Domes, earmolds, and wires

Hearing Aids
#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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#37

Interesting. What they are calling the “cap dome” looks somewhat similar to the Signia sleeve, but it appears to only come in one size.

image

#38

@Sierra, the cap dome is a very tiny thing that just fits over the tip of the RIC receiver to make it a little less scrapey and wax-hungry as you insert it. I’m going to ask for some of these from my audi to see if I can get stable deep insertion with an open fitting (I’m tuned now for open domes but the medium open dome doesn’t really work right and I lost my sample of the small open domes).

#39

I have forgotten. Is your fitter Costco? If so they probably would give you some Rexton/Signia sleeves to try to see if they fit. Or, they may know there is no hope of them fitting. The Rexton receiver is about 0.083" in diameter, in the area where they click into the fitting.

#40

The responses to my post about “domes,earmolds amd wires” have been extremely
helpful - it is useful to know this is a common problem,
and to hear about possible solutions.
I can not quite visualize how the click sleeves can
be inserted deep enough into the canal. The shape seems too wide to sit in the
canal. As others have stated the receiver hanging out
just at the entrance to the canal does not work;
I wonder if this click sleeves would work with starkey LIvio or resound aids–
Also I would like to know if the RIC insertion tool by jrhaggis is available
Many thanks!

#41

They come in 4 different sizes. I tried the XS, Small, and Medium, and decided on the Small. On the XS size the vent comes out the side of the sleeve.

image

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#42

Unfortunately, not Costco. It’s Kaiser Permanente. But I’ll ask them about Rexton/Signia sleeves.

I happen to have a caliper here. I have a Phonak 3M receiver, and the outer diameter at the fitting flange is 3.25mm (0.128") where the inner diameter below the flange is 2.25mm (0.088"), so it sounds like they may be compatible.

#43

They may work. The Rexton receivers make quite a firm feeling and loud click when they snap into place, and are also somewhat difficult to remove. You have to be very firm to get them out. Not sure if there is metal or some hard plastic in the sleeves that they “click” into.

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#44

Two observations:

  1. It looks like most users in this thread are using RIC aids, while I am using large tube BTE. But since I posted here before (Nov 14). I’ll follow up with this.
  2. It is evident that everyone’s ears are different. Different dome retention solutions work for different people.

My post: After making custom tube elbows, with a non-standard angle, dome retention was greatly improved, but not perfect. Using the same technique, I make some custom “S” shape elbows, which solved the problem for me.CustomElbows-S.pdf (102.4 KB)

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#45

@david3, you’re absolutely right. And whether it’s BTE or RIC, the geometry is extremely important.

I really liked your document and your custom modification.

What I finally found after weeks of messing around with oto-endoscopes and bending of the wires is that the retention works a whole lot better if your tubes/wires are naturally pointing into your canal. If they aren’t, the domes will keep popping out because the supporting structure puts lateral tension on them.

What pisses me off is that Phonak plays dumb about this, and gives me a single wire shape that is completely at odds with my anatomy. Even my audi wasn’t aware of this. It took me months to figure this out on my own.

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#46

Phonak evidently has a one-size-fits-all for geometry. We were fortunate to be in the one size that fit! :sunglasses:

However they do have different wire lengths that evidently all point in the same direction. My audiologist measured both of us carefully and the length and direction fits each of us perfectly.