The pros and cons of very small hearing aids in your ears.

Many people want the smallest, best, cheapest and most reliable hearing aids all in on product. Unfortunately, such a single product does not currently exist.

Small hearing aids such as completely-in-the-canal (CIC) or the newer, smaller Invisible-in-the canal (IIC) devices are very popular in the client’s mind, but they do come with some caveats, that far too few people are aware of when they first get them. This in part is the clinician prescribing these devices’ fault, but is often also a decision the client makes without fully appreciating what is being sacrificed in order to obtain the least visible device possible.


So what do you get with the smallest hearing aids on the market today? (pros of invisible hearing aids):

  • Confidence in knowing that no-one should notice you are wearing anything
  • Some brands offer wireless connection to mobile phones etc. with these – although the antenna required makes it a little bigger than the smallest ones on the market.
  • One model – the Siemens Insio 7 Bx even allows directionality for significant improvement in hearing in background noise. It is quite an expensive premium option though.
  • Improved hearing in quiet
  • The ability to wear headphones over the hearing aids -comfortable
  • Easy, natural use of the phone
  • Excellent Bass reproduction due to blocking off the ear – great for some hearing loss and actually problematic for hearing loss, where the low pitched hearing is normal or close to normal.


What are the catches of these small wonders? (Cons of invisible hearing aids)

  • Reliability – As these devices are worn in wet (sweat & wax), hot (core body temperature) and oily (ear wax) conditions, they tend to fail to the extent of requiring repairs up to 10 times more than other styles of hearing aids. This might mean that you will be without your hearing aids up to 2 or 3 times a year as they go in for repair. Other styles may only need one repair every 3 or so years.
  • Requires vigilant care, cleaning and maintenance to try and avoid the above mentioned repairs.
  • Strength – These hearing aids are normally encased in a thin acrylic custom made shell. These shells are kept thin to ensure the small size while still being able to accommodate the electronics and acoustic tweaks, required for different hearing loss. These shells are prone to cracking and breaking over time, so it is not unusual to have to have the aid reshelled a few times during its working life at around $200 a time.
  • Batteries – to keep these devices small, they use the smallest batteries. This means a battery might only last 4 or so days, compared to a larger battery which might give 8 days. So your battery costs will be higher too.
  • Compromise – Due to its small size, certain very useful hearing aid technologies such as directional microphones (the only proven technology to improve speech understanding in noise) cannot fit. Sure, Siemens’ Insio Binax 7 has found a way to use wireless technology to achieve something akin to traditional directionality. It does however come at a premium price and its performance in noise is about as good as a lower mid-range hearing aid in another style.
  • Blocked up ears – If you have fairly normal hearing in the low frequency range of your hearing, then wearing these small hearing aids, that fill your whole ear canal, can cause a blocked feeling (Occlusion). This feeling is akin to having a bad flu and means you might not be able to tolerate the echo in your own voice. We will try to alleviate this by adding venting to the aid, but the size of the vent is limited by the size of your ear. Occlusion is not such an issue if your loss is greater than about 45db in the low frequencies (250 & 500Hz)


So how do I pick?

The intention of this is certainly not to discourage you to use hearing aids. Any hearing aid is better than nothing at all and saying that, a hearing aid you are willing to wear is much better than the best hearing aid sitting in the drawer because you are too self-conscious to use it.

I have found through many years of clinical practice, that all these things are manageable as long as you, the wearer is fully aware of the expectations.


If the cons are just too much for you, then you still have options available to you:

Make sure your audiologist gives you at least 60 days money back guarantee, with the option to exchange for another model if things don’t work out.

I usually recommend you try the device with the most benefits first and only if you end up finding you cannot use it confidently, then consider the smaller model.

5/5 (1 Review)

6 Comments to “ The pros and cons of very small hearing aids in your ears.”

  1. Lois fleming says :Reply

    very complicated. I think I understand. Although being 83 I am still vain and would rather have a hearing aid that was not visible. unfortunately with my ears they have a large canal that narrows into a very narrow one due to swimming a lot in my youth. Not sure if this is correct. Anyway what is the cost of the very expensive range with the 2 batteries. I can get an idea and not a shock if they are the ones I need. Lois

    1. christo says :Reply

      Hi Lois,

      Cost and size aren’t as related as they used to be.
      You can get small hearing aids starting at around $2,050 a pair right through to around $7,800 a pair.
      The condition you are describing is Exostosis, which is a bony growth in the ear canal, caused with cold water. It is benign, but makes it hard to fit very small devices right in your ears. You might want to consider a very small over the ear device such as Phonak’s Audeo V90-10. They are still extremely hard to see in someone’s ear, but has very little apart from a small speaker in the ear itself. This solution works extremely well with Exostosis and small ear canals in general, while being cosmetically appealing.

  2. Colin O'Hara says :Reply

    My wife and I are getting to the stage where we are thinking of the need to get educated about hearing aids. We are mainly beginning to have problems in group situations. Yes, as mostly- we are concerned with the initial cost as well as ongoing costs.
    Possibly in ear is preferred, but we are not interested in a lot of maintenance, being without while they are sent away etc. We live in a town 200 klm from Sydney.We welcome any guidance….

    1. christo says :Reply

      Hi Colin,

      Thank you for your comments. As you mentioned, in the ear has a LOT more need for maintenance and service compared to even small over the ear instruments. These over the ear instruments are pretty much invisible when worn, but perform better with more reliability. I would suggest you have a look at our Hearing aid buyers guide if you have not yet done so.

  3. Leigh Roden says :Reply

    Very good article, explaining the pros and cons of small “invisible” aids. I have recently had a Starkey fitted and it has changed my life from saying “what was that” to “don’t shout”. I think the biggest factor with mine, and I’d venture to say with most/all hearing aids is simply getting used to them. In m case it is a slightly different sound to my own hearing. This is something I believe you have to accept. And yes I’m vain as well and must have an in the air type. But from the day it was fitted it has been a gem. And of course a couple of visits to tweak it to get it all perfect, but I expected this. I’d certainly suggest to anyone who has hearing loss, go get it checked out. You will be amazed as to what is available today within ranges, and with in the ear types the pros to me certainly outweigh any cons there might be as far as I am concerned about wearing them and the new hearing you achieve from them.

    1. christo says :Reply

      Thank you for your comments Leigh. The intention of the article is not to put people off small hearing aids at all. It is just so that you can make a fully informed decision. I find that unrealistic expectations are the cause of many disappointments.

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