Hearing aids come in several shapes and sizes. There are two types of hearing aids that sit on top of, or slightly behind, the ear. These are behind the ear (BTE) and receiver in the canal (RIC) hearing aids. There are five basic styles of hearing aids that sit inside the ear. Collectively, they are called in-ear (ITE) hearing aids.
From smallest to largest, these are invisible in the canal (IIC), completely in the canal (CIC), in the canal (ITC), half-shell in the ear (ITE) and full-shell in the ear (ITE) hearing aids. Audiologists choose certain hearing aid styles based on a patient’s hearing loss, ear canal shape and size, manual dexterity, and other factors. While receiver in the canal (RIC) hearing aids are the most commonly fit style of hearing aid, in the ear (ITE) hearing aids are a good option for people who want custom hearing aids that fit inside of their ears.
How Hearing Aids Work
Hearing aids are sophisticated devices with four important parts.
- Microphone: The hearing aid microphone picks up sound and sends it to the amplifier. Most hearing aids have two microphones for directional hearing. This allows the user to hear sounds in front of them more than sounds behind them, which helps in noisy situations.
- Amplifier: The hearing aid amplifier makes the sound louder. Different pitches receive different amounts of amplification, based on the user’s hearing loss.
- Sound Processor: This is a computer chip that converts the sound into a digital signal that can be changed in various ways to improve the sound quality for different types of hearing loss and different listening needs.
- Receiver: This is the speaker that sends the amplified and processed sound into the ear.
It is important for hearing aids to be cleaned regularly in order to ensure proper function. They should also be checked by an audiologist or hearing instrument specialist on a regular basis (one-two times per year) for deep cleaning, firmware updates, and programming adjustments.
Do all hearing aids work the same way?
The vast majority of today’s hearing aids use digital processing. However, there are many different factors that influence how digital hearing aids work. One factor is the style of hearing aid. Behind the ear (BTE) hearing aids work slightly differently than in the ear (ITE) hearing aids. Another factor that affects how hearing aids work is the digital processing strategy.
The digital processing varies between different hearing aid manufacturers and it can also be changed in the programming software by the hearing care provider. The final factor that affects how hearing aids work is the technology level. Economy-level hearing aids work differently than more expensive premium-level devices.
In general, premium-level devices tend to be more automatic while economy-level devices require that adjustments be made by the user.
What are in-the-ear hearing aids?
In the ear (ITE) hearing aids are custom-made for each user and they sit inside the ear rather than over the top of the ear like behind the ear (BTE) and receiver in the canal (RIC) hearing aids. There are five different styles of in the ear (ITE) hearing aids ranging from invisible in the canal (IIC) hearing aids that sit deep in the ear canal to full-shell in the ear (ITE) hearing aids that fill up the entire bowl of the ear and are quite visible.
In the ear (ITE) hearing aids are custom-made for each user. The audiologist or hearing instrument specialist must first take an earmold impression of each ear by injecting a silicone substance into the ears which hardens and creates molds of the ear canals and bowls of the ears.
These earmold impressions are then sent to the manufacturer where the hearing aids are built according to the specifications requested by the hearing care provider. It typically takes 2-3 weeks from the time the earmold impression is mailed to the manufacturer to the time the finished product is received back at the clinic.
What are the different in-the-ear hearing aid styles?
There are five different in the ear (ITE) hearing aid styles. From smallest to largest, these are invisible in the canal (IIC), completely in the canal (CIC), in the canal (ITC), half-shell in the ear (ITE) and full-shell in the ear (ITE) hearing aids. Let’s take a look at the pros and cons of each style:
Invisible in the Canal (IIC) and Completely in the Canal (CIC) Hearing Aids
Pros: These are the smallest hearing aids available and therefore the most invisible. These might be a good choice for people who are concerned about the cosmetics of wearing hearing aids. Because these sit deep in the ear canal, they are not affected by wind noise like some of the larger hearing aids are.
Cons: IIC hearing aids use the smallest battery (size 10) which doesn’t last as long as larger batteries. Size 10 batteries typically last 3-4 days. Because the hearing aids and batteries are small, they can be difficult to handle for those with dexterity or vision challenges.
While CIC hearing aids can accommodate a button for manual controls, IIC hearing aids are too small for a button so no manual controls can be made on IIC devices. Both CIC and IIC hearing aids are also too small to accommodate an antenna, so wireless streaming is typically not available in these tiny hearing aids.
