Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Amplification II > 3 - Ear Impressions > Flashcards

3 - Ear Impressions Flashcards

1
Q

What 7 reasons are ear impressions required?

A

1) Custom hearing aids
2) Custom shells for RICs (slimtips, cshells, etc.)
3) Earmolds for BTEs
4) Noise plugs
5) Sleep plugs
6) Swim plugs
7) Custom ear monitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 5 characteristics of a good earmold, custom aid, or custom earplug?

A

1) Good acoustic seal for reduction of feedback (a loose fitting earmold can cause feedback)
2) Good retention (we don’t want an earmold that’s falling out of the ear - peds)
3) Comfortable to wear for long periods
4) Easy to insert and remove (snug, but not super tight fit - have to be able to put it in and take it out)
5) Shaped so that sound is directed toward the eardrum rather than the canal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the shape of the ear canal?

A

An “s” shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two portions of the ear canal?

A

1) Cartilaginous portion between 1st & 2nd bend
- cerumen production area
- cartilage is flexible and can shift with jaw movements
2) Bony portion past the 2nd bend
- more rigid
- more sensitive compared to cartilaginous portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most sensitive part of the ear canal?

A

The bottom inferior portion of the ear is more sensitive than the superior portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What parts of the pinna should you include in your ear impression & why?

A
  • Filling the outer ear with impression material to provide detailed information
  • Concha, tragus detail, helix lock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the patient-specific medical history that is important to obtain before taking an ear-impression?

A

1) Risk for infection?
2) Allergies?
3) Diabetic?
4) Immune compromised?
5) Bleeding risks (bleeding disorders)?
6) Surgical interventions (may or may not be obvious upon otoscopic examination)?
7) Known malformations, genetic anomalies of the ear?
8) Sensitivity in the ear (cough/vagus nerve sensitivity)?
9) Bleeding risks (bleeding disorders)?
10) Anti-coagulant medications?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens if a patient answers yes to any of the patient-specific medical history questions?

A

If a patient has one of these, may have to refer or proceed with extra caution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is diabetes an important question?

A

More prone to infection and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some examples of anti-coagulant medications?

A
  • apixaban (Eliquis)
  • dabigatran (Pradaxa)
  • edoxaban (Lixiana)
  • rivaroxaban (Xarelto)
  • warfarin (Coumadin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do we do otoscopy before performing an ear-impression?

A

Familiarization of individual characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What 8 questions do we ask ourselves when doing otoscopy before performing an ear-impression?

A

1) Are there anomalies in the ear which are going to prevent you from taking an impression?
2) Are there anomalies which will influence the style of hearing aids able to be worn?
3) Where will the otoblock be placed in the canal?
4) Cerumen? Where in the canal
5) Myringotomy tubes?
6) Hair at the canal entrance to be trimmed?
7) Size and shape of ear canal- any unique characteristics?
8) Determine the need for medical clearance active fluid discharge
–inflammation
–pain in touching the pinna, manipulating the pinna
–bony growths in ear canal/exostosis
–perforated eardrum
–previous surgery (e.g., mastoidectomy)
8) How does it look behind the ear (mastoid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of anomaly could prevent an ear-impression from being taken?

A

Exostoses and osteoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 4 components of impression material?

A

1) viscosity
2) shore value
3) contraction ratio
4) stress relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is viscosity?

A
  • In reference to impression material, viscosity is the consistency of the material before it hardens in the process.
  • Low = soft/runny
  • High = thick/dense/firmer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is low & high viscosity material used?

A
  • Lower viscosity material is generally preferred (generally used with an injection gun).
  • High viscosity material may be better for canals with hair, or in open-jawed impressions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is shore value?

A
  • Once the impression material parts have been mixed, an impression has been taken, and impressions form, its “hardness” has a particular shore value.
  • Furthermore, shore value refers to the hardness of the created earmold
  • This is important for keeping shape, and for shipping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is contraction ratio?

A
  • How much does the impression shrink over time?
  • Less than 3% is acceptable
  • How do you ensure an acceptable ratio? Mix material according to directions of the package
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why is contraction ratio important?

A
  • If you have a patient that is having an ear impression done, but isn’t going through with purchasing the HAs quite yet
  • If impressions are sitting for months, it’s better to get a fresh impression done
  • Can keep an ear impression for usually up to a year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is stress relaxation?

