Short answer: Neither in-the-ear nor behind-the-ear hearing aids are better for everyone. Research has not shown that any one style gives better results for all users. Behind-the-ear aids can be used across a wide range of hearing loss, from mild to profound, and are usually the first choice for children. In-the-ear aids can be less visible, but the smaller they get, the more limited they may be in power, features and ease of handling. The right style depends on the degree and type of hearing loss, the shape and size of the ear canal, dexterity, care habits and personal preference.
This guide explains how behind-the-ear (BTE and RIC) and in-the-ear (ITE, ITC, CIC and IIC) hearing aids work, when each may be a good fit, and where the evidence is still limited. It draws on guidance from international health organisations and peer-reviewed research. The final decision should be made individually, after an ear examination and a hearing test.
Summary: Quick Answers
Which is better: in-the-ear or behind-the-ear?
There is no single right answer. Behind-the-ear aids suit a wider range of hearing loss, while in-the-ear aids can be more discreet. The choice depends on the degree of hearing loss, ear anatomy, ease of use and personal priorities.
Are invisible hearing aids suitable for everyone?
No. Completely-in-canal (CIC) and invisible-in-canal (IIC) aids need an ear canal that is large enough and a hearing loss within the power range of such small devices. They are usually not recommended for severe to profound hearing loss or for young children.
Which hearing aid is easiest for older adults?
Dexterity, eyesight and daily routines matter more than age. Very small aids can be hard to insert, remove and adjust, so larger behind-the-ear or in-the-ear (ITE) aids may be easier for some people.
Which hearing aids do children use?
Children usually wear behind-the-ear (BTE) aids with custom earmolds. As the ear grows, only the earmold needs to be replaced.
What Are the Different Types of Hearing Aids?
Hearing aids fall into two main groups depending on where the case sits: behind-the-ear aids, whose case rests behind the outer ear, and in-the-ear aids, which sit entirely in the bowl of the outer ear or in the ear canal. All of them pick up sound with a microphone, process it and deliver it to the ear through a receiver (speaker) (NIDCD).
Behind-the-ear (BTE) hearing aids
The electronics sit in a case behind the ear. Sound travels through an ear hook and tube to a custom earmold, or through a thin tube to a soft ear tip. The US National Institute on Deafness and Other Communication Disorders (NIDCD) notes that BTE aids are used by people of all ages for mild to profound hearing loss. The NHS describes BTE as the most common type of hearing aid.
Receiver-in-canal (RIC/RITE) hearing aids
A smaller case sits behind the ear, and the receiver is placed inside the ear canal on a thin wire. Because the part behind the ear is small, it is less noticeable. The NHS notes that these aids can be more fiddly to use. With the receiver in the canal, it is more exposed to earwax, heat and moisture, and some small-case models do not include extras such as a telecoil (American Academy of Audiology).
In-the-ear (ITE) hearing aids
An ITE aid is a custom shell made from an impression of the ear, filling the bowl of the outer ear (the concha). NIDCD notes that ITE aids are used for mild to severe hearing loss and are usually not worn by young children, because the shell needs replacing often as the ear grows.
Canal aids (ITC, CIC and IIC)
ITC (in-the-canal) aids sit in the ear canal and are partly visible in the outer ear. CIC (completely-in-canal) aids sit entirely inside the canal, with a small cord for removal. IIC (invisible-in-canal) aids sit deeper in the canal. According to NIDCD, canal aids can be hard to adjust and remove because of their size, and they are usually not recommended for young children or for severe to profound hearing loss. The US Food and Drug Administration (FDA) also notes that their small size can make them difficult to handle.
In-the-Ear vs Behind-the-Ear: Side-by-Side Comparison
Most differences between the two groups come from device size and where the parts sit in the ear. The table below shows general tendencies; models within the same group can differ considerably.
| Feature | Behind the ear (BTE / RIC) | In the ear (ITE / ITC / CIC / IIC) |
|---|---|---|
| Typical hearing loss range | BTE: mild to profound; RIC: depends on receiver power | ITE: mild to severe; ITC/CIC/IIC: usually mild to moderate |
| Visibility | Case sits behind the ear; RIC cases are smaller | ITE is visible in the outer ear; CIC and IIC are barely visible |
| Inserting, removing, adjusting | Larger case; controls may be easier to reach | ITE may be relatively easy; CIC and IIC can be harder because of their size |
| Own voice sounding “boomy” (occlusion) | May be reduced with fittings that leave the canal open | Can occur because the canal is closed; venting and insertion depth affect it |
| Earwax and moisture | BTE electronics stay outside the canal; the RIC receiver sits inside it | Electronics sit in the ear and are more exposed |
| Extra features (telecoil, larger battery, wireless accessories) | Case size may leave room for more options | Space becomes limited as size shrinks; varies by model |
| Use in children | Usually preferred | Usually not recommended for young children |
How Do the Degree and Type of Hearing Loss Affect the Choice?