In the Canal (ITC) Hearing Aids
Pros: ITC hearing aids are slightly larger so they use a bigger battery (size 312) that lasts longer, typically 5-7 days, and is easier to handle. ITC hearing aids are large enough to accommodate 2 microphones which allow for directional hearing, and a program button which allows for on-board control of programs or volume. They are also large enough to hold an antenna which allows for wireless streaming.
Cons: ITC hearing aids are more noticeable because they are larger and stick out of the ear canal farther than the IIC and CIC styles. This also makes them more susceptible to wind noise.
Half-Shell and Full-Shell In the Ear (ITE) Hearing Aids
Pros: While half-shell ITEs typically use a size 312 battery, the full-shell ITE style uses a larger size 13 battery that can last up to 2 weeks. In addition, there are now ITE-style hearing aids that have rechargeable batteries so the user simply puts the hearing aids in the charger at night and then puts them in their ears in the morning. Because these are the largest of the ITE hearing aids, they can be the easiest to manipulate for those who have dexterity or visual challenges.
These styles can accommodate both a button for program changes and a wheel for volume changes. They can also easily accommodate an antenna for wireless streaming. Finally, the larger size of this style can accommodate the largest amplifier making these the best option for people who have severe hearing loss but can’t or won’t wear behind the ear (BTE) hearing aids.
Cons: These hearing aids fill up half or all of the bowl of the ear canal (the concha bowl), making them very visible in the ear and the least cosmetically appealing. Because they sit farther out in the bowl of the ear, they are also more susceptible to wind noise.
How is the hearing aid battery life of in-ear hearing aids?
In-ear hearing aids, also known as IIC (Invisible-in-the-Canal) or CIC (Completely-in-the-Canal) hearing aids, are designed to be discreet and fit snugly within the ear canal. Hearing aid battery life in these devices can vary depending on factors like the size of the hearing aid, the battery’s capacity, and the level of usage.
Generally, smaller hearing aids have smaller batteries that may need to be replaced more often, while larger ones can offer longer battery life. It’s common for in-ear hearing aids to use zinc-air batteries, which can last anywhere from a few days to two weeks, depending on the specific model and usage patterns. It’s important to follow the manufacturer’s instructions for battery replacement and to carry spare batteries to ensure uninterrupted hearing assistance.
Behind-the-ear vs. in-the-ear hearing aids
Behind-the-ear (BTE) hearing aids work differently than in the ear (ITE) hearing aids. In the ear (ITE) hearing aids contain all of the components inside the custom hearing aid shell that sits inside the ear. This can be nice from a cosmetic perspective, but it can also make the ITE electronics more susceptible to malfunction as all of the components are sitting in a warm, moist, waxy ear canal.
With the receiver in the canal (RIC) hearing aids, the microphone, amplifier, and sound processor are all encased inside the device that sits behind the ear and there is a tiny wire that connects this piece to the receiver (speaker) that sits inside the ear. Behind the ear (BTE) hearing aids house all of the electronic parts in the device behind the ear and the amplified sound is sent through a rubber tube that connects to a custom earpiece that sits inside the ear.
Because of the larger size, BTE and RIC hearing aids utilize larger battery sizes that last longer. In addition, BTE and RIC hearing aids all have a convenient rechargeable battery option.
Which hearing aid will work best for me?
Your audiologist or hearing instrument specialist will work closely with you to determine the best hearing aid style, manufacturer, and technology level for your specific needs.
They will take into consideration your hearing loss, your ear size and shape, your vision and dexterity, the type of mobile phone that you use (some hearing aids work better with iPhones, and some work better with Android phones), and your lifestyle.
You will share your own preferences for the style, size, standard vs. rechargeable battery, and pricing that fits your budget. Sometimes the first hearing aids that you try aren’t the best option for you, so it is important to be very honest with your hearing care provider about your experiences and preferences and be open to trying more than one style or manufacturer.
It takes time to adjust to hearing aids and having patience will make the entire experience easier and more fun.
How can I adjust to my hearing aid?
Typically, people who seek treatment for their hearing loss early tend to have an easier time adjusting to hearing aids. Alternatively, those who wait many years to get hearing aids sometimes have a more difficult time adjusting because they’ve gotten used to living with hearing loss.
Either way, it is important to keep in mind that hearing aids will amplify all sounds and so you need to give your brain time to get used to hearing all the new sounds again.
