Types of hearing aid: who each one is for

The conversation about hearing aids almost always starts in the wrong place: “I want one that doesn’t show.”

It is a legitimate concern and we understand it. But the style is not an aesthetic decision with a price attached. It is a technical decision that depends on four things, and only one of them is visible in the mirror.

• How much hearing loss you have and at which frequencies. Small devices do not deliver the power of large ones.
• What your ear canal is like. There are narrow or sharply curved canals in which an in-the-canal aid does not sit well.
• Your manual dexterity and your close vision. You are going to handle a two-centimetre object several times a day, often without your glasses on.
• How much wax you produce and how humid it is where you live. On the coast, that last factor counts.

The five styles

RIC: receiver in the canal

The body of the device sits behind the ear and the receiver sits inside the canal, joined by a thin wire. It is the most widely fitted style today.

In favour. The body is very slim, because the receiver is not inside it, so it barely shows and it lives happily alongside the arms of your glasses. It allows open fittings, which keep the canal ventilated and avoid that sensation of having your head in a barrel when you hear your own voice. It covers everything from mild to severe loss by changing the receiver. It almost always comes in a rechargeable version, and it is usually the first to get new connectivity features.

Against. The receiver lives inside the canal, exposed to wax and moisture, and it is a part that has to be replaced from time to time. The wire is thin and does not take being tugged.

Who it is for. It is the default answer in presbycusis, the gradual age-related loss that mainly affects the high frequencies. If nobody has explained why this style is being suggested to you, this is why.

Classic behind-the-ear (BTE)

The whole device sits behind the ear and the sound travels down a tube to a mould made to measure for your ear.

In favour. It is the most powerful style and the one that covers the widest range of losses: the American national institute on deafness states that it is used for mild to profound loss. It is the most robust, the best at coping with wax and moisture, and the easiest to handle with your fingers. Its wearing parts, tubing and mould, are cheap to replace. The battery lasts longer because the compartment is bigger.

Against. It shows more. And it occupies the space behind the ear, which is exactly where the arm of your glasses rests.

Who it is for. Significant loss, ears that produce a lot of wax or discharge, hands with limited dexterity, and people who want the device with the least possible maintenance.

In-the-ear (ITE)

Custom made, it fills the concha, the visible part of the outer ear.

In favour. There is nothing behind the ear, so it does not compete with glasses. It is the largest of the in-the-ear family, so it has room for a decent battery, for manual controls and for a telecoil. It sits securely and it is easy to grip.

Against. It shows, and it shows from the front. It sits inside the ear, so it takes wax and moisture. The American national institute on deafness places it in mild to severe loss and does not recommend it for young children, because the ear grows and a custom shell stops fitting.

Who it is for. Anyone with wide-armed glasses, anyone with limited dexterity who does not want anything behind the ear, and anyone who needs physical controls they can find with a fingertip.

In-the-canal (ITC)

Custom made, it partly fills the canal and barely protrudes.

In favour. Discreet. It uses the shape of the outer ear to collect sound more naturally than a device with the microphone behind the ear.

Against. The American national institute on deafness is explicit: it can be difficult to adjust and to remove, it has less room for the battery and for extra features, and it is not recommended for severe to profound loss.

Who it is for. Mild or moderate loss, a canal of adequate size and good manual dexterity.

CIC: completely in the canal

Custom made, it sits almost hidden inside the canal. It is the smallest of the usual styles.

In favour. It is the most discreet. It is practically invisible.

Against. Here it is worth being frank, because it is the style most people ask for and the one that most often ends up in a drawer.

• Less power. It is no use for severe to profound loss.
• Less battery and fewer features, for lack of physical space. It rarely comes in a rechargeable version.
• More vulnerable to wax and moisture, because it sits at the deepest point of the canal.
• Hard to handle. Putting it in and taking it out demands a fine pinch grip and good vision. With arthritis in the hands, with tremor, or with presbyopia and no glasses on, that manoeuvre twice a day becomes a real reason to stop using it.
• The controls are operated from the phone or not at all. There is no room for a volume wheel.
• A blocked-ear sensation. By occluding the canal, your own voice booms. It is corrected by the design of the venting, but not always completely.

Who it is for. Mild or moderate loss, a suitable canal, little wax, good dexterity and a clear priority on discretion, knowing the price that is paid.

The table, at a glance

Rechargeable or battery

Rechargeable. You leave it in the charger overnight and in the morning it is ready. Nobody has to handle a seven-millimetre button cell. For clumsy hands or tired eyes, it is an enormous improvement. In exchange, the battery is internal and degrades over the years, and if one day you forget to charge it you are left without a hearing aid.

Battery. You carry a spare cell in your pocket and the device is never out of action. But it has to be changed every few days, and button cells are small, slippery and dangerous if a grandchild finds them. The American national institute on deafness expressly recommends keeping spare batteries and small devices out of reach of children and pets.

Our general recommendation, for most people over seventy: rechargeable, unless there is a specific reason against it.

What connectivity really changes

A Bluetooth connection to your phone or your television is not a technological whim. It is the point at which most people notice the leap: the sound of the call or the television goes straight into both hearing aids, without crossing the room or mixing with the noise.

For anyone living far from their children, which is the case for almost all our foreign resident patients, that means being able to talk to the family on the phone without asking them to repeat. It is the argument that weighs most in favour of a style with room for the aerial, and it is one of the things a CIC cannot always offer.

The choice is not made from a catalogue

The style is decided after the audiogram and after looking at the canal. Not before.

A device that does not cover your loss is not fixed by turning the volume up: it saturates and distorts. A device you cannot fit on your own ends up unused, and a hearing aid in a drawer is no good to anybody, however handsome it is.

At the hearing assessment we measure the loss at each frequency, check how well you understand speech, examine the canal and talk about what your day looks like: whether you drive, whether you go to meals with a lot of people, whether you play an instrument, how much time you spend at the beach. Out of that come two or three possible styles, not one.

And then you try them. In Puerto de Mazarrón you can take them away and use them at home, on your terrace and in your bar before deciding anything, which is the only place where you really find out whether a hearing aid works for you.