Interview with Westone, Colorado Springs Colorado
Share:
Topic: Fall 2005 Earmolds, Impressions, Digital Impressions and Related Issues
Beck: Good Morning Westone!
Westone: Good Morning Doug.
Beck: I should explain to the readers that "Westone" is actually a group of folks at Westone Labs, who've agreed to chat with me about the topics below.
Westone: Right...we're happy to meet with you Doug, and we'll do our best to answer your questions based on our knowledge and experience.
Beck: OK then....Let's start with an introduction to the Westone products and services. I know you guys have everything related to ear impressions, impression materials, foam and cotton dams, ear syringes and guns, shipping materials and all that, but you also supply FM systems and a few other, non-earmold items, too. Can you give me a run-down of the total product categories?
Westone: Sure. As you mentioned, earmolds for hearing aids, but also hearing protection products for musicians, hunters and others, custom communication headsets, custom fit ear monitors and products for musicians, swim molds, FM systems, supplies and consumables for the hearing aid industry, and one of the newer products -- laser earmolds. We also provide ear plugs for motorcycle riders, custom made stethoscope tips and lots of other unique products..
Beck: Very good. Please tell me, what are the most popular styles of earmolds based on what ya'll ship out the door every day...and how does the clinician know which one to order?
Westone: Skeleton is probably the most popular, then the ¾ skeleton and the half and full-shells, and then probably the "canal only." As far as knowing which to order, certainly the type and degree of hearing loss matter. The more hearing loss, the more gain required, and usually, the more gain required means more of a full shell situation. Of course dexterity, ability, skin texture, the individual's ear anatomy, cosmetic issues and other factors, such as previous earmold design, matter too.
Beck: When ordering earmolds, how do I know which vent to order?
Westone: Well, that's been an excellent question for a long time. The best vent for any particular type and degree of hearing loss, and for a particular earmold style, and for the depth of the ear canal, and based on the patient's preference -- will vary! There is no solid, 100 percent method of choosing the right vent every time. Therefore, if you're not positive which vent to order, its almost always best to order the variable vent...and that way you have options available without having to remake or drill out the earmold!
Beck: And in general, the more gain, the smaller the vent....right?
Westone: Yes, in general, that's true. But there is a trend towards more open fittings these days, and the sophisticated hearing aid circuits allow that to work very well, so sometimes even with a lot of gain, more than you might suspect from a few years ago, we can have larger vents.
Beck: So again, the variable vent is the way to go?
Westone: Yes. It makes sense and preserves your options.
Beck: OK. And in general...do you prefer parallel vents?
Westone: Yes. That's the standard whenever it's possible, if the physical parameters allow it.
Beck: What can you tell me about "trench vents"? I have drilled them now and then...and frankly, it usually seems like the ultimate in "last minute options." I usually only go for it when I'm totally desperate, the ear is still occluded, and the patient is about to punch me in the nose!
Westone: Yes, you're right. The trench vent is sometimes placed as a last resort by the clinician, as a channel located on the exterior side of the earmold. It can be used to help "vent out" the lows, but it can also be used in a draining ear, to allow a path for fluids, without occluding the ear or the earmold. In that situation, we call it a "half external vent" for a draining ear. Of course, the patient has to be instructed about careful and ongoing care, maintenance and cleaning.
Beck: One thing that I've noticed in grocery stores, and sometimes even on hearing aid patients walking into the office, is that they may be unaware that the helix section of their earmold is sticking out. It surprises me that they cannot hear or feel that something s not quite right...but I have seen that often over the years, so I believe they often simply cannot tell.
Westone: I think you're right. It seems this happens with senior citizens sometimes with skeleton and ¾ skeleton earmolds, as the patient may not have the dexterity to get the entire helix portion in their ear. Sometimes they like using the "handle" of those earmolds to help place the earmold, but then once they get it started, they may not be able to tell when it's placed, or seated all the way in the ear.
Beck: What about materials...what do you like, prefer and perhaps caution against, regarding earmold and impression materials?
