What to Consider When Comparing Hearing Aid Styles
When you see an audiologist for a hearing aid consultation, he or she will most likely show you what styles of hearing aids are available, and then narrow the choice down to what would be most appropriate for your particular hearing loss and cosmetic preferences.
But what makes one style more appropriate than another? And what are the pros and cons of each style? Let's start with a full-size "BTE", which stands for "behind-the-ear".
This consists of a piece containing all of the electronic components of the hearing aid housed in a case which is then attached to a custom-made "earmold" via tubing.
The earmold sits in the concha or "bowl" of the outer ear and the tubing connects the earmold to the hearing aid.
With this style, there are no electronic components in the ear canal, only "plumbing," which will carry the amplified sound into the ear.
The advantages of the BTE style are many.
First, with no electronic components in the ear canal, earwax rarely poses a problem.
The tubing and earmold can be removed from the hearing aid to be cleaned or replaced.
Second, if a patient has a severe-to-profound hearing loss, a BTE can provide more overall gain (loudness) with less danger of feedback (the whistling noise heard when sound recycles through the amplifier).
More features, such as a program changing button and volume control wheel, usually come standard with this style.
Lastly, having space for a larger battery will translate into longer battery life and less frequent battery changes.
Even with all of these advantages, many people will not willingly choose this style due to cosmetic issues.
Growing children who wear hearing aids will nearly always have this style because the earmold can be replaced when the ear grows, and a whole new hearing aid is not necessarily needed.
To continue chronologically with the year of development, next is the "ITE" or "in-the-ear" style of hearing aid.
This style is custom-made from a silicone ear impression taken by the audiologist.
All of the components are contained in the shell which sits in the bowl of the outer ear and the ear canal.
These can be made very small.
In fact there are different terms to describe smaller versions of this style: "HS" (or "half-shell"), "ITC" (or "in-the-canal"), and "CIC" (or "completely-in-canal").
One advantage to this style, especially the smaller versions, is cosmetic.
It can also sometimes be more easily manipulated by a person with poor vision and/or poor dexterity in the fingers.
This style also takes advantage of the natural directionality effect of the outer ear which "funnels" sound to the ear canal.
One drawback to this style is its tendency to become occluded with earwax.
These styles are sent in for repair more often for this reason.
Also, for patients with only mild hearing loss in the lower frequencies, these styles can cause what is called "the occlusion effect.
" The ears will feel plugged up, and the patient's own voice will seem "trapped" in the head.
It will sound to them like they are "talking in a barrel.
" Another type of behind-the-ear style is the "open fit" hearing aid.
This is basically a smaller version of the original full-size BTE, but with thinner, less-noticeable tubing and a small, non-occluding dome.
This style is popular for use with high-frequency-only hearing loss because it leaves the ear canal mostly open to collect low-frequency sounds naturally.
This style is not appropriate for hearing loss greater than mild-to-moderate, as the amplification needed would cause feedback.
A newer type of behind-the-ear style is the "RIC" (or "receiver-in-canal") which is also known as the "RITE" (or "receiver-in-the-ear").
This style has become the most popular style of hearing aid recently.
It has some of the advantages of the full-size BTE, with the added benefit of being smaller and less conspicuous.
One major advantage of the RIC is the separation of the microphone and the receiver.
The receiver is the "speaker", where the sound comes out after being amplified, and it sits in the ear canal.
What looks like tubing connecting the piece behind the ear to the piece in the ear is actually a covered wire.
By separating the microphone and the receiver, good feedback control is achieved.
RICs also typically have better amplification in the higher frequencies, which is where greater hearing loss usually occurs.
This style is most often fit with a non-occluding, soft "dome" which comes in a variety of standard sizes and shapes.
A custom earmold adaptor can also be fit to this style if needed or desired.
These are usually done in cases where the receiver will not stay securely in the ear using a standard dome.
A few companies sell long-wearing (24 hour), disposable-type CIC hearing aids.
This style is bought much like a subscription.
These sit very deep in the ear canal, and the audiologist replaces each unit usually every 3-4 months when the battery dies.
Most patients are not candidates for this style due to strict eligibility criteria.
With these, the head must not be submersed in water, and the patient cannot participate in dynamic elevation changing activities such as skydiving.
Surgically implanted hearing devices are beyond the scope of this article.
Middle ear implants, bone anchored amplifiers, and cochlear implants are options for very specific populations, and patients would need to have a medical evaluation to determine if they are candidates for any of these.
As you can see, there are advantages and disadvantages to all styles of hearing aids.
There is no "best" hearing aid for every patient because everyone's hearing loss and lifestyle are different.
Please also note that this tutorial covers only the style of hearing aids, not the internal technology.
