem with the molds, until the left became loosen my ear.

Feedback heard today is only when the left double dome loosens up in my ear canal, AND I either get my head within a foot or two of something like an open cabinet door adjacent to my left ear, or I stick my head in some tight area like working under a car. Alternatively, when the dome loosens up and I turn on the kitchen sink faucet full blast, the screech becomes intense.

I’m learning stuff as we go along, and I hope this helps clarify my problems.
Ciao, DC
Dixter

In reply to @user206

@user206 said:

Thank you for your replies The vent diameter is 0.086, the same size as a #44 drill bit, nominally 2.2mm.

That’s crazy big, you may as well be using open domes! of course that’s not an option with your level of loss

Maybe the new tech simply isn’t comfortable with the process of fitting you with new molds. It’s complicated and there’s a good chance of needing a redo or two.

In reply to @user206

OK. I totally get your experience with both the custom mold and the double dome (typically made from a soft silicone that’s like two saucers stacked, one on top of the other).

I’ve had issues with BOTH! My ears would swell UP and DOWN throughout the day, so the hard plastic custom mold would hurt first thing in the morning, but I’d end the day with leaky-squeaky feedback as my ear canals opened up. GONG!

I’ve overall done better with the double power domes, but as you’ve experienced, these slip out the ear canal NO. MATTER. WHAT. I’ve tried having the leash put on the speakers to no avail. I end up pushing them back in my ear canal 100 or more times a day cuz every time I open my mouth, chew, speak, or articulate that jaw at all, the soft power dome starts to work its way out backwards. Like you, if I’m near a cabinet or doing yoga exercises with my ear close to the mat, I’ll get some feedback due to the POWER/VOLUME I need given the non-custom mold.

As others say, the audi will typically recommend a custom mold for those with severe to profound hearing loss; in fact some aids are also recommended for use with ONLY a custom mold (Oticon Intent, Phonak Sphere). But ultimately, it’s up to the individual wearing the aid what works best for him or her.

For now, I’m staying with the double power dome (going on 10 yrs use). I am also very allergic to the materials used for most custom molds: hard or firm acrylic.

Note that with a non-custom mold it will be much harder for your speaker to be aligned at the sweet spot in your ear canal! Indeed, my soft double domes are rammed against some wall in my ear canal most of the day! I simply can not get the speaker to point at the actual canal! A custom mold will align that speaker to the best spot in your ear.

Don’t get caught up in the audi’s recommendation. Try both and go from there. Your own ear canals may swell and recede every day! Over time as we age, our ear canals change shape, so it’s a lifelong process to find the best tip on the speaker that works. Hope that makes sense!

Edited

I read through the other replies and didn’t see anything along these lines, so let me share my experience.

My previous aids were Oticons. I started out with power domes and they were good at first, but then I started having problems with the right one moving around in my ear. When I would chew, or swallow, or sometimes even talking, the receiver felt like it would move in my ear canal. Usually, it felt like it would move in a little bit and mute itself against something in there.

I went to my audi & he just shrugged at first. I went back and complained again and he put on those plastic retainer things that hook inside the outer part of your ear. That didn’t work either. So I complained again and he sold me “shells” (custom ear mold that hold my receiver). Those seemed like they were going to help, but no. So he made them again. And then again.

Eventually I just resigned myself to constantly fiddling with my right hearing aid.

Long story short, after dealing with it for several years, and describing the problem to three different audiologists, I figured out on my own that the receiver wires come in “sizes”. The wires are different lengths to accommodate different ear sizes and shapes. The one in my right ear was a size 3 while the left one was a size 2. When I looked closely at how they fit after noticing this, it was clear and obvious that the wire for my left ear rested gently on the top curve of my outer ear, while the wire on my right-side aid was 1/8" above the same spot. This meant that the entire weight of the hearing aid was being supported by the wire - which was only anchored by the friction of the mold in my ear canal. That weight would push the mold around in my ear. (almost the same idea as balancing a broomstick on your finger).

I was able to order a replacement set of receivers online (done dealing with audis at that point), replaced them myself, and they worked great for another 2 years.

So, to summarize, I would ask your audiologist to look closely at your wire length and position to see if something can be done on that front to help.

Thank you Allen, yours is a nice, clear, response and quite helpful. I’m off to the audio this morning with a list of things we need to work on.

Season’s Greetings everyone,
Dixter

Unless you were personally bothered by earmolds, I do not see an indication for domes, particularly since now you are running into the hallmark issue of high gain with domes: feedback. Most want to avoid “plugging you up” if they can, which is why you are more likely to see them stretching the limits of domes, even into murky territory. Also, domes are traditionally more comfortable for users, so an HCP may be excited to say that you “don’t need” earmolds. We all want to be the guy who succeeds where others fail, but in your case it seems like nothing was really failing related to your use of earmolds.

Thank you Paul. Your assessment is good. The only problem I had was with the left ear mold loosening up through the day, hence my visit and request for new molds.

Earlier today I returned to the audio, set up another appointment for impressions and while at the office surrendered the domes and walked out with my old molds.

I thank all who participated in my ongoing education, and leave with the opinion, we can park this discussion in the closed folder.

Seasons greetings and happy holidays.
Dixter

In reply to @PaulC

The other BIG reason for getting the venting right has got to be the level of the low frequency correct. You’ve got a pretty big risk for occlusion and the downward spread of masking here.

It’s easy to forget that even with only 1/3 gain rule, the level of output variation from the low to high frequencies is getting on for 250-500x intensity: you’ve got to lose that energy somewhere.

That said, if you can get a decent custom canal tip fitted deep enough with some sort of slot venting you might be able to mitigate against most of the occlusion.

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