Westone: Well...materials, like styles, are often a personal preference. Nonetheless, there are some good guidelines. For example, I wouldn't recommend silicone for older people, say ages 70 or 75 and older, as it tends to drag on the skin and irritate tender ear canal skin. I would recommend vinyl for those patients, like our Formula Two Clear. It's comfortable, flexible and easy to insert and can be made in almost any style. I generally don't recommend acrylic, which is the hard material also known as lucite, except for mild and moderate hearing losses, such as a skeleton, ¾ skeleton or a variation of a CROS mold with open venting. In those fittings, you need some rigidity and strength, and the Lucite can provide that readily.
Beck: What about hypoallergenic earmolds? How do you handle that?
Westone: When a patient has a skin sensitivity or allergy, we can boil the materials to reduce the possibility of a reaction. Another possibility is to order no colors or dyes in polyethelene or silicone earmolds, to reduce the likelihood of skin reactions.
Beck: What about latex in earmolds? I know many people have reactions to latex.
Westone: We don't use latex in any of our products.
Beck: That's great. What about jaw blocks...does it matter?
Westone: That's been one of those issues that comes and goes and people either love or hate them. At this time, we do recommend them. As we've gotten more and more into cartridge materials, and less involved with syringe materials we've learned that because syringe materials were a little heavier, they tended to expand the ear. The cartridge materials are lighter, and so we get an even better replica of the ear. Of course, the goal is to have an accurate impression that accounts for jaw motion. So we do recommend bite blocks between the two front teeth, keep the lips off the bite block, and just relax the jaw.
Beck: What about "e-impressions" and the ability to take an electronic digital image of the ear? I guess there are two or three major issues...the first is probably cost, and of course, that will go down dramatically as the technology spreads. Then the advantage of never having to make a physical impression on the ear, which means no mess, no bad impressions, no shipping delays and more importantly, a perfect digital replica of the ear! Another major advantage of the e-impression is that once you have the file, you can always order another earmold from the stored file, so if the earmold is lost, or destroyed, it can be remade just as if the impression was taken the day before.
Westone: All of those issues are important. Cost is a factor, but we think
e-impressions will be a part of the mainstream clinical practice pretty soon. The clinician could create a 3-D digital image, e-mail that to us, and within seconds we could start producing the earmold - pretty neat. But as far as retaining and saving the digital image, there are a few things to consider....For kids, as their ear canal changes a little, it's probably best to have a new e-impression most times...and even on older folks, we know their ears change, elongate, lose elasticity too, and so sometomes, the best impression will be a new one. However, if someone in their 20s, 30s or 40s, misplaced a fairly current earmold, then yes, making a duplicate from the e-impression would probably be a good idea.
Beck: You guys have been really generous with your time, and I'll let you run in just a moment...Last topic...What are the primary clinician-based contributory issues and factors, that cause a brand new earmold to fit poorly?
Westone: Thanks for that question, and thanks even more for asking about "clinician- based errors." Of course, we make errors too! But, as you asked for "clinician-based" errors...there are a few we can mention....Probably the most basic reason is that the ear impression was not deep enough, meaning all impressions really should go past the second bend, regardless of the exact type of earmold desired. The better we can tell the exact and detailed anatomy, the better the final product. Another issue is concha bowls that are not completely filled-in. We also get some air bubbles and voids in ear impressions, and in those cases, we always call the professional to ask for a better ear impression. If a better impression is not available, we try to fill it in using our best guess, but those are low percentage guesses, and not an ideal way to do anything. We really like to provide excellence and perfection as best we can, and to do that, we need darn near perfect ear impressions!
Beck: I understand. I know that sometimes I've sent impressions that I knew were not ideal, but boy-oh-boy...when those less than ideal impressions are from a screaming child...I usually used the "cross my fingers and hope" protocol. But I guess remaking the ear impression would've been the better way to go?
Westone: Every time!
Beck: OK guys. Thanks for your time today. I always learn a lot while visiting with ya'll.
Westone: Thank you, too, Doug. Happy to help!
