By Ray Woodworth, custom hearing aid expert at Starkey’s Center for Excellence, America.
After more than 23 years working with custom hearing solutions, there is one truth that guides everything I do when it comes to building customs for the ear: The ear is the boss.
I learned a great lesson from Starkey owner and chairman Bill Austin early in my career at Starkey, and over time it stopped being a saying and became a discipline: the ear tells us what we can and cannot do.
Our responsibility is to listen – to the patient, yes – but also to the ear. The anatomy, texture, movement, and acoustics of each ear are unique. The more we understand, not only the hearing loss, but the patients’ ears, the better the solutions.
Custom is about understanding, not just building
When I started in private practice, I thought a good impression and solid programming were enough. But real customisation goes deeper.
Custom is not just about the style of the hearing aid – it is about how sound couples and travel, how the canal moves, how power, venting, and retention interact with the ear itself. It also brings a personal connection to us and the patient. When we build something custom, it becomes more personal and individualised to that patient.
No two ear canals are the same. For example, this is one of the main reasons why REM (real ear measurement) is used by professionals. Each ear has its own acoustic signature because of the uniqueness of each ear. Some ear canals shift dramatically with jaw movement. Some collapse. Some have loose skin, sharp bends, or limited space. These factors matter just as much as the audiogram.
That is why truly custom solutions – whether in-the-ear custom devices or custom case molds – can outperform standard options. They allow us to direct sound to the eardrum better, give more lower frequency gain, reduce feedback, improve comfort, and deliver clearer hearing.
It all starts with the impression
One of the biggest challenges I see today is that, as an industry, we have moved away from consistently making great ear impressions. It seems to have become a lost art.
I’ve learned that repetition is key to becoming skilled at shooting ear impressions. I always say, “The tools are only as good as the person that uses them.” And a quote from Aristotle, “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”
A shallow or incomplete ear impression forces technicians to do guess work, and guessing leads to protruding, remakes, feedback, and poor retention issues of custom hearing aids, not to mention frustrated patients.
My philosophy is simple:
- Use tools most comfortable to you
- Take your time
- Get a good visual of the ear canal
- Make a good deep impression
- Use properly sized and flattened cotton block
- Break the seal when removing impression.
Poor ear impressions can lead to poor fits.
Power, venting, and trade-offs
I am often asked about oversizing receiver power “for the future.” In my experience, fitting what the patient needs now leads to better first-time success. Larger receivers often mean smaller vents, more occlusion, and bigger devices – sometimes before the patient even puts them on.
If hearing changes later, we will adapt. A happy patient today is more valuable than theoretical reserve gain tomorrow.
Technology matters, but people matter more
Verification, targets, and measurements are essential. But hearing is also emotional and perceptual.
I once worked with a patient who had zero-word recognition scores, but she could understand her son’s voice on the phone. That moment was a reminder that familiar voices, personal priorities, and lived experience matter just as much as the data.
Why this still matters
With the rise of over-the-counter options, accessibility has improved, and that is a good thing. But convenience is not always the best solution for the user. Craftmanship and human touch are just as important as technology.
Getting hearing help over the counter has limitations of needs. It is about respect for everyone’s uniqueness of hearing loss and ears.
At the end of the day, the goal is not just about a perfect graph – it is also about the human touch!
The ear is the boss.
The patient is the purpose.
And getting it right matters.
Listen to my full conversation with Dr Dave Fabry on Starkey Sound Bites at this link.