The degree of hearing loss is one of the most important factors: the more amplification someone needs, the more the options shift towards behind-the-ear styles. NIDCD and the NHS both note that small canal aids are often not powerful enough for severe hearing loss.
A key reason is acoustic feedback, the whistling that happens when sound from the receiver leaks back into the microphone. The risk grows as the aid gets more powerful and as the microphone and receiver get closer together. Fittings that leave the ear canal open can feel comfortable, but a literature review found that they considerably reduce how much amplification can be given before feedback occurs. Open fittings are therefore mainly used for mild to moderate losses where low-pitch hearing is relatively good (Winkler et al., 2016).
The type of hearing loss and the health of the ear matter too. Ear drainage and earwax can damage a hearing aid (NIDCD). The FDA advises seeing a doctor, preferably an ear, nose and throat (ENT) specialist, first if you have sudden hearing loss, much worse hearing in one ear, or fluid, pus or blood coming from the ear in the past six months (FDA). In these cases a medical assessment should come before choosing a hearing aid style.
Sound Quality and Understanding Speech in Noise: What Does the Evidence Say?
There is no strong evidence that either in-the-ear or behind-the-ear hearing aids consistently help people understand speech in noise better. Most studies have small samples and were carried out in laboratory conditions.
- Overall benefit of hearing aids: A Cochrane systematic review of adults with mild to moderate hearing loss found that hearing aids substantially improve listening ability and hearing-related quality of life. The review did not compare styles (Ferguson et al., 2017).
- Directional microphones: Directional microphones, which help focus on a talker in front, may offer extra benefit in noise, but a systematic review rated the evidence as limited (Bentler, 2005). Whether an aid has this feature depends on its size and model, and the benefit may be smaller with open fittings (Winkler et al., 2016).
- Microphone position: In a study of 11 listeners, completely-in-canal aids led to fewer front-back confusions, with no difference in other localisation measures. With both styles, results remained below those of people with normal hearing (Best et al., 2010).
- Sound quality: In a study comparing different microphone and receiver placements, listeners with hearing loss rated in-the-ear and behind-the-ear aids similarly for speech. The researchers emphasised that a wide frequency range matters regardless of style (Stone et al., 2023).
Limits of the evidence: There are no large randomised controlled trials comparing hearing aid styles for speech understanding in noise or user satisfaction. Claims such as “in-the-ear aids sound more natural” or “behind-the-ear aids are better in noise” should not be treated as true for everyone. Accurate fitting and verification affect results, whatever the style.
Comfort, Visibility and Appearance: Invisible Hearing Aids
Wanting a discreet hearing aid is a valid preference, but it should not be the only factor. Completely-in-canal (CIC) and invisible-in-canal (IIC) aids are the least visible; receiver-in-canal (RIC) aids, with their thin wire and small case, can also be discreet (NHS).
However, canal aids may not suit people with narrow ear canals or frequent ear infections (NDCS). A common comfort complaint is the occlusion effect: when the ear canal is blocked, your own voice can sound muffled, hollow or too loud. The FDA notes that small behind-the-ear ear tips that block less of the canal may reduce this effect. With in-the-ear aids, venting and how the shell sits can influence it.
Batteries, Charging and Connectivity
Battery, charging and wireless features depend more on the model than on the style, and independent studies comparing styles are limited. Some general patterns still apply:
- Battery size: Smaller aids usually use smaller batteries. Changing tiny batteries takes good eyesight and finger dexterity; rechargeable models may be worth considering for people who find this difficult.
- Telecoil: A telecoil lets sound from compatible phones and hearing loop systems go directly into the hearing aid (NIDCD). Some small-case models do not have one.
- Wireless connection: Many current hearing aids can connect wirelessly to phones or TVs; whether and how depends on the model. For children, compatibility with remote microphone (FM) systems used at school is also important (American Academy of Audiology).
- Battery safety: Button batteries are a swallowing hazard for young children. Tamper-resistant battery doors are recommended for children (American Academy of Audiology). Keep batteries out of reach of children and pets.
