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Know Your Hearing Aid Tubes
When it comes to hearing aids that go behind your ear, they all need a type of tube to carry the sound from behind your ear into your ear canal. There is a lot that goes in to how these tubes work, interaction with the in ear mould and connection to the hearing aid behind your ear.
We have created this resource about hearing aid tubes to help you understand whats going on between the major sections of your hearing aids.
Tubing is very simple and has one main function, the hearing aid tubes main function is to transfer sound from the hearing aid sat behind your ear in to the ear mould and your ear.
There are other purposes for the hearing aid tubing:
- It provides anchorage to the ear which helps with securing your hearing aid in place
- They are made sea through and transparent who makes them more inconspicuous and harder to notice
- The tube adds distance from in the ear and the electronic hearing aid device, helping it stay cleaner and last longer
Looking After Your Hearing Aid Tubing
If your hearing aid has an ear mould you are most likely to have a plastic tube that has been cut and tapered to fit securely in your ear mould. At the other end the tube will attach to your hearing aid. This type of tubing will get brittle over time and will need replacing about every 6 months to keep it working efficiently. Moisture can be another element that causes a problem with this type of tubing. If you suffer a lot with perspiration, sweat or moisture build up around your hearing aids, there is a likelyness your hearing aid tubing will block up with moisture. This can be the case as well if there is no air circulation getting into the ear which is normally provided by a vent in the ear mould.
Some tubing are also made (depending on the manufacturer) with a cut tapered end. This allows for easy application into your ear mould. A hearing aid tube is cut to fit the mould and also cut to measure up neatly to match up with the hearing aid. This allows the hearing aid to sit comfortably behind the ear. If the tubing is cut too short it can feel tight or if it is cut too long the tubing will make the hearing aid sit higher allowing it to move off the ear.
Size of the tubing is also a factor, everyones ear shapes are different and therefore different ear moulds made for different ears means the tubing size can not always be the same. A persons hearing loss is also taken into consideration when selecting the right tubing this is because the tubing does impact the the acoustic properties of the sound going into your ear . This type of tube comes with a number of different sizes and shapes but are all made of plastic.
A standard size hearing aid tube is approximately 2.16mm diameter on the inside and 3.17mm diameter outside. A standard tube as named 'standard' is your usual hearing aid tubing size that is more likely to fit most ear moulds. If you can't get the tubing in then you you will need to select a smaller size tube. If the tubing easily pulls through the mould and out the other side then you will need a larger size tubing. If you require a lot of power from your hearing aid then a standard tubing may be too thin to deal with the amount of sound, therefore in some circumstances a thick wall tubing is more appropriate.
Slim tubing measures roughly 1.93mm inside and 3.10mm outside. This is the thinnest option when it comes to hearing aid tubing for ear moulds. It is a fantastic piece of tubing for smaller ears. It works well for ear moulds that have particularly sharp bends or minute holes to them. This is because the thin tube is a little more flexible than the other tubing. It is most appropriate for indviduals with a mild to moderate hearing loss due to the thin aspect of the tubing. It is the most comfortable of tubing due to it feeling slim next to the ear.
Thick wall tubing roughly measures 1.93mm inside and 3.60mm outside, this is the thickest tubing option. It works well in ear moulds that require a slightly larger tubing to fit into the mould. This can happen over time with some ear moulds as the hole stretches it can no longer take the standard size tubing. A thick wall tubing also provides an acoustic benefit of being more suitable in sustaining higher power amplification without feedback.
Stay Dry Tubing
Stay dry tubing or moisture free tubing as they are alternatively named are designed to prevent the build up of moisture within the tubing. For some individuals this can be a particuarly common event. If moisture builds up regularly in the tubing it can block the hearing aid tube causing none or very little sound to come through. This means you need to regularly take action to empty and dry out the tube which can be quite an inconvenience at times.
Stay dry tubing tends to come in a standard or thick wall tubing option. This means that some ear moulds are unsuitable for a stay dry tubing fit, if this is the case and moisture is a problem then aspects of making a new mould could be the next option to try. A stay dry tubing feels quite rubbery and bouncy in texture in comparison to the other tubing styles therefore if you type feels this way you know this is the tubing that has been applied to your hearing aid ear mould.
Stay dry tubing is not standard on the NHS and you will have to ask for it if you require it. If you are having moisture problems your audiologist will note that down for the future and you will be fitted with one at future appointments.
3mm / 4mm Libby Horn
A libby horn tubing was designed not particuarly to fill the largest holes in the ear mould but actually for the benefit of high frequency amplification. A gradual increase in the internal diameter of the tubing will help boast the high frequency gain of the hearing aid a little. It is important that the larger end of the libby horn is preferably left intact as the length of the libby horn has been created at the correct length for such added amplification to occur (at least 17mm).
