Michele Hurley: Our objectives for this course today are that you will be able to list key steps in taking successful ear impressions, be able to identify the various types of ear impression materials that are currently on the market, and be able to discuss the benefits of establishing a professional ear impression protocol within your practice.
Many things that were commonplace not that many years ago, such as penmanship, letter writing, the art of conversation and noodle making have become somewhat of a dying art. In the era of receiver-in-the-canal (RIC) hearing aids, is the art and skill of taking ear impressions becoming a dying art as well?
There is a need to be skilled at taking impressions for a number of reasons. One of those is the opportunity that lies in being able to be proficient at making ear impressions. The opportunity to provide custom solutions for your patient in a non-custom world is one of the key benefits of being skilled and proficient at making ear impressions. The opportunity to demonstrate your professionalism through the care and effort that it takes to provide the best impression of anatomy, ear texture, and desired product are essential. Although we may be fitting primarily non-custom technology, there are a lot of other options where we might need an impression. We need to be able to maintain those skills.
We often hear references to the MarkeTrak studies and the concept of patient delight. One of the most frequent components of “delight” in those studies is you, the professional. As hearing professionals, we need to view the skill of impression taking as a critical one that can impact our potential to delight our patients.
There are a number of different roles of the ear impression itself. It was designed to create a three-dimensional image of the ear, whether that was for the fabrication of custom hearing aids, the fabrication of a custom ear mold for behind-the-ear (BTE) technology or RIC instruments, custom ear monitors, hearing protection, or swim molds. These types of products are great revenue opportunities for us in practice. We tend to think about hearing aids as the main source of our revenue in a hearing aid practice, but very often these ancillary products can be beneficial and require custom ear molds.
A survey done a number of years ago by a group of doctoral students at Pennsylvania College of Optometry looked at the concept of impression taking and whether there is any sort of consistency across manufacturers who build custom types of products. In a series of phone interviews, they gathered data from 34 manufacturers on:
The survey said that most of the companies had no official policy in regard to impression taking techniques that they were able to convey if someone posed those questions. Most recommended the use of silicone material over powder and liquid, citing its better shape stability and less shrinkage than that powder and liquid material. Most respondents did not see any need for different impression taking techniques for different products. If the impression showed 2 mm past the canal second bend, it was considered satisfactory to build any product.
If more specific advice was offered, most labs preferred a closed jaw impression. Those that cited chewing as preferred indicated that it helped get a better seal at the bony portion of the canal. At times, an open jaw impression was recommended if excessive jaw movement had been observed during otoscopy. Other labs suggested both an open and a closed impression to be able to assess the difference. The reps were quick to add that when 2 mm impressions were received, the open jaw was most often used. Of the manufacturers polled, there was a high degree of variability across answers. That leaves you, the professional, wondering what you should do now.
Making a good impression involves science, because we need to be able to understand the different material applications and anatomy, as well as artistry that goes into creating that perfect impression to suit your patient’s needs.