A
  • Does the impression keep shape after it is stretched or bent?
  • Does it change when we physically pull the impression out of the ear?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Viscosity and shore value impressions picture

A

We generally do something in the middle of low and high viscosity and 20-70 shore value

22
Q

How does addition-cure vinylpolysiloxane work?

A
  • Impression material consisting of 2 parts: 2 bases (2 different colours)
  • Viscosity ranges: generally medium to high viscosity for “hand mix” material, lower viscosity for cartridge mixes
  • Material is mixed, and begins to harden between 1-4 minutes
    • Hand mixed material: 2-4 minutes generally
    • Cartridge material: 1-2 minutes generally
    • The key is working quickly with either
  • Impressions are taken with all the aforementioned steps
  • Never put the materials together until you are ready to mix (keep completely separate)
23
Q

Silicone that is mixed by hand or with a spatula, and inserted in a syringe, generally has ____

A

Medium to high viscosity

24
Q

Silicone that comes in a cartridge, and is mixed and injected with a “gun”, generally has ____

A

Low viscosity

25
Q

What are the 8 steps of taking an ear-impression?

A

1) hand washing/infection control
2) otoscopic examination
3) select otoblock
4) place otoblock past the 2nd bend
5) prepare syringes
6) break seal and remove impression
7) examine the impression
8) examine the ear

26
Q

What happens during step 1) hand washing/infection control?

A
  • Hand washing/Infection Control, gathering of materials.
  • Ensuring materials are placed on clean surface. Gloves are advised.
  • Explain the procedure to the patient
27
Q

What happens during step 2) otoscopic examination?

A
  • Otoscopic examination, familiarizing yourself with individual characteristics of shape— be cautious of irregularities, seek medical clearance accordingly
  • Obtain medical clearance prior to taking impression if: active fluid discharge, inflammation, bony growths
28
Q

What happens during step 3) select otoblock

A

Select a dam or “otoblock” that fills periphery of the canal — you are protecting the tympanic membrane

29
Q

What happens during step 4) place otoblock past the 2nd bend

A
  • Place the otoblock past the second bend using a lighted device such as a “penlight”.
  • Have your patient seated comfortably.
  • Recheck the placement of the otoblock through otoscopy
  • Check that the otoblock is flat into the ear and that there are no gaps around it
30
Q

What happens during step 5) prepare syringes

A
  • Prepare the syringes.
  • Prepare the impression material (mix by hand or with spatula).
  • Fill the ear with material— the canal, the concha— the more “information” provided by the impression, the better
  • Tell the patient that once the material is in the ear, it will be about 5 minutes, it will be like an earplug so its going to be very quiet
31
Q

What happens during step 6) break seal and remove impression

A
  • Once the material has hardened (indentation check), break the seal of the material to ear by moving the pinna “up” and “out”.
  • Rotate the impression, rolling forward to remove from the ear
  • Tell the patient that as the material is coming out of the ear to open their jaw
32
Q

What happens during step 7) examine the impression

A
  • Examine the impression.
  • Are there gaps?
  • Is the otoblock attached to the material?
  • Do you see the landmarks of the ear canal bends and concha?
33
Q

What happens during step 8) examine the ear

A
  • Examine the ear.
  • Ensure there is no impression material left behind, or significant irritation.
  • Slight redness is normal.
  • Tell patients not to put anything in their ears (besides HAs) after impressions are taken as can be quite sensitive
34
Q

What happens if you don’t place the otoblock past the second bend?

A

If we don’t pick up the second bend, we don’t have an idea of where the sound should be directed too

35
Q

Why is otoblock placement important?

A
  • Stops the impression material from reaching the eardrum, or middle ear space if TM perforation exists
  • Should fit tightly in the canal. You should feel slight resistance on insertion
  • Brace your little finger against the side of the head or cheek when using an ear- light to place the oto-block
  • When putting the otoblock in the ear, we want to brace ourselves, so no damage is done (particularly important for kids)
36
Q

How do you take an ear-impression on someone who has had a mastoidectomy?

