Guidelines for the Taking of Impressions and Provision of Ear Moulds within a Children’s Hearing Aid Service
Introduction
Well fitting ear moulds play a key role in ensuring optimal amplification over time for a hearing impaired child. New moulds will be required as the child grows and the process of habilitation should not be compromised by unacceptable time delays in provision of new moulds. These guidelines are intended to provide guidance and quality standards for the provision of earmoulds in a children’s hearing aid service. They assume that the standard procedures for taking impressions, as recommended by the BSA (1986, 1994) are being followed.
Taking an ear impression
· Impressions must always be taken by experienced personnel who are used to handling babies and young children.
· Impressions for ear moulds should be taken as often as necessary. This may be every two / three weeks for infants under six months of age, and frequently thereafter.
· Newly identified babies, especially under 12 months of age, will be seen for frequent hearing aid review, and ear impression taking should be a routine part of these appointments.
· Children should not have to wait more than two working days for an impression to be taken once a decision has been made that new moulds are required.
· Services must make impression-taking easily accessible to parents and children with a combination of open access arrangements, outreach clinics, domiciliary visits, impression-taking by other agencies after appropriate training (eg education services), and set regular appointment times. Some of these arrangements must be offered in out-of-work hours.
· Light pens with meatal depth marked on the probe tip should be used for tiny ears (2 –6 months) using 10mm from the ear canal entrance as a guide. This may need to be modified with smaller or premature babies .
· The baby’s hearing aids should be positioned on the pinna before the impression is taken.
· Clinicians should be experienced in making appropriate judgements about earmould material, tubing thickness and specialised tubing.
· Services should offer earmoulds in a variety of different colours and decorations.
· Ear impressions must leave the hearing aid clinic (or wherever they are taken) on the same day that they are taken, using first class post.
· Rigid boxes should be used for packaging earmoulds.
· Distinctive dispatch labels must be used which identify the impressions as ‘Paediatric’ and ‘Urgent’ so that they can be ‘fast tracked’ on receipt by the laboratory (in agreement with the earmould laboratory).
· Cotton blocks rather than foam otostops should be used for babies and young children and trimmed to an appropriate size.
· An appropriately small syringe is recommended rather than the standard audiological syringes. For babies under 3 months of age, or for any child with very narrow external auditory meati, a dental syringe with a curved disposable nozzle that can be cut to any diameter is recommended.
Manufacture of the earmoulds
· Manufacturers must prioritise paediatric ear impressions – with no longer than 36 hours working time turn around.
· Services should be provided with distinctive labels to facilitate a “fast track” routing for these paediatric ear impressions.
· Finished products should to be dispatched to any address requested using First Class post
· Efforts must be made to enhance communication between clinicians and manufacturers eg over difficult to fit cases, problems with impressions, ear mould fit etc.
· Fabrication of earmoulds for babies (or children with tiny ears) requires special techniques to be used.
· Where tubing retention in silicone moulds is a problem tube retention enhancements such as metal or plastic tube locks, anchor connectors and gluing tubes in with silicone are possible solutions.
· Double bend tubing may help avoid the problem of angle of tubing forcing mould out of the ear when connected to the hearing aid.
Fitting earmoulds
· Parents should be shown how to fit new earmoulds, enabling the moulds to be dispatched directly to the family from the manufacturer.
· In some circumstances it may be useful to have the earmoulds fitted by the child’s teacher of the deaf. When this is the case the earmoulds should be dispatched to the teacher direct from the manufacturer for fitting to the child within 24 hours.
· When the fitting is done through the hearing aid clinic, a flexible and quick appointment system will be required to avoid delay in fitting the new earmoulds. There should be immediate notification (by telephone or similar) to families when new earmoulds arrive back at the hearing aid centre, and an appointment within 24 hours for fitting must be arranged.
· Parents should be shown how to retube earmoulds at an appropriate stage and be provided with the necessary equipment.
Revised Sept 2005
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