Types of Hearing Aids Explained: BTE, RIC, ITE, CIC and IIC

Nearly every buyer walks in wanting the smallest device available. Nearly every buyer who has worn hearing aids for five years cares more about battery life, streaming, and being able to get the thing into their ear on a cold morning. Both preferences are legitimate. Knowing the trade-off in advance is what keeps you from buying twice.

First, the two families

Every style is a variation on one of two arrangements:

• Behind-the-ear designs put the electronics in a housing that sits behind your ear, connected to your ear canal by either a thin tube (BTE) or a thin wire ending in a speaker (RIC). More room means more power, bigger batteries, and more features.
• In-the-ear designs put everything into a custom shell molded to your ear anatomy, sitting in the outer bowl (ITE), the canal opening (ITC), fully in the canal (CIC), or deep in the canal (IIC). Smaller means more discreet and less capable.

All six styles compared

BTE: behind-the-ear

The original design and still the most capable. The full electronics package sits behind the ear and routes sound through a tube into a custom earmold. Because the housing is large, BTE can hold the biggest receiver and battery on the market. For an example of a super-power BTE for severe to profound loss, see ReSound Enzo IA.

Choose it if

• Your loss is severe to profound. Nothing else delivers comparable gain without feedback.
• You have arthritis, tremor, or reduced fine motor control. It is by far the easiest style to handle, insert, and clean.
• You want the longest battery life available.
• Your ears produce a lot of wax, which destroys small in-canal electronics faster.

Trade-offs

• Most visible option, though modern slim BTEs are far less conspicuous than the beige devices people picture.
• Can compete for space with heavy eyeglass frames and masks.
• Custom earmold means a more occluded feel, which some wearers dislike at first.

RIC: receiver-in-canal

The most commonly fitted style today, and the sensible default for most first-time buyers. The processor sits behind the ear like a BTE, but the speaker itself moves into the ear canal on a thin wire. Moving the receiver closer to the eardrum improves sound quality and lets the behind-the-ear portion shrink dramatically. For an example of a current flagship RIC with dual AI systems, see Phonak Audéo Sphere Infinio.

Choose it if

• Your loss is anywhere from mild to severe, which covers the large majority of adults.
• You want Bluetooth streaming for phone calls, TV, and music.
• You want rechargeable batteries and a charging case.
• You want an open fit, which uses a vented dome instead of a sealed mold so your own voice sounds natural and low-frequency hearing stays unblocked.
• You want upgradeable power. The receiver is a separate component, so a provider can swap in a stronger one if your hearing declines, without buying new devices.

Trade-offs

• The receiver sits in a warm, humid canal, so wax guards need changing regularly.
• Slightly more fiddly than a BTE for people with dexterity limits.

ITE: in-the-ear, full shell

A custom-molded device filling the outer bowl of the ear. Nothing sits behind the ear at all, which is the whole appeal for some wearers.

Choose it if

• You want nothing behind your ear, whether because of glasses, masks, hats, or hearing protection at work.
• Your loss is mild to moderately severe.
• You need something easier to insert than the tiny canal styles but do not want a BTE. The larger faceplate gives you something to grip.
• You want physical volume controls and program buttons, which fit on an ITE faceplate but not on a CIC.

Trade-offs

• Clearly visible in the ear bowl.
• Fills the ear, which produces more occlusion than an open-fit RIC.
• Requires an ear impression, so replacement takes longer than swapping a dome.

ITC and CIC: in-the-canal and completely-in-canal

Both are custom shells, sized down. ITC sits in the canal opening and the lower part of the ear bowl. CIC sits entirely inside the canal with only a small removal handle visible if someone looks directly in.

Choose them if

• Your loss is mild to moderate.
• Discreetness ranks above features for you.
• You dislike the feeling of anything behind your ear.
• You have good dexterity and vision, because these are small.

Trade-offs

• Bluetooth streaming and rechargeable batteries are uncommon at these sizes, and directional microphone systems are limited by how close the two mics can sit.
• Small disposable batteries mean more frequent changes and fiddly handling.
• Sitting in the canal means wax and moisture exposure, so more repairs over the device's life.
• ITC generally supports more features than CIC. If you are choosing between them, ITC is the better value.

IIC: invisible-in-canal

The smallest style made, seated deep in the bony portion of the canal and genuinely invisible from any normal viewing angle. It is placed and removed with a small pull cord. For an example of an invisible-in-canal model, see Signia Insio IX IIC.

Choose it if

• Invisibility is your deciding factor, full stop.
• Your loss is mild to moderate.
• Your ear canal anatomy accommodates one. Not everyone's does, and the provider determines this from the impression, not from your preference.
• You are comfortable handling something the size of a coffee bean, daily.

Trade-offs

• No Bluetooth, no rechargeable battery, minimal directional processing, no physical controls.
• Highest maintenance burden of any style, because it sits deepest in the wax.
• Deep insertion causes discomfort for a minority of wearers, and it takes several weeks to know.
• If your hearing declines, there is little headroom. You will be buying a different style.

Choosing your style in the right order

Style is the last decision, not the first. Work through it in this sequence:

1. Get an audiogram. Your degree and configuration of loss eliminates several styles outright. Severe loss means BTE or a powerful RIC, and no amount of preference changes that. If you have single-sided deafness or unilateral loss where one ear cannot be aided, a CROS (Contralateral Routing of Signal) device is a different category entirely; for an example see Phonak CROS Infinio.
2. Decide on your must-have features. Bluetooth streaming? Rechargeable? Telecoil for looped venues? Each of these has a minimum size.
3. Be honest about dexterity and vision. Test-handle the actual device in the office. Insert it and remove it yourself, five times, before you commit.
4. Consider your ears' physiology. Heavy wax production, narrow canals, chronic drainage history, or previous ear surgery all steer the choice.
5. Then apply cosmetic preference among whatever styles survived steps one through four.
6. Choose the technology tier separately. Style and tier are independent decisions, and the tier is where the money is. See our cost guide for what each tier actually changes.

Once you have narrowed the list, browse the hearing aid catalog to see which manufacturers offer the styles and features you need.

Features worth caring about, whatever the style

Frequently asked questions