Earwax, Moisture and Maintenance
Earwax and moisture can affect any hearing aid, but parts that sit inside the ear canal are more exposed. NIDCD notes that earwax and ear drainage can damage hearing aids, and that open-fit behind-the-ear aids may be a good choice for people prone to earwax build-up. In-the-ear aids keep all their electronics in the ear, and the receiver of a RIC aid also sits in the canal, exposed to wax and moisture.
Reliable, independent data comparing repair rates or lifespan by style are limited. Whatever the style, wipe the aid daily with a soft dry cloth, change wax filters as advised, protect it from moisture and attend regular check-ups. If your hearing aid gets wet, see our guide on what to do if a hearing aid gets wet.
Which Hearing Aids Are Easiest for Older Adults to Use?
For older adults, dexterity, eyesight, finger sensitivity and available day-to-day support shape the choice more than age itself. The American Speech-Language-Hearing Association (ASHA) notes that because hearing aids are small, the audiologist will also consider a person's ability to see and handle them. NIDCD, the NHS and the FDA all point out that very small aids can be hard to insert, remove and adjust; the FDA notes that in-the-ear (ITE) aids may be easier to handle than smaller styles.
Many older adults manage small aids perfectly well. During the trial and fitting, practise inserting and removing the aid, changing or charging the battery and adjusting the volume, and involve a family member if helpful.
Choosing Hearing Aids for Children
Children usually wear behind-the-ear (BTE) hearing aids with custom earmolds. The American Academy of Audiology's paediatric amplification guideline recommends this style because the outer ear can keep growing into puberty: as the ear grows, only the relatively inexpensive earmold needs replacing, not the whole aid. The guideline also highlights compatibility with remote microphone systems, tamper-resistant battery doors and repeating measurements with each new earmold.
In-the-ear shells need frequent replacement as the ear grows (NIDCD). The UK's National Deaf Children's Society (NDCS) notes that in-the-ear and in-the-canal aids can be a choking hazard and are only recommended for older children and young adults.
Which Hearing Aid Style May Suit Which Need?
The table below summarises which styles may be considered in common situations. These are general tendencies; several factors often apply at once, and the final decision follows an ear examination and hearing assessment.
| Situation | Styles that may be considered | Things to keep in mind |
|---|---|---|
| Mild to moderate hearing loss | RIC, BTE, ITE, ITC, CIC | Smaller styles may be options if the ear canal allows |
| Severe hearing loss | BTE; in some cases RIC with a power receiver, or ITE | Small canal aids may not be powerful enough |
| Profound hearing loss | BTE | Canal styles are usually not recommended |
| Limited dexterity or eyesight | BTE, ITE | Very small aids can be hard to insert and remove |
| Discreet look is a priority | CIC, IIC, RIC | Hearing loss and canal size must be suitable |
| Own voice sounds “boomy” | Open-fit RIC or BTE | Especially when low-pitch hearing is relatively good |
| Frequent earwax build-up | Open-fit BTE | Ear discharge needs an ENT check first |
| Children | BTE with earmold | Only the earmold is replaced as the ear grows |
Hearing Assessment, Fitting and Verification
How much you benefit from a hearing aid depends not only on its style but also on a thorough assessment, accurate fitting and regular follow-up. The process usually includes:
- Ear examination and history: identifying anything that needs a doctor's assessment, such as earwax blockage, discharge, sudden hearing loss or a marked loss in one ear.
- Hearing test: measuring the degree and type of hearing loss and how well you understand speech. See how a hearing test works.
- Needs and lifestyle assessment: everyday listening situations, phone and TV use, eyesight and dexterity (ASHA).
- Ear impressions: taken for in-the-ear aids and custom earmolds.
- Programming and verification: the aid is programmed to your hearing test results. The British Society of Audiology describes real-ear measurement, using a thin probe microphone placed in the ear canal to measure the sound the aid produces in your ear, as the most direct way to verify a fitting and recommends it as the starting point.
- Follow-up and fine-tuning: check-ups during the adjustment period allow settings to be updated based on your experience (ASHA).
If you have hearing loss in both ears, the number of aids is part of this assessment too; see why wear hearing aids in both ears, and for general buying considerations, what to consider when buying a hearing aid.
Frequently Asked Questions
What are the pros and cons of in-the-ear hearing aids?
In-the-ear aids are custom-made, and canal styles in particular are less visible. On the other hand, the smaller they are, the more limited their power and features can be, the harder they can be to handle, and the more exposed they are to earwax and moisture. They are usually not the first choice for severe hearing loss or young children.
What are the advantages of behind-the-ear hearing aids?
