Paediatric Audiology —
Training activity: 6

Details

Safely take ear impressions and select appropriate earmoulds for  pre-school and school-age children

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Principles of patient-centred care and support
• Infection control
• Parental/child consent
• Acoustic, comfort and aesthetic considerations
• Shared decision making
• Local, national and international guidance and best practice

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What does success look like?
  • What constitutes a safe ear impression technique for pre-school and school-age children, considering their canal anatomy and potential movement?
  • How do you select appropriate earmoulds based on the child’s hearing loss, ear anatomy, and hearing aid type?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you taken ear impressions on children of these age groups before?
  • What do you already know about safe impression techniques and age-specific considerations?
  • What specific challenges related to child cooperation, small or difficult ear canals, or ensuring safety during impression taking might you face? How might you plan to handle them?
  • What is the scope of your own practice for taking paediatric impressions and selecting earmoulds? When will you need supervision or help, and from whom?
  • How do you feel about taking impressions on children?
• What do you anticipate you will learn from the experience?
  • What specific techniques for taking safe and accurate impressions on children do you want to refine, drawing upon previous experiences?
  • What specific insights into appropriate earmould selection for paediatric hearing aids, including factors like material and style, do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on taking ear impressions (paediatric or adult) or earmould selection?
  • Do you need to check that all impression materials and equipment are ready and appropriate for use with children?
  • Do you need to review different earmould styles and their suitability for different paediatric needs?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the impression taking and selection process? Are you encountering situations such as:
    • Unexpected anatomical issues revealed by otoscopy (like canal strictures or complex middle ear findings) that complicate the safe insertion of the otoblock?
    • The child displaying extreme distress or anxiety that impacts their ability to stay still for the necessary duration of the impression procedure?
    • The child or family immediately and strongly rejecting the selected earmould style or material, impacting the hearing habilitation plan?
  • How is this experience comparing with previous experiences of similar activities?
• How are you reacting to the unexpected development?
  • How is the unexpected development being resolved as you progress during the activity? Are you successfully managing the situation yourself (e.g., using distraction techniques, safely removing the otoblock), or do you need support because the complexity of the child’s reaction or the anatomical risk is beyond your current scope?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a safer technique for impression taking in a moving child, or a more effective way to present earmould options to ensure patient/family buy-in?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately, prioritising the child’s safety and comfort? Are you adapting or changing your approach to the procedure (e.g., switching the impression material or modifying the insertion angle)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately using active listening and validation techniques to address child distress, or are you adjusting the procedure based on the specific anatomical complication observed?
  • How are you feeling in this moment?
• What is the conclusion or outcome?
  • How are you working within your scope of practice? E.g. Are you successfully prioritising the child’s safety and comfort, recognising when an anatomical risk or distress necessitates immediately stopping the impression procedure? Are you practising within your scope by adjusting the procedure (e.g., modifying insertion angle or switching materials) based on observations of anatomical complications or behavioural reactions, ensuring a safe outcome?
  • What do you learn as a result of the unexpected development? E.g. Are you learning a safer technique for impression, taking in a moving or anxious child, enhancing your ability to safely take ear impressions? Are you gaining a more effective way to present and discuss earmould options to overcome family resistance and ensure compliance with the hearing recovery plan

On action

• What happened?
  • Begin by summarising the process of safely taking ear impressions and selecting earmoulds.
  • Consider specific events or actions that felt important, such as successfully managing the child’s movement during the impression-taking or ensuring the otoblock was placed correctly for a small ear canal. What feelings were you experiencing while dealing with these practical challenges?
  • Include any ‘reflect-in-action’ moments, where you immediately adapted your technique, for instance, calming an upset pre-school child to maintain stillness, or adjusting the impression material syringe due to blockage.
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience. What strengths did you demonstrate (e.g., knowledge of safety protocols, speed of procedure)? What skills and/or knowledge gaps were evident (e.g., selecting the appropriate venting or material for a child with changing anatomical needs, managing unexpected anatomical variations)?
  • Compare this experience against previous engagements. Has your practical skill in impression taking improved?
  • Identify any challenges you experienced (e.g., getting a full impression of a deep canal, managing pain/discomfort reported by the child) and how you reacted.
  • Identify anything significant, such as needing to seek advice or clarification on appropriate earmould material for a specific skin condition.
• What will you take from the experience moving forward?
  • Identify the actions or ‘next steps’ you will take.
  • What will you do differently next time? Do you need to practise any specific aspect of managing the child’s behaviour during the procedure or ensuring the safety of the impression taking process? E.g.
    • Refining your technique for otoblock placement to ensure safety, especially in small ear canals. Practising managing movement when dealing with pre-school children.
    • Consulting resources on selecting appropriate venting, material, and tubing for children with specific anatomical variations or skin conditions to optimise earmould selection.
    • Practising efficient troubleshooting of impression material blockages or other technical issues that could cause delays and minimise distress to the child.

Beyond action

• Have you revisited the experiences?
• • Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (safely taking ear impressions and selecting appropriate earmoulds)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to achieving consistently high-quality impressions, maintaining safety protocols during the procedure, managing uncooperative children, or justifying the selection rationale for different earmould styles?
  • Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing this task?
  • Have you engaged in professional storytelling or discussed your experiences of ear impressions and earmould selection with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of handling unusual paediatric ear anatomies, minimising discomfort during impression taking, or technical considerations for acoustic seal?
• How have these experiences impacted upon current practice?
• • Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module? Your improved skill and safety awareness in this procedure supports your overall ability to provide hearing habilitation for school-age children.
  • How has your practice related to safely taking ear impressions and selecting appropriate earmoulds developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in patient positioning for safety, achieving a quick and clean impression, or correctly matching earmould features (e.g., venting) to the child’s prescription?
  • Based on your experiences, how has your ability to recognise when something related to ear impressions or earmoulds is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, ENT surgeon, senior paediatric audiologist) you need to seek advice or clarification regarding unmanageable cooperation issues, severe anatomical anomalies, or adverse reactions during the procedure?

Relevant learning outcomes

#	Outcome
# 6	Outcome Provide hearing habilitation for school-age children.