-------------------
For more information on earmolds, ear impressions and all Westone products and services, www.westone.com
Westone: Good Morning Doug.
Beck: I should explain to the readers that "Westone" is actually a group of folks at Westone Labs, who've agreed to chat with me about the topics below.
Westone: Right...we're happy to meet with you Doug, and we'll do our best to answer your questions based on our knowledge and experience.
Beck: OK then....Let's start with an introduction to the Westone products and services. I know you guys have everything related to ear impressions, impression materials, foam and cotton dams, ear syringes and guns, shipping materials and all that, but you also supply FM systems and a few other, non-earmold items, too. Can you give me a run-down of the total product categories?
Westone: Sure. As you mentioned, earmolds for hearing aids, but also hearing protection products for musicians, hunters and others, custom communication headsets, custom fit ear monitors and products for musicians, swim molds, FM systems, supplies and consumables for the hearing aid industry, and one of the newer products -- laser earmolds. We also provide ear plugs for motorcycle riders, custom made stethoscope tips and lots of other unique products..
Beck: Very good. Please tell me, what are the most popular styles of earmolds based on what ya'll ship out the door every day...and how does the clinician know which one to order?
Westone: Skeleton is probably the most popular, then the ¾ skeleton and the half and full-shells, and then probably the "canal only." As far as knowing which to order, certainly the type and degree of hearing loss matter. The more hearing loss, the more gain required, and usually, the more gain required means more of a full shell situation. Of course dexterity, ability, skin texture, the individual's ear anatomy, cosmetic issues and other factors, such as previous earmold design, matter too.
Beck: When ordering earmolds, how do I know which vent to order?
Westone: Well, that's been an excellent question for a long time. The best vent for any particular type and degree of hearing loss, and for a particular earmold style, and for the depth of the ear canal, and based on the patient's preference -- will vary! There is no solid, 100 percent method of choosing the right vent every time. Therefore, if you're not positive which vent to order, its almost always best to order the variable vent...and that way you have options available without having to remake or drill out the earmold!
Beck: And in general, the more gain, the smaller the vent....right?
Westone: Yes, in general, that's true. But there is a trend towards more open fittings these days, and the sophisticated hearing aid circuits allow that to work very well, so sometimes even with a lot of gain, more than you might suspect from a few years ago, we can have larger vents.
Beck: So again, the variable vent is the way to go?
Westone: Yes. It makes sense and preserves your options.
Beck: OK. And in general...do you prefer parallel vents?
Westone: Yes. That's the standard whenever it's possible, if the physical parameters allow it.
Beck: What can you tell me about "trench vents"? I have drilled them now and then...and frankly, it usually seems like the ultimate in "last minute options." I usually only go for it when I'm totally desperate, the ear is still occluded, and the patient is about to punch me in the nose!
Westone: Yes, you're right. The trench vent is sometimes placed as a last resort by the clinician, as a channel located on the exterior side of the earmold. It can be used to help "vent out" the lows, but it can also be used in a draining ear, to allow a path for fluids, without occluding the ear or the earmold. In that situation, we call it a "half external vent" for a draining ear. Of course, the patient has to be instructed about careful and ongoing care, maintenance and cleaning.
Beck: One thing that I've noticed in grocery stores, and sometimes even on hearing aid patients walking into the office, is that they may be unaware that the helix section of their earmold is sticking out. It surprises me that they cannot hear or feel that something s not quite right...but I have seen that often over the years, so I believe they often simply cannot tell.
Westone: I think you're right. It seems this happens with senior citizens sometimes with skeleton and ¾ skeleton earmolds, as the patient may not have the dexterity to get the entire helix portion in their ear. Sometimes they like using the "handle" of those earmolds to help place the earmold, but then once they get it started, they may not be able to tell when it's placed, or seated all the way in the ear.
Beck: What about materials...what do you like, prefer and perhaps caution against, regarding earmold and impression materials?
