The human ear comes in many different shapes and sizes, some of them highly problematic when you’re trying to fit hearing aids on them.
Because patients cannot see deep inside their ears, they are unaware if their ears have some peculiarity. As a result, they are not sympathetic with the inherent problem facing the audiologist who is trying to help them here better. They expect from the start that their new hearing aids will be comfortable to wear and easy to insert and remove. If they are not instantly comfortable or are difficult to insert or remove, patients consign the entire category of hearing aids to the “problems” basket.
CANALS WITH SHARP BENDS
Let me tell you about a very good friend of mine, a dear sweet lady, whose friends all call her Grandma. She has moderate hearing loss and very sharp bends in her ear canals (close to the entrance).
When an ear canal has a sharp bend near the entrance, the resulting hearing aid (or earmold) is called a “fish hook” because it can “hook” the ear if you try to remove it by lifting it up from the back. If you remove this hearing aid from the ear incorrectly you push the end of the aid into the canal wall – just like a fishing hook that has hooked a fish. This action causes pain and abrasions of the tissue in the ear canal.
I attempted to remedy this problem for Grandma by having the factory shorten the canals markedly. Only now, I have traded one problem for another. When Grandma inserts one of these hearing aids with their very short canals, she has to pull her ear open and give the hearing aid a little push to get the canal-on-the-hearing-aid to drop into the ear canal. Otherwise the opening on the sound tube misses the “ear” and is occluded by skin. The result is that the hearing aid emits no audible sound.
Another highly problematic ear shape is the collapsing ear canal. When you make a set of standard impressions on collapsing ears, the canal part of the impression has a lot of vertical space and almost no horizontal space. The canal is too narrow to get a standard sound tube through the plastic.
There is no simple solution for fitting these ears. My favorite expert at the earmold lab I use suggests that I make at least two different impressions: a basic standard impression and an impression made while I pull the ear open. In making the second impression, I hold the patient’s ear open while injecting the impression material and then continue holding it open for several minutes until the material has set up.
My earmold lab friend also recommends that I flag orders like this one and talk the situation over with customer service rep before sending the order to the factory. If the tissue in the patient’s ear is flexible, this idea works. If not, you have a tough problem.
TOO MUCH SPACE IN THE OUTER EAR
I also want to discuss ears that have huge amounts of “retention” (deep recesses in the helix and tragus-antitragus area). You become aware of this excessive retention when you find it difficult to remove the impression from the ear.
In these cases, I put extra effort into eliminating all unneeded plastic from the helix area. If I’m using a custom-fitted hearing aid, I’ll order a half-shell or canal instrument (a standard ITE would be difficult to insert and remove). If I’m using a BTE, I will also use the half-shell style mold (a full-shell or skeleton would be problematic).
A GOOD FIT IS WORTH WAITING FOR
Last thought. When I fit hearing aids on a patient, I make sure I can put them on easily and remove them without a struggle. If it is difficult for me, an experienced practitioner, it will be very difficult for the patient, who will become frustrated.
I used to let patients take hearing aids home and try them for a week. That was a mistake. Now, if they are too tight or if there is a problem with the fitting, I send them right back to the factory. Patients may be unhappy for a week as they wait for their new hearing aids, but they will be happy for years to come.