Behind-the-ear aids can be used across a wide range of hearing loss, from mild to profound, suit all ages and have room for extra features. Open fittings leave the ear canal less blocked. The main drawback is a visible case behind the ear, which is smaller in RIC styles.
Can invisible hearing aids be used for severe hearing loss?
Usually not. Because completely-in-canal and invisible-in-canal aids are so small, they often cannot provide enough amplification for severe to profound hearing loss. Behind-the-ear aids are usually considered instead.
Do in-the-ear hearing aids work better in noise?
There is no strong evidence for this. Having the microphone in the ear gave a small benefit for telling front from back in some small studies, but no style has been shown to be consistently better for understanding speech in noise. Features such as directional microphones and an accurate fitting may matter more.
Will an in-the-ear hearing aid change how my own voice sounds?
It can. Aids and earmolds that close off the ear canal can make your own voice sound muffled or echoey; this is called the occlusion effect. Venting, insertion depth and adjustments can reduce it. Behind-the-ear fittings that leave the canal open are another option.
Can someone with a lot of earwax wear an in-the-ear hearing aid?
Yes, but the wax filter needs changing regularly and the aid needs regular checks. Because earwax and ear discharge can damage hearing aids, open-fit behind-the-ear aids may also be considered for people who build up earwax often. If there is discharge from the ear, see a doctor first.
Why are ear impressions taken for in-the-ear hearing aids?
The shell of an in-the-ear aid is custom-made to the shape of your outer ear and ear canal, so an impression of the ear is taken. Impressions are also taken for behind-the-ear aids that use custom earmolds, but not usually when ready-made ear tips are used.
Who decides which hearing aid style I should use?
The style is chosen together with an audiologist, based on an ear examination, hearing test results, the shape of the ear canal, your needs and your preferences. If there are signs of a medical problem, an ENT doctor should assess the ear first.
Find Out Which Style Suits You
Whether an in-the-ear or behind-the-ear hearing aid is right for you depends on the degree and type of your hearing loss, the shape of your ears and your daily needs.
To find out more about hearing assessments and hearing aid fitting in and around Dalaman, Ortaca, Köyceğiz and Fethiye, you can contact Dalaman Hearing Aids Sales and Fitting Centre.
Sources
- National Institute on Deafness and Other Communication Disorders (NIDCD). Hearing Aids. Last updated 11 October 2022. nidcd.nih.gov
- NHS. Hearing aids and implants. Last reviewed 18 October 2023. nhs.uk
- U.S. Food and Drug Administration (FDA). Types of Hearing Aids. 14 November 2022. fda.gov
- U.S. Food and Drug Administration (FDA). OTC Hearing Aids: What You Should Know. 3 May 2023. fda.gov
- American Speech-Language-Hearing Association (ASHA). Audiology Information Series: Learning About Hearing Aids, 2015. asha.org
- American Academy of Audiology. Clinical Practice Guidelines: Pediatric Amplification, 2013. audiology.org
- National Deaf Children's Society (NDCS). In-the-ear and in-the-canal hearing aids. Last reviewed May 2025. ndcs.org.uk
- British Society of Audiology. Practice Guidance: Guidance on the verification of hearing devices using probe microphone measurements, 2018. baaudiology.org
- Ferguson MA, Kitterick PT, Chong LY, Edmondson-Jones M, Barker F, Hoare DJ. Hearing aids for mild to moderate hearing loss in adults. Cochrane Database of Systematic Reviews, 2017;9:CD012023. PubMed 28944461
- Winkler A, Latzel M, Holube I. Open Versus Closed Hearing-Aid Fittings: A Literature Review of Both Fitting Approaches. Trends in Hearing, 2016;20. PMC4765810
- Bentler RA. Effectiveness of directional microphones and noise reduction schemes in hearing aids: a systematic review of the evidence. Journal of the American Academy of Audiology, 2005;16(7):473–484. PubMed 16295234
- Best V, Kalluri S, McLachlan S, Valentine S, Edwards B, Carlile S. A comparison of CIC and BTE hearing aids for three-dimensional localization of speech. International Journal of Audiology, 2010;49(10):723–732. PubMed 20515424
- Stone MA, Lough M, Kühnel V, Biggins AE, Whiston H, Dillon H. Perceived Sound Quality of Hearing Aids With Varying Placements of Microphone and Receiver. American Journal of Audiology, 2023;32(1):135–149. PubMed 36580494
Wishing you days full of clear, healthy sound!
Audiologist Damla Gül Karadevren
Last updated: 13 October 2026 · For corrections or feedback on this article, please reach us through our contact page.