Hearing Aids: Which is Best, Behind the Ear or In the Ear?

To BTE or not to BTE: That is the Question


Aside from cosmetics is the behind the ear aid as effective or more effective than an in-canal aid? N.D.


Dear N.D.:  Most of what is priority in fitting style is based on patient needs and preferences. To me and a good number of my patients behind-the-ear (BTE) instruments enjoy some superior features, mostly in reliability and larger processing capacity over their smaller custom cousins. Uniformity and quality control are much tighter in the BTE production than in custom instrument production, with far fewer repairs. Certainly, longer battery life, more digital processing ability and memory are available in BTE confirgurations.

But that does not mean custom instruments are intrisically inferior. For some people the simplicity of a one-piece custom instrument is more important, and sometimes determines whether or not they will wear them. Custom instruments also enjoy better microphone locus in the ear, which in mild and moderate losses is important for transparency in amplification. Arguably, in many cases--if feedback does not compromise acoustic gain--custom instruments offer better control of loudness growth in limited dynamic ranges.

However, I believe there are two principal groups of users for which BTEs are by far the best choice. They are:

  1. Those patients with near normal lows but who drop off precipitously in the highs, and who need at least 45-55dB gain at 3KHz or 4KHz without feedback. Custom instruments are notorious for feedback (and also resonant distortion) in such cases, while the greater mic-receiver partition in the BTE provides lots more gain without feedback or resonant distortion.
  2. Those patients with more severe losses, and who would like to be able to use assistive devices. BTEs are really the only choice for most of these, the lone exceptions when handling an earmold and BTE setup is too difficult. Then, the compromise by going ITE may be worth it.

I guess you could say that the amount of high-frequency gain required to accommodate a given loss is the deciding factor of which is electroacoustically superior.

Until recently, everyone and his brother thought the only way to go was custom instruments. But, alas, a renaissance in reason has gathered, and BTEs are capturing a growing share of the market---it looks as if about 30% of hearing aids for 2005 will be BTE. And if present trends continue, will likely climb close to 38% by end of 2006.

Not knowing anything about your particular hearing needs or expectations I cannot comment on your particular case. However, hopefully the above guidelines will help....and, by the way, contrary to what most people think, the new, smaller BTEs are really less noticeable than most custom instruments with the exception of the CIC and minicanal. The key for success with BTEs often lies with the material and design of the earmold.

Whatever you do, whatever instrumentation makes you happy is the one you should go for. Just don't delay your health, happiness and better hearing any longer than necessary.

Dr. Max Stanley Chartrand, Director of Research

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