Hearing Aid Domes vs Custom Earmolds | Which one is Best?

Hi guys. Cliff Olson, Doctor of Audiology and founder of Applied Hearing Solutions in Phoenix, Arizona. And in this video I'm gonna teach you how to know if you should be using a rubber dome or a custom ear mold to get the most out of your hearing aids...coming up!

If you've been watching my channel for a while now, then you already know how complicated it can be to hear your absolute best. Even if you have a great pair of hearing aids, there are literally hundreds of different variables that must be taken into account when selecting the most appropriate technology, the most appropriate components, and the most appropriate way to program your devices. And like I say, if you make a mistake and even one of these different variables, it can have a detrimental effect on your overall performance with your devices. One of the variables that I'm going to be talking about in this video is how you couple your hearing aids to your ear canals, and I'm specifically talking about whether or not you use a rubber dome or a custom ear malt. But before I teach you how to select the right one, if you could do me a huge favor and click the like button, it really helps out my channel because it gets these videos in front of a bigger audience.

And while you're at it, if you have not yet hit that subscribe button with notification bell, go ahead and do that as well, because that ensures that you never miss one of my newly released videos and I release multiple new videos every single week. That being said, I really appreciate it. Now let's take a look at why there's even a debate between rubber domes and custom ear molds, and make sure that you stay tuned to the end of this video because I will be giving you audiogram examples to help you understand why you should be going with one or the other. Receiver and canal hearing aids have been extremely popular for a while now, and they're the most widely used style of hearing aid on the planet. They are so commonly recommended by hearing care professionals because they are extremely comfortable. They can fit a wide range of hearing losses.

They have a ton of great features like Bluetooth connectivity and rechargeability, and they're even quicker to fit because you don't have to wait for a custom product. That's because you can use a rubber dome on the tips of these hearing aids like you see right here. But not only can you use a rubber dome on this style of hearing aid, you can use one of those custom ear molds like you see right here as well, which allows you to fit a wide range of hearing losses between both of these. So the question then becomes why would you actually want to use a rubber dome instead of a custom ear mold? Let's go ahead and get into it. Rubber domes are by far more popular than custom ear molds, not because they're always better, but because they're much easier for a hearing care professional to fit much quicker.

Domes come in a variety of different sizes all the way from small to large, and they come in a variety of different styles as well. Going from an open fit to a vented fit to a closed fit, all your hearing care professional has to do is select the most appropriate dome for your ears and for your hearing loss, and they could technically fit you with a pair of hearing aids the exact same day that you get your hearing tested. Domes are also typically very comfortable because they're made from a very soft silicone and they can bend and contour to your ear canal shape acoustically. Rubber domes are typically more appropriate for individuals who have a mild to moderate level of hearing loss with that hearing loss being primarily in the mid and high frequency ranges with normal low frequency hearing. This is because rubber domes, especially open invented styles of rubber domes are such a good option because they typically allow in the low frequencies that you can hear naturally already and just supplement the mid and high frequencies depending on the level of hearing loss that you have.

And it does a very good job of preventing a phenomenon called insertion loss, which is something that you experience if you plug up your ears with something. This then allows the mid and high frequencies that are being amplified by the hearing aid to combine with the natural low frequency sounds that are entering into your ear canal unaffected. Now, if you do happen to have a low, mid and high frequency hearing loss and you're in a pinch, you can use a closed dome or a power dome to try to trap in the low frequency sounds as well. I never typically recommend this dough if you can help it. Rubber domes are also very easy to replace and exchange. So if you wear out your dome, you can just put on another one, or if your hearing loss changes, your hearing care professional can grab a different style of dome, attach it to your hearing aid and reprogram your devices for you.

Even though rubber domes are extremely critical to the performance of your hearing aids, they are still very cheap. So if you have to replace them often it's not gonna hit you in the pocketbook very hard. But as great as rubber domes are for a lot of individuals with hearing loss, custom ear molds can oftentimes be even more appropriate. So let's go ahead and take a look and actually see what a custom ear mold is. Custom ear molds are made by either taking a physical impression of your ear and ear canal using a form of injectable silicone or gel that solidifies after three to four minutes or a 3D ear impression with a laser scanner to create an instant digital image of your ear that could be sent to a manufacturer For custom ear mold fabrication. Custom ear molds typically outperform rubber domes for more complex cases of hearing loss and more severe cases of hearing loss.

This is because you can do a much more precise job of trapping amplification inside of your ear canals when you have a custom molded earpiece that is made specifically for your ear canal anatomy. Custom venting inside of a custom ear mold is also another reason why a custom ear mold can outperform a generic rubber dome. By being able to control the exact vent size, your hearing care professional can determine which sounds they want to allow to enter into your ear canal naturally and which sounds they want to be amplified by the hearing aids, all while preventing whistling and feedback. The ability to restrict which sounds enter into your ear canal naturally. Also allow your hearing aid to do a better job of noise reduction and directionality, so you can cut out a lot more background noise. Wireless music streaming almost always sounds better with a custom ear mold because custom ear molds allow you to trap in the low frequency base tones.

So music sounds much more rich and full. If you use a rubber dome, a lot of these base tones will just leak outside of your ear canals and you won't even perceive them. Not only do custom ear molds give you more precision when programming and trap in more low frequency sounds for better music streaming, but they also have better retention as well, because if a custom custom ear mold doesn't wanna stay inside of your ears, you can add on canal locks, you can add on helix locks, and you can even add on skeleton locks to make sure that those hearing aids never fall out of your ears. Now, you might be thinking to yourself, there's gotta be a visual difference between a rubber dome and a custom ear mold while you're wearing them. Well, I'm gonna go ahead and put in a rubber dome inside of my left ear canal here, and I'm going to put a custom ear mold inside of my right ear and let you decide for yourself which one looks better and if they have a big difference between them.

So this is the open dome on this side, and then this is the custom ear mold on this side. So if you ask me, I think that they look very similar When you look inside of someone's ear canal, both of them are relatively inconspicuous and you probably cannot even tell a difference when you're looking at me head on. Now that you have a basic understanding of rubber domes and custom ear molds, let's go ahead and take a look at some different audiograms to show you what I'm looking for when I'm selecting which type of ear coupling to go with. And let's go ahead and start with the rubber domes first. In general, when looking at an audiogram, I'm always the most concerned with what speech information is able to make it to the brain without amplification, and what information is not able to make it to the brain without amplification, as well as how much amplification would be required based on the severity of a particular hearing loss.

Any of these speech sounds that are below the X's and the O's are able to make it to the brain without any assistance of a hearing aid. Any of these speech sounds above the X's and the O's, however, require amplification to return them back to the brain so they can be heard. In the case of this mild high frequency hearing loss, an open rubber dome would be the most appropriate because they would allow the low frequencies to enter the ear canal naturally and allow the hearing aid to amplify the high frequencies enough to make them audible again, all without the risk of feedback or whistling from the hearing aid as long as the hearing aids are programmed properly using real ear measurement. Now, if you do not know what real ear measurement is, I highly recommend that you check out my video that I will link in the description because being able to determine the acoustic differences between a rubber dome and a custom ear mold are impossible unless they're being measured inside of your ear canals.

In the case of this mild mid frequency to moderate high frequency hearing loss, a vented dome would likely be most appropriate because it would not restrict the good low frequency hearing, but would allow for better amplification of the mid and high frequencies. And the unique case of a reverse low hearing loss, either an open dome or vented dome, is also often the most appropriate despite the inability to be able to amplify low frequency sounds. Without a closed dome or custom ear mold, going with an open or vented dome will prevent the upward spread of masking that can easily occur with reverse slope peering losses, and totally destroy your performance. Now, reverse slope peering losses are very complicated, and I do have another video where I discuss how to treat a reversal hearing loss, and of course, I'll link that in the description as well. All right, let's go ahead and take a look at a few hearing loss examples that would be more appropriately treated with a custom ear mold instead of a rubber dome.

In the case of a moderate flat hearing loss, we need to be able to trap enough low, mid, and high frequency amplification inside of the ear canals so it does not just leak out substantially limiting hearing aid benefit. A custom ear mold would do this extremely well as long as the proper vent size is selected by your hearing care professional and again, verified using real ear measurement. In the case of a steeply sloping high frequency hearing loss, a custom ear mold with a custom vent size is also most appropriate because it can allow for the low frequencies to enter the ear canal naturally, but without the vent being so large that it allows the hearing aid to whistle because we need to amplify the high frequencies so much. This can be a tricky hearing loss to treat, but it is much easier to do with a properly fit custom ear mold.

In the case of a severe to profound hearing loss, it is critical to use a custom ear mold either without event or just a very small pressure vent to ensure that enough amplification is retained inside of the ear canal. Attempting to fit a hearing loss severity such as this with a rubber dome would be in extremely poor decision and ultimately a waste of a good hearing aid. All right. Hopefully me going over these different types of audiograms helps you understand a little bit better if you should be using a rubber dome or a custom ear mold at the end of the day. In order to correctly identify whether or not you need a rubber dome or a custom ear mold, it comes down to your understanding of acoustics and if those acoustics have been verified inside of your ear canals using real ear measurement, ideally, you should be able to rely on your hearing care professional's recommendation of whether or not you should be going with one versus the other, but you have to make sure that you go to a hearing care professional who knows what they're doing, because in my opinion, rubber domes are way over-prescribed for most types of hearing losses that are out there, and there's a lot of benefit that's just leaking out of people's ears.

So the next time you get a new set of hearing aids and your hearing care professional is fitting you with those devices, make sure that you ask them why they selected a rubber dome or a custom ear mold so you can make sure that you hear your absolute best. That's it for this video. If you have any questions, leave them in the comments section below. If you like the video, please share it. If you wanna see other videos just like this one, go ahead and hit that subscribe button. Also, feel free to check out my website, HearingUp.com.