If you are working with a hard-to-please patient, I suggest that you introduce two concepts at the same time: maximum comfort (what feels good to wear) and maximum hearing (the fitting that will give the patient the “best” hearing).
When a new hearing aid user is finicky, you need to win instant approval from the person. It is easiest to achieve that with open-fitted hearing aids. However, that is not the appropriate fitting for every patient. In cases where an open fit is not the best choice, I explain both concepts (start with comfort, work toward maximum hearing) to the patient and order sets of “domes” and earmolds.
TIPS ON PROVIDING COMFORT
I recommend that you have a “standing order” at your earmold lab. Mine includes: (1) Always parallel-vent if space permits; never angle-vent or T-vent. (2) Reduce the plastic in the helix area as much as possible (Note, I do not like using the retention in the upper helix area; it causes too many sores). (3) Remove all edges and bumps; I want highly polished, smooth earmolds. (4) If you have any questions, ask “Sam” (the earmold company’s expert at the factory I use). I trust Sam.
Before taking an ear impression, make absolutely sure to pack the patient’s ear canal securely. After packing the ear canal with “otodams” or cotton, use a light probe to test the packing. If it isn’t adequate, you run the risk of causing long-term damage to ears during the impression process.
My favorite earmold material is acrylic, also call Lucite. It is the easiest to work with on all counts: easy to sand, polish, grind, and drill. If an acrylic earmold has a sharp edge, it can be easily removed. I work with a strong vacuum outlet on my grinder as I don’t want to breathe in any of the dust from the sanding. A well-made acrylic mold will last for many years, and it is easy to retube and easy to clean. Most of my earmolds are half-shell medium canal, medium-vent acrylic molds.
If earmolds are not carefully fitted, the patient may return to the office in pain, saying, “I think I’m allergic to the plastic in this earmold.” In my experience, true allergic reactions are rare, while sores in the ear, from edges on the earmold, are common. A true allergic reaction causes all the skin in the canal to become inflamed and turn red. If the redness is very localized, look for a corresponding edge on the earmold. Also, ask your patients if they have any allergies. Patients with severe allergies are very aware of their problem.
I never use coloring in an earmold since some patients are allergic to the dye.
If I have a patient with severe feedback, I make two or three sets of earmolds. Money spent on earmolds generally pays off. Since you never know what type of earmold is going to work best for a patient, you want to be able to use the trial-and-error process quickly—either the same day as the fitting or at least during the first week, and not stretched over several months.
I’d like to conclude by saying that it is possible to fit hearing aids successfully on most patients with hearing loss. However, to do that, they have to give you the opportunity. If the first fitting you give them is disaster, you may not get another chance.
So, try to figure out why the patient is having trouble hearing, and then plan a long-term strategy to address the problem. Ask yourself, “How can I give this patient a comfortable start and an easy-to-use fitting that will help them hear well while eliminating feedback?”