A

Sometimes an ENT can pack the open space then remove it, but if you don’t work with an ENT, you will have to refer out

37
Q

How do you do an ear-impression when a very deep impression is required?

A
  • Deeply fitted IICs or extended wear HAs
  • Some devices require impressions performed with oto-block placed very close to the eardrum
  • Use oto-block with pressure-relief tube (helps to relieve pressure as the impression is curing)
38
Q

What are the 5 steps when mixing impression material by hand?

A

1) Set up all materials/tools prior to beginning. Have the otoblock in place.
2) Wear gloves.
- Note: latex gloves are not recommended as latex can affect the curing of the ear impression material itself (use vinyl)
- Choose a “powder-free” glove
3) Mix the base and hardener until the two colors are well blended.
4) Put material into syringe, starting pushing material through so that material has reached to exit point of the syringe
5) Work quickly

39
Q

What are the 4 steps of delivering the impression material into the ear canal?

A

1) Start near the oto-block and pull back syringe gradually (deliver deep in the canal and work your way out)
2) Keep the tip of syringe submerged into the material
3) Fill ear canal canal, then concha bowl, move up to helix-cover the tragus
4) Work quickly

40
Q

When would you need an open-jaw ear impression?

A
  • If mandibular movements interfere with HA use (e.g., HA retention, feedback, perceived low power), take impression while patient has jaw opened (use bite block & have tissue handy!).
  • Opening the jaw will make the ear canal wider (makes the impression a little bit tighter)
41
Q

What should you do if you need a tighter fit ear impression?

A

Open jaw impression?

42
Q

Why should you mark the impression of the horizontal place during the cure process?

A

Determines the position of the directional microphones in the manufacturing process

43
Q

Why is it necessary to cover the tragus with impression material?

A

We need tragus information because we don’t want the microphone of the HA to be covered by the tragus

44
Q

What are the 4 steps of removing the ear impression with ease and comfort?

A

1) Pull the ear up, back, and out to break the seal.
2) Remove helix portion first.
3) Pull out the impression slowly while rotating forward.
4) Ask the patient to “open their mouth” when rotating for easier removal.

45
Q

Why do you have to evaluate the impression?

A
  • Need a good quality ear impression
  • Do not want an ear impression that is:
    • Not deep enough
    • Under filled canal
    • Under filled canal, concha, and helix
    • under filled helix
  • If you take a poor impression, do another one
46
Q

What type of impression material is used for deep ear-impressions?

A

Low viscosity material

47
Q

How is a shell or mold created from the impression (the cast method)?

A
  • This used to be the way impressions were made, not as much anymore
    1) Manufacturer modifies the impression (e.g., cutting canal to desired length) & creates a cast.
    2) Liquid plastic is poured into the cast.
    3) The liquid plastic is poured out before hardening, leaving a thin shell of plastic inside the cast to produce a custom HA shell.
48
Q

Instead of the cast method, what is the newer way shells or molds are created?

A
  • Newer technology scans the impression instead of using a cast.
  • CAMISHA (Computer Aided Manufacturing of Individuals Shells for Hearing Aids) developed by Widex
  • 3-D laser scan of the impression
  • Virtual modification of the impression as needed
  • Computer screen view of where HA components will fit within the shell (virtual layout of components)
49
Q

Why is a computer scanned technology better?

A
  • Once the impression is scanned, we don’t have to worry about stress relaxation
  • Typically, the keep the scanned impression on file for 5 years
  • The manufacturer will let you know if the HA the patient is wanting will work in their specific ear canal
50
Q

What are the 2 most popular technologies for digitally scanning patients ears instead of taking an ear impression?

A
  • Otoscan 3D (video otoscope with wide angle)
  • Lantos Direct Ear Scanner
51
Q

How does the Lantos scanner work?

A
  • Membrane attached to tip of scanner is inserted in ear canal and then fills up with liquid to determine the shape of the ear canal.
  • Once filled with liquid, the scanning occurs.
  • Then the liquid is withdrawn and the tip of the scanner removed from the ear canal.
52
Q

What are 3 take home messages for taking ear impressions?

A

1) Remember that taking ear impressions is an invasive procedure! We must prioritize patient safety
2) Take your time. It will go faster
3) Quality of the impression matter are directly related to the quality of the product that will be created

Amplification II (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions