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​BTE (Behind-The-Ear) 
Hearing Aids


​BTE (Behind-The-Ear) Hearing Aids

​​As the name indicates, BTE hearing aids are worn "behind the ear". In this case, the hearing aid unit is connected to a tube, through which sound is transmitted directly into the ear canal. The other end of the tube could be connected to a microphone or a custom-moulded casing to provide extra support and stability.

The key element of BTE hearing aids is the external casing. This is the casing which fits over the top of the ear, and needs to be shaped accordingly so that it rests comfortably and reliably in place. The casing of a BTE device is often much larger than those supplied with ITE (In-The-Ear) hearing aids, allowing manufacturers to add many additional features that smaller devices lack. These could involve additional pre-programmed settings, telecoils, or processors to assist with streaming from digital devices - all of which add to the functionality of the hearing aid, and may be essential for some wearers.

Another important aspect of BTE hearing aids is the fact that they are worn externally. This means that they may avoid the problems associated with ITE models, such as moisture damage and occlusion. It should also ensure that BTE hearing aids require less regular maintenance work, and make them more durable, saving the wearer money and time.

However, this doesn't apply to BTE models that use earmolds to hold their speakers. And it also doesn't necessarily apply to those that use tube microphones either. The tube microphone comes into contact with the ear canal as well, and will require cleaning and maintenance.

Another strength of BTE hearing aids is that they are generally more flexible than competing varieties. There is usually no need to create a custom-mold when the physical requirements of the wearer change. For instance, when children develop, they can simply exchange different sizes of casing, instead of having periodic remoldings of ITE devices. Again, these advantages are lessened if the BTE hearing aid combines with an earmold to hold the speaker.

Because they rest outside the ear, BTE devices are also much easier to manipulate and program, further adding to their adaptability. Various forms of BTE hearing aid are available to choose from, with mini, standard-sized, and high-powered larger versions. Their look can also be customized, using varying color schemes and materials, which will appeal to the individual needs of the hearing aid user.

Cosmetics are another potential strong point. Despite being worn outside the ear canal, BTE hearing aids are not always highly visible when in use. The acoustic tube is usually transparent and slender, drawing little attention, while the device itself is concealed behind the ear, and can be seen only from behind. This is even more pronounced when the wearer chooses a mini-BTE hearing aid, which is one of the most inconspicuous options on the market. However, smaller BTE devices can have problems of their own. For example, their programmable settings may be harder to use if button sizes are reduced - so there's often a trade-off between size and functionality.

Typically, the way that BTE hearing aids are designed makes them ideal for almost all hearing aid users, which may be why they are the most common variety, worldwide. However, it's worth noting that they can pose problems for eyeglass wearers, who can periodically experience a slight "thump" when the frame of their glasses comes into contact with the tube of their hearing aid. More advanced devices have the ability to handle this effect, but some eyeglass wearers prefer ITE alternatives to avoid any incompatibility.

By and large, BTE hearing aids are among the most user-friendly around, and they are also among the most technologically advanced. For example, it is becoming increasingly common to find BTE devices with Bluetooth connectivity, rechargeable batteries, and specialist tinnitus support functions. Modern units commonly also hook up with digital devices like smartphones, which serve as remote controls, as well as smart technology to allow users to hear TV or audio content with the full benefit of their BTE hearing aid. It's the size of BTE casings that makes these features possible, and which differentiates them from ITE alternatives.

Again, as the name indicates, BTE hearing aids are worn "behind the ear". In this case, the hearing aid unit is connected to a tube, through which sound is transmitted directly into the ear canal. The other end of the tube could be connected to a microphone or a custom-moulded casing to provide extra support and stability.

The key element of BTE hearing aids is the external casing. This is the casing which fits over the top of the ear, and needs to be shaped accordingly so that it rests comfortably and reliably in place. The casing of a BTE device is often much larger than those supplied with ITE hearing aids, allowing manufacturers to add many additional features that smaller devices lack. These could involve additional pre-programmed settings, telecoils, or processors to assist with streaming from digital devices - all of which add to the functionality of the hearing aid, and may be essential for some wearers.

Another important aspect of BTE hearing aids is the fact that they are worn externally. This means that they may avoid the problems associated with ITE models, such as moisture damage and occlusion. It should also ensure that BTE hearing aids require less regular maintenance work, and make them more durable, saving the wearer money and time.

However, this doesn't apply to BTE models that use earmolds to hold their speakers. And it also doesn't necessarily apply to those that use tube microphones either. The tube microphone comes into contact with the ear canal as well, and will require cleaning and maintenance.