Most people are thrilled to be able to hear voices more clearly with their hearing aids, but sometimes they are dismayed by the fact that they also hear their footsteps on gravel or people talking at a neighboring table in a restaurant. While these environmental sounds may be louder than you remember them, they will get easier and easier to tune out as your brain re-learns to process the noisy world that we live in.
For the best outcomes, you should wear your hearing aids all waking hours. Wearing your hearing aids is like physical therapy for your brain, so the more you wear them, the stronger the sound-processing areas of your brain will be. Regular follow-up visits with your audiologist for fine-tuning, training, and education will also make your adjustment much faster and easier.
What to Consider Before Buying Hearing Aids
There are several things to consider before buying in-the-ear (or any style) hearing aids. First, it’s important to have a full hearing test performed by a licensed audiologist. If the audiologist finds anything concerning, you will be referred to a physician for a medical evaluation which you should have prior to purchasing hearing aids.
Second, you want to be prepared to pay for the hearing aids. Hearing aids and the professional services required to properly fit and maintain them can be costly, so plan ahead for how you will pay for this important part of your health care. Check with your insurance company to see if you have any hearing aid benefits, add funds to your health savings account, or look into financing options.
Third, beware of misleading claims that you may see advertised online. If the cost or the benefits seem too good to be true, they probably are! And finally, find a hearing care provider who you feel comfortable with. This person will be a big part of your life for many years to come, so don’t hesitate to “shop around” for an audiologist or provider who truly listens to your concerns and wants to work closely with you to create a personalized hearing plan for your specific needs.
Shopping for the right provider is much more important, in the long run, than shopping for the best price. You and your audiologist should discuss your current and future needs in order to choose the best hearing aids for you.
Be sure to ask about the trial period (all states require that you be given a trial period with the option to return the hearing aids if you are unsatisfied with them). Also, you’ll want to learn the details about the manufacturer’s repair warranty, loss/damage warranty, and in-clinic service plan.
Over-the-counter hearing aids
Are Amazon hearing aids any good for in-ear models?
When it comes to in-ear hearing aids, the quality and suitability of Amazon hearing aids or any other over-the-counter devices can vary. While Amazon might offer a range of options, the effectiveness of in-ear hearing aids relies on factors such as your specific hearing needs, the device’s features, and the expertise of an audiologist in ensuring proper fitting and programming.
Keep in mind that in-ear hearing aids require precise customization to match your unique auditory requirements and ear anatomy. While you may find affordable options on Amazon, it’s crucial to prioritize your hearing health by consulting a licensed audiologist who can recommend and properly fit in-ear hearing aids to maximize their performance, comfort, and long-term benefits.
Getting Used To Your ITE Hearing Aid
Some people get used to hearing aids quickly and others take a bit longer. In-the-ear (ITE) hearing aids should be comfortable in your ears, but they may feel strange at first as your ears get used to having something in them. One of the first things you might notice is that your own voice sounds different when you are wearing your new hearing aids. This is because you are now hearing your voice through the hearing aid microphones so it will naturally sound amplified to you.
Don’t worry! The more you talk, the faster you’ll get used to the new sound of your own voice, and eventually you’ll even prefer the amplified sound. I often instruct my patients to sing out loud to the radio, or read a book out loud for 10 minutes per day to help speed up this adjustment process.
You should also be prepared to hear lots of different environmental sounds that you aren’t used to hearing or that seem louder than you remember them.
Sounds like water running and paper crinkling can seem annoying at first because your brain has forgotten how loud these sounds actually are. But just like with your own voice, you will get used to the environmental sounds with time and experience.
Are In-The-Ear hearing aids right for you?
You and your audiologist will work closely together to determine if in the ear (ITE) hearing aids are right for you. You’ll want to take into consideration your hearing loss, the shape and size of your ear canal, and your manual dexterity. In the ear (ITE) hearing aids are great options for people who want custom-fit devices that fit inside the ear canal (IICs, CICs, or ITCs) or in the bowl of the ear (half-shell or full-shell ITEs). The smaller the device, the less visible it is to other people.
However, the smaller ITE hearing aids also have smaller batteries that don’t last as long, and they may not have wireless streaming capabilities. Larger ITE hearing aids are more visible but also have more space for features such as wireless streaming and on-board controls like program buttons and volume control wheels.
While most behind-the-ear (BTE) hearing aids sold these days have rechargeable batteries, there are currently only a couple of in the ear (ITE) options that are rechargeable, and these are the larger styles.
Ultimately, the most important part of treating hearing loss is finding an audiologist or hearing care provider who listens carefully to your concerns and works closely with you to find the solution that is best for you.