The use of a libby horn was much more crucial with analog hearing aids. This is becuase with digital hearing aids more adjustments can be done to accomodate further high frequency amplification needs. However this does not eliminate the need for a libby horn, an example being a hearing aid may be at max high frequency amplification and you just need a little bit more the physical modification such as a libby horn can help. Libby horn tubing come in two different size options, a 3mm or 4mm.
To keep the inside of the hearing aid tube clean you will need to take the hearing aid out from the top of the tubing (do not pull the tubing out from the mould as it will not be able go back in again securely). This is because you can simply slot back in to the tube to the hearing aid, but the mould has the tube fitted through it professionaly.
You will be left with the mould and the tube still together and the hearing aid separate, put the hearing aid in to its box, or hearing aid dryer.
The ear mould and tubing can then be flushed through with warm soapy water, we recommend a neutral PH and plant based soap. This will help to remove any debris or wax in the tubing. Wipe dry the outside of the ear mould and tubing before giving it a shake off any excess water and leave to dry for a number of hours (if you have a dry box, even better!) . If you notice any wax to the entrance of the tubing that will not budge this can be removed with a pin or a hearing aid cleaning tool. Giving your hearing aid a wash is an activity that should be done regurlarly to keep it working well.
Another important actvitity in keeping your hearing aid tubing working to its best is having it replaced when needed. This occurs every 6-9 months, you will find the tubing starts to become more rigid and solid which will start to lessen the sound quality that you hear through your hearing aid. Having your hearing aid retubed can often be an overlooked activity and when you think your hearing aid isn't working as efficiently as it should be it can often be the tubing.
Retubing your hearing aid is something you get done at your local audiology department or the hearing centre that provided your hearing aid. If you have had this done a few times and feel more confident having a go yourself it is a good idea to have a chat while you are having your hearing aid retubed for them to demonstrate how to do this yourself at home. They will usually give you a leaflet and a couple of spare tubes of the correct size for you to try doing at home.
Below is a helpful video by National Children's Deaf Society about how to retube your hearing aid.
You may be happy with a see through and transparent hearing aid tubing option but for some the idea of it being inconspicious is a little boring. There are a number of fun options to decorate your hearing aid without it harming your sound quality. You can get different coloured tubing options from a translucent pink to suit a skin tone to a bright pink to show off your personality. You can get blue, yellow, green and red tubing, different colour options are something you will need to purchase. You do need to be careful where you have bought it from and that you don't just colour them yourself as you might find with moisture build up the colour rubs off onto your ear.
Other hearing aid tubing decorations are jewels and fun characters that attach around the tubing. In the UK there are couple of small bussiness out there that have developed such decorations as hearing aid wearers themselves or parents to children who are hearing aid wearers to add a bit more jazz to them. Ones to check out our tubtastic pimps, my lugs and the beautiful earring style designs by Hearrings.
What I would say is be careful of the weight of the item, if you choose to wear a decoration on your hearing aid tubing. You do not want to compress the tube preventing the sound from getting through.
Open fit tubing applies to hearing aids that do not have an ear mould and have a specific manufacture created tubing that is designed to go with that hearing aid. They are very much more like in-ear headphones, where you buy a pair, like everybody else and they push in to your ear and are not custom made to fit your ear shape.
As there is no tightly fitted seal of a mould in your ear, these are termed 'open fits'. Instead sitting into the opennig of your ear canal will be a silicone rubber like 'dome' rather than an ear mould. It also allows more air into your ear, feeling less blocked. You are less likely to get an occlussion effect with this type of fitting however you are more likely to get feedback and that is one reason why open fit tubing is normally only fitted to those with a mild to moderate hearing loss.
This tubing is thinner and more rigid than the other options because there is no ear mould used.
Open Fit Tubing Sizes
When it comes to choosing which size of open fit tubing, there is less to think about as the same thickness tubing is generally applied throughout size range (varies through manufacturer). The main focus for the tubing is getting the fit absolutely right. Due to there not being any custom made ear mould it is crucial that the tubing is angled into the ear right and that it allows the hearing aid to sit securely but comfortably on the ear. Each hearing aid manufacturer supplies their hearing aid open fittings with a measuring tool. The closest number to the top of the ear canal.
The first consideration before looking at the numbers is whether you need an A or a B, each size option comes with an option of either an A or a B attached to it. It will say for example a size 3A or 2B. The diference is to do with where the curve of the tube sits.
The A size is the longer of the two, the legth from the curve of the tubing to the end tip goes deeper into the ear than the B fitting. The A fitting works better with larger ears or when it does need to sit a little further into the ear.
The B size fitting has a shorter length from the curve of the tubing to the tip of the tubing, for some ears this provides a tighter and snugger fit to the head but for others it does not quite reach into the ear quite enough.
This is the smallest open ear fitting tubing, rarely used as it is for the tiniest of ears.
This is the a small open ear fitting tubing, this is used for small ears and children.
Size 1 is the second to smallest size open fitting and is used for many hearing aid user ears
Size 2 is a size of open fitting size commonly used, it is a mid range size tubing.
size 3 is the largest of the open fitting sizes, this is used for larger sized ears.