Another strength of BTE hearing aids is that they are generally more flexible than competing varieties. There is usually no need to create a custom-mold when the physical requirements of the wearer change. For instance, when children develop, they can simply exchange different sizes of casing, instead of having periodic remoldings of ITE devices. Again, these advantages are lessened if the BTE hearing aid combines with an earmold to hold the speaker.

Because they rest outside the ear, BTE devices are also much easier to manipulate and program, further adding to their adaptability. Various forms of BTE hearing aid are available to choose from, with mini, standard-sized, and high-powered larger versions. Their look can also be customized, using varying color schemes and materials, which will appeal to the individual needs of the hearing aid user.

Cosmetics are another potential strong point. Despite being worn outside the ear canal, BTE hearing aids are not always highly visible when in use. The acoustic tube is usually transparent and slender, drawing little attention, while the device itself is concealed behind the ear, and can be seen only from behind. This is even more pronounced when the wearer chooses a mini-BTE hearing aid, which is one of the most inconspicuous options on the market. However, smaller BTE devices can have problems of their own. For example, their programmable settings may be harder to use if button sizes are reduced - so there's often a trade-off between size and functionality.

Typically, the way that BTE hearing aids are designed makes them ideal for almost all hearing aid users, which may be why they are the most common variety, worldwide. However, it's worth noting that they can pose problems for eyeglass wearers, who can periodically experience a slight "thump" when the frame of their glasses comes into contact with the tube of their hearing aid. More advanced devices have the ability to handle this effect, but some eyeglass wearers prefer ITE alternatives to avoid any incompatibility.

By and large, BTE hearing aids are among the most user-friendly around, and they are also among the most technologically advanced. For example, it is becoming increasingly common to find BTE devices with Bluetooth connectivity, rechargeable batteries, and specialist tinnitus support functions. Modern units commonly also hook up with digital devices like smartphones, which serve as remote controls, as well as smart technology to allow users to hear TV or audio content with the full benefit of their BTE hearing aid. It's the size of BTE casings that makes these features possible, and which differentiates them from ITE alternatives.
As their name suggests, ITE hearing aids are worn inside the ear. To enable them to fit properly, they usually have to be custom-made for every individual, creating a molded unit that sits inside the ear without friction or the possibility of becoming dislodged.

In terms of appearance, ITE hearing aids are invisible from behind, unlike BTE (Behind-the-ear) models, and they can also be camouflaged by making the cases in colors which resemble the wearer's skin tone. This makes them a slightly less visible hearing aid option, although they will generally be visible from the side, no matter how their appearance is masked.

ITE heading aids come in a range of different styles, which vary by size and technology. Firstly, there are very small ITE devices, which may be referred to as IIC (Invisible-in-the-canal) or CIC (Completely-in-the-canal).  These tend to be more advanced devices, and have been engineered to be as small as possible. They are inserted deep into the wearer's ear canal, in theory collecting more powerful sound waves as they hit the pinna and penetrate the canal. However, because of their small size, these hearing aids tend to be relatively low-powered, and are associated mainly with moderate or low levels of hearing loss.

IIC and CIC hearing aids are also generally more suited to younger users with greater manual dexterity, as they can be harder to access when battery changes or cleaning are required. And manufacturers generally recommend removing these devices on a daily basis, so users need to be able to access them without any problems. Thanks to their comparatively inconspicuous design, they are popular among people who have mild auditory problems and don't want their hearing aid to be visible.

The second type of ITE hearing aids are called ITC (In-the-canal) devices, and are positioned much closer to the opening of the ear canal. In fact, they tend to rest on the inner part of the outer ear bowl, making them more visible, but often more comfortable and esy to access. ITC devices are also usually larger than IIC or CIC versions, which makes them easier to manipulate and maintain, and also gives them longer battery lives, which some users will find appealing.

With a bit of extra size, ITC hearing aids are often able to accommodate additional features compared with those of inner ear varieties, such as better detection of sound based on direction, and dials to control features like volume or noise cancellation. At the same time, the extra power they can mobilize also makes ITC hearing aids a more common suggestion for those with moderate to severe hearing loss.

There are also intermediate hearing aids which bridge the gap between the various ITE designs. They will tend to be smaller than ITE/ITC models, but still have some elements showing from the outside. And they boast greater power levels than IIC/CIC hearing aids, making them more suitable for those with moderate or severe hearing loss.

