The earmold is a plastic insert that fits inside the outer ear and canal.  The purpose of the earmold is to conduct amplified sound to the eardrum.  A properly fitted, comfortable, custom made earmold is just as important as any other component in the successful fitting of a hearing instrument.  Since the custom earmold is a duplicate of the ear impression you make, it is extremely important to take a full and complete impression.

Remakes

Whenever a remake or replacement mold is needed, be sure a new impression is sent.  Full information should be furnished on the order form.

Preparation

Follow hygienic procedures: wash hands thoroughly. aWash specula, earlight tips, etc. thoroughly before immersing them in an antiseptic solution.  Caution: alcohol or other antiseptic injurious to plastics should be avoided. 

Ask the client if they have had any prior ear problems such as injury, surgery, infection, or currently have any irritation, swelling, or soreness in the ear.  It is inadvisable to take an impression of an ear which has been operated on within the last 90 days, and advise client to consult with a doctor if there is any apparent irritation, swelling, or soreness in the ear.

Inspection of the Ear

If you will perform all of these inspections, you will instill a great deal of confidence in your customer, as well as gaining the information you need to make a good impression.

• A complete inspection with an otoscope will usually reveal any difficulties that might hinder the taking of the best possible impression.  By taking the "pina", or back of the ear, and extending it forward and up, the canal will straighten out for a thorough inspection.
• Inspect for any discharge, infection or swelling, do not take the impression, and advise any customer with these conditions to see their doctor.
• Inspect for excessive wax.  If the canal is entirely blocked or nearly blocked, do not take an impression, and advise the customer to see a physician to have the excess wax removed.  Clearing the canal should also result in better hearing.
• Inspect for any malformations and be sure they are shown clearly on the impression.  Note these malformations on the earmold lab order form.
• Check the texture of the ear to see if it is hard, medium, or very soft.  You should be very careful in making an impression of a soft ear, not to stretch it out of shape.  Many earmold problems are caused by pressing the material too hard into a soft ear, thus oversizing and misshaping the impression.

The Otoblock

The otoblock (or dam) should be the same size, or slightly larger, than the canal area at the point it is inserted.  It will function as a complete block of the ear canal and will not move as the impression material is forced into the canal. 

Blocking the ear with an otoblock before taking an impression is of paramount importance.  Without a dam, the material will taper off and not give a true "picture" of the canal.  If the dam is too small, the material will flow around it.  If too large, it may expand the canal to an abnormal size, resulting in an impression too large at the section of the canal.

The dam serves two important functions:

• stops the inward flow of impression material at the proper point.
• safety measure to prevent the impression material from penetrating too far into the ear canal

The Impression

Your impressions need sufficient canal depth. Take your time with dam placement.  
Inadequate dam placement results in an under-filled canal. When taking the impression, one of the most important aspects of an impression is the canal.  Fill it first. Hold your hand steady and apply the impression material with even pressure. 



Impression Removal

To remove the impression, grasp the bulk of the material with one hand, and begin to press or peel the edges of the ear back and away from the impression with the other hand.  Slowly begin to rotate the top of the impression forward towards the nose, which will disengage the conch and helix area.  The forward motion should also be accompanied with an outward motion away from the head.

This removal should be slow so as to not stretch or tear the canal portion, or form a vacuum.  The dam should come out attached to the end of the canal section.  If the dam remains in the ear, remove it by using the attached thread.

Carefully inspect your impression, paying particular attention to the canal, helix, and conch areas, checking for fullness and any undesirable pockets or ripples.  If any areas are questionable, take a second impression.

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