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Custom Earmolds - complete occlusion vs. tiny vent (and type of vent)

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Edited

Six months ago, I switched from KS9 and purchased the Costco Philips 9050 . They seemed tinny when streaming and I was having trouble w/speech in noise….this was with the power domes. So, 2 months ago, I asked my Costco provider for custom molds to improve those issues. We discussed the amount of occlusion, but since I was insistent that I didn’t care about a little “own voice”, he said I could get completely occluded earmolds. (Also said I could later poke a hole in it later if needed…but not the other way around)

I’ve given the completely occluded earmolds almost 2 months of daily use. I’ve become accustomed to walking, and even eating with them, but internal noises still are quite loud. I haven’t done any tinkering as I’ve been busy, and just to let things settle in.

o Positives

  • Speech in noise with “speech in noise” mode is superior and more intelligible. (ie. I can hear the Pilates teacher over the music even when relatively far away)
  • Phone calls and streaming are very intelligible and intimate…similar to Airpods in noise canceling mode.
  • They are comfortable in my ears and do not feel itchy like to power domes (Acrylic not silicone)

o Challenges

  • I still have difficultly holding conversation while eating as the chewing sound is loud…enough to affect comprehension. (I do notice however, that if I press in the earmolds with my fingers, the movement of my jaw has less auditory component) Would silicone earmolds be better for this, or is this just a byproduct of total occlusion?
  • Spatial awareness and directionality has always been a problem w/the Philips 9050, but these earmolds exacerbate the situation. (I believe that’s the reason I prefer using “Music Mode” as this feels more natural at the expense of comprehension)
  • Along the same lines, I often have no awareness of someone speaking to me from the rear. (Also poor to the sides) Could this be a simple directional toggle in the Philips fitting s/w?

Note: With these occluded , I tend to use only two modes “Speech in Noise” when I need to understand a conversation, and “Music” when I prefer natural & spatial awareness.

I am hesitant to poke a small hole (1 mm?) in the earmolds until I have more information. (It’s easier to poke a hole than to plug one ) Would I lose my gains in speech intelligibility with a small hole? What about streaming? What size would anyone recommend for my ? I know there are charts (40db@500Hz suggest 1-2mm), but I’m curious as to folks experience here? Also, I see items like diagonal slits, multiple very small holes, etc on the web? Any experience?

Alternatively, due to the amazing support of this forum, I am able to alter the s/w program myself. Are there any recommended s/w toggles that could improve the situation before I have my provider poke a hole in the earmolds? Any thoughts, suggestions, experience very welcome! Thanks!

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I have acrylic ear molds with UP receivers and with the smallest vent hole that Phonak does. You can see my is severe/profound. No issues with feedback. Something to note, the vent holes are not straight drilled, they take a bend in the middle. I presume this not only follows the profile of the ear canal, but also lessens external noise from sneaking in, or feedback from bleeding out.

I wouldn’t try to drill it out. There’s a good chance you’ll break the bit off. MTCW

@pkeita said:

I am hesitant to poke a small hole (1 mm?) in the earmolds until I have more information.

Definitely don’t try this, it’s called venting and you need to get the the moulds made, because as stated it’s not like it’s a straight line, they are quite thin as well (acrylic) this is mainly used to help with occlusion or people with good low frequency response, you could well do with small vent .9 to 1.2 no problem, your Audiologist will need to reprogram obviously, only you’ll know for sure if you’d get any further benefits after getting used to occluded fit, using only those two different programs tells me you like some features turned off and directional beam forming of the microphones, so these things can be experimented within Hearsuite, you should work with your Audiologist on getting this sorted, as just jumping in blind may not give the results your looking for, you can always make some changes “after” to tweak them.

In reply to @CaptainTrips

Thanks so much for that info. I had read about diagonal & slits. Was contemplating using either drill or razor blade, but never realized they have a bend in the middle. In hindsight, makes perfect sense what you said. Guess I can’t :rofl:

Any reason you chose acrylic over silicone? I read that silicone could be itchy, but that perhaps a tighter fit against the jaw bone could reduce low freq sound from chewing food. Then again, I have more of a ski slope , thus am more sensitive to low freq sounds from walking and chewing.

I initially tried the softer silicon molds because I thought that they might make a better seal, but found that they got dirty and were difficult to clean. They only lasted about a year. The acrylic molds seal just as well and are easy to clean and don’t deteriorate. They do, however, crack if you drop them on a hard surface, such as porcelain tile. So handle them with care. I haven’t had any issues with allergic reactions to the acrylic.

In reply to @pkeita

@pkeita said:

I had read about diagonal & slits. Was contemplating using either drill or razor blade

A razor blade on acrylic? Drilling silicone?Where did you read this stuff!

Silicone are pretty good fitting wise, a good solution for severe profound losses because a tighter fit with comfort, moves with the jaw, these things your Audiologist should know and discuss with you, I’ve used both and am quite happy with both types.

In reply to @tenkan

Thanks for the size range suggestion! I’m liking some of the benefits of the “occlusion”, but having a conversation while walking or eating is difficult. Am afraid I’ll lose the benefits like increased clarity over the powerdomes. Will try .9mm….only $50 at Costco for new molds.

When you speak of reprogramming, are you referring to ? Are there other variables that might need to be modified going from occluded to tiny vent?

“jumping in blind” ….yes that’s what I did with my old KS9s :rofl: I will try a quick test with eliminating or reducing beam forming in Hear Suite to then see if standard program gives me enough spatial awareness.
Thanks again for the help everyone! I’ll report back after I get the new earmolds.

In reply to @tenkan

Too funny! What I read was someone using razor blades on power domes (soft silicone) to insure better fit. Now that you mention it, the acrylic is quite hard and I can’t even get an indent w/my fingernail. Oh well, that idea to the dustbin.

My fitter mentioned that if I didn’t like the totally occluded earmolds, he could poke a hole. I assumed with a dremel, but perhaps a hot needle. I have no idea. He originally comes from an impoverished country where they improvise to make things work and was trying to be helpful. My sweetie comes from the Philippines, and constantly comes up with ideas to repurpose or give things a second life. I’ll bite the bullet and buy new earmolds.

The problem with chewing while in conversation will not be helped with a vent. I generally choose easy foods that don’t require too much chewing when I’m out. A burger rather

You’ve stepped through a door that is very tempting to me, and for the same reasons: better speech in loud noise, better streaming. I wish you luck. It does seem as others have said that your audiologist can take some of the characteristics you like in your Music program and incorporate them into your “automatic” settings, and potentially other specialized sub-programs for specific situations. For spatial awareness in particular your audiologist can adjust the mix between your aid microphones to make this seem more natural to you. Though it can take a little while for your brain to map these (new, after adjustment) inputs into three-dimensional space that seems accurate to you. All bets are off on that for speech in loud noise setting which are fighting with loud ambient noise all around you in restaurants.

On Streaming specifically (from my own journey, in case you haven’t tried it): with music streaming sources you can often adjust the e.q. at the Source (within the streaming app you’re using) before it hits your hearing aids. Tweaking there, coupled with any ambience/aid-mix slider your aid’s app might have, can reduce the tinny highs and beef up the lows that your fitting probably doesn’t emphasize enough for your liking - again, before the hearing aid processing kicks in. It’s not perfect, won’t sound as good as fully closed earbuds with beefy bass or over-the-ear headphones… but you may be able to make music sound better for you by taming the frequencies that annoy and beefing up the low end at the music source. Something to try.

Edited

OK. Firstly my hearing loss is very similar to yours. Secondly, I hate occlusion. Thirdly, I’ve struggled to get music to be anything other than tinny, especially when streaming.

I’ve experiment a lot in finding the right solution, and I’m getting there.

I self programme, but do have an Audiologist who will make custom acrylic mo(u)lds for me. I have various pairs of Phonak aids, but the make of aids shouldn’t matter much here.

Anyway, I asked my Audiologist to take deep impressions, whilst using a 25mm bite block. The latter ensured a tighter fit, and took away a lot of the chewing issues. I asked for a 3mm vent, to ensure no occlusion. When they arrived, one was near 3mm, the other was much less. So, like you’re considering, I took a drill to it, to make the vents 3mm. This worked, although it’s crude, and on one aid, a little bit of acrylic came off. I sanded the area down. This solution eliminated occlusion. I do have pretty wide ear canals, so there was ‘room’ in the mo(u)ld to do this drilling. I drilled from each end, and met at the bend. The acrylic is clear so you can see what you’re doing. This solution was fine, but music and streaming were still tinny.

I ordered 2 more pairs of mo(u)lds, only with different venting. 1mm, and a very fine pressure vent. I didn’t need new impressions as they had a digital record.

20251209_193211

I thought I could use some aids for just streaming, and others for general use. I soon realised this wasn’t for me, the occlusion was unbearable. So out came the drill again. This time, I researched and bought a different type of drill bit. Using a standard bit, is very rough, even at slow speeds. This is much much better, leaving a smooth finish. Again, I could see the vent holes, so I followed them, from each end, until they met.

20251020_193156

With music and streaming, I’ve found a different solution. I’ve not got it quite right yet, but I can now hear the bass guitar and the drums much better. It can be sorted, by experimenting with the fitting programmes.

In Phonak Target, you can try a few different fitting programmes. Mine default at (Adaptive Phonak Digital). This is fine for general speech, but not music. I tried and DSLv5 (Adult). I found music and streaming much improved, especially with DSLv5 (Adult), however, speech suffered from “upwards masking”. My solution was to make a note of the and Gains in Music & Streaming from the DSLv5 curves, switch everything back to APD, then manually alter the Music and Streaming curves to the DSLv5 (Adult) levels.

I’ve added 3 manual programs:
Calm Situation (APD)
Music (DSLv5 levels)
Speech in noise (APD)

I’ve set calm situation as default (startup), and manually scroll through.

Oh, and make sure you allow overprogramming of gains (above feedback threshold) or you’ll lose clarity.

Hope this helps
Peter

I have vented ear molds. If one gets filled with wax, and becomes occluded, I find I can’t hear as well. I think the tight fit in my ear canal, and the occluded vent, doesn’t allow my ear drum to move as freely. Note: That’s a non-professional answer.

I have worn aids with custom ear molds for 21 years. Over the years the size of the vents have gotten smaller. For me I seldom notice if the vents get clogged but I will notice the second that my get clogged.

In reply to @PeterH

Thanks for sharing your experience Peter…it’s very helpful!

Yes, 35/40db @ 500Hz, so our low frequency hearing isn’t that bad….but it makes occlusion worse.

My streaming improved greatly with complete occlusion, but unfortunately this won’t work for you. You might also try using an equalizer as clayville has suggested as the leakage on the 3mm vents may be pushing the limits of the bass frequencies on your .

Thanks for the great tip about the bite block. Googling said this fitting technique is used particularly for musicians that have open jaw movements like singing and certain instruments. Apparently it’s supposed to improve the seal and minimize occlusion….which you mentioned that it helps when chewing. That would be fantastic!!! :grin:

What do you mean when you say they had a digital record? Was this done with a handheld 3D scanner, or did you do the standard silicone putty? Which would you recommend to get the best seal as this seems key to minimizing bone conduction “occlusion” rattling around in my head.

“make sure you allow overprogramming of gains (above feedback threshold) or you’ll lose clarity.”

That makes sense with large 3mm vents as I assume with our loss, the target s/w will limit you. I suspect that in my case, I notice increased clarity because there were no reduction of gains due to feedback with the occluded ear molds. The power domes had caused the program to scale back. I also find comprehension more difficult when noise is coming in through the vent, so the combination of no reduction of gain in high freq where I have more severe hearing loss coupled with sealing out outside noise works well for me. It’s just that damn occlusion is so loud when chewing that I can’t hear anything else. I’m starting to understand that finding that sweet spot for comprehension vs. occlusion, seems to be unique to each person. Guess when my 500Hz hearing gets worse, this won’t be as much of a problem. :rofl:

@pkeita said:

What do you mean when you say they had a digital record? Was this done with a handheld 3D scanner, or did you do the standard silicone putty?

My first private (UK) Audiologist suggested the bite block, when he had acrylic slimtips made for me. Phonak made these. The impressions were made with standard putty. Phonak must then have scanned the slimtip, and then stamp a code on the mo(u)ld. The deep mo(u)lds were done by Starkey, again with putty, butvlater scanned. I understand that Phonak keep a record on file for 12 months.

Another metric to look at with earmolds is canal length. As the earmold extends deeper into the ear (i.e. closer to the bony part of the canal), the occlusion effect is reduced so you do not have to rely quite as much on vent size. Also, with a deeper canal length you can vent for acoustics with a lesser risk for feedback, and you could expect streamed audio to be more robust.

@PaulC said:

Another metric to look at with earmolds is canal length. As the earmold extends deeper into the ear (i.e. closer to the bony part of the canal), the occlusion effect is reduced so you do not have to rely quite as much on vent size

Ear_Molds_Overall_View

Ear_Molds_One_Bend

Thanks! The benefits of a deep earmold sound great. Less occlusion & less risk of feedback from the vent allowing full amplification of higher frequencies would be fantastic!
Soooo….I Googled :rofl: : “How to know earmolds are as deep as possible?” and got the following response:

Ear molds are as deep as possible when they pass the second bend of the ear canal, sitting securely in the bony portion without causing pain.

I only see a single bend in my current fully occluded ear molds, and they don’t look very deep to me. My recollection was that the original impression was much longer and did have multiple bends. Anybody have any feedback on the depth of my current ear molds?

Is it possible that Philips/Oticon didn’t include the full length providing a stubby ear mold from the impression?

In reply to @pkeita

@pkeita said:

Spatial awareness and directionality has always been a problem w/the Philips 9050, but these earmolds exacerbate the situation. (I believe that’s the reason I prefer using “Music Mode” as this feels more natural at the expense of comprehension)

Another part of the equation is receiver wire length. It shouldn't be too long, the two mics on each should be positioned horizontally, for better front-rear differentiation and better directionality.

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