Whichever model of ITE hearing aid users go for, these devices always include the microphone inside the hearing aid unit, unlike with RIC devices, where the two are separated. Which one is the better option to go for? That depends on the needs of the user and their personal tastes. The great advantage of ITE hearing aids is that they are shaped to suit the dimensions of every individual ear, as well as their hard-to-see fit. So, they will typically be comfortable to wear, and suitable for image-conscious wearers (although more powerful ITE models are far from invisible when in place).

On the negative side, ITE hearing aids often fail to deliver the most powerful performance levels, making them slightly less appropriate for those with a greater degree of hearing loss. Being worn inside the ear, they are also associated with moisture damage and "occlusion", which is the sensation of the wearer's ears feeling "clogged up". These problems can be mitigated by looking after ITE hearing aids diligently, but they are still an issue for some users, and are worth bearing in mind when making a selection.
Hearing aids have delivered huge benefits to individuals afflicted by hearing loss in the past 50 years, and they continue to develop at a rapid rate. For those who are new to the world of hearing aids, it sometimes comes as a surprise to find out how varied their internal and external features can be.

Because choosing the correct hearing aid makes a huge difference to how well it performs, it's essential to learn more about what these devices do (and what they don't). This guide will introduce major varieties such as BTE, RIC, ITE, CROS, and BiCROS devices, and help you find the ideal hearing aid for your specific needs.

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If we break it down, hearing aids are quite simple devices. All they need to do is take noises from the outside world, receive them, amplify them, and then send them to a speaker which conveys them into the ear of the wearer. At this simple level, hearing aids are just a very specific, technologically advanced form of speaker - but there's much more to the technology behind them than that, as we'll see.

For one thing, there is the microphone. This tiny component has to be sensitive enough to pick up music, conversation, and ambient sounds and have the resolution to do so as close to the human ear as it's possible to be. But modern hearing aid microphones need to do more than this. They are also often "directional", which means they can pick up the source of noises, and focus their collection efforts in that direction, improving the quality of the resulting signal. Directional systems usually involve two or more microphones which are both placed inside the hearing aid. By triangulating the distance between them and the strength of external noises, the hearing aid can calculate where sounds are coming from and point the "null" part of the microphone directly towards it. This reduces white noise and interference, blanking out other people's chatter and ambient sounds.

After sounds have been received by the microphone, the hearing aid then turns them into a signal to be amplified, and there are two broad ways of doing so. Firstly, there are analogous hearing aids which convert vibrations from sound into electrical impulses, which in turn pass through an amplifier to make them suitable for transmission. The second type are digital hearing aids, which convert sound into binary data. Both types are still widely available, but digital designs are becoming dominant due to their superior adaptability and ability to work with directional microphone systems.

The third key element of a hearing aid unit is the speaker, which as we'll see can be placed in a variety of different positions. In all cases, they work by delivering amplified sounds to the cochlea, which covered in cilia - a kind of hair which turns sound into nervous impulses, which in turn are interpreted by the brain. In many cases, deafness results from the decay of these cilia, and hearing aids can help compensate for that process.

Aside from those core components of hearing aids, it's also worth noting that advanced versions have many more components. Some have active noise cancellation to reduce unwanted ambient noise. Others feature Bluetooth receivers which can stream audio from mobile phones, mp3 players, computers, or TVs. Many also include "telecoils", which can pick up specific audio feeds such as museum tours or academic lectures. The majority have processing units which store preset programs, and manage all of the various features.

Finally, and very importantly, all have batteries to supply power to their various components. These batteries come in various sizes, and deliver varying amounts of power. That's why you'll find that most hearing aids have various price points, which correspond to weak, medium, and strong models. In advanced hearing aids, batteries can be recharged, but many still require manual changes.

So plenty of innovation and technology goes inside the average hearing aid. The same level of engineering applies to the external aspect of hearing aids as well. For instance, their cases come in a range of different shapes which are adapted to the shape of the human ear. Designers need to balance comfort, ergonomics, the need to fit in internal components, and cosmetic factors – not an easy challenge.

If the hearing aid involves the use of an “earmold” (which contains the speaker), then this has to be precisely molded to suit the shape of the wearer's ear. This is essential for a couple of reasons. Firstly, an ill-fitting earmold is uncomfortable, but it's also dysfunctional. If the seal between the earmold and the ear's concha bowl is imperfect, the hearing aid's acoustic properties will be compromised. But there are some exceptions. In cases where hearing loss is not too severe, earmolds do not need to be airtight, and can be sculpted to look as unobtrusive as possible.

Now we've looked at the interior and exterior aspects of hearing aid design, let's move on to discuss the different hearing aid varieties the market has to offer.

If you have any other questions about the process of buying hearing aids, you can contact me at williamanderson@hearingaidinstitute.com.

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