2/23/2018

Hearing
Aid
Center HAAP Workshop #8

Lessons 29 - 32

Objectives
Learners will be able to:
• Demonstrate knowledge of a standard for the electroacoustic performance analysis of hearing
instruments
• Evaluate a candidate’s audiological, lifestyle, and budgetary considerations in the process of
recommending appropriate amplification solutions
• Defend your recommendation(s) for amplification options for each patient/client.
• Adapt your amplification recommendations in consideration of the patient’s/client's’ impairments
• Understand and respect all patients’/clients’ perceptions of the impact of their hearing loss on
activities of daily living and their desire to accept an action plan for auditory rehabilitation.
• Demonstrate all proper sanitary procedures and precautions for ear impressions
• Demonstrate safety and proficiency in making ear impressions
• Evaluate ear impressions for accuracy

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Lesson 29

HEARING INSTRUMENT ELECTROACOUSTIC

MEASUREMENTS (ANSI STANDARDS)

ANSI/ASA Hearing Aid Standards

ANSI = American National Standards Institute
ASA = Acoustical Society of America
ASA’s Mission
To generate, disseminate, and promote the knowledge and practical
applications of acoustics.

ANSI’s Mission
To enhance both the global competitiveness of U.S. business and the U.S.
quality of life by promoting and facilitating voluntary consensus standards
and conformity assessment systems, and safeguarding their integrity.

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ANSI/ASA Hearing Aid Standards

ANSI Standard
• Working Group 48, Subcommittee S3 Bioacoustics
– Volunteers
– Hearing professionals
U.S. Food and Drug Administration recognizes that the
ANSI standard’s test results properly label the product.

Current Standard: ANSI/ASA S3.22-2009

ANSI/ASA Hearing Aid Standards

The ANSI S3.22 test battery measures: They do not measure:
• Performance of the major • Directionality
components • Bone Conduction Hearing Aids
– Microphones, t-coil, and
receiver
• Battery Drain
• Digital Processer
• Air Conduction Hearing Aids

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ANSI/ASA Hearing Aid Standards

The benefits of ANSI testing:
1. Results can be duplicated from one test facility to another.

2. Results can be applied clinically.

3. Results can be used as the manufacturing standard for quality control

purposes.

*ANSI is NOT real ear verification*

ANSI/ASA Hearing Aid Standards

To determine if hearing aids are meeting the
standard they are tested in a Hearing Instrument
Test Box or “HIT Box.”

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HIT Box
Test Chamber:
• Sealed from external noise interference
• Calibrated for a controlled test signal
• Minimizes acoustic reflections

HIT Box
Couplers:
• Physically joins the HI to the microphone of the test box.
• The volume (in cubic centimeters) of the coupler approximates
that of an average adult ear.
– Makes performance measurements related to a consistent, relevant
standard.

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Hit Box
More Couplers
• When HI’s are mounted on the coupler, any vents must be
occluded to preclude acoustical performance changes arising from
venting.
– Vents must be sealed on the outside surface.

Hit Box – Test Results

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ANSI S3.22-2009 Tests

• Most Test Boxes have an auto test feature
• Before tests are run:
– HI’s have to be programmed to “test settings” before
being placed in the test box

Maximum Output Curve (OSPL90)

• This is the maximum output of the hearing aid
• Measured with the input level set to 90 dB SPL over a
frequency range of 200 – 5000 Hz.
• Two parameters are noted:
– The frequency at which the output is maximum
• Tolerance: 3 dB for OSPL90 Max
– The High Frequency Average or HFA-OSPL90
• Tolerance: +/- 4 dB for HFA-OSPL90 (Bentler, Mueller, & Rickets, 2016)

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OSPL90

Full-on Gain (FOG)

• High-Frequency Average (HFA) Full-on Gain (FOG)
quantifies the gain of the HI
– HFA uses 1000, 1600, & 2500 Hz
• The input sound level is set to 50 dB SPL
• Tolerance: +/- 5 dB for FOG

(Bentler et al., 2016)

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FOG

Reference Test Gain (RTG)

