Over the years, a common discussion encountered in clinic has been surrounding the infamous earmould. Working with individuals suffering from predominantly severe to profound hearing losses, my personal experience highlights a general lack of knowledge about this component of the amplification device.
A well fitted earmould is paramount to a successful fitting appointment and subsequent acclimatisation period, if the audiologist wishes the client to use the device every day. If we consider the consequences of various client earmould conundrums, I will share with you a few suggestions which have helped in my clinic.
For most people, learning to insert a mould is not so simple. It is useful to explain to the client the purpose of the mould and how it needs to sit properly in the ear for optimal hearing to occur while using the hearing aid. Savvy Audiology strongly recommends showing the client different earmoulds in the initial aid discussion appointment. I have my own set of dummy moulds made in each of the different materials. It has proven extremely useful to have something tangible – let the client feel the mould material. For clients who may also be vision impaired, having something to feel is most beneficial and helps to build trust.
Whilst the audiologist ultimately makes the decision about which mould will suit best, I find it more engaging for the client if they can understand what is going to be placed into the ear and how it may feel. On so many occasions I have met clients who know very little, if anything at all, about mould options.
In front of me now I observe at least ten different mould styles offered by one manufacturer. That is a good range to choose from and yet rarely is the client engaged in a discussion about the style of mould that is recommended, if it is mentioned at all. It does not take much time to compare hard acrylic and soft acrylic mould materials, highlight the basic differences and why you recommend one over the other. It is the client who must wear the mould, not the clinician, so involving them in mould choice appears to be in their best interest and of course, promotes person centred care and shared decision making.
Common problems associated with the earmould
- the client cannot insert the mould correctly
Practising mould insertion in the clinic usually proves valuable to the client despite the frustration of sometimes multiple false attempts. I usually put myself in the shoes of my client- would I want to sit in a room with my audiologist hovering right next to me ensuring I get this thing in my ear without taking up too much clinical time? The answer is of course no and my approach has always been to demonstrate – be it visually or via touch if vision impaired – and then move away so the client can attempt the task independently. If a family member is also present, ensure they are familiar with the insertion technique too and in addition, understand the sensitivity of the skin and cartilage in the ear. Watching me insert my own dummy mould provides a great visual also for the client.
- the mould feels bulky or loose, the surface of the mould is rough, the mould rubs and is causing irritation
A common occurrence in hearing clinics is addressing earmould discomfort. Especially for first time users, having something in the ear is not natural and we need to reassure clients that it may take some time initially to become accustomed to the device. Of equal importance, is confirming their complaint as justified and common for first time fittings. Often, a solution can be found quickly over the counter so to speak – maybe it needs to have a piece ground off or a section sliced off completely. These two options however, must be performed with great care and attention to detail. A rough surface on an earmould will likely cause further discomfort and all staff in the hearing centre need to be fully appraised of the techniques for mould alterations.
Savvy Audiology recommends offering a new mould (with an explanation from an audiologist if required as to why the change is recommended) if the client is still frustrated or concerned about the fit and comfort of his or her mould. Sometimes the moulds just do not fit well and no amount of grinding or slicing is going to solve the problem. Person centred care dictates that we do everything in the best interest of our client. Although timely for both clinic and client, ‘quick fix’ solutions are not always going to resolve the issue
- superior mould fit for clients with severe to profound losses
A brief note on clients with more severe losses who depend so much on their hearing aids and moulds. If they approach the front counter complaining of mould discomfort, please do not get involved in the trivial nature of trying to make a quick alteration. Instead, check the age of the mould and if older than 12 months, order a new mould. For clients who may live remotely, order a spare set of moulds. For these clients, having a dependable set of well fitted moulds is essential. It is really non-negotiable for them and we need to consider it as such.
Great article. Very informative.
Melda