Two hearing aids can look exactly the same but be very different inside, and it is the level of technology that affects the price of a hearing aid more than the style.
But what makes one style more appropriate than another? And what are the pros and cons of each style? Let's start with a full-size "BTE", which stands for "behind-the-ear".
This consists of a piece containing all of the electronic components of the hearing aid housed in a case which is then attached to a custom-made "earmold" via tubing.
The earmold sits in the concha or "bowl" of the outer ear and the tubing connects the earmold to the hearing aid.
With this style, there are no electronic components in the ear canal, only "plumbing," which will carry the amplified sound into the ear.
The advantages of the BTE style are many.
First, with no electronic components in the ear canal, earwax rarely poses a problem.
The tubing and earmold can be removed from the hearing aid to be cleaned or replaced.
Second, if a patient has a severe-to-profound hearing loss, a BTE can provide more overall gain (loudness) with less danger of feedback (the whistling noise heard when sound recycles through the amplifier).
More features, such as a program changing button and volume control wheel, usually come standard with this style.
Lastly, having space for a larger battery will translate into longer battery life and less frequent battery changes.
Even with all of these advantages, many people will not willingly choose this style due to cosmetic issues.
Growing children who wear hearing aids will nearly always have this style because the earmold can be replaced when the ear grows, and a whole new hearing aid is not necessarily needed.
To continue chronologically with the year of development, next is the "ITE" or "in-the-ear" style of hearing aid.
This style is custom-made from a silicone ear impression taken by the audiologist.
All of the components are contained in the shell which sits in the bowl of the outer ear and the ear canal.
These can be made very small.
In fact there are different terms to describe smaller versions of this style: "HS" (or "half-shell"), "ITC" (or "in-the-canal"), and "CIC" (or "completely-in-canal").
One advantage to this style, especially the smaller versions, is cosmetic.
It can also sometimes be more easily manipulated by a person with poor vision and/or poor dexterity in the fingers.
This style also takes advantage of the natural directionality effect of the outer ear which "funnels" sound to the ear canal.
One drawback to this style is its tendency to become occluded with earwax.
These styles are sent in for repair more often for this reason.
Also, for patients with only mild hearing loss in the lower frequencies, these styles can cause what is called "the occlusion effect.
" The ears will feel plugged up, and the patient's own voice will seem "trapped" in the head.
It will sound to them like they are "talking in a barrel.
" Another type of behind-the-ear style is the "open fit" hearing aid.
This is basically a smaller version of the original full-size BTE, but with thinner, less-noticeable tubing and a small, non-occluding dome.
This style is popular for use with high-frequency-only hearing loss because it leaves the ear canal mostly open to collect low-frequency sounds naturally.
This style is not appropriate for hearing loss greater than mild-to-moderate, as the amplification needed would cause feedback.
A newer type of behind-the-ear style is the "RIC" (or "receiver-in-canal") which is also known as the "RITE" (or "receiver-in-the-ear").
This style has become the most popular style of hearing aid recently.
It has some of the advantages of the full-size BTE, with the added benefit of being smaller and less conspicuous.
One major advantage of the RIC is the separation of the microphone and the receiver.
The receiver is the "speaker", where the sound comes out after being amplified, and it sits in the ear canal.
What looks like tubing connecting the piece behind the ear to the piece in the ear is actually a covered wire.
By separating the microphone and the receiver, good feedback control is achieved.
RICs also typically have better amplification in the higher frequencies, which is where greater hearing loss usually occurs.
This style is most often fit with a non-occluding, soft "dome" which comes in a variety of standard sizes and shapes.
A custom earmold adaptor can also be fit to this style if needed or desired.
These are usually done in cases where the receiver will not stay securely in the ear using a standard dome.
A few companies sell long-wearing (24 hour), disposable-type CIC hearing aids.
This style is bought much like a subscription.
These sit very deep in the ear canal, and the audiologist replaces each unit usually every 3-4 months when the battery dies.
Most patients are not candidates for this style due to strict eligibility criteria.
With these, the head must not be submersed in water, and the patient cannot participate in dynamic elevation changing activities such as skydiving.
Surgically implanted hearing devices are beyond the scope of this article.
Middle ear implants, bone anchored amplifiers, and cochlear implants are options for very specific populations, and patients would need to have a medical evaluation to determine if they are candidates for any of these.
As you can see, there are advantages and disadvantages to all styles of hearing aids.
There is no "best" hearing aid for every patient because everyone's hearing loss and lifestyle are different.
Please also note that this tutorial covers only the style of hearing aids, not the internal technology.
Two hearing aids can look exactly the same but be very different inside, and it is the level of technology that affects the price of a hearing aid more than the style.
Source...