This is the largest of the open fitting sizes and only used for ears that are particularly large.
Attached to each piece of tubing there is a curly piece of thin plastic that looks like a little antennae. What this does is help add extra security to the hearing aid staying in your ear. All you need to do is fold this backwards into your ear. For some ears this tail just doesn't stay into the ear without it later flicking out, in which case your audiologist may remove it.
A dome is the small silicone rubber piece that sits at the end of the tubing at the entrace to your ear canal. We mentioned earlier that with open fits the size of the tubings are the same when it comes to diameter and thickness. This is due to the dome being the important factor when it comes to sound properties. It has a number of important jobs to do. It needs to sit in the right position to direct sound into your ear canal to your ear drum. It needs to seal your ear canal in a way that is comfortable and prevents your hearing aid from whistling.
A dome is measured across the widest part. The size can range from 7mm to 12 mm in range.
This is a dome with holes for ventilation and to allow sound to pass through naturally. Open domes provide less of an occlusion effect meaning that your ear will feel less blocked. You are also less likely to hear your own voice as loud in comparison to when your ear is a little more closed off.
A tulip dome is a partcular dome assosiated with Resound hearing aids that has to flaps to it and rather than being circular it has a rather elongated appearance.
Closed domes have no holes in them and can in some cases increase the low frequency amplification up to 20dB. Therefore for those on the borderline with their hearing level in suitability for an open fit hearing aid, a closed or double dome will be needed.
Also known as power domes significantly occlude the ear canal by using a dome that consists of a larger then smaller down to provide. It helps to provide with a moderate to severe level hearing aid still able to use an open fit hearing aid. It also is less likely to cause whistling although a double dome shouldn't really be used as a solution to whistling.
Attaching a new tubing for an open fit hearing aid requires either unscrewing or unclipping it from the top of the hearing aid depending on the hearing aid. It is worth checking in your hearing aid user guide to find out which it is. Once you have removed the last make sure it is clear of debris and attach the new one the same way. A right dome is then attached to the tubing by pushing it onto the end of the tubing.
Cleaning the open fit tubing requires removing the tubing as per above and then using what is called a 'cleaning wire' or 'cleaning wire rod' to push through from one end to the other to push out any wax, moisture or debris from the tubing. It needs to be cleaning wires made for open fit hearing aids as they have the correct diameter to fit through.
Tubing for receiver in the canal (RIC) hearing aids are similar to open fit hearing aids however they contain a receiver wire inside the tubing. Therefore instead of the sound being sent from the hearing aid down the tube, the speaker sits right at the end of the tube at the entrace to the ear canal. This type of tubing means that the sound has a shorter distance to travel to reach your ear drum. As well as using less battery power to do so.
This means you have an electronic hearing technology sat behind and in your ear.
These types of hearing aids are able to provide suitable amplification for moderate to profound losses in comparison to open fit hearing aid options. The sizes of RIC tubing is labelled in the same numerical order from 1-4, 1 being the smallest and 4 being the longest. You do have to take more care with this hearing aid design as they are more delicate. Wax or dead skin can easily get trapped in the end of the ear tip which is ultimately the speaker.
You cannot place a cleaning wire down the tubing or get it wet, instead you need to keep an eye on the entrance of the dome, brush and wipe away any debris. The replacement of these tubes is about £40-60. Some RIC tube are attached to a small custom made ear tip, especially with more profound losses, this is a particularly good combination.
Wax filters are important when using RIC tubing. Inside the receiver will be a wax filter. This is a small piece that helps protect the receiver from becoming blocked with wax. This will require replacement monthly or 6 monthly depending on how often it gets blocked up. You will be issued with wax filters when you purchase you RIC hearing aid. It does not take much to get blocked up therefore make sure your hands are clean when holding your RIC hearing aid.
Hearing Aid Tubing Summary
The type of hearing aid tubing you have depends greatly on what you and your audiologist or hearing specialist have discussed is the right course of treatment. Some tubing is literally plastic piping others such as Receiver in the Canal tubing has an extra job to do. Some are easier to clean and easier to maintain, such as ear mould tubing. Making it one of the reasons it works so well for NHS hearing aids as the method of retubing a hearing aid can be taught to hearing aid users to retube themselves.
Open fit hearing aids are now a popular option in the NHS as they are quick to fit, quick to repair and have positive feedback amongst users. This helps with bringing down waiting times as no ear mould is required to be made which takes up a big part of a hearing aid fitting apointment.
You may have a hearing aid with an ear mould tubing and wonder why you don't have an open fitting tubing. This is most likely down to your hearing levels and dexterity. When people are eligible for either, some people change from ear mould tubing to using open fitting due to being more open and discreet and some change from open fitting to ear mould and tubing fitting due to comfort and ease of manouvering. Which ever hearing aid tubing you have it is always worth viewing your hearing aid user guide if you are unsure.