• This is not a test, this is a way to verify the HI meets the setting for additional
testing
• A reduced volume control setting that approximates typical use gain
• Input sound level set to 60 dB SPL
• HFA-OPSL90 – 17 dB = RTG
– We want to turn down volume to a "use" setting….
• So that could be the setting that allows the typical input level (65) plus variation (+12) to not exceed
OSPL90;
• So if we want to find that level…then work backwards…Take OSPL90 minus 65 minus 12
– BUT
• We use 60 dB input….so we subtract 17 dB from HFA OSPL90 and adjust VC to get that output with
average input at 1, 1.6, and 2.5 kHz at 60 dB SPL

Thibodeau, L.M., EVALUATION OF NEW HEARING AID TECHNOLOGY[HTML

Document] . Retrieved from Lecture Notes Online Web site:
http://www.utdallas.edu/~thib/HA2class/HA28a_blanknotes.htm

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Frequency Response Curve

• A gain curve run at 60 dB SPL that allows for the
calculation of the frequency range of the HI
• A way to calculate the frequency limits of the
hearing aid.
– Finding F1 & F2

Frequency Response Curve

1. From the response curve determine
HFA
2. Subtract 20 dB
3. Draw a horizontal line parallel to the x-
axis at the reduced dB level which
intersects f1 and f2
1. These values (f1 & f2) represent the
frequency range of the hearing aid.

Tolerances:
a. 1.25f1 or 200 Hz (whichever is higher) +/-
4dB
b. .8f2 or 2000 to 4000 Hz (whichever is
lower) +/- 6dB
(Bentler et al., 2016)

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Total Harmonic Distortion (THD)

• Measured by putting a pure tone signal into the HI and
analyzing the result.
• An artifact resulting from the amplification of the signal would
be classified as distortion.
• Measured with three different pure tones: 500 Hz with a 70 dB
input, 800 Hz with a 70 dB input, and 1600 Hz with a 60 dB
input.
• THD is expressed as a percentage.
• Tolerance: Spec sheet percentage + 3% is acceptable
– Lower than the spec sheet percentage is also acceptable (Mueller & Taylor, 2011)

THD

Bentler et al. (2016) indicate

that a high harmonic
distortion measurement is a
good indication that the
hearing aid (often the
receiver) are close to failing.

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Equivalent Input Noise (EIN)

• Relates to the noise made by the circuit of the HI
– Noise made by the internal noise the microphones and
receivers generate.
• Measurement of the magnitude of the noise at the output
of the HI and then subtracting the gain of the hearing aid.
• As a rule of thumb this measure should be less than 30 dB
• Tolerance: EIN shall not exceed the maximum value
specified by the manufacturer plus 3 dB. (Bentler et al., 2016)
(Mueller & Taylor, 2011)

Battery Current
• Measure of battery drain using a battery pill.
– Measured using a 1000 Hz input signal at 65 dB SPL.
– Single number measure, expressed in milliamps, reflects how
much current is being drawn from the battery in to the hearing
aid.
– Higher than expected battery drain can be indicative of a
mechanical failure that has either already occurred or will
soon.
• Result should not exceed 20% of the spec sheet number.
(Bentler et al., 2016)

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Battery Drain Formula

Battery mAh rating/Current Drain = Battery Life in Hours

150/1.2 = 125

Battery Life in Hours/Member’s Avg. Hours per day = Approx. days Batteries will last

125/11.5 = 10.86 Days

10 312 13 675
mAh rating 97 150 215 620

Battery Drain
Important factors to consider:
• MFI Aids will have higher battery drain!
– Typically takes several minutes to settle to “normal” drain after the battery
door is closed.
– Have higher battery drain when direct streaming audio.

KS 6.0 (Costco’s 1st MFI HI)

While steaming audio from iPhone

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Telecoil Measurement
• Sound Pressure Level in an Inductive Telephone
Simulator (SPLITS) measures the strength of a HI’s
t-coil
• Tolerance: +/- 6 dB of manufacturer’s specified
value.

(Bentler et al., 2016)

What Can Go Wrong?

Failure to set HI in correct test settings
Failure to calibrate
Incorrect coupling
Failure to shut the test box
Failure to plug the vents for custom aids
Not orienting the product properly in the test box
Not placing the HI microphone close enough to the
reference microphone (Bentler et al., 2016)

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Matrix
• Shorthand that specifies the OPSL90, the HFA-
FOG, and the slope of the low frequency segment
of the OPSL90 curve
• Example
– 133/60/06
• Output = 133 dB SPL, FOG = 60, Slope of 6 dB per octave
between 500 Hz and the next high frequency peak on the
OSPL90 curve

Practical Applications
Best practices in HI fitting and dispensing include:
• Gaining practical experience with the hearing aid test box by performing
test sequences on inventory, demo, and loaner HI’s to verify they are
performing to manufacturers’ specifications.

• Performing an evaluation of every new or repaired HI that arrives at the

office.

• Verifying performance of HI’s to validate a service complaint.

• Periodic check-ups that include electroacoustic analysis

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Guest Lecturer
Debbie Auzas

Lesson 30

HEARING INSTRUMENT CANDIDACY

2018 Bay Area Regional Apprentice Training

Debbie Auzas, H.I.S.

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 If a member’s audiogram shows a hearing loss, are they

automatically a candidate for hearing aids?
 What is the member’s motivation?
 Does the member want or need a hearing device?

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 It’s important to discuss the hearing loss in terms of its impact on

communication effectiveness
‒ As hearing loss becomes worse, problems with speech distortions, omissions, and
substitutions increase without the use of amplification

 The slope and configuration of the hearing loss can introduce fitting
challenges

 Since most hearing loss is binaural, we typically fit both ears

 Binaural fittings have several advantages compared to monaural
fittings
 Why then might you want to fit Monaurally?

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 Monaural fitting is for one ear only

‒ When is a monaural fit appropriate?
‒ When should a monaural fit be discouraged?

 Head Shadow effect

‒ the effect of the head in reducing
gain on the opposite side of the head
(up to 15 dB in the high frequencies)

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 Auditory Deprivation
‒ Unaided ear can lose speech understanding capabilities that may not be recoverable if
binaural amplification is eventually selected

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 One normal ear, one unaidable ear

 Microphone and transmitter are placed on
unaidable ear
 Receiver is placed on the normal ear
 Acoustic signals detected by the microphone are
transmitted to the normal ear and sent through the
ear canal by way of a thin-tube open fitting
 The normal ear experiences its natural hearing
and also receives the signal from the opposite
side

 One unaidable ear, one ear with aidable

hearing loss
 Fully functional hearing instrument fit to the
aidable ear and … microphone/transmitter is
fit to the unaidable ear

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 For candidates who have significant

conductive hearing loss with or without
sensorineural involvement
 They may have atresia, external auditory
canal stenosis, chronically draining ears, or
another type of craniofacial anomaly or
medical condition that precludes the use of
a conventional air conduction hearing aid
 AKA - BAHA (Bone Anchored Hearing Aid)
 Single Sided Deafness

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 Does the member have any challenges with

manual dexterity, visual acuity, and cognitive
ability?
 Size and cosmetic considerations
‒ Is the member willing to wear the style of hearing aid that
you recommend?
‒ BTE or RIC versus Custom device?

 Occlusion or feedback concerns

‒ Adequate venting may be required to address the issue of occlusion
(tiny ears ≠ Large vents)

 Feedback can cause embarrassment and annoyance

‒ Also, it can cause sounds to become distorted and reduce speech intelligibility and sound
quality

 Software adjustments cannot eliminate feedback when its cause is due

to an inappropriate style choice!

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 Accessories
 Demonstrating hearing aids
 Overcoming objections
 Counseling
 Realistic expectations

 Streaming accessories
 TV adapter
 Remote microphone
 Remote control options
 Telephone/cell phone options
 When is it appropriate to offer accessories to the member? Why?

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 When and why should you demo hearing aids?

 What is the advantage of demonstrating hearing aids?
 When would you choose not to demo the hearing aids?

 Objections from people who are diagnosed with a hearing loss and
recommended hearing aids are common
‒ Denial
‒ Anger
‒ Embarrassment / Shame
‒ Vanity
‒ Cost

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 Counseling the member and family on hearing loss and hearing aids
is just as important as choosing the appropriate hearing instrument,
proper physical fit, and programming
 Counseling is absolutely crucial for successful fitting outcomes!
‒ Does the member expect to hear the same as when they were a child with normal hearing?
‒ Setting up realistic expectations in the beginning will save you and the member time and
grief in the future

 Proper counseling helps guide the member to accept their hearing

loss diagnosis and prepare them for realistic hearing aids wearing
expectations
‒ Commit to wearing the hearing aids daily
‒ Accept that hearing aids will not fully restore normal hearing
‒ Learn proper daily cleaning and care of hearing aids
‒ Attend follow-up appointments
‒ Ask questions and communicate concerns as well as successes to their Hearing Specialist
‒ Educate family members about how they can support the member during this process

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Lesson 31

GERIATRIC AND OTHER CONSIDERATIONS

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Geriatric Considerations

Older adults typically have characteristics,

needs, and requirements that are different
from those of the younger population.

Geriatric Considerations
Challenges faced by older adults and the hearing healthcare
providers who serve them include:
• Pre-fitting concerns
– Lack of problem awareness and readiness for hearing aids
• Personal characteristics during fitting
– Increased likelihood of cognitive and psychoacoustic auditory processing
components to the listening difficulties
• Manual dexterity compromises
• Sensory difficulties beyond hearing loss (touch and vision)
• Special issues in adjusting to hearing loss and hearing aids

(Kricos, 2006)

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Geriatric Considerations
“The hearing healthcare professional collaborates
with patients/clients in the management of their
hearing. Understanding and respecting their
perception of the degree of the hearing problem
and their desire to accept amplification and
auditory rehabilitation are paramount to a
successful professional relationship.”
(Professional Training Workbook in Hearing Health Sciences, 2016)

Geriatric Considerations: Pre-test

• First Impressions
• Review Case History prior to meeting member
• You must gain their trust and confidence
• Engage the member
– Talk with them, not at them
– Talk to them, not to the person who brought them in
• Keep questions simple and easy to understand
• Ask them how they feel about hearing help
• Discuss their needs and concerns
• Explain the testing process and assure them that you will give them instructions for each part of the
test as you move through it.
• Put the member at ease – they will be very apprehensive about the hearing test

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Geriatric Considerations: Testing

• Be prepared to go slower than you normally do
Don’t forget your talk over mic!
– Your audiometric exam may take longer
You can adjust the volume for
• Do a practice presentation
the member’s listening comfort.
– This will give your member confidence
• Be prepared to alter your presentation based on your member’s needs
• It’s okay to have the member give verbal responses if having them push the
button presents issues
• Keep in mind BC testing and masking may be challenging
– In some cases they may not be completed with a high confidence in the accuracy.
• Stop throughout the test and give positive feedback
– This will encourage the member and help them know they are doing what they are
expected to do

Geriatric Considerations: Testing

When member’s complain of an inability to hear in noise with
good pure-tone and speech in quiet results, it is advisable to
assess word recognition in noise.

Auditory processing disorders typically result in difficulties

understanding speech in noise settings.

(Kricos, 2006)

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Geriatric Considerations: Consultation

• Review your findings
• Use everyday language that is easy to understand
• Discuss the importance of the pure tone and speech testing
– AI score in relation to WRS score
– Explain that the ear is impaired, but the brain is where we hear!
• Discuss your recommendation
– Monaural or Binaural
– Hearing aid Form Factor (Style)
– Not to proceed with HI’s
– Justify your recommendation
• If you are concerned with test validity it is okay to recommend a medical referral

Geriatric Considerations: Recommendations

Wearing and caring for HI’s involves a number of motor tasks:
• Insertion and Removal of HI’s
• Manipulative tasks such as pressing buttons, replacing batteries, changing wax
guards and domes
• Maintenance tasks – Wiping, Brushing, Picking…

• You need to be evaluating your member’s manual dexterity throughout the test
appointment.
– Dexterity of the hands and fingers and also the ability to raise the arms to the ears.

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Geriatric Considerations: Recommendations

Factors affecting the provision of HI’s to older adults: Things to keep in mind:
• Manual Dexterity • You need to access the dexterity of the hands
– Arthritis and fingers and also the ability to raise the arms
– Parkinson’s Disease to the ears.
– Secondary effects of strokes • When any of these factors are present, consider:
– Other neurological problems – Automatic directional HI’s
• Reduced Tactile Sensation – Automatic t-coils
– Affects members ability to: – Rechargeable batteries
• Manipulate HI controls – Raised Volume Controls
• Insert HI batteries – Written materials with a larger font (14 point)
• Position HI’s in ears – Custom options may be very appropriate
• Other Sensory Deficits
– Vison
– Touch

(Kricos, 2006)

Geriatric Considerations: Fitting

• Set the appointment for a time of day that the
member will be attentive and not likely to fatigue.
• Allow enough time, but do not exceed an hour.
– Be aware of signs of fatigue and inattention.
• Explain and run REM to verify gain settings.
• Allow adequate time for learning insertion and
removal.
• Practice Battery insertion and removal

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Geriatric Considerations: Fitting

Informational Counseling:
• Give the most important information first!
• Use common everyday language.
• Cover the basics.
– You can expand on them at follow-up appointments.
• Elicit the member’s understanding throughout the appointment.
• Send them home with written instructions to refer to when they forget.
– Use at least a 14 point font.
• Make sure they have a follow-up appointment scheduled when the leave.
– It’s okay to bring them back sooner if they had issues.

Geriatric Considerations: Follow-up

• Be patient!
• Be prepared to review.
• Be prepared to listen.
• Be prepared to counsel.
• Be prepared to be supportive.

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Post-fitting Counseling
• The importance of post-fitting counseling and support cannot be
emphasized enough.
• A collaborative problem-solving approach to helping members cope with
their listening difficulties is more successful than a one-size-fits-all approach.
• Include the members support system
– Family, close friends, PCP, personal staff, living facility staff, and other healthcare providers.
• Post fitting support programs can be found in many forms.
– Group and individual counseling, reading materials, use of daily journals, online resources, and
auditory rehabilitation programs.
• Self-efficacy is another consideration for older member’s who have just
received HI’s.
– You will need to make selections that minimize problems and make the member successful with
their new HI’s

Change
• Change is Hard!
• Difficulty adjusting to amplification may
require an acclimatization strategy.
• Many individuals may prefer to stay with
a style and acoustics similar to what they
have successively worn.

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Slower Processing Rates

• Some individuals process cognitive information
and sensory input at slower rates.
• Allow sufficient time between test stimuli for
these individuals to respond.
• Informational counseling should be provided at a
slower speed.

Communication Strategies
• Stand or sit in front of the hearing impaired person
• Ensure that their attention is on the speaker
• Be sure a source of light is revealing the speakers face
• Speak up but do not shout
• Speak slowly and clearly, and emphasize key words
• Minimize background noise if possible
• Maintain eye contact
• Rephrase rather than repeat
• Be patient
• Be supportive

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Lesson 32

EAR IMPRESSIONS

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Impressions
• Quality Matters!
– When the earmold lab receives a poor impression they must do
one of two things:
• Request a new impression
• Guess at what the impression should be
• The only part of the fitting process in which injury is Costco’s
possible. Ear
Impression

– Proper procedures must be followed. Certification

– We must learn and consistently practice an impression protocol

that will minimize the risk to the member.

Pinna Anatomy
• Use common terminology
when describing the anatomy
of the pinna.
– This ensures that both you and
the earmold lab are talking
about the same anatomical
feature!
• It is important to capture all of
the pinna anatomy to ensure
hearing aid retention.

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Impression Materials
There are three basic types of impression materials:
1. Two-part vinyl polysiloxane or A+B silicone
a. Equal parts of catalyst and based are mixed together
b. Hand mixing is not possible at Costco due to our Ear Impression Protocol.
a. It is discouraged generally due to the possibility of contamination and the potential for overheating the material.
2. Silicone cartridges
a. Used in impression guns
b. Equal parts of a base and catalyst forced through a mixing tip.
c. Can have lower viscosity than A+B material
3. Powder-liquid
a. Pre-measured portion of powder combined with a precise amount of liquid and mixed.
b. Does not have resistance to heat and can distort in transit to the lab.

Always check the expiration date of your impression material prior to use.
DO NOT use material that is out of date, it may not cure properly.

Impression Delivery Systems

There are two delivery systems for impressioning:

Silicone Syringe Impression Gun

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Impressioning Procedures
Before taking an impression:
• Review the Case History for contraindications:
– Allergies
– Medications
– Surgeries
• Explain the procedure to the member
• Follow Infection Control Procedures

Impressioning Procedures
Otoscopy:
• Three Times!
1. Prior to beginning the impression

2. After placing the otoblock to verify placement

3. After removing impression from ear

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Impressioning Procedures
Otoscopy:
• Using proper bracing perform an otoscopic
examination of the ear, ear canal, and TM.
• Are all four quadrants of the TM visible?
• Are there any abnormalities present in any part of the ear?
• Are there any signs of surgery?
• Are there contraindications for taking the impression?
• Would a medical referral be prudent?

• Note the size and direction of the canal for otoblock selection
and placement.

Impressioning Procedures
Otoblock Selection & Placement:
• A crucial part of the impressioning process in terms of member
safety.
• If size or placement are incorrect there is a risk that impression
material will flow past the block (blow-by) and possibly reach the
TM which has the potential to cause serious damage.
• Be meticulous in your otoblock placement and always verify with
your otoscope.
– Surgical ears may need to be referred out for impressioning.

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Impressioning Procedures
Otoblock Selection & Placement:
• Two Types of otoblocks:
– Foam
• Easier to verify placement visually
• May be lightly lubricated
– Blood Thinner use
• Vented ones offer comfort through pressure equalization
– Cotton
• DO NOT LUBRICATE – Lubrication will cause cotton otoblocks to shrink

Impressioning Procedures
Otoblock Selection & Placement:
• Select a block that is larger in diameter than the
ear canal.
• It must expand against the canal wall so that it
does not easily move when the impression
material is injected against it.
• Before placing in the ear canal, tug on the vent
tube to ensure it is firmly attached to the
otoblock.

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Impressioning Process
Otoblock Selection & Placement:
• Using a proper bracing technique (B,B,R) place the
otoblock at the canal aperture and gently use the tip
of your ear light to tap around the edges of the block
to place it in position.
• NEVER place an otoblock by pushing in the center of
the block. You run the risk of pushing through the
block.

Impressioning Process
Otoblock Selection & Placement:

Brace Brace Roll

Non-Tool Hand Tool Hand Tool Into Ear Canal

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Impressioning Process
Otoblock Selection & Placement
Once the otoblock is placed in the
12
canal aperture -
Gently tap the otoblock with your
ear light in a clockwise motion
(12, 3, 6, 9 o’clock) until it is 9 3
placed just beyond the second
bend.

Impressioning Procedures
Otoblock Selection & Placement:
• The block should be placed just beyond the
second bend.
• The block when placed should be centered in
the canal with the vent tube coming out of
the center of the block.
• There should be no visible gaps around the
edges of the otoblock when it is properly
placed.

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Impressioning Process
Otoblock Selection & Placement:
• The block must also be square in the ear canal.

Impressioning Process
Otoblock Selection & Placement:
• Proper block placement ensures that you have correctly captured the
canal dimension correctly.
– This ensures that the manufacturer will make a product that fits correctly and in
which the sound bore is pointed directly at the TM and not into a canal wall.
• Very small or large ears may require the use of cotton otoblocks.
– When using multiple blocks for large ears, they must be tied together.
• For collapsed canals ensure that the otoblock is large enough to hold
the canal open.
• Surgical ears often require multiple otoblocks to adequately seal the
ear canal (Think cotton).

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Impressioning Process
Otoblock Placement Otoscopy:
• Once your otoblock is placed you must verify its
placement with your otoscope!
– Is it just past the second bend?
– Does it completely seal the ear canal (No Gaps!)?
– Is the block square in the canal?
– Is the vent tube centered in the canal?

Impressioning Process
Impression Material Preparation & Injection:
• Non-cartridge material:
– Equal parts of the base and catalyst must be measured
out.
– The base and catalyst must be mixed on a splead pad with
a spatula until it is one consistent color.
– The mixed material is placed into the syringe using a
cookie cutter method.

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Impressioning Process
Impression Material Preparation & Injection:
• Non-cartridge material

Spleading Impression Material Cookie Cutter Method

Impressioning Process
Impression Material Preparation & Injection:
• Non-cartridge material:

Bleed off approximately a ½ inch of

material prior to injecting into the ear.

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Impressioning Process
Impression Material Preparation & Injection:
• Cartridge Material
• Install cartridge in gun
• Install new tip on cartridge
• Eject and discard
approximately ½ inch of
material

Impressioning Process
Impression Material Preparation & Injection:
Bracing:

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Impressioning Process
Impression Material Preparation & Injection:
• Technique is similar regardless of tool.
– Place the tip of the tool approximately ½ way between the canal aperture and the
otoblock.
– Slowly but firmly inject the impression material.
– When the material begins to flow out of the ear and around the tip of the tool,
keeping the tip of the tool below the surface of the material begin to move out of
the ear canal.
– When the canal is filled move down to fill the concha beginning at the intertragal
notch and working upward.
– Make certain that both the tragus and antitragus are covered and that the entire
concha is filled.
– Continue into the upper concha or helix area and into the helix curl.

Impressioning Process
Impression Material Preparation & Injection:

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Impressioning Process
Impression Material Preparation & Injection:
• Excessive pressure during material injection:
– Can cause damage to the member’s ear  Blow-By
– Can cause unwanted expansion of the ear canal that may cause discomfort once the
earpiece is fit.
• Jaw movement is discouraged during the curing.
– Movement will distort the shape of the canal at its deepest points and can result in
acoustic feedback from the finished earpiece.
• Allow the material to cure for the time specified by the supplier.
– Remember the ½ inch of bleed off?
– Premature removal will result in a distorted impression at best, and at worst an
impression may separate into pieces  which could remain in the canal.

Impressioning Process
Impression Removal:
• Pull up and back on the pinna
• Release the helix curl and upper concha
• Rotate the impression forward and gently pull it
out of the ear
– Do not pull it so hard that it stretches or breaks

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Impressioning Process
Impression Removal:
• IMMEDIATELY upon removal of the
impression set it down, without
looking at it, and perform otoscopy.
– Ensure that no damage has been done
to the ear canal.
– Ensure that no impression material has
been left behind.

Impression Process
Impression Critique:
• A good impression must:
– Have a complete canal that reaches the second bend.
– A concha that is complete and shows both the tragus
and antitragus.
– A well defined intertragal notch and helix curl

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Impression Process
Impression Critique:
• A bad impression:
– Has voids Void Overfilled
– Weld marks
– Does not meet the otoblock
– Is under filled
– Is overfilled
Short Under filled

Impression Process
Will it fit?
After completing your impression make a
determination about the size of the ear canal
in relation to the size of the receiver.

Determine if it is realistic to ask the vendor

to make the hearing aid you need for you
member.

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Impressioning Process
Prepare the Order:
• Fill out the order form
• Indicate both on the form and on the impression if
there are any abnormalities
• Specify desired length of product using
manufacturer’s guide
• Fold order from and place in box with impressions

The Open-Jaw Impression

Conditions that indicate an open-jaw impression would be
appropriate:
• Significant jaw displacement observed externally
• Changes in ear canal shape detected during otoscopy
• Member complains of feedback or loose fitting HI
• Earmold or HI slides out of the ear
• Member reports loss of gain during jaw movement
*Note: There is a greater risk of blow-by when taking open-jaw impressions.*

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Costco Ear Impression Certification

Upon completion of this lesson you will need to get ready
to complete the Costco Ear Impression Certification. All
apprentices have 180 days to complete this certification
from their enrollment in the HAAP.

Please note: Employees are NOT allowed to take ear

impressions on members until they have completed the
Costco Ear Impression Certification.

References
Bentler, R. A., Mueller, H. G., & Ricketts, T. (2016). Modern hearing aids: verification, outcome measures, and follow-up. San
Diego, CA: Plural Publishing Inc.

Kricos, P. B. (2006, July 31). Audiologic Rehabilitation with the Geriatric Population Patricia B. Kricos. Retrieved February 14,
2018, from https://www.audiologyonline.com/articles/audiologic-rehabilitation-with-geriatric-population-976

Mueller, H. G., & Taylor, B. (2011). Fitting and Dispensing Hearing Aids. San Diego, CA: Plural Publishing.

Professional Training Textbook in Hearing Health Sciences. (2016). Plymouth, MI: Macmillan Learning Curriculum Solutions.

Professional Training Workbook in Hearing Health Sciences. (2016). Plymouth, MI: Macmillan Learning Curriculum Solutions.

Thibodeau, Ph.D., L. M. (n.d.). EVALUATION OF NEW HEARING AID TECHNOLOGY. Retrieved February 13, 2018, from
http://www.utdallas.edu/~thib/HA2class/HA28a_blanknotes.htm

W. (2018, January 16). Ten Commandments the Hearing Impaired Wish You Knew. Retrieved February 14, 2018, from
https://www.levinehearing.com/ten-commandments-the-hearing-impaired-wish-you-knew/

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