Domes, earmolds, and wires

Hearing Aids
#17

saburman, I can TOTALLY relate to your situation here. Three years ago, I transitioned from the hard plastic, custom molded ITE aids to RIE aids with the earwires attached to the unit behind my ear. I’ve tried double power domes, tulip domes, custom molded silicone molds - you-name-it, I’ve tried everything but titanium.

Here’s what I’ve come to realize: wearing receivers in the ear is like having a pair of glasses on the nose. You just have to reconcile yourself to pushing them into the canal 100 or more times a day. I know it’s irritating, but I’ve not seen one single device to keep the receiver and dome IN the ear, seated snug for optimum hearing and comfort. If you jam the mold in, you’ll have a compression sore at day’s end. If you wear a softer dome, it’s gonna come out as you articulate all day long: eating, smiling, laughing, yawning, sneezing, talking - all of these movements just work on the receiver to loosen it from the ear canal.

I’ve tried leashes of various length, even 3M medical tape to TAPE the earwire right next to my ear canal - nothing keeps those receivers from sloooooooowly working their way out. In humid climates, I can’t get any kind of receiver into my ear; in dry climates, the receivers slip out over the course of the day.

I’ve fantasized about laser-imaging my ear canal to get a mold that sits in that canal like my own SKIN - but I’ve simply never found anything out there that is a total fix.

Not that we should stop looking, but like a revelation, I finally GET it: don’t expect the receiver to stay in your ear all day! Accept that like eyeglasses, it’s gonna need to be gently pressed back in over and over.

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#18

Kate and I both have Marvel M90-R’s. I recall when we went in to the audiologist for testing and fitting that she carefully measured our ears. The fit we have is just right and we’ve never felt the need to try to adjust the wires or change the shape in any way. Maybe we have standard ears, I don’t know. I only know that after almost a year the fit seems to work just as it should. And she did spend a lot of time measuring with her ruler and making notes before ordering.

#19

Did she use the ruler to measure the EAR wire?! Cuz my audi just put on a long one, and it juts out with a BIG elbow bend. That is why I sometimes tape it to my ear. Drives me nuts, cuz it snags glasses, combs and my fingers. He seems strangely set against every changing it tho, cuz I’ve asked him to do so a few times now. Feh.

#20

The ear measurements for the Phonak RIC “wires” only pertain to the height from the entrance to the ear canal up to where it wraps around the top of the helix to go to the electronics behind the ear.

They have NO measurements, variants, or guidance for how it fits where it enters the ear. Nor was my audi very savvy about it.

The normal Phonak “wire” bend at the end directs the receiver backwards and slightly down as if to point into the canal in that direction.

My ear canals go decidedly forward and slightly upward. In other words my canals are at almost right angles to the natural direction of the receivers due to the one and only wire bend shape Phonak supplies.

As a result, nothing will stay in my canals. Any some I’ve tried immediately works its way out and then turns to point right into the flesh of my outer ear behind the tragus. Not very good acoustics there.

After straightening the “wire”/tube bend through painstaking exercises with tweezers, I’ve finally got them pointing more forward. So far they seem to be staying in more.

This is why I wish Phonak paid more attention to this.

#21

There’s one much more simple thing you can do to check one critical issue. What I did was to stick a q-tip a little ways into my ear canal and looked at it in the middle to see how it was pointing.

If it’s not going in down and toward the back of your head, the Phobak RIC wires are going to be constantly wrenching the drones from your canals.

Give it a try and see if you canal goes forward or backward, and slightly up or down.

#22

Yes. That seems to be what the audiologist did. She measured both Kate and me, went to her desk and wrote things down, and then came back and measured us both a second time. Even though it was a year ago, I definitely remember that process.

The wire lays flat against the side of my head and then flat against the entire inside of my ear and then flat as it enters the ear canal. Nothing sticks out anywhere that could possibly get caught on anything. When I put my HA’s in, I was taught to push them all the way in until the wire was flat to the side of my ear.

I have to look very carefully at Kate to even be sure that she has her “ears” on, as she calls them.

Here’s my wire in my ear…

IMG_20191117_224536
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ReSound Omnias with M&RIE Receivers
#23

Now that I have my wires pointing in the correct direction, the old-style open domes work, but the Widex tulip domes I got a while ago also work.

But how to get them in my canals without kinking the tube every time and weakening the wires?

Tonight I designed and made an insertion tool to push the RIC receivers into the ear canal to your desired depth, with no stress on the wires.

Here are a couple of photos and the link to Thingiverse in case you have access to a 3D Printer.

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#24

Haggis, I’d like to order two of these, one for Kate and one for me. Let me know the price, including shipping. :sunglasses:

#25

That’s a neat idea, Haggis. But just a caution on using such a device. I’m currently recovering from a left external ear canal infection. And in researching what factors might contribute to a fungal infection such as I had, besides humidity and ear pH, a major culprit cited in two different reviews by M.D.'s was scratching or roughening the ear canal lining, exposing and potentially wounding, however lightly, flesh under the ear wax, etc. The reviews cited things like Q-tips and hearing aids as a source of ear infection, presumably because of the abrasion a user can cause by roughly inserting them into the ear canals. See links to reviews in following post: Dryers - actually helpful, or not?

