Document Type

Capstone Project

Publication Date

Fall 2026

First Advisor

Antony Joseph, MA, Au.D., Ph.D., ABAC, CCC-A, CPS/A, F-NAP, DFAAA

Keywords

allergic or adverse reaction, hypoallergenic, irritant contact dermatitis, iatrogenic, mechanical irritation, allergic contact dermatitis

Disciplines

Speech Pathology and Audiology

Abstract

Abstract (Case 1)

An adverse reaction of the external auditory canal for an adult hearing aid user

Introduction: Contact dermatitis, an allergic skin reaction triggered by exposure to irritants or allergens, has become more common with the widespread use of in-ear devices such as hearing aids. Prolonged contact may lead to redness, itching, pain, and skin breakdown, potentially impacting device use and user satisfaction.

Case Presentation: An adult male who wears a turban was fitted with binaural in-the-ear hearing aids. Shortly after initial use, he experienced bilateral ear discomfort. His hearing aids were remade to address presumed physical fit issues. However, following the adjustment, he developed a more severe skin reaction consistent with contact dermatitis and discontinued use of the devices.

Discussion: The patient’s adverse reaction was initially misattributed to mechanical irritation rather than dermatologic sensitivity. Extended delays in the appropriate identification of dermatologic sensitivity led to continued symptoms, discontinuation of amplification, and a negative first experience with hearing aids. The absence of a structured, allergy‑focused screening process during and after the initial audiological evaluation compelled us to develop the Hearing Aid‑Related Allergic Reactions Questionnaire (HA‑RARQ).

Conclusion: Clinicians should specifically ask about dermatologic hypersensitivities or material allergies when prescribing in-ear hearing aids. Early detection and adaptation to hypoallergenic materials should improve patient outcomes and enhance successful device tolerance.

Abstract (Case 2)

A suspected allergic reaction to earmold materials in a pediatric hearing aid user

Introduction: Allergic and irritant reactions to hearing aid materials are uncommon but clinically significant causes of discomfort and reduced device use. Because frequent earmold replacement is expected during growth and development, pediatric patients may be particularly vulnerable to delayed recognition of allergic and irritant reactions.

Case Presentation: A pediatric patient was first fit with BTE hearing aids and silicone earmolds at age 8. Over several years, the child returned frequently due to recurrent earmold tearing and deterioration, leading clinicians in 2022 to prescribe clear vinyl earmolds. The patient experienced ear pain from a replacement earmold obtained through the school system, and examination suggested irritation likely related to the earmold dyes. He was subsequently fit with new hearing aids and earmolds.

Discussion: Mechanical irritation, allergic contact dermatitis, and irritant contact dermatitis are common but distinct causes of skin reactions related to hearing devices. In the presented case, the patient’s reaction may have been related to the earmold material, dyes, or both, and was initially misattributed to normal pediatric earmold deterioration. A clinical flow chart was developed to assist in identifying adverse reactions to hearing devices.

Conclusion: Understanding material composition and patient sensitivity is important because some patients experience adverse reactions to prescribed products. Preventive measures, such as using pre-appointment questionnaires and recognizing signs of material-related reactions, can help clinicians identify risks and improve patient outcomes.

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