Widex Evoke Custom Mold popping out

[Bones]

I have a Widex Evoke hearing aid. I’ve had it for less than a year – my first hearing aid ever at age 56 – and my hearing continues to decline. It is in the profound range of loss in both ears, one more so than the other.

I will likely get a cochlear implant later this year . . . but hoping to avoid that if at all possible.

My question for now is – I am trying to maximize the positive impact of my hearing aid and recently got a custom ear mold with the wire portion being of the higher power. It definitely helps boost the effectiveness of the aid. Before the custom mold I was using a Double Ear Tip. The custom mold is not staying in place in my ear. Within minutes of putting it in it begins to pop out and sometimes almost falls right out of the ear. More frequently, it pops out about a quarter of an inch and remains in that location.

When this happens I hear more poorly because the aid is not optimally positioned, and it also looks lousy (the “elbow” of the wire sticks out and looks much less discrete).

I have shared this concern with my audiologist and she said there is nothing she can do, no anchor or other device to hold it in place, and my only options are to deal with it as is or switch back to the Double Ear Tip which will probably mean I’ll hear less.

Any advice? Anyone else deal with a similar problem?

Thanks!

[jim_lewis]

I don’t have much experience, having just got my first HA’s and my first earmolds in the last few months. But I had hard silicone molds made by ReSound. They actually seem to be made just a tad larger than the dimensions of my ear canal and were made from a 3D scan of an impression (injection of silicone molding plastic). When properly inserted, the outside seems to be a few mm below the plane of the concha area surface and the molds go 15 to 16 mm into the ear canal. So the first section of the ear canal is cartilaginous and somewhat elastic - so I seem to have to stretch my ear canals just a bit to get them in (I pull up and slightly out on the upper back portion of my ear lobes both on inserting and removing the molds and I do it by an off-and-on tugging motion since I’m unsure exactly how much tugging is best). Nevertheless the tension of my ear canals gripping the molds holds them rock steady in place. The small plastic string with a bulb on the end used to pull them out has to bend a bit, too, against my ear lobe when the molds are inserted to perhaps that slight pressure of that plastic also works slightly like a concha lock with its slight springiness helping to press the mold against the other side of my ear canal and creating additional friction. With domes I had concha locks that couldn’t seat properly in my “antitragi,” since I have little or none but strangely, I have never had a problem with either domes or molds slipping out.

I have attached a picture of my right ear mold. The red arrow is pointing to a notch and protrusion in the upper part of the mold, present in both molds, that may be designed to catch the mold when inserted on the crus helias arch of the ear lobe that crosses the lobe from front to back just above the concha area, either that or to keep me from trying to insert the molds too far. Haven’t figured out which.

Image of crus helicis (“crus helias” is Dillon terminology in 2012 HA book)
https ://en.wikipedia.org/wiki/Helicis_minor#/media/File:Slide3COR.JPG
By Anatomist90 - Own work, CC BY-SA 3.0, File:Slide3COR.JPG - Wikimedia Commons

[MFAUD]

If there is not one on there already get the clinician to remake the shell with a canal / concha or skeleton lock and will fit in much better

[NateS]

The custom mold is not staying in place in my ear. Within minutes of putting it in it begins to pop out and sometimes almost falls right out of the ear. More frequently, it pops out about a quarter of an inch and remains in that location.

When this happens I hear more poorly because the aid is not optimally positioned, and it also looks lousy (the “elbow” of the wire sticks out and looks much less discrete).

I have shared this concern with my audiologist and she said there is nothing she can do, no anchor or other device to hold it in place,

She should have the earmold remade with a canal lock at no additional cost to you.

[dusmith1.ds]

I agree they need to try a different style of mold I have a semi skeleton that holds great as long I have it sitting correctly

[jim_lewis]

I have attached a picture of my right ear mold. The red arrow is pointing to a notch and protrusion in the upper part of the mold, present in both molds, that may be designed to catch the mold when inserted on the crus helias arch of the ear lobe that crosses the lobe from front to back just above the concha area,

Decided to investigate further what makes a (ReSound) mold stay in so well. It does appear that the top of the mold indicated by the red arrow in the previous picture is deliberately caught below my crus helicis - arrow #1 in picture below. But there appear to be two further features (at least!) that aid in retention. #2 is that the springiness of the receiver wire embeds itself a bit into the inside of my tragus, creating additional friction against movement. #3 is that I mentioned in my previous post above, the removal knob and plastic string have a certain springiness and they are also bent against the inside of my tragus with the knob just sticking down below the bottom edge of the tragus (little pearly blob). The stiffness of the plastic “thread” pressing against the inside of the tragus/concha valley restricts movement. I don’t feel any of this. I have zero sensation of anything in my ears talking, chewing, yawning, whatever. And I am a relative scrawny, -er, “sinewy,” guy so it’s not like I have a tremendous amount of adipose tissue for stuff to dig into.

So my mold impression when taken filled the whole concha area and probably the cymba of concha area, too (at least - see figure in post I’m replying to). I guess that gives the folks who actually design the mold from the impression a good idea of what in your ear canal and concha region that they can use to make a mold that will actually stay in your ear canal. I guess the bigger the mold you might need to keep things in place, the bigger the impression required.

Another neat thing about having a translucent silicone mold that has no color is the mold “transmits” the darkness of the interior of my ear canal to the outer surface of the mold. So one just sees the ear canal as a “dark place” with a wire running into it.

Edit_Update: Earmolds and More: Maximizing Patient Satisfaction Michael West Earmolds / Impressions Hearing Aids - Adults Hearing Aids - Children Pediatrics 850

[skyemac11]

I’ve been told it is quite common for Widex custom molds to extend out too far. And the reason I haven’t pursued it
in the RIC type.

You can go the largest double dome to also get a good seal. This might help😊

[parth_p]

First skin coloured open tip is bullshit. Go for hard earmould if ho receiver used.

[Bones]

Hey can’t thank you all enough for those detailed and wise comments and suggestions! Many many thanks!! So I will ask her about a new mold with the addition of a a canal, concha, or skeleton lock.

Regarding the option of a double dome instead . . . my memory is that I did not hear as well with that (less sound quality and volume) thus the reason why we gave the custom mold a try. Is it generally the case that a custom mold will give a superior outcome compared to a double dome? Trying to determine which of those approaches is the best investment of time and energy.

Thanks again!

[JeffBowser]

Ear-locks never helped me. What worked well for me is requesting that make the mold slightly oversized and WAY deeper (longer) than they usually do. To get that, I had to refuse molds twice until they made one long enough. The wee stub they do by default had the same issues you describe.

[skyemac11]

If it’s oversized a bit it will. You will rely on your HAs mics not your residual hearing. Also you have tolerate the possible occlusion. They are not vented like molds
could be. Ask for another company’s. mold, it sounds like heresy - but why not?
Some make better molds than others.

[Bones]

Great suggestions. Yeah mine is definitely shorter than I thought it would be. About half the depth of the one Jim’s photo shows in the first response to this thread. Slightly oversized and way deeper sounds like a winner – every bit that mic goes in deeper seems to make a real difference in how well I hear.

Skyemac Could you clarify what you’re saying please? Not clear what you’re saying regarding hearing through mics vs. residual hearing, and possible occlusion. Thanks.

[skyemac11]

The oversized double domes would give a complete seal. Therefore, only the on board mics, two at least would give you the sound.

The occlusion effect is when you hear your own voice bassy and the complete seal feels uncomfortable. Also other sounds are enhanced to have a lot more
bass in general. Some hear booming or hollow sounds. This why they vent molds and custom HAs

[skyemac11]

Oh yeah, the receiver NOT the mic goes into your ear. The mics are on top and face of the HAs.

[jim_lewis]

my hearing continues to decline. It is in the profound range of loss in both ears, one more so than the other.

The oversized double domes would give a complete seal.

Double domes might give a complete seal but I think that I read in Dillon (2012 HA book) that domes do not have the sound “opacity” of molds so probably wouldn’t work as well as molds to seal sound in, particularly low frequency sound, when one is reaching the limit of high-powered receivers and almost at the point of needing a cochlear implant. Can’t find a page to quote now so may be wrong.

[jim_lewis]

About half the depth of the one Jim’s photo shows in the first response to this thread.

Because you mentioned wire in your OP, I have been assuming you have an RIC rather than sound tube configuration with your BTE device (wouldn’t a BTE with sound tube fitted to a mold allow for more power?). But I’m amazed if your molds are half the canal length of mine (mine are ~15 mm in depth length). If you look at the first picture I posted, the receiver occupies most of the length of the mold - and I’ve wondered because of the limitations of fitting that type of mold whether the receivers do not end up positioned a bit further away from my ear drums than when I was wearing domes - the wires stick out a bit more from the plane of my ear lobe than they used to. So are your molds really only ~8 mm (~1/3 in.) in depth length?

[Bones]

Ok I am going to try to take a photo of my mold, and entire hearing aid, to give you all more of an idea of what I’m talking about. Let’s see if I exaggerated on how small it is. May have a little but I will hunt down a ruler.

[Bones]

And the question of double dome vs. custom mold and does the custom mold give better sound quality and power for someone with a profound loss is something I’d appreciate more comments on.

[Bones]

[Bones]

Hope those 3 photos help. The mold is 3/8 of an inch deep.

Is that a shallow mold?

Would I be better off with a different type of aid?

As mentioned earlier I am in the profound stage of hearing loss and will likely have CI surgery in the summer. But every week of hearing better in the meantime, and during healing, recovery, and auditory therapy, is worth every penny.