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The Wizard Appreciation Thread - Long Live the Wizard - The former HA Appreciation Thread - Page 258  

post #3856 of 7980
Quote:
Originally Posted by tomscy2000 View Post

Impressions are a delicate balance between the experience of the audiologist, the materials/methods they use to take impressions, and how well they adhere to the manufacturer's instructions, which is paramount to getting impressions that fit well.

 

Just because someone was trained by Sensaphonics' Golden Circle (two-day seminar only) doesn't mean they will know exactly what to do with all manner of impressions, including acrylic ear molds, nor does it guarantee that they'll necessarily keep up with current literature in audiology. Silcone CIEMs do not require open-jaw impression techniques, either, which is vastly different from impressions for acrylic molds.

 

Most acrylic CIEM companies will assume an open-jaw, bite block assisted impression taking technique, along with medium to high viscosity material --- a position championed by both Westone and Starkey. The material used affects curing time, as well as compliance to the ear canal and the shape of the pinna.

 

Figure 1. [1]


Figure 1 shows that open-jaw impressions with high viscosity material produces the least variances in results at all three critical areas of impression taking within the canal.

 

From Piranski & Berge, "an impression for a higher gain instrument should be taken with a more viscous silicone and the patient's mouth wide open. This will maximize the instrument's acoustic seal and lower the risk of acoustic feedback. To ensure the instrument's comfortable fit deep in the ear, the canal tip on the impression must be skillfully trimmed. The ear tissue at and past the canal second bend is more sensitive to touch than the cartilage between the bends and will not tolerate pressure from the instrument. The Au.D. students who focused on hearing aid remakes secondary to; acoustic feedback, insecure fit, discomfort, or poor sound quality, found that for 114 out of 136 (84%) patients, taking open jaw impressions with more viscous silicone remedied or diminished the fitting problems. Of course, had such impressions been taken in the first place, the majority of the remakes could have been avoided. Unfortunately, some earmold labs are against open jaw impressions and more viscous silicones because they lack confidence in their skills in processing such impressions into comfortable hearing aids." [1]

 

In terms of the pinna, Heir Audio wants the superior junction of the tragus covered and compressed as well [2], presumably to ensure that the soft cartilage of the tragus is sufficiently distended for a good seal.

 

  1. Piranski C, Berge B. 2002. Ear impressions: art or science? Audiology Online. Published Online, March 18, 2002.
  2. http://www.heiraudio.com/upload/Ear_Mold_Impression_Instructions.pdf

 

     Not really, I NEED to know where the socket should be placed, and it amazes me how many impressions we get without that area covered! 

 

    I could rant but why bother....

 

   By the way, we do not trim, sand down etc the ear canal portion of the ear mold impressions, as we try our best to keep everything as intact as possible. Truth is, Hearing Aids are far more forgiving than CIEMs.

Dr. John Moulton

Here at Noble, we craft some of the finest universal and custom in-ear monitors available today. 

post #3857 of 7980
Quote:
Originally Posted by FullCircle View Post

 

     Not really, I NEED to know where the socket should be placed, and it amazes me how many impressions we get without that area covered! 

 

    I could rant but why bother....

 

   By the way, we do not trim, sand down etc the ear canal portion of the ear mold impressions, as we try our best to keep everything as intact as possible. Truth is, Hearing Aids are far more forgiving than CIEMs.

 

Could you snap a photo of a "perfect" mold? That might make it easier for some of us to determine whether or not the ear mold impressions we just paid to have done are actually complete in this regard. 

post #3858 of 7980
Quote:
Originally Posted by Staal View Post

Could you snap a photo of a "perfect" mold? That might make it easier for some of us to determine whether or not the ear mold impressions we just paid to have done are actually complete in this regard. 

 

x2

 

That would be great! smile.gif

post #3859 of 7980

Ah, that makes more sense. Thanks

post #3860 of 7980

I know it won't be a bulletproof solution to just compare to a photo, but it might save some the hassle of having to wait for the impressions to arrive at the Heir lab before they learn that they aren't very good. 

post #3861 of 7980

Me too, unfortunately.  mad.gif  Soooo glad North American customers can ship to a US address to act as a checkpoint for this inspection.  According to Brannan the audiologist did not use enough material on the outer ear/tragal area, which is where the connector assembly sits.  This despite actually seeing my 4.A's (remember, this is a remold/refit so I had them with me) and having Heir's instructions in front of him.  For anyone getting molds done make Heir's requirements clear to the audi and bring this sheet from the FAQ with you...

 

http://www.heiraudio.com/upload/Ear_Mold_Impression_Instructions.pdf

 

Twice now I've had them give this document only passing notice, no doubt relying on their experience that they know how to do an impression.  Don't let this happen - explain that CIEM's are different from the hearing aids to which they are accustomed as larger with more components and also have an acute need for a tight seal for proper sound.  Relate stories like this one of failed molds, and the cost to you in terms of time and money.  Also make sure they understand you fully expect a re-do at no charge (and lobby for shipping as well) if they screw it up.  There is no reason for a burned mold if they're following the requirements; it really does not appear to be a difficult process.  If not smile and vote with your feet if possible.  Fortunately this company has been very accommodating with the new impressions and to that end their service has been exceptional.  Nevertheless frustrating as the process of getting CIEM's is time consuming enough without added delays for remolds.

 

This should be much, much easier.

 

 

Quote:
Originally Posted by thegrobe View Post


DANG...just after I posted that I received an email from Brannan saying my impressions were no good. Missing a critical part.
Good news though - had then redone immediately by the actual doctor rather than the assistant.
They are way better looking than last time, in fact she did two sets to make sure they are perfect.
..but the clock starts over...there goes two weeks.