One relative advantage of the custom semi-hard silicon molds that I have is that I can gently push them into my ear canals by pressing on the outer surface of the molds - no need to use the wires and the molds have a knobbed plastic “stick” or “wire” attached to each to gently pull on for receiver-and-mold removal.

Gary’s wire shaping is fantastic. I should bring his picture into my audi and tell her I want mine done like that!

Edit_Update: Occurs to me, too, if one’s receivers are continually slipping out and if one has to keep pushing them back in all day, that’s going to be a source of skin irritation and possibly lead to infection, so trying the various remedies that folks suggest in this thread or seeing what one’s HCP can do to remedy the situation is probably a good idea.

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#26

Wow lots of great posts here about the fit, insertion, removal and comfort of domes. I am guilty of the abrasion-related irritation in my ear canals. I DID notice that wearing the custom silicone molded domes were the least irritating BUT would lead to compression sores due to fit (and me pressing them in to much). I am back to wearing the softer silicone double domes - made especially for Marvel receivers. They feel comfy, but I find I still want to press them in throughout the day. MY BAD.

TraderGary, your audi is a remarkable anomaly! I am definitely taking a picture of THAT EAR to show my aud-guy. I just don’t get why my ear wires have to poke out like a goofball’s all day long! This can’t be rocket science, and given the “memory” quality of the wire, I’d hope that once they’re measured correctly, they’d curl right into that ear with a perfect fit.

#27

Your points are well taken, Jim. I thought of that even as I posted this.

I’ve had a lot of people tell me that with my mild/moderate loss, open domes of some kind are really acoustically the best for me. My problem is finding some that will give me some performance by staying in place in the proper position.

Regarding the last point, I think that’s the key problem for a lot of people on this thread. And the crux of the problem is that most of the HCPs AND the manufacturers are blithely apathetic about the issue. My audi thinks that it’s OK for the open domes to seat in my outer ear just outside the canal, right behind the tragus, pointing right into my skin. I can’t get any acoustic performance out of that configuration.

Gary’s audi sized the wires vertically (it’s the only option sanctioned by Phonak). That does nothing for the anatomical shape which critically determines how and where the domes seat. Gary’s audi also gave him tulip domes which Phonak doesn’t support. Maybe they did other creative things (not supported by Phonak). Unfortunately, it seems like few of the HCPs are as resourceful, creative, and dedicated as Gary’s.

I’m trying to get some experience and information before I go back to the audi because I have to be the one driving this.

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#28

I have the KS8’s (Signia/Rexton) so this may not apply to yours. But, I asked for three different sizes of click sleeves to try for an extended time at home; XS, S, and M. The XS sleeves were the most comfortable, and did stay in place well. However, they gave me the most feedback. The M size had the least feedback but were the most uncomfortable. In the end the S size was not perfect but it was the best compromise.

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#29

Thanks, Sierra.

Phonak has something like that; I’ll have to check it out. Maybe with my lower gains for my lower losses, the feedback won’t be a problem.

What gives a “click sleeve” its name? Like, what does the “click” refer to?

#30

The click part seems to apply to all the off the shelf fittings, and to even the molds up to the P power. The receiver just snaps in place with a click. The sleeve name probably comes from the shape of the fittings. Instead of looking like a mushroom they are just a hollow sleeve. The other unique part is that they are oval shaped rather than round. They look surprisingly like the custom mold shape i got. The difference is that the sleeves are very thin and flexible, while the molds were solid and not so flexible, even though they were made from silicone. Here is a bit of a write up on them. I think they are a good idea. If you believe Signia the closed sleeves provide more feedback isolation than even double domes.

Signia Click Sleeves for RIC fittings improve audiology and usability

#31

Thank you.

It sounds like the Phonak equivalent is their “c-shells”.

#32

do all the different brands of HA’s use different receiver wires? or can these click sleeves be used on HA’s other than Signia?

#33

No, if I understand the c-shells, they are custom molds for the physically larger ultra power Phonak receivers. That is totally different than the Signia Sleeves. The sleeves are off the shelf and made for the three lower power receivers. Unlike a custom mold, they are very light and flexible. I think the first ones were a clear silicone and now they are smoky color. Here is an image of what may be a clear one and you can kind of see through it. They are like a tiny flared cup with the walls being very thin and flexible. The standard receivers click into them. They are not symmetrical and that little tab you see on them goes on the side of the receiver that has the size and power specified like 3M.

image

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#34

The sleeves are independent of the receiver and wire. They fit the Rexton and Signia S, M, and P receivers. They snap (click) quite tightly into the sleeve. I don’t know if they could be used by other manufacturer receivers. Your would have to compare what the end of the receiver looks like compared to the Signia/Rexton ones.

#35

I think there is some de-facto standardization, or at least enough similarity in the exit diameter of the receivers (it’s hard to make them any other size/shape) and combined with the pliancy of most of the domes, there’s some interchangeability.

For instance, I’m using Widex tulip domes on my Phonak Audeo/Marvel receivers.

#36

You’re right. I was mistaken. I found a more informative document that we might find interesting on this thread. It’s a fitting guide for HCPs. It has better pictures of all the domes, molds, and shells. It also specifies the measurement process that the HCP uses for physical fitting.

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