A colleague recently asked me how many earmolds a baby was likely to need from the time hearing loss is identified until they are five. He is an adult audiologist and had been surprised when someone told him it could be as many as 32. It is a good question and one that it helps to consider. So how many earmolds? The first answer is “more than you think”. Audiologists need to recognize that the number is a big one so we can help parents anticipate the need.
Hearing loss is now identified within weeks of birth so we start fitting babies with earmolds very early. And little ears grow very, very quickly (just as the rest of the babies do). Babies ears grow at such a rate that it is not unusual for babies to need new earmolds every 4-6 weeks. (9-13 earmolds in year one). By age the second year, ears grow at a little bit more slowly. So that it might be 8 weeks before a baby needs a new earmold. (6-7 in the 2nd year.)
By the 3rd year earmolds last about 3 months. (4 a year, 12 in the 3 year period from 3-5 years.) (Obviously, if a child moves to a cochlear implant the earmold problem is reduced.)
What do parents need to know
So in the first 5 years babies will likely have as many as 32 earmolds. Can you imagine how confusing that much be to parents? When do you get a new earmold? How do you know it’s time? Should I just come in every few weeks and get a new earmold? Parents need to be the monitors because audiologists are not with babies that often. Parents or therapists need to recognize when it’s time to get a new earmold.
As soon as the earmold starts feeding back it is time to get a new impression. Don’t wait until there is a lot of feedback. If families wait, it may be several weeks before the baby has a new earmold. It may take awhile to get an earmold appoint and then it can take 10-15 days for the earmold to get back. If families do not understand that babies are going to need a lot of earmolds they are going to be surprised when earmolds start whistling.
Understanding why earmolds need to be replaced
Families need to understand that hearing loss is a neurological emergency. If children are not hearing well, the auditory brain will not develop. The auditory brain is critical for learning language, speech perception, speech production, and literacy. If the child does not have sufficient access to sound the auditory brain will not develop.
Technology is the way sound gets in. It is the doorway to the brain. So we need to be sure technology is working well every minute. If earmolds are not fitting well, sound will not reach the brain. Feedback is very annoying. So parents may turn down the volume just to get some relief from the noise. I understand that, but they need to understand that yes, they are turning down the noise but they are also turning down access to language. Not a good idea.
Think twice about feedback control
Feedback control was a very good invention. It works well for a lot of people but not for kids. What feedback control does is reduce the high frequencies. Are high frequencies important? Not just important, they are essential.
About 40% of consonants (sibilants, fricatives…) have significant high frequency information. If we cut the high frequencies we reduce access to high frequency information. That means kids will be missing pluralization, possessives etc.
So no, we cannot cut high frequencies. We need to find a way to work around it. Pediatric audiologists need to develop really good earmold making skills. They need to be able to make a mold that is tight but not uncomfortable. And we need to help parents understand that they need to make sure kids have technology on and working at least 10 hours/day. And we need to help everyone realize we are going to need to make a lot of earmolds in a babies life. And don’t forget, earmolds come in lots of colors, and with sparkles, and with color swirls. Consider them jewelry and they are much more appealing. (We can use the old ones to make jewelry ;-)