Domes Versus Earmolds: Which Are Better for You?

Expert review by Dr. Megan Gerhart Redon

As with smartphones and all technology, hearing aids are rapidly evolving. In the past, options for these devices were limited, but now they are offered in an array of styles.

One decision to make when wearing hearing aids is whether to choose domes or earmolds to fit inside your ear canal. Your unique hearing loss, lifestyle, and personal preferences will play a role in this choice. To help you make an informed selection, HearingTracker shares some important information.

How hearing aid domes work

Hearing aid domes are tiny pieces of medical-grade silicone (typically transparent, gray, or black) that attach to the end of hearing aid tubing or wiring and fit deeply into the ear canal. They are typically cone- or dome-shaped (hence the name), and they range in size from 4 mm to 12 mm. The main categories of domes are open, vented, closed, and what’s known as power.

  • Open dome: This type of dome has small vents that allow sound to enter the ear, moving past the hearing aid. It is ideal for mild to moderate hearing loss and especially high pitch loss. Worth noting: It does not work well with low-pitch losses, and feedback can be an issue for those with moderate hearing loss.
  • Closed dome: A closed dome, sometimes called a vented dome, allows for a lesser amount of air and outside sound because it has considerably less venting than an open dome. This results in better amplification of lower pitch sounds. You will get a more robust and balanced sound if you use a closed dome versus open as it allows you to hear the low frequencies better. Closed domes generally work better for those with moderate hearing loss.
  • Power dome: For those with more severe hearing loss, power domes block (or occlude) the ear canal, allowing maximum amplification with minimal sound leakage.

Are domes the right option for you?

Often, selecting the right hearing aid and deciding between domes or earmolds is an evolution. Jennifer Gallo, who has been wearing hearing aids intermittently for 34 years, explained, “My hearing journey has taken me from analog, full-shell hearing aids [ones that almost completely fill the outer ear] to digital, rechargeable hearing aids with a medium power dome.”

Reflecting on her experiences, Gallo said, “I like the size and amplification my current dome provides. The added bonus for those that wish to ‘hide’ their hearing aids is that you cannot see any part of my aids, even with my hair up.”

Besides being practically invisible, domes can seamlessly be switched by the hearing-aid user when they need replacing. They are affordable (often $10 or so for a pack of 6 or more) and can be replaced if they become damaged or get lost. However, if your ear canal happens to be between sizes, the domes may either be too large or too small to create a proper seal.

Hearing aid with dome

A more occluding double dome includes air slits to provide some relief from the occlusion effect.

For some people, this sizing issue can mean that domes fail to stay in place. “For me, domes can get pulled out too easily,” said Kim Powers-Brown, a hearing-aid wearer. If this is the case, it’s often recommended to get a custom earpiece (or earmold) made for a better fit.

How hearing aid earmolds work

Earmolds are another option. These custom-made devices, made of silicone, acrylic, or vinyl, fit into the ear canal and connect to your hearing aid. They are often designed with tiny vents to let air and sound through; there are a variety of shapes available, with names like skeleton, sleeve, canal, and shell. The style is selected based on considerations of hearing needs, dexterity, and ear anatomy.

A hearing aid with earmold

A hearing aid with a "half shell" earmold.

How custom earmolds are made

First, the audiologist will take an impression of your ear. To do so, the audiologist will put a cotton or foam block in the ear, making sure the impression material will not get near the eardrum. The impression material is a soft putty that will harden over a few minutes. Once it dries, the audiologist will remove it, and the block, from your ear. You are able to use your existing hearing aid right away, if you have one. The impression is sent to the hearing-aid manufacturer. When your earmold arrives, the audiologist simply slides your original tubing or receiver (wiring) into the new earmold. They usually have a very comfortable, personalized fit. However, over time, your ear shape may change, and new molds may be required.

Are earmolds right for you?

Earmolds are often recommended for severe or profound hearing loss as they seal the ear better than domes. “Generally, the more significant the hearing loss, the more likely it is that earmolds are necessary. Domes work well for patients with mild hearing loss and for those with a lot of residual low-pitch hearing. When a patient has a hearing loss that requires more gain (volume), earmolds are much better at keeping that sound in the ear canal and directed toward the eardrum,” said Emily Hehl, AuD, audiologist at Educational Service Center of Lake Erie West, in Columbus, OH.

Debra Cook, who was born with hearing loss, noted, “I have used [earmolds] since I was I kid. An individual with a less significant hearing loss might benefit from other options, but I have found, with my level of hearing loss, earmolds provide a better seal which allows for better hearing.”

Making the decision

Still unsure of whether to choose domes or earmolds? Consult with your audiologist about the degree of your hearing loss and get a recommendation. If either is an option, the prevailing wisdom is to try domes first as they are affordable and easy to replace. If after a trial period, you aren’t satisfied, you can request an ear impression and transition to earmolds.

With either, it’s worth noting that those who wear hearing aids should get regular ear care to avoid having impacted earwax – that is, earwax (your body’s natural, protective secretion) can build up inside and block the canal, causing pain and further muffling hearing.