Hearing aids: ITE or BTE
There are two basic types of hearing aid styles:
- In the ear (ITE) styles - These hearing aids are worn in the ear and are usually custom-fit, based on an impression that is taken by the hearing care professional at the time of the hearing aid consultation. These styles are typically available in different skin tones to blend with the outer ear.
- Behind the ear (BTE) hearing aids sit behind or on top of the outer ear with tubing that routes the sound down into the ear canal via a custom-fit earmold or an ear tip that doesn’t block the entire ear canal opening. BTE styles are available in different colors to match hair or skin tone, as well as flashier designs to highlight personal flair.
All custom made ITE hearing aids and earmolds for BTEs are made from a "cast" of the ear called and ear impression. The hearing professional can make an ear impression in the office in about 10-15 minutes. They begin by placing a special cotton or foam dam in your ear canal to protect the eardrum, and then a waxy material is applied to fill the ear canal and bowl of the outer ear. When the material hardens a few minutes later, the cast, along with the dam are removed from the ear canal.
When selecting hearing aids, consider not only appearance, but also your manual dexterity and lifestyle needs.
Different sizes of hearing aids accommodate different features, exterior control options and battery sizes. Larger hearing aids, whether ITE or BTE style, accommodate more buttons, more interior circuitry and larger batteries that may be needed for to meet power consumption requirements. While many people choose discreet ITE and BTE styles that largely go unnoticed when worn, others enjoy showing off the cool colors they’ve chosen!
Common ITE styles, small to large
Invisible in the canal (IIC) or completely in the canal (CIC) hearing aids
IIC and CIC styles are the tiniest hearing aids made. They fit very deeply in the ear canal, allowing the wearer to benefit from the pinna’s natural resonance and localization characteristics. They are typically fit for mild or moderate hearing losses and offer high cosmetic appeal as they’re nearly invisible when worn. Because of their small size, they don’t usually come with any manual controls, like volume controls or program buttons. Unfortunately, the deep positioning also makes these styles the most susceptible to damage from ear wax and moisture in the ear canal. IIC and CIC styles are only practical for individuals with good dexterity because they have the smallest battery size and can be tricky to remove and insert.
In the canal (ITC) hearing aids
ITC hearing aids sit in the lower portion of the outer ear bowl, making them comfortable and easy to use. Because they’re slightly larger than IIC and CIC styles, they have a longer battery life and can fit a wider range of hearing losses. Their size also allows them to host additional features such as directional microphones for better understanding in noisy environments and manual controls, like a volume wheel.
Low profile hearing aids
Low profile instruments range from half shell designs that fill half the bowl of the outer ear to designs that fill almost the entire outer ear bowl. Like ITC styles, low profile designs are large enough to enable the addition of features such as directional microphones and manual controls, such as a volume wheel and a push-button for changing programs. The size of a low profile style makes it desirable for people with dexterity issues because it is easier to handle than the smaller sizes.
Common BTE styles, small to large
Mini BTE with slim tube and tip
Mini BTE styles are designed to hide behind the outer ear and have ultra-thin tubing to discreetly route sound into the ear. The tubing typically connects to a soft tip that sits in the ear canal but doesn’t occlude it. The result is a natural, open feeling as airflow and sound enter the ear naturally around the tip, while amplified sound enters through the tip. This is known as “open fitting” and is recommended for mild to moderate high frequency losses. This style is so popular that more occluding ear tips have become available in order to accommodate a greater degree of hearing loss.
Receiver in the ear (RITE) or receiver in the canal (RIC)
RITE or RIC (mini RITE or mini RIC) hearing aid styles are BTEs that have the speaker built into the ear tip instead of the main body of the hearing aid. Thus, the speaker of the hearing aid rests in the ear canal but the microphone and processor sit in a tiny case behind the ear. They are connected by a thin wire. The ear tip is larger to accommodate the speaker but if it malfunctions due to wax or moisture damage, it can often be replaced at the hearing aid center instead of going to the manufacturer for repair.
