Behind-The-Ear vs. Receiver-In-Canal Hearing Aids

There are many styles of hearing aids available, but two of the most popular styles are receiver-in-the-canal (RIC) and behind-the-ear (BTE) hearing aids. While these two styles look similar on the outside and share some similar functions and benefits, there are several key differences that set them apart.  

Both RIC and BTE hearing aids feature a hard case, or shell, that rests behind the ear. This case has most (or in some cases, all) of the hearing aid’s electronic components, such as the microphone, amplifier, digital chip, and speaker.

Both styles also feature an earpiece that is placed in the ear—this earpiece can be either a custom earmold or a non-custom ear dome. The earpiece connects to the hearing aid via tubing, an ear hook, or a thin wire, depending on the style. 

In terms of technology, both BTE and RIC hearing aids are equipped to make the most of a modern lifestyle. You can find the following capabilities in both styles, depending on the model:

• Direct streaming from your smartphone 
• Tinnitus treatment 
• Fully rechargeable (no batteries to replace) 
• Remote adjustment of volume/programs via a mobile app

1. Device size
   Since all electronic parts must be housed inside the case, BTE hearing aids have traditionally been the larger style. The bigger case can also accommodate larger batteries for more amplification power (see more below). However, the big-and-bulky reputation of BTE styles is quickly fading now that today’s models boast a slimmer, sleeker design more like the RIC style hearing aids.
2. Amplification ability
   The traditionally elongated shape of BTE hearing aids allows them to house a strong amplifier and large battery. They can magnify sounds in both the high-frequency and low-frequency ranges. RIC hearing aids can also offer considerable range, but those with severe hearing loss may still need the extra boost from a BTE style.
3. Speaker location
   One of the most significant differences between RIC and BTE hearing aids is the location of the speaker (or receiver). The speaker location can help feedback reduction resulting in better sound quality. In behind-the-ear hearing aids, the speaker is inside the hard case along with the other electronic components.
   
   Receiver-in-the-canal hearing aids, on the other hand, place the speaker at the end of a thin electrical wire connected to the case. The speaker is then enclosed inside a flexible ear dome or earmold placed in the ear. Placing the speaker in the canal allows for hearing aids to be made smaller.

Pros: Since the RIC’s case does not need to house the speaker, it’s typically slimmer and smaller than most BTE models. RIC styles also boast a thin, electrical wire instead of an ear hook or tubing, which when combined with a small, translucent ear dome makes them barely visible to others.

Sounds tend to be clearer and more intact with RIC hearing aids, as the speaker rests closer to the ear canal. And distancing the speaker from the microphone minimizes another common complaint: feedback.

RIC hearing aids’ open and semi-open fit ear domes also allow low-frequency sounds to escape, resulting in a more natural-sounding speaking voice. These hearing aids are most effective at addressing high-frequency hearing loss.

Cons: The smaller size of RIC hearing aids may make them more difficult to insert/remove, adjust settings and clean—especially for those with limited fine motor skills. And while it can accommodate a range of hearing loss levels, it does not offer as much amplification as the BTE. The placement of the speaker in the ear canal also makes it more vulnerable to moisture and wax buildup, thus requiring regular maintenance to minimize damage or sound issues.

Pros: Behind-the-Ear hearing aids offer the most powerful sound amplification out of any style, making them suitable for all levels of hearing loss—particularly those with profound hearing loss.

Since all sensitive electronics rest in the case outside of the ear, BTE styles are less susceptible to moisture and wax—the two leading causes of hearing aid damage. Even when those issues are present, they can often be easily cleared out of the tubing with an air blower or washed from the earmold by detaching and soaking it in warm, soapy water. The result? Fewer repairs and longer lifespan.

BTE hearing aids’ traditionally larger size also makes them easier to insert/remove, adjust settings and replace the battery—a big benefit for those with dexterity concerns.

Cons: Traditional BTE models—particularly those that offer maximum amplification—still tend to be bigger and thicker. Besides being more visible, the larger case may feel heavier or more uncomfortable for some wearers. And while ear domes are available for select BTE styles, many BTE hearing aids still require an earmold, which are typically more noticeable and can lead to a more plugged-up feeling.

Though the above is a quick guide to help you understand the differences between receiver-in-the-canal and behind-the-ear hearing aids, it is critical that you meet with a licensed hearing care provider to have your hearing professionally evaluated. Your hearing care provider will work with you to recommend a style and model or hearing aid that best meets your degree/type of hearing loss and your lifestyle. Knowing the differences between the different styles of hearing aids empowers you to make the right decision for you based on your provider’s recommendations.