RIC vs Custom
Hearing aid technology continues to advance significantly, providing diverse options tailored to various types and severities of hearing loss. Two common and popular form factors today are Receiver-in-Canal (RIC) hearing aids and custom-made hearing aids.
Understanding the strengths, limitations, and best use cases for these options can profoundly impact the effectiveness of hearing rehabilitation. Whilst Receiver in the Canal (RIC) hearing aids have significant market share dominance over all the major manufacturers by their adaptability and ability to be configured to a massive different ranges of hearing losses there is still a strong case for custom made hearing aids.
Receiver-in-Canal (RIC) Hearing Aids
RIC hearing aids are characterized by a discreet design where the receiver (speaker) sits directly in the ear canal, connected by a thin wire to a small behind-the-ear casing housing the microphone and amplifier.
Strengths of RIC Hearing Aids
1. Cosmetic Appeal and Comfort: RIC devices are exceptionally discreet and cosmetically appealing. Their slim, lightweight design provides greater comfort and aesthetics compared to larger hearing aids (Powers & Hamacher, 2019). They typically suit users who prioritize subtlety.
2. Reduced Occlusion Effect: Due to the open fit capability, RIC devices effectively reduce occlusion—the phenomenon where one’s voice sounds overly loud or hollow—particularly when used with open domes (Keidser et al., 2011).
3. Enhanced Sound Quality: RIC designs offer superior sound quality, especially for high-frequency amplification, due to the direct placement of the receiver in the ear canal, minimizing acoustic distortions from tubing (Valente, 2020).
4. Versatility: RIC hearing aids support a wide range of hearing losses, from mild to severe. They easily adapt by changing receiver power levels or ear domes.
Weaknesses of RIC Hearing Aids
1. Maintenance and Durability: The external placement of the receiver makes it susceptible to moisture and wax damage, increasing maintenance requirements (Powers & Hamacher, 2019).
2. Feedback Issues: While better than traditional open-fit Behind-the-Ear (BTE) hearing aids, RIC devices can still experience feedback, especially with higher power receivers or poorly fitting domes (Valente, 2020).
Custom-Made Hearing Aids
Custom-made hearing aids are individually manufactured based on the user’s ear canal impressions. These aids range in size from In-the-Ear (ITE) models to Completely-in-the-Canal (CIC) devices, fitting deeply within the canal.
Strengths of Custom-Made Hearing Aids
1. Personalized Comfort and Secure Fit, Discretion: Custom-made devices provide exceptional comfort and stability due to their precise fit, essential for active individuals or those requiring a secure placement. Smaller devices such as the CIC and IIC can be more difficult to detect and is appealing to people who may feel a stigma to themselves wearing hearing aids. (Mueller & Ricketts, 2018).
2. Effective Occlusion Management: Though smaller devices, like CIC aids, might initially cause more occlusion, custom venting and advanced ear impression techniques significantly mitigate this effect, tailoring the solution to individual needs (Staab, 2018).
3. Better Directionality and Localization: The placement of custom aids within the pinna allows natural localization cues to enhance spatial hearing, helping users better determine sound direction and distance (Mueller & Ricketts, 2018).
4. Suitable for Various Hearing Losses: Custom-made hearing aids effectively support a broad spectrum of hearing loss severities, especially moderate to severe losses, by offering robust amplification capabilities.
Weaknesses of Custom-Made Hearing Aids
1. Size and Cosmetic Considerations: Although discrete, certain custom aids, particularly ITE models, can be more noticeable compared to RIC aids, especially for individuals with smaller ear canals.
2. Limited Adjustability: Once manufactured, custom devices have fewer options for physical adjustments compared to RIC aids, making flexibility somewhat restricted post-manufacture.
3. Ear Canal Changes: Physical changes in the ear canal due to weight fluctuations or aging can compromise the fit, necessitating remakes or adjustments (Staab, 2018).
4. Occlusion effect issues: Venting for custom molded hearing aids are based on your Audiogram sent into the Hearing Aid manufacturer. The manufacturer then makes a calculation on how much venting is required for your hearing loss however as your ear canal is completely sealed from the molded hearing aid this can be an issue for people with mild to Moderate hearing loss, especially when the person has good low frequency hearing. This can generally be rectified by modifying the hearing aid vents but for some clients it is too overwhelming regardless of vent modification and they have no choice but to go with Receiver in the Canal Hearing aids with domes
Optimal Types and Severities of Hearing Loss
RIC Hearing Aids
RIC aids are particularly effective for mild to moderate, predominantly high-frequency hearing loss, which typically arises with age-related (presbycusis) or noise-induced losses (Keidser et al., 2011). The open-fit dome reduces low-frequency amplification, ensuring comfort and natural sound quality. However, higher power receivers enable RIC aids to manage moderately severe to severe losses effectively, provided the domes or earmolds offer adequate acoustic sealing to reduce feedback.
Custom-Made Hearing Aids
Custom aids excel in managing moderate to severe hearing losses, including flat or reverse-slope audiometric configurations. The precision fit and potential for increased amplification make them suitable for individuals requiring robust low-frequency amplification, essential in managing conductive or mixed hearing losses (Mueller & Ricketts, 2018).
Occlusion Issues with Both Options
RIC Hearing Aids
The primary advantage of RIC devices regarding occlusion is their open-fit dome capability. Open domes minimize occlusion, ensuring users perceive their voice naturally. However, for those requiring higher amplification and closed domes or Molds, occlusion might become noticeable, necessitating careful vent management (Keidser et al., 2011).
Custom-Made Hearing Aids
Custom aids can initially pose occlusion challenges, particularly with smaller devices like CIC or deep-fit aids. Audiologists manage occlusion by carefully venting or selecting slightly larger aids (e.g., canal aids) to optimize comfort and acoustic performance (Staab, 2018).
Conclusion
Both Receiver-in-Canal and Custom-made hearing aids offer distinct advantages and challenges. RIC devices are ideal for mild-to-severe hearing losses, providing discreetness, comfort, and flexibility. However, their maintenance needs and potential for feedback should be considered. Custom aids, while slightly more noticeable and requiring more precise fitting, deliver superior personalized comfort, excellent amplification for broader hearing loss ranges, and enhanced spatial hearing capabilities.
Careful consultation with your hearing care professional, considering individual lifestyle needs, aesthetic preferences, hearing loss type, and severity, ensures the best selection between RIC and custom-made devices, maximizing both hearing improvement and overall user satisfaction.
References
Keidser, G., Dillon, H., Convery, E., & Mejia, J. (2011). Factors influencing individual variation in perceptual directional microphone benefit. Journal of the American Academy of Audiology, 22(10), 693–709. Mueller, H. G., & Ricketts, T. A. (2018). Modern Hearing Aids: Pre-Fitting Testing and Selection Considerations. Plural Publishing. Powers, T. A., & Hamacher, V. (2019). Advanced Digital Signal Processing and Noise Reduction. Thieme. Staab, W. J. (2018). Custom hearing aid earmolds: Physical and acoustic considerations. Hearing Review, 25(2), 12–16. Valente, M. (2020). Hearing Aids: Standards, Options, and Limitations. Thieme.