Hearing Aid Types
There are six principle hearing aid types. These are ‘Behind The Ear’, ‘Receiver in the Canal’, ‘In the Canal’, ‘Completely in the Canal’, Body worn Hearing Aids and Spectacle Worn Hearing Aids. They are all made up of the same component parts but offer different styles and methods of amplifying hearing.
Hearing aids come in a wide range of types, styles, shapes, sizes and colours. Regardless of their design, all digital hearing aids require the same basic assembly of components - microphone/s, chips, receivers and a battery to supply power. How these components are placed within the hearing aids is determined by the design.
The design of hearing aids continues to evolve with manufacturers provide an extensive range to suit every taste and requirement.
Before considering the colour and style of the hearing aid, we must first need to identify the type of hearing aid that will be right for you. Read on for our detailed guide to hearing aid types with feedback from our hearing aid customers.
- Behind-the-ear hearing aids
- Receiver in the canal hearing aids
- In the canal hearing aids
- Completely in the canal hearing aids
- Body-worn hearing aids
- Spectacle worn hearing aids
Behind The Ear Hearing Aids
Behind-the-ear hearing aids are often abbreviated to BTE or occasionally OTE (on-the-ear). As the name suggests, behind-the-ear aids are designed with most of the electronic components enclosed in a casing which sits behind the ear, with a tubing of some kind allowing the processed sound to pass from the housing, over the ear and down into the ear canal itself.
On the casing there may be some controls that can be accessed by the wearer – usually a volume and/or programme button. Remote devices can also control some BTEs. Wireless connectivity is currently very popular, with hearing aids able to link via a transmitter or even directly to TVs, mobiles, and external microphones, offering even greater assistance to the wearer for those specific listening situations.
Advances in electronics and component design have allowed many manufacturers to produce extremely small and light BTE products, meaning that the part which needs to be placed behind someone’s ear is not more than an inch in length.
How are Behind the Ear Hearing aids fitted?
The tubings that direct sound from the electronic components into the ear can also vary in design.
A traditional BTE fitting is considered to be that of an earmould. An impression of the empty parts of the outer ear and ear canal is taken using a quick drying (usually) silicone impression material. The impression is sent to a lab, which creates the customised earmould. A hole (bore) is then drilled through the earmould roughly following the path of the ear canal. The output (usually referred as the ‘hook’) of the BTE is inserted into to the bore via a short piece of flexible tubing.
In the past decade, the so-called thin-tubing fitting has increased in popularity.
Earmoulds, which can be made of hard or soft materials, are usually clear or pinkish in colour, but hearing aid users can select brightly coloured or decorative earmoulds. Some designs are meant to make the earmoulds less visible, and some are meant to make them more noticeable.
In the past decade, the so-called thin-tubing fitting has increased in popularity. Thin-tubing fitting usually refer to ‘open-fit’ BTEs. Substantial improvements in hearing aid technology and design have enabled hearing aid users to move away from earmould fittings and consider open-fittings instead, of the customised ear mould.
'Thin tubings' are very thin (2mm diameter or so) tubings that direct the sound from the casing into the ear canal. Instead of the tubing ending in the bore of the earmould, they are pre-shaped to bend into the ear canal and a soft silicon dome is attached to the end of the thin tubing to improve wearing comfort and retain the tubing in the ear canal. Domes vary in size and most manufacturers have a range of options for consumers.
Who are the BTE manufacturers?
The first digital, truly open-fitting product was called the ReSound Air, which was launched in 2003 by the Danish GN Re Sound hearing aid manufacturer. Since then, all the other big-name hearing aid manufacturers, (Siemens, Phonak, Oticon, Starkey, Widex) have launched a number of generations of their own thin-tubing products.
Hearing Direct also showcase several different thin-tubing hearing aids:
The Hearing Direct thin tubing options very in size, as well as the type of sound-processing features available within the chip.
What are the pros and cons of BTE hearing aids?
One of the major reasons for different sized BTEs is that different sized hearing aid batteries are used, as well as bigger or smaller amplifier units for more or less amplification. Smaller batteries (e.g. size 10) will need to be replaced much more frequently than bigger batteries (e.g. size 13).
One of the most frequently reported advantages of open-fitting products is improved wearing comfort compared to earmould fittings. ‘Open fitting’ implies that something is open – the thin tubing diameter and smaller dome on the end allows for natural air flow in and out of the ear canal, something which was much more difficult to achieve with earmoulds. An associated benefit of having the ear canal open is that users report that their own voice sounds more natural when they speak and that chewing and drinking sounds are not over-amplified.
