Approaches Towards In-the-Ear and In-the-Canal Hearing Aids (ITE &CIC):

Hello.

In-the-ear and in-the-canal hearing aids (ITE, ITC, and CIC) can be classified in many ways. In this article, I will discuss the positive and negative aspects of these devices during their application, as well as feedback from users.

The appealing feature of in-the-ear hearing aids is, of course, that they offer a more cosmetic appearance than behind-the-ear hearing aids. These small-sized devices contain basic components such as a microphone, amplifier, and speaker that are expected to be in a hearing aid. However, this has both positive and negative aspects. Generally, experts are hesitant to apply this type of device due to its negative aspects.

In summary, in Turkey, the process of obtaining a hearing aid typically involves a doctor’s evaluation, followed by a hearing test and the issuance of a hearing aid report. Individuals then approach hearing aid providers with the report, specifying which type of hearing aid is recommended and which ear it should be used for, as determined by the doctor. When a patient comes to our center seeking a hearing aid, our approach is to review the hearing aid report and work with the patient to determine the best course of action.

In my approach, I start by carefully listening to the patient’s history, as any health worker should do. After providing the patient with general theoretical information about the type, degree, and which ear the hearing aid should be used for, I select the device that meets the criteria and try to reach a common ground with the patient (by taking into account factors such as price and the number of channels of the hearing aid).

Of course, the process is not as short and easy for every user. Personally, I can say that I find it challenging to convince my patients in the stage of using the hearing aid. With patients who have received an ear-in hearing aid report from a doctor and have a suitable ear structure for the use of the hearing aid, it is relatively easier to convince them to use the device due to its cosmetic appearance. However, the same thing cannot be said for patients who are referred for behind-the-ear hearing aids. In Turkey, past wrong practices, lack of expertise and the acceptance of hearing loss as a mental disability still make it quite difficult for more visible behind-the-ear hearing aids to be used.

When I insist on focusing only on the degree of hearing loss for the use of behind-the-ear hearing aids, I have often witnessed that users completely postpone the use of the hearing aid. Although in-ear hearing aids have less output power than behind-the-ear devices, I believe that by also considering the user’s expectations and motivations for using the hearing aid, more flexible applications should be provided to the user. Also, I criticize the approach of “you will not benefit from this type of device with this hearing loss” taken by doctors and experts without listening to the user.

To sum up, I do not hesitate to apply in-ear hearing aids with an empathetic approach without ignoring the requests of my client, even if the hearing loss is not appropriate, and even if the doctor’s report is not written for the application, I prepare a document that shows that the patient benefits from the in-ear device and request the correction of the report. Of course, I also get the user’s consent form for the procedures explained to the user.

After writing about the use of behind-the-ear hearing aids, it may seem that the only positive aspect of these devices is their cosmetic appearance. However, for readers who are interested in learning more, I will list both the positive and negative aspects of these devices below.

Wish you all the best. :)

The positive aspects of In-Ear and Canal Hearing Aids:

• With in-ear hearing aids, a more natural sound is presented to the patient compared to behind-ear hearing aids.
• The ear canal’s sound gathering advantage can be used with in-ear hearing aids.
• It is more advantageous in determining the direction of sound compared to behind-ear devices.
• Because the device is placed inside the ear, the patient hears less wind noise compared to behind-ear devices.
• Talking on the phone is easier with behind-ear devices.

The negative aspects of In-Ear and Canal Hearing Aids:

The most significant disadvantage is that, due to the smaller size, the output power of the device is less than that of behind-ear devices and it may not provide enough amplification for advanced hearing loss.

• They are not recommended for narrow ear canals or ears with excessive earwax.
• The electronic components of the device are exposed to direct contamination in the ear.
• If cleaning and clinical maintenance are neglected, the risk of malfunction increases.
• They have fewer features compared to other hearing aids (such as sound transmission, Bluetooth, etc.)