Behind-The-Ear vs. In-The-Ear: A Complete Guide to Hearing Aid Styles

The style question most people ask backwards

Most people walk into an Ontario hearing aid fitting already decided “I want the invisible one.” Then their audiologist shows them their audiogram, and half the time the invisible option is not powerful enough for their loss. The question is not which style looks best. It is which style works best for your specific hearing loss, ear anatomy, and daily life. Comparing behind the ear vs in the ear hearing aids properly means looking at three things, your audiogram, your manual dexterity, and how you actually spend your day.

Behind-the-ear styles: BTE and RIC

BTE (behind-the-ear) and RIC (receiver-in-canal) are both worn with the main electronics sitting behind the ear. The difference is where the speaker sits, in a traditional BTE, the speaker is in the case behind the ear, and sound travels through a tube into the ear canal; in a RIC (also called RITE, receiver-in-the-ear), the speaker is a small module that sits inside the canal connected by a thin wire.

RIC has largely replaced traditional BTE for mild to severe losses because the wire allows for a more natural, open sound. But traditional BTE is still the right choice for severe to profound losses, because it can house a larger amplifier and battery. It is also the style most audiologists recommend for children, older adults with limited dexterity, or anyone who needs a device that is easy to handle, clean, and service.

 

In-the-ear styles: ITE, ITC, CIC, IIC

In-the-ear styles are custom-molded to fit your specific ear canal. They range from the ITE (in-the-ear), which fills the outer ear bowl and is easy to handle, to the IIC (invisible-in-canal), which sits deep enough in the canal to be essentially invisible when worn. Here is what each style actually means in practice:

• ITE (in-the-ear): Fills the concha (the outer bowl of the ear). Easiest to handle of all the custom styles. Accommodates mild to severe hearing loss. Large enough to fit directional microphones and telecoil. Visible to others.
• ITC (in-the-canal): Sits partly inside the canal, with only a small faceplate visible in the opening. Handles mild to moderately severe loss. More discreet than ITE, but smaller controls can be tricky for people with limited hand dexterity.
• CIC (completely-in-canal): Sits entirely inside the canal, visible only as a small removal cord. For mild to moderate loss only. Almost no wind noise, but very small batteries and limited power.
• IIC (invisible-in-canal): Deepest fitting. Genuinely invisible from most angles. For mild hearing loss only. Not suitable for severe loss or narrow ear canals. Shortest battery life of any style.

If you want more details on each hearing aid style and which one would be best for you, reach out to us today! With years of experience, our audiologist can give you expert hearing aid advice!

Which fits your hearing loss?

Your audiogram is the deciding factor for which styles are clinically appropriate. Here is a general guide by hearing loss degree:

Lifestyle considerations

Once you know which styles your audiogram supports, lifestyle factors often make the final call:

• You wear glasses: Some people find BTE devices awkward behind the ear alongside eyeglass temples. RIC often fits more naturally. ITE styles avoid this entirely.
• You use the phone frequently: Telecoil (T-coil) is most easily accommodated in BTE, power BTE, and larger ITE styles. CIC and IIC usually cannot fit a telecoil.
• You are active outdoors: BTE and RIC devices can handle wind noise better with directional microphone systems. CIC devices, sitting deep in the canal, actually benefit from the ear’s natural pinna effect for wind reduction.
• You have limited dexterity: Larger devices are almost always easier to insert, remove, and change batteries. ITE and BTE are the right starting point.
• You want rechargeable batteries: Most rechargeable options are available in RIC and BTE form factors. Tiny CIC/IIC styles rarely accommodate rechargeable cells.

Sources and references

• Ontario Ministry of Health – Assistive Devices Program hearing aid subsidy
• Audiology Canada – Hearing aid fitting standards
• Health Canada – Hearing aids as regulated medical devices

What to do next

• Book a hearing test at Hearvana to get your audiogram if you do not have a recent one
• Bring questions about specific styles to your fitting appointment
• Ask about the ADP subsidy and whether your extended benefits apply