Types of Hearing Aid
The most common types of hearing aid 

Go to your local NHS audiology department, and they will essentially offer one model of hearing aid.  Which manufacturer they use will depend on what has been negotiated locally, but in almost 100% of cases it will be a behind-the-ear type, as this suits the needs of the vast majority of patients.  So you get your hearing tested, they find you have an aidable hearing loss, and you get the hearing aids that everyone gets.

In private hearing care, things are a little more complicated by the choice available to you.  Hearing aid manufacturers produce an array of different fitting styles to suit the needs and wants of as wide a section of the population as possible.  The main fitting styles are outlined below, with a brief explanation of the pros and cons of each.
Receiver-In-Canal (RIC)

RIC hearing systems have a small casing placed behind the ear and sound is transmitted via an ultra-thin wire to a small receiver (speaker) held in the ear canal by a soft silicone dome.
Key Facts:
  •     Discreet: it can be virtually invisible once inserted.
  •     Physically comfortable: as there is relatively little contact with the ear canal, wearers usually   reportfeeling almost nothing in the ear after a few minutes’ use.
  •     Directional microphones (for better control of background noise).
  •     Can be used to keep the ear open, providing more natural sound quality.
  •     Open fitting also helps avoid “occlusion”: the ‘head in a barrel’ effect we get when speaking with our ear canals blocked.

Invisible-In-Canal (iic)

This is the smallest type of ‘in-the-ear’ hearing aid.  In common with all in-the-ear aids, it's custom made from an impression of the ear and has nothing behind the ear at all.  The IIC sits deep in the ear canal, making it virtually invisible when worn.
Key Facts:
  •     The most discreet in-the-ear option.
  •     It’s position deep in the canal makes it less susceptible to wind noise.
  •     A more natural microphone placement makes it easier to use with the telephone.
  •     Because of its small size, it cannot include directional microphones, volume control, telecoil or wireless features.
  •     Not powerful enough to aid severe levels of hearing loss.
  •     Uses the smallest size of battery, which doesn’t last as long as larger ones.
  •     Sometimes cannot be made for people with particularly small ear canals.

Completely-In-Canal (CIC)

Before the advent of IICs, this was the smallest in-the-ear aid available.
Key Facts:
  •     Slightly less discreet than the IIC.
  •     Can be produced as a ‘power’ aid to help more severe levels of hearing loss.
  •     Can include a program button, allowing the user to switch settings manually.
  •     Usually cannot include directional microphones, or volume control, though recently some manufacturers have been able to incorporate wireless functions.
  •     Uses the smallest batteries.

In-the-Canal (ITC)

This type of aid is also custom moulded to fit the ear perfectly.  It sits partly in the concha (the lower, bowl-shaped part of the outer ear), making it more noticeable, but its size means more useful features can be added.
Key Facts:
  •      Suitable for practically any degree of hearing loss.
  •      Can include useful features, such as directional microphones, manual program buttons, volume control, telecoil and wireless functions.
  •     Includes features that won’t fit on completely-in-the-canal aids, but the small size can make the features difficult to adjust.
  •     May not fit well in smaller ears.

Half Shell In-The-Ear (ITE)

This is slightly larger than the ITC, occupying most of the lower part of the concha. It is often fitted to clients who have difficulty handling smaller types of hearing aid.
Key Facts:
  •     Suitable for practically any degree of hearing loss.
  •      It’s size can make it easier to handle than smaller in-the-ear aids, and therefore a better option for people with manual dexterity issues.
  •      Usually uses bigger batteries which last longer.
  •     Can include a host of beneficial features such as directional microphones, telecoil and wireless functions.
  •     Can usually be made to fit even the smallest ears.

Full Shell In-The-Ear (ITE)

This is the largest type of in-the-ear hearing aid. It fills most of the concha, which can be useful for securing the aid in the ear, especially if the wearer has unusually narrow ear canals which necessitates a ‘shallow’ fitting.
Key Facts:
  •     The most visible in-the-ear option.
  •     Microphone placement can make it more susceptible to wind noise.
  •     Generally easier to handle than smaller aids.
  •     Uses larger size batteries.
  •     Can include many useful additional features.

Behind the ear (BTE)

This is the fitting style most people associate with hearing aids.  It has a relatively large casing that hooks over the ear and sound is channeled into the ear canal by plastic tubing which is usually held in place by a custom-made mould.  Being ‘off the shelf’, relatively easy to maintain, and suitable for almost all types of hearing loss, this is the style of hearing aid most commonly dispensed by the NHS.
Key Facts:
  •     The largest, most visible type of hearing aid.
  •     Can be very powerful: suitable for the most profound hearing losses.
  •     Can be easier to handle than some types of hearing aid.


Technology levels and features

As well as a choice of fitting styles, manufacturers produce hearing aids in a range of different technology levels.  Depending on the make, there can be anything from three to nine different levels offering a mind-boggling array of complicated-sounding features to deal with various environments.  The higher up the technology scale you go, the better the hearing aids will be at dealing with more difficult listening situations such as group conversations, acoustically 'bright' rooms that cause reverberation, background noise, etc.  Put simply, the more socially active you are, the more you're likely to benefit from the higher levels of technology.  It's about matching the capability of the hearing aids to the demands of your daily life.

It's important to get this right, since hearing aids that aren't up to the job will leave you frustrated in some scenarios, while on the other hand it's possible to pay extra for technology and features that you'll never benefit from because your lifestyle never puts you in the kind of situations they're designed to deal with.  That's why the honest advice of your audiologist is so important, and it's why we spend so much time discussing your life and your specific hearing difficulties, so that we can boil the choices down to the model that will meet your requirements without having you spending money on clever technology that you don't need.  

You don't have to be called Scott to work for Phonak, but clearly it helps...

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