ITE vs BTE : which hearing aid to choose?

ITE hearing aid VS BTE hearing aid : which one to choose ?

There are two well-known types of hearing aids :

  • The ITE (In-The-Ear) type, which includes the CIC (Completely-In-the-Canal) hearing aids, such as the instant-fit Orison,
  • The BTE (Behind-The-Ear) hearing aids. 

While the first type is easily preferred by users because of its discretion and the natural way it uses the ear (anatomical amplifier), the second type is the most widely sold and currently accounts for 80% of worldwide sales of hearing aids.

Whether In-The-Ear (ITE) hearing aid or Behind-The-Ear (BTE) hearing aid, each type has its advantages and disadvantages. When we talk about 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 or her best. In order to help this choice, we will try to highlight the advantages and disadvantages of each type of hearing aid.

The Behing-The-Ear (BTE) hearing aid

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

• Advantages of the Behind-The-Ear (BTE) hearing aid

Larger than the ITE hearing aid, the main advantage of the BTE is that it is easier to handle, especially for people with reduced manual dexterity or shoulder mobility problems. The BTE hearing aid is also recommended for people with very small ear canals, as the ITE 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 to the ear canal and prefer a device placed on the ear, rather than in the ear : this is a personal feeling. Finally, if it is true that the ear is an anatomical amplifier that the ITE exploits perfectly, it remains that the ear is also a resonance chamber. We have all experienced this by wearing a shell in our ear, to hear the sea... The advantage of bypassing the ear allows, in this case, to feel less "resonance" when using it, contrary to the intra-auricular (ITE) device for some sensitive people.

• Disadvantages of the Behind-The-Ear (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, the BTE hearing aid deprives itself of many of the ear's natural abilities, which help us to hear better. Indeed, a BTE 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 device, the distance that the sound must travel to reach the ear, captured then amplified, causes a shift between the ear that is fitted and the one that is not : for this reason also, a bilateral fitting is strongly recommended, harmonizing this shift 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 behind the ear, 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 In-The-Ear (ITE) hearing aid

The In-The-Ear (ITE) hearing aid, which includes the Completely-In-the-Canal (CIC) type, is defined as "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 natural capabilities of the ear and enjoy great discretion. Recent studies have highlighted the benefits of such ITE position. 

• Advantages of the In-The-Ear (ITE) hearing aid

For years, the in-the-ear (ITE) hearing aid has been the gold standard for invisible hearing aids. Recent studies describe the advantages of in-the-canal position of a hearing aid over the BTE model, such as:

  • Reduced occlusion effect ;
  • Increased user satisfaction ;
  • Discretion, even with a short haircut ;
  • No discomfort if the user wears glasses and/or a COVID mask ;
  • Reduced amplification of wind noise, as the microphone is in the ear canal ;
  • An improvement of the localization of the sounds in space, the auricle of the ear playing its full 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 tympanic proximity.

• Disadvantages of the In-The-Ear (ITE) hearing aid

However, there are three things to keep in mind.

Being located in the auditory canal can lead some people to feel a "resonance", which could requires few days of adaptation. Then, because of its position, the ITE hearing aid is also subject to daily humidity and earwax deposits of the ear canal : its maintenance must be daily and rigorous. Finally, being relatively small, the ITE hearing aid requires good manual dexterity to be handled without difficulty.

Synthesis :

BEHIND-THE-EAR (BTE)

IN-THE-EAR (ITE)

Who is it for ?

• Very small ear canals

• Reduced manual dexterity

• Shoulder mobility problems

• High sensitivity in the ear canal

• All people

Handling and use

• Simple, relatively large device• Simple, but requires good manual dexterity (small device)

Aesthetics

• Discreet with a medium or long haircut• Almost invisible, slid into the ear canal
Comfort

• Comfortable

• Possible discomfort at the end of the day, with glasses + anti-COVID mask

• Comfortable

• A "resonance feeling" is possible during the first days of use

Use of the ear

• No, the ear is bypassed• Yes, fully

Spatialization of sounds

• Yes with a bilateral fitting• Yes, even with an unilateral fitting

Interference noise

• Possible discomfort in the open air (wind noise)• No

Maintenance, care

• Once or twice a week• After each use