CIC hearing aids vs BTE hearing aids : which one to choose ?

CIC vs BTE : which hearing aid to choose?

Two well-known types of hearing aids exist :

The Completely-In-the-Canal (CIC) hearing aid, such as our ORISON hearing aid,
The Behind-The-Ear (BTE) hearing aid, such as our AZUR mini-BTE hearing aid.

If the first one easily win the users' preference for its very great discretion and the use which is made of the ear (anatomical amplifier), the second one represent 80% of the worldwide sales of hearing aids.

CIC or BTE, each type of hearing aid has its own advantages and disadvantages. In hearing aids for presbycusis, it is important to understand that both types of hearing aids are perfectly suitable and that the user is therefore free to choose the one that suits him / her best. In order to make an enlightened choice, we will try to highlight the advantages and disadvantages of each type of hearing aid.

The Behind-The-Ear (BTE) hearing aid

BTE hearing aids account for 80% of worldwide hearing aid sales. As its name suggests, this device bypasses the ear and is placed on the auricle. The sound is picked up by the microphone, which is therefore located behind the ear, and is then guided to the eardrum by a transparent tube that connects the device to the transmitter, located in the ear.

• Advantages of the BTE hearing aid

Larger than the CIC hearing aid, the main advantage of the BTE hearing aid is that it is easier to handle, especially for people with reduced manual dexterity or shoulder mobility problems. The Behind-The-Ear hearing aid is also recommended for people with very small ear canals, as the CIC cannot fit into them. If you have a short, medium or long haircut, then the BTE hearing aid will be hidden by your hair, allowing it to be discreet. It may also be more appreciated by people who are particularly sensitive and prefer a device placed on the ear, rather than in the ear canal : this is a personal feeling. Finally, if it is true that the ear is an anatomical amplifier that the CIC knows perfectly well how to exploit, it does not remain less than the ear is also a "resonance room". We have all experienced this by wearing a shell in our ear, to hear the sea... The advantage of bypassing the ear thus makes it possible, in this case, to feel less "resonance" with the use, contrary to the intra auricular device for some very sensitive people.

• Disadvantages of the BTE hearing aid

Bypassing the ear is therefore an advantage, but can also be a disadvantage, because the ear is an anatomical amplifier of great performance. By bypassing the ear, this type of hearing aid deprives itself of many of the ear's natural abilities, which help us to hear better. A BTE hearing aid does not use :

The pinna, which naturally captures, amplifies and spatializes sound through its shape and folds. Therefore, for an optimal sound experience, it is recommended to wear a BTE hearing aid on each ear (bilateral fitting) ;
The proximity of the eardrum, which allows the sounds picked up by the microphone to be reproduced without delay. With a BTE, the distance that the sound has to travel, captured then amplified, to reach the eardrum causes a delay between the ear that is fitted and the one that is not : for this reason also, a bilateral fitting is highly recommended, harmonizing this delay on both ears and providing a real listening comfort ;
The ear canal, which protects the microphone from wind and noise. Thus, because the microphone is located at the back of the ear, it picks up sounds located behind the person and is exposed to wind noise, which can cause discomfort in certain outdoor locations.

Finally, because of its position, the BTE hearing aid can become uncomfortable at the end of the day when the user is already wearing a pair of glasses and an anti-COVID mask.

The Completely-In-the-Canal (CIC) hearing aid

The CIC hearing aid is defined by "the location of the circuit board 1 - 2 millimeters from the meatus of the external auditory canal". Thus positioned, this model of hearing aid uses the capabilities of the ear, anatomical amplifier and enjoys great discretion. Great favorite of hearing aid users, numerous studies have highlighted the many benefits of such a position.

• Advantages of the CIC hearing aid

For years, the CIC hearing aid has been the gold standard of invisible hearing aids. Numerous studies describe the advantages of CIC position of a hearing aid over the BTE model, such as :

Decreased occlusion effect ;
Increased user satisfaction ;
Greater discretion, even with a short haircut ;
No discomfort if the user wears glasses and/or an anti-COVID mask ;
Reduction of wind noise amplification, as the microphone is hidden in the ear canal ;
An improvement of the localization of the sounds in space, the auricle of the ear fully playing its role ;
A more natural hearing comfort, the ear being used ;
A restitution without delay of the amplified sounds, even by wearing only one hearing aid, thanks to the eardrum proximity.

• Disadvantages of the CIC hearing aid

However, three elements must be taken into account.

By its position in the ear canal, its use can lead some people to feel a "resonance", which then requires a few days of adaptation. On the other hand, also because of its position, it is daily subjected to the humidity of the ear canal and the deposit of cerumen : its care and maintenance must be daily and rigorous. Finally, being relatively small, the CIC hearing aid requires good manual dexterity to be handled without difficulty.

Synthesis :

	BEHIND-THE-EAR (AZURE)	IN-THE-EAR (ORISON)
People concerned	• Very small ear canals • Low manual dexterity • Shoulder mobility problem • High sensitivity in the ear canal	• Everybody
Handling	• Simple, the device is larger device than a CIC	• Requires a good manual dexterity
Aesthetics	• Discreet with a mid to long haircut	• Almost invisible, slipped into the ear canal
Comfort	• Comfortable • Possible discomfort with glasses + anti-COVID mask	• Comfortable • Feeling of "resonance" possible during the first days
Use of the ear	• No, the ear is bypassed • Bilateral fitting recommended	• Yes, fully • Unilateral fitting possible
Spatialization of sound	• Yes with a bilateral fitting	• Yes, even with a unilateral fitting
Interference noise	• Possible discomfort in the open air (wind noise)	• No
Maintenance / Care	• Once or twice a week	• After each use