Hearing Aids  - Behind the Ear vs In The Ear

At Sunraysia Hearing Clinic we have always promoted ‘behind the ear’ hearing aids (BTE’s), even when it was not the industry norm. Consequently over 99% of our clients, who we have fitted, have BTE’s.

Even five years ago the majority of hearing aids fitted in Australia were the ‘in the ear’ (ITE) variety. However, this has completely reversed because clinicians have gradually become aware that their clients usually achieve better outcomes with BTE’s ...

This shift has come about because clinicians have gradually become aware that their clients usually achieve much better outcomes with BTE’s. It is worth noting that at Sunraysia Hearing Clinic we have always actively promoted BTE’s and over 99% of our clients, who we have fitted, have BTE’s. Here is the explanation: the majority of individuals with hearing loss have reasonable low frequency hearing, and most people with a low frequency loss which is less than 40 decibels are prone to the occlusion effect. (Normal hearing is 20 decibels or less across all frequencies.)

The occlusion effect is that ‘drummy’ sound that you get if you talk with your fingers in your ears. So the problem is that we get this significant detraction from the ITE hearing aids if we have reasonable low frequency hearing. That gives us a problem, but it does get worse for the ITE’s. They struggle to reach amplification target when the hearing loss is greater than 55 decibels in the low frequencies, and 75 decibels in the high frequencies. Essentially, the window for success is narrow and excludes many people with hearing loss.

Unfortunately that is not the end of the problems with the ITE’s. They live in the ear canal where wax is a natural phenomenon. A tiny spec of wax in the receiver prevents the ITE from working. Moisture which is also very natural, especially when you block the ventilation to the ear, can have a catastrophic effect on the ITE. This means they are forever being sent off for repair, leaving the wearer without a hearing aid. The last issue worthy of discussion is directional microphones, which help cut down on background noise, are not as effective on ITE’s. The Government recognises this and does not include directional microphones as part of the free package to pensioners and veterans on the ITE’s.

How this translates for the average wearer is that they find the ITE hearing aids simply don’t work unless they are turned up to full volume. On full volume they are very prone to feedback or whistling, and in addition the wearer’s own voice sounds unacceptable. The result is often another pair of ‘In the Drawer’ hearing aids.

However, there is great news and it involves “Behind the ear” hearing aids:

• We can vent the mould to prevent the occlusion effect on the BTE’s.
• Directional microphones which cut down background noise are very effective on BTE’s, (and are included as free on the Government program.)
• Wax and moisture are not a big problem and are easily dealt with when the hearing aid is located away from the canal as on the BTE’s.
• BTE’s are capable of being very powerful, and are the only appropriate hearing aid for individuals with significant hearing loss.
• We can always offer a loan aid to a BTE wearer if their own aid is sent for repair, as the mould is the only custom made component.

It’s worth mentioning that there are some clients who derive a lot of benefit from their ITE’s, and that is obviously very pleasing for all concerned.