Westone: Well...materials, like styles, are often a personal preference. Nonetheless, there are some good guidelines. For example, I wouldn't recommend silicone for older people, say ages 70 or 75 and older, as it tends to drag on the skin and irritate tender ear canal skin. I would recommend vinyl for those patients, like our Formula Two Clear. It's comfortable, flexible and easy to insert and can be made in almost any style. I generally don't recommend acrylic, which is the hard material also known as lucite, except for mild and moderate hearing losses, such as a skeleton, ¾ skeleton or a variation of a CROS mold with open venting. In those fittings, you need some rigidity and strength, and the Lucite can provide that readily.
Beck: What about hypoallergenic earmolds? How do you handle that?
Westone: When a patient has a skin sensitivity or allergy, we can boil the materials to reduce the possibility of a reaction. Another possibility is to order no colors or dyes in polyethelene or silicone earmolds, to reduce the likelihood of skin reactions.
Beck: What about latex in earmolds? I know many people have reactions to latex.
Westone: We don't use latex in any of our products.
Beck: That's great. What about jaw blocks...does it matter?
Westone: That's been one of those issues that comes and goes and people either love or hate them. At this time, we do recommend them. As we've gotten more and more into cartridge materials, and less involved with syringe materials we've learned that because syringe materials were a little heavier, they tended to expand the ear. The cartridge materials are lighter, and so we get an even better replica of the ear. Of course, the goal is to have an accurate impression that accounts for jaw motion. So we do recommend bite blocks between the two front teeth, keep the lips off the bite block, and just relax the jaw.
Beck: What about "e-impressions" and the ability to take an electronic digital image of the ear? I guess there are two or three major issues...the first is probably cost, and of course, that will go down dramatically as the technology spreads. Then the advantage of never having to make a physical impression on the ear, which means no mess, no bad impressions, no shipping delays and more importantly, a perfect digital replica of the ear! Another major advantage of the e-impression is that once you have the file, you can always order another earmold from the stored file, so if the earmold is lost, or destroyed, it can be remade just as if the impression was taken the day before.
Westone: All of those issues are important. Cost is a factor, but we think
e-impressions will be a part of the mainstream clinical practice pretty soon. The clinician could create a 3-D digital image, e-mail that to us, and within seconds we could start producing the earmold - pretty neat. But as far as retaining and saving the digital image, there are a few things to consider....For kids, as their ear canal changes a little, it's probably best to have a new e-impression most times...and even on older folks, we know their ears change, elongate, lose elasticity too, and so sometomes, the best impression will be a new one. However, if someone in their 20s, 30s or 40s, misplaced a fairly current earmold, then yes, making a duplicate from the e-impression would probably be a good idea.
Beck: You guys have been really generous with your time, and I'll let you run in just a moment...Last topic...What are the primary clinician-based contributory issues and factors, that cause a brand new earmold to fit poorly?
Westone: Thanks for that question, and thanks even more for asking about "clinician- based errors." Of course, we make errors too! But, as you asked for "clinician-based" errors...there are a few we can mention....Probably the most basic reason is that the ear impression was not deep enough, meaning all impressions really should go past the second bend, regardless of the exact type of earmold desired. The better we can tell the exact and detailed anatomy, the better the final product. Another issue is concha bowls that are not completely filled-in. We also get some air bubbles and voids in ear impressions, and in those cases, we always call the professional to ask for a better ear impression. If a better impression is not available, we try to fill it in using our best guess, but those are low percentage guesses, and not an ideal way to do anything. We really like to provide excellence and perfection as best we can, and to do that, we need darn near perfect ear impressions!
Beck: I understand. I know that sometimes I've sent impressions that I knew were not ideal, but boy-oh-boy...when those less than ideal impressions are from a screaming child...I usually used the "cross my fingers and hope" protocol. But I guess remaking the ear impression would've been the better way to go?
Westone: Every time!
Beck: OK guys. Thanks for your time today. I always learn a lot while visiting with ya'll.
Westone: Thank you, too, Doug. Happy to help!
-------------------
For more information on earmolds, ear impressions and all Westone products and services, www.westone.com