BTE with earmold
BTE styles that come with earmolds can fit any type of hearing loss, from mild to profound. Their longer shape follows the contour behind the outer ear and can generally house more features, controls and power than any other style of hearing aid. Because the sensitive electrical components rest behind the ear, they are usually less susceptible to moisture or wax damage, requiring less frequent repairs. The custom-fit earmold can be ordered in a variety of colors and styles. The tubing that connects the earmold, as well as the earmold itself, can be cleaned and replaced over time. The BTE with earmold style is commonly used for children because the BTE can be reprogrammed as needed and the earmold can be replaced as the child grows.
Selecting and understanding what hearing aid is the right fit for you can be challenging. That’s why we created this flow chart to help first-time hearing aid users or individuals in the market for a new device figure out which hearing technology might be the best fit.
When it comes to hearing aids, there are multiple features and styles available to suit different hearing loss needs. It’s important to consider a number of different things when selecting the right style to fit your needs.
Do you currently wear hearing aids?
For individuals already wearing hearing aids and seeking to update their technology, the best place to start is with the current device. Because hearing technology is constantly evolving, hearing aid users will often be able to find the same or a similar style to their outdated device, just equipped with newer and more modern features. It’s possible the type of hearing loss has changed over time, however; so it’s important to have your hearing tested before updating hearing aids.
Do you have any problems with dexterity?
For individuals with dexterity issues (difficulty grasping small items or losing feeling in fingertips), it’s usually easier to avoid smaller devices. Low profile In-the-Ear (ITE) devices or Behind-the-Ear (BTE) devices with earmolds might be suitable because they are the largest instruments and easiest to handle. Additionally, the batteries will be the largest—size 13 or 675— which will allow for simpler battery swaps. Automated features should also be considered to assist adjusting volume, changing between programs and using the telephone. You may also want to talk to your hearing care practitioner about the possibility of a remote control if the volume or program controls on your hearing aids are difficult to use.
Are your activities limited?
If the individual seeking hearing aids is homebound, restricted in daily activities or cognitively impaired, BTE devices with earmolds might be most suitable. Selecting earmolds made of soft, flexible material can help it fit comfortably in the ear and makes it easy for a caretaker to assist. Other items to consider, such as assistive listening devices, include amplified telephones, special smoke detectors, bed-shaker alarms, doorbells that flash a light or a device to amplify the television.
What is your hearing ability?
Mild to moderate hearing loss
If you have a mild or moderate hearing loss, there are several options to consider when selecting hearing aids, including Completely-in-Canal (CIC), In-the-Canal (ITC) and Receiver-in-Canal (RIC). If you have hearing loss in the lows and the highs, a more occluding fit from CIC or ITC styles will accommodate the loss while still being quite discreet. If your hearing loss is primarily in the high frequencies, open fit RIC styles are the most comfortable because they still let in the natural low-frequency sounds while they amplify the high frequencies. These options can also be equipped with advanced features to allow hearing aids to filter noise from speech, adapt to different environments, suppress feedback and wirelessly connect to mobile phones, a personal microphone system or other public assistive listening devices.
Severe to profound loss
For individuals with a severe or profound hearing loss, ITC hearing aids, low-profile ITE hearing aids or BTE hearing aids with earmolds might be suitable, depending on the degree of loss. These styles of hearing aids provide the most powerful amplification and are least susceptible to moisture damage from the ear canal. It can be helpful to select by taking into account the size of your ears, personal preference and the amount of wax that builds up in your ear canals. Advanced features are important when this type of loss is present, as they can filter noise from speech, adapt to different environments, suppress feedback and wirelessly connect mobile phones, a personal microphone system or other public assistive listening devices. Other items to consider when dealing with severe to profound hearing loss include assistive listening devices, such as amplified phones, specialized smoke detectors, bed-shaker alarms, doorbells that flash a light or a device that amplifies the television.
For more information
This flow chart should be used only as a guide when considering and selecting a pair of hearing aids. Hearing aids can be fitted for a broad range of hearing losses in more styles and sizes than ever before, in part due to the miniaturization of electronics. More people than ever can wear tiny, nearly invisible models, and even the larger-sized instruments are available in very sleek styles. Visit a hearing healthcare professional to learn more.