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Comments on vent size for new custom molds (slim tips)

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My inclination is to request/suggest to new audiologist that vent size be the same as current older molds, namely 2.1mm; but rule of thumb chart (see Dr Cliff YouTube) would suggest 3.5mm as my 500HZ loss is only 25DB. These seem to work OK for me, yet I struggle with speech accuracy even with small amounts of ambient noise. (Using Phonak Infinio Sphere that will be upgraded to the Ultra firmware.) Any trade-off or benefit from a larger vent size?

Current and new molds would be soft silicone which is material most prior audiologists have suggested both for fit and comfort (my ear canal is not complicated/unusual but quite sensitive to skin irritation).

It seems to me that since I am not annoyed by slight occlusion @2.1mm, the advantage of being smaller opening is that it cuts down on ambient sound and would compete the least with sound delivered by the Roger ON external mic that I often use; or when using Sphere program (even when this has slider to eliminate “ambient” the most).

My programming also uses for my very steep ski slope .

I know there are always lots of interaction effects with hearing aids and accessories, and usually no free lunch, so checking with forum to get any thoughts-input as I might be missing an important factor or consideration.

My current ear molds (about 15 months old) are still fine but were not made by Phonak and were based on my doing the ear mold goo impression myself and sending to lab. Having professional do impression, or use the Phonak digital device to create 3D image will probably produce a better custom mold, followed by . Time will tell.

Thanks in advance for any input …

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Yeah this way you take anything Mr Clifford says with a pinch of salt, what works for him doesn’t work for all, 2.1mm I’d go even smaller 1.8mm lift some Bass and get more gain on those mids/higher frequency, plus without risk of feedback, yeah I like the silicon moulds for comfort and a good fit,what’s this mean?

@Edma said:

and would compete the least with sound delivered by the Roger ON external mic

Doing the pro moulds fitting is your best bet, Phonak make pretty good one’s! Lot’s of ways to skin a possum!

I also prefer smaller vent size. Remember vent size is more complicated than just a diameter. If you like your current molds I’d see if the Phonak receiver will fit in them. If you go with Phonak I think your stuck with the receiver being a part of the mold and mold and receiver have to be replaced as a unit. Lastly, you have quite a high frequency loss. What are your word recognition scores? If under 60% you might consider a cochlear implant eval.

You have nothing to gain and everything to loose with larger venting if you have no discomfort with smaller venting.

@Edma said:

My programming also uses frequency lowering for my very steep ski slope audiogram.

If you can truly hear the upper frequencies I would not push much if at all.

What receivers are you using?

The Spheres are a great choice for that loss IMO.

I agree with less venting is a good thing.

Silicone molds are known to be best for those with severe/profound hearing losses. Your great lower frequency hearing would be fine with acrylic molds if you preferred. They are easier to work with and more durable IMO. Receivers tend to move around in silicone.

I share an with a little more loss. I am using custom, skeletal acrylic mold with a 0.8mm vent. Full tubes on Naida Paradise. No feedback or occlusion issues. You can also leave the vent large and reduce it as needed with inserts.

Thanks to each of you - great input. I will definitely go/continue with smaller vent size =< 2.1, than the rule of thumb generic recommendation for my 25DB loss @ 500hz.

@tenkan By “pro mould fitting” are you referring to Phonak’s 3D imaging of canal geometry? I’ll discuss with new audi as I’ve moved to new city an even smaller vent size e.g. 1.8mm, but I don’t think she has tons of exp. with molds. FYI the Dr Cliff chart is from an audi journal article from years ago NOT authored by him. And is only meant as a preliminary starting place.

@MDB From other forum users and from photos whether a silicone Slimtip (Phonaak’s name for a type of custom mold) has fused or user replaceable receivers can be “yes” or “no.” When it is not fused, then user (or audi) must remove the silicone mold, which I am comfortable doinng myself every 6-8 weeks to replace . (Wax guards like for my current non-Phonak molds, are recessed perhaps 4mm into the opening for the receiver. This helps keep them free of wax, but a nuisance to change; versus some I have seen where the receiver output are at end of the tube opening and the wax guard is on the surface (easy replacement, more prone to clogging. My consumer Jodi vac usually can keep either approach wax free.
My word recognition scores have improved some from R/L 76/44 3 years ago; to 2-years ago 76/44 (and this time testing included testing = 90. Yet subjectively and particularly in even slight noise seem quite poor, and effortful (brain focusing to hear). Prior audi did not feel riak/reward of cochlear implant was favorable.

@Raudrive I had acrylic molds perhaps 5 years ago, and expect I will stick now with silicone. Yes, I get the trade off of comfort and changing shape with temperature, and from speaking, chewing. Interesting suggestion on the , and perhaps I’ll start a separate thread on that. While “yes” I can detect sound at higher frequency even unaided, my brain has I believe gotten used to most of the information from that range to be “transposed to a lower band. Like with all aspects of hearing aids, each intervention has pros/cons, interacts with other interventions, is dynamic, and at least somewhat unique to a particular individual, and then what they are listening to and the external environment. To me clearly the domain can be informed by science and acoustics, and implementation is really an art form, with at times much experimentation and trial/feedback/adjustment. (That’s in part why I will be returning to some self fitting.)

Some of you might find this Phonak reeference guide of interest on custom molds (made from traditional goo in the ear impressions). There are even more options for customizing than I had known about previously. https://www.phonakpro.com/content/dam/phonakpro/gc_hq/en/campaigns/ite-excellence/documents/PH_ReferenceGuide_CustomProducts_210x297_EN_027-0670-02.pdf23

@Edma said:

My word recognition scores have improved some from R/L 76/44 3 years ago; to 2-years ago 76/44 (and this time testing included binaural testing = 90. Yet subjectively and particularly in even slight noise WRS seem quite poor, and effortful (brain focusing to hear). Prior audi did not feel riak/reward of cochlear implant was favorable.

You might be able to get better with those Spheres if they are properly set up. Good luck with that. We have a few members with worse hearing loss than yours getting much better WRS than yours.

That comment from your Audi about is incorrect. The threshold for CI candidate is 60 WRS I believe. You can typically expect to get that up into the 90’s with CI but no guarantees. Getting the CI evaluation can answer many questions about your hearing without obligation. Always a smart thing for those with low WRS.

I was measured for custom molds a few weeks ago for my Oticon Intents. I told the H.I.S. I wanted the smallest vent diameter to allow for minimum low frequency leakage and no occlusion.

He suggested I would be better served with a selectable vent. He says it comes with 5 or 6 user replacebable plugs with size ranges from fully closed to 4mm. That sounded great so I went with that option.

I’ll be picking them up next Monday. I’m looking forward to getting them. They don’t cost any more than the single vent.

@mikejl Yes that is a good option for some, to be able to modify (and perhaps experiment with vent size).

In reply to @Raudrive

@Raudrive Thanks for addtional input. I will make it more of a priority to read about, review some forum threads here, etc. to educated myself on option. For the next 6 moonths I don’t have the bandwidth to explore it, but is good to know that even though it’d be a time, energy, money commitment and adjustment period, that it might be a better approach for me than . On the flip side is that I haven’t really worked with an audi who has good grasp of sphere’s and adjustment tweaks/experiments that might improve my word recognition scores. The test resultls today were a major disappointing step in the wrong direction, which is probably not an anomaly as it somewhat matches my subjective experience/self-evaulation.

I will see what it is like for me with Infinio Sphere with the Ultra firmware update that happened today.

@Valeriy “Do you have a similar document for Resound?” No I do not. I expect that doing an internet search you should be able to find something similar.

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