+ Discreet Design
+ Instant Fitting
- Some BTEs not suitable for severe hearing loss
- Perceived often as more 'visible'
- Larger models may interfere with glasses
Thin tubing BTEs can be fitted instantly, allowing for a trial of amplification to be done immediately following a hearing test. A disadvantage of open fitting BTEs is that very severe hearing losses usually cannot be accommodated, as the risk of feedback or whistling from the hearing aids increases substantially as the degree of hearing loss increases. However, BTEs with ear mould fittings are considered to offer the most powerful amplification options for people with severe or profound hearing loss; and even these powerful products are now produced in considerably smaller designs than a decade ago.
RIC or RIE (Receiver in the ear) hearing aids are sometimes considered a sub-type of the behind-the-ear category of products. However, more and more RIC products appear every year from manufacturers, such that RIC is now considered a category on its own.
The reason why RIC hearing aids can be considered a sub-design within BTEs is because they look very similar; they have a casing containing components and user controls which sits behind the ear and then a 'tubing' coming down over the top of the ear, ending in the ear canal. The major difference however, is that this tubing actually encloses a wire, which connects to the receiver (loudspeaker) component of the hearing aid, which effectively now sits within the ear canal and not in the casing behind the ear.
How are RIC hearing aids fitted?
The end of the receiver tubing usually fits into a soft silicon dome of some sort, which makes the fitting more comfortable within the delicate skin of the ear canal.
"feedback is kept to a minimum when the RIC is being used"
As with thin-tubings, the domes come in a variety of sizes and are often used as a way to further ensure feedback is kept to a minimum when the RIC is being used. The domes also serve as an additional protection against wax and moisture ingress.
What are the pros and cons of RIC hearing aid types?
Having an electronic component in the ear canal does increase the risk of it being affected by wax build ups or skin debris or moisture present in some ear canals. In most RIC designs, the receivers also have a wax guard built into them, which can be changed as part of the general care and maintenance required for the hearing aid. Some RIC wearers only change their wax guards every few months; others may need to change them much more frequently.
Because one of the major electronic components is not in the casing behind the ear, space is saved, allowing RICs to be made in surprisingly small designs, particularly if the battery size is also a size 10 (the smallest possible hearing aid battery).
+ Choice of amplification
+ Low feedback
- Risk of wax build up
- Cost of replacement receiver
The fact that the receiver component lies in the ear canal means that the distance between it and the hearing aid microphone is increased, certainly compared to the distance between these components in a traditional BTE. The risk of feedback is decreased by this physical design element, one of the commonly reported advantages of RICs.
While the receiver is included in the hearing aid warranty, after this period is over, if the receiver requires repairs, it is costly to replace and will be considerably more than replacing the thin tubing of a BTE.
For a specific example of a RIC see the HD450
Despite the increase in availability of small RIC and thin-tubing BTE products, many people still prefer the idea of in the canal hearing aids. For most people without hearing aid experience, ITC (in-the-canal) or ITE (in-the-ear) hearing aids are still thought to offer a more cosmetic fit and many people ask for these initially when investigating hearing aids for the first time.
Most manufacturers distinguish between the ITC and ITEs, usually on the basis of size. ITC hearing aids are generally manufactured smaller than ITEs (the ‘ear’ part of the description referring to the product filling some of the actual concha or bowl part of the outer ear, rather than just the canal and entrance to the canal sections). ITEs may also be further categorised as ‘full-shell’ or ‘half-shell,’ which describes how much of the concha section will be filled.
How are ITC hearing aids fitted?
As its name suggests, ITCs are hearing aids which fit into the ear canal, all the components sit within a casing, usually known as a shell.
"this shell is moulded for an individual ear"
Most commonly, this shell is moulded for an individual ear, after that person has had an ear impression taken. Some products are also available in a ‘one-size-fits-all’ shell, which is modelled for the average adult ear canal.
Hearing Direct also showcase several different in the canal hearing aids:
What are the pros and cons of ITC hearing aids?
If a comfortable fit is achieved, many people find ITC products easy to wear, and easy to put in and take out.
However, even if the fit is physically comfortable within the canal, many people, particularly those with more mild/moderate high-frequency losses do report feeling rather ‘blocked up’ with something now in their ear. This is referred to as ‘occlusion. ’ Some people will acclimatise to this sensation very quickly; others may struggle to get used to it at all. Occlusion can be minimised by drilling a hole through the shell, known as a ‘vent.’ This can rise to an increase in feedback so we recommend you take advice before drilling a hole!