Edited by JayMitch - 12/6/12 at 7:19am
post #3862 of 7980

Yup, I got an email from Brannan too stating that I was missing the outer ear/tragal area :(

 

$25 shiipping and one week wait to get to San Diego down the tubes... Hopefully round two works out better. My audiologist literally covered my entire ear cavity this time.

 

Darren

post #3863 of 7980

Before Heir had a San Diego office, we early adopters had to fedex our impressions directly to Chengdu for almost $100 a pop if we wanted them there within a week and a half, and we faced the same risk of having bad impressions made. Heir has a good reputation for customer service, and they earned it the hard way, from having to deal with us and our nerves and the problems of international shipping.

 

Also, we all had to go uphill, against the wind through waist-deep snow to get to school every morning, where they fed us cold gruel for lunch.

 

 

You kids these days don't know how easy you have it!

post #3864 of 7980
Quote

 

     Not really, I NEED to know where the socket should be placed, and it amazes me how many impressions we get without that area covered! 

 

 

Quote:
Originally Posted by dgcrane View Post

Yup, I got an email from Brannan too stating that I was missing the outer ear/tragal area :(

 

$25 shiipping and one week wait to get to San Diego down the tubes... Hopefully round two works out better. My audiologist literally covered my entire ear cavity this time.

 

Darren

That is exactly what was wrong with my impressions, the tragal area. It seems this is an area overlooked while having impressions made, I would urge everyone to share this info with the person doing impressions.

 

Although my first set was botched, my redo was actually a good experience. I called up the audiologist's office, anf they hustled to make it right. They had me immediately come in, and I saw the doctor (the assistant did the botched set)

 

The doctor took the time to read over the directions again, read the email I got from Heir, look up their website, etc..Then she proceeded to do TWO sets of impressions using much more material then before and more overall coverage of the ear. 

 

So she checked them out and sent me home with two more sets to forward to Heir, a "backup" set in case something was wrong with the first. She also said not to hesitate to come back if there was another problem.

Anyway, of course there was no additional charge, excellent service, lets hope these are good.

 

BTW -- $40 

post #3865 of 7980
Quote:
Originally Posted by ardgedee View Post

 

if you're in the U.S. and your state requires licensing, his lack of a license is a good reason to avoid him. If your state does not require licensing, ask about his certifications -- you can then confirm them with the certifying organizations.

 

The quoted price is high and the guarantee of perfect impressions sounds excessive, too.

apparently the "impression" he already made is far from perfect!

post #3866 of 7980
Edit: Ignore.

Edited by serious7 - 12/6/12 at 8:16am
post #3867 of 7980
Quote:
Originally Posted by ardgedee View Post

Before Heir had a San Diego office, we early adopters had to fedex our impressions directly to Chengdu for almost $100 a pop if we wanted them there within a week and a half, and we faced the same risk of having bad impressions made. Heir has a good reputation for customer service, and they earned it the hard way, from having to deal with us and our nerves and the problems of international shipping.

 

Also, we all had to go uphill, against the wind through waist-deep snow to get to school every morning, where they fed us cold gruel for lunch.

 

 

You kids these days don't know how easy you have it!

 

post #3868 of 7980
...and the Spectacular Service Tour continues. Not only did the audiologist call me direct to coordinate re-mold, he also (unprompted) got in touch with Brannan to confirm the requirements and even got a photo of my failed molds. So now he knows exactly what is needed, and is even covering the incremental shipping costs.

It's amazing how great service can make mishaps much easier to handle. Kudos.

PS. While I'm at it quick question re open mouth position and bite block. The block is rectangular, so depending on how you use it the mouth position is different. Is it better to have your mouth open with the wider or narrower edge of the block? Does the wider edge, bigger opening yield a tighter finished fit? I don't believe I've seen anything re how open it should be.

Quote:
Originally Posted by JayMitch View Post

Me too, unfortunately.  mad.gif   Soooo glad North American customers can ship to a US address to act as a checkpoint for this inspection.  According to Brannan the audiologist did not use enough material on the outer ear/tragal area, which is where the connector assembly sits.  This despite actually seeing my 4.A's (remember, this is a remold/refit so I had them with me) and having Heir's instructions in front of him.  For anyone getting molds done make Heir's requirements clear to the audi and bring this sheet from the FAQ with you...

http://www.heiraudio.com/upload/Ear_Mold_Impression_Instructions.pdf

Twice now I've had them give this document only passing notice, no doubt relying on their experience that they know how to do an impression.  Don't let this happen - explain that CIEM's are different from the hearing aids to which they are accustomed as larger with more components and also have an acute need for a tight seal for proper sound.  Relate stories like this one of failed molds, and the cost to you in terms of time and money.  Also make sure they understand you fully expect a re-do at no charge (and lobby for shipping as well) if they screw it up.  There is no reason for a burned mold if they're following the requirements; it really does not appear to be a difficult process.  If not smile and vote with your feet if possible.  Fortunately this company has been very accommodating with the new impressions and to that end their service has been exceptional.  Nevertheless frustrating as the process of getting CIEM's is time consuming enough without added delays for remolds.

This should be much, much easier.

post #3869 of 7980

Well....my wallet is now considerably lighter !

8.A ordered

post #3870 of 7980
Quote:
Originally Posted by JayMitch View Post

...and the Spectacular Service Tour continues. Not only did the audiologist call me direct to coordinate re-mold, he also (unprompted) got in touch with Brannan to confirm the requirements and even got a photo of my failed molds. So now he knows exactly what is needed, and is even covering the incremental shipping costs.
It's amazing how great service can make mishaps much easier to handle. Kudos.
 

 

     you don't hear that too often

Dr. John Moulton

Here at Noble, we craft some of the finest universal and custom in-ear monitors available today. 

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