+ Easy to put in/take out
+ Cosmetic Design
+ Good with spectacles
- High maintenance
- 'Blocked up' sensation
Care and maintenance of ITCs is more involved than with BTEs, and similar to what is required for a RIC device. The most important thing is to keep the instrument free from wax build up and as dry as possible – something which can be difficult, as all the components are now worn inside the canal. All ITCs will be manufactured with some form of wax guard in place, which will need to be inspected daily (or whenever the ITC is put in the ear) for any wax build up. Most wax guards can be replaced by the wearer, some people replace as frequently as once a week, others once every few months.
An advantage of ITC fittings over those of RIC and BTEs comes to the fore when people complain about having to wear spectacles as well as hearing aids. While most people do get used to wearing a BTE/RIE with their glasses, it can be troublesome for some and an ITC device does not of course interfere with the arms of ones glasses at all.
Completely in the canal hearing aid types, or CICs, refer to those in-the-canal products which are specifically manufactured to sit deep within the ear canal. A well-manufactured CIC may really be invisible, even when the ear containing the CIC is viewed side-on.
What are the pros and cons of CIC hearing aids?
Not surprisingly, the components used for CIC products are the smallest available – which does mean that battery life and available amplification is limited. User controls are also limited, at most a programme button only (although some can still be controlled via remote control).
+ Small size
+ Almost invisible
+ Individual fitting
- Battery life
- Amplification level
- User controls
For most CICs, the quality of the ear impression taken for the shell is critical and some manufacturers insist on providing further training to those hearing health professionals who wish to be able to order their CIC products.
The same advantages and disadvantages apply to CICs as for ITCs as discussed above.
Body worn hearing aids are hearing aids where the electronic components are situated in a little box-shaped container, which is not worn on or in the ear, but on the body.
"the amplified sound is delivered to the ear via a cord"
The box is usually clipped to a pocket or belt or worn around the neck and the amplified sound is delivered to the ear via a cord and earphone. The microphone is situated on the box, so wearers must be aware that if they wish to have any sound amplified, the microphone on the box must be able to pick up that sound.
What are the pros and cons of body worn hearing aids?
Body worn hearing aids were very popular a couple of decades back, as they were, at the time, the only way to provide a lot of power for more severe hearing losses. As technology in smaller BTEs improved, the need for body worn products decreased sharply. However, new body worn hearing aids are still produced by some hearing aid manufacturers (including the likes of Panasonic).
+ Battery life/cost
+ Powerful amplification
+ User controls
The super-power amplification provided is still required by some hearing impaired individuals. Additionally, new markets have opened up within developing countries – where body worn hearing aids are used for less severe hearing losses purely because the batteries powering the devices are AA or AAA types; which are much more accessible and cheaper than the specific hearing aid battery options. Some body-worn products have also been produced to run on solar power.
Spectacle hearing aids, or 'hearing aid glasses', refer to designs where a hearing aid is built into or attached to the arms or frame of a pair of spectacles. As many people have vision as well as hearing impairments, it surely makes sense to combine the two?
"fittings using spectacle hearing aids are difficult to achieve"
However, successful hearing aid fittings using spectacle hearing aids are difficult to achieve and it is quite telling that many of the world’s major hearing aid manufacturers no longer, or have never, produced a product within this category.
What are the pros and cons of spectacle hearing aids?
Spectacle hearing aids are often recommended for those individuals with ‘conductive hearing loss.’ This is where the inner ear is functioning well, but the outer and/or middle ear parts are affected, such that the transmission of sound through to the inner ear is obstructed to a large extent. The hearing aid part of the glasses is designed to sit right on or very close to the mastoid bone of the skull, within protects the inner ear. The amplified sound coming out of the transmitter will then stimulate the inner ear via vibrations of the bone.
+ Recommended for conductive hearing loss
+ Can offer a disguised hearing solution
- Difficult to fit
- Removing glasses removes hearing ability
More common sensori-neural hearing losses can be accommodated by spectacle hearing aids which deliver the amplified sound to the ear via a tube or earmould. These types of fittings are not popular; as one’s choice of glasses frames and hearing aid is severely restricted and when the glasses are removed, the hearing aid needs to be taken out as well.
At Hearing Direct, we have a great selection of hearing aid types. We have a no quibble, 30-day, money back guarantee to give you the comfort of finding the right hearing aid. Click here to view our range of hearing aids.