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Here's How to Decide Between In-Ear vs. Behind-Ear Hearing Aids

Choosing between the three main types of over-the-counter hearing aids can be difficult. Deciding what your needs are makes it easy.

Taylor Leamey Senior Writer
Taylor Leamey writes about all things wellness, specializing in mental health, sleep and nutrition coverage. She has invested hundreds of hours into studying and researching sleep and holds a Certified Sleep Science Coach certification from the Spencer Institute. Not to mention the years she spent studying mental health fundamentals while earning her bachelor's degrees in both Psychology and Sociology. She is also a Certified Stress Management Coach.
Expertise Sleep, Mental Health, Nutrition and Supplements Credentials
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Taylor Leamey
6 min read
Row of types of different types of hearing aids.
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If you've noticed your hearing has gotten worse or have to blare the TV just to hear it, you may be considering an over-the-counter hearing aid, which you can now purchase online. OTC hearing aids are available for adults with varying levels of hearing loss. And now you have more options than just the traditional options. Some are so small that you can't see them at all. But how do you choose between the different styles on the market? Below, we'll go through each and discern who they're best for. 

Read more: Everything You Need to Know About Buying Over-the-Counter Hearing Aids

How do hearing aids work?

Regardless of your style, hearing aids generally work the same way. The goal is always to amplify sounds while filtering out certain types of noise to improve hearing and communication. 

Hearing aids do this with three components -- a microphone, amplifier and speaker. The microphones on the device intake sound from the environment. Then it goes to a computer chip with an amplifier that takes sound and converts it to a digital code, which the hearing aid then adjusts to your needs. Then the device converts the signals to sound waves and delivers them through the speaker into your ear. 

Read more: How Hearing Aids Work

While you aren't required to visit with an ENT doctor or audiologist before purchasing over-the-counter hearing aids, it's generally still a good idea to have a hearing assessment if it's available for you. Many OTC hearing aid brands offer online hearing tests but will not physically address your ear. 

Meeting with an audiologist for a full hearing assessment can rule out hearing loss due to medical conditions and ensure you fully understand your communication needs. Over-the-counter hearing aids are best suited for those with mild or moderate hearing loss. 

According to the National Institute on Deafness and Other Communication Disorders, OTC hearing aids are not intended for children or adults with severe hearing loss. 

Which hearing aid style is best for you?

There are generally three main categories of hearing aid styles -- behind-the-ear, in-the-ear and in-the-canal. Under each of these, there can be subcategories that also vary by fit and price. Let's go through the benefits and things to consider for each category so you can find the best choice for your hearing needs. 

Behind the ear

Person holding over-the-ear hearing aid.
Johner Images/Getty Images

When you think of hearing aids, you're probably picturing behind-the-ear models, which have the device sitting on the back of the ear, a thin wire that wraps around the ear with a dome that fits into the canal. This type of hearing aid can address most degrees of hearing loss. 

Pros

  • Behind-the-ear hearing aids are generally the most affordable OTC option 
  • Often are available in rechargeable or battery-power options
  • There are two microphones on the device
  • Despite sitting on the back of your ear, most people can't feel them

Cons

  • Behind-the-ear hearing aids are less discreet than other options 
  • They can be hard to put on if you have dexterity issues.
  • Your hearing aid may get in the way of glasses

There are also behind-the-ear hearing aids that don't have a wire and dome that fit into the canal. Instead, they have a tube that carries sound into the ear. 

In the ear

Older person holding in-ear hearing aid.
Andrew Bret Wallis/Getty Images

This style of hearing aid reminds me of Bluetooth headphones. They sit in the ear, but you can still see them from the side. The larger models will fill the outer ear and are very light, so they don't press down on your ear. 

Pros

  • They are easier to insert than over-the-ear hearing aids 
  • In-the-ear hearing aids are less noticeable 
  • They often can be connected to your phone through Bluetooth

Cons

  • Are subject to more cleaning due to wax build-up and moisture 
  • In-the-ear hearing aids are smaller, typically allowing for only one microphone on the device 
  • This style of hearing aid is more expensive than traditional, behind-the-ear options 
  • Some people complain of hearing an echo of their voice while wearing in-the-ear hearing aids 

In the canal

Person holding out an in-canal hearing aid.
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Similar to in-the-ear hearing aids, this style is the most discreet and often the most expensive because of the need for specialized technology to fit the side. Under the in-the-canal umbrella, there are two main types -- in-the-canal and completely-in-canal. Both are discreet and often go unnoticed. 

Pros 

  • In-the-canal hearing aids are easy to put in 
  • Because of how they sit in the ear, they are good at blocking outside sounds 
  • They are also the most discreet hearing aid option. The smallest devices can't be seen from the side 

Cons

  • Some people describe them as feeling like your ears are "plugged" 
  • Generally not recommended for people who have excess earwax 
  • They can be hard for some to get out of the ear 
  • In-the-canal hearing aids are some of the most expensive on the market 

What factors matter in choosing hearing aids?

The over-the-counter hearing aid market has special features that many prescription options don't have, like Bluetooth capabilities. However, you should always consider these four main factors when choosing which hearing aid is best for you.

Trial period

OTC hearing aids don't require a prescription or a doctor's appointment to purchase. While this makes them more accessible, you don't necessarily have a doctor's expertise to lean on when purchasing. The good news is that nearly all OTC hearing aid manufacturers offer a trial period that allows you to test the hearing aid and return them if they don't meet your needs. This is great if you aren't sure which style you want to use. 

During this trial period, many companies offer calls and video chats with hearing specialists to assist in setting up and fitting your hearing aids.

Hearing aid cost

Most insurance companies don't cover purchasing over-the-counter hearing aids, though you should check your coverage to see if yours does. Coverage varies, though most insurance companies currently only cover prescription hearing aids. However, the OTC market is new, and this may change. 

Over-the-counter hearing aids vary in price depending on the style and features of the device. The prices can range from as affordable as $300 up to $3,000. The price tag isn't always indicative of functionality. Instead, it tells you what type of hardware, quality and additional functionalities like Bluetooth or directional hearing you're getting. You can get great hearing aids on the lower end of the scale, they might just not be as flashy as other options. 

Some over-the-counter hearing aids are expensive, and your budget matters. But that doesn't mean that you can't get your desired device. Many OTC hearing aid brands offer monthly financing programs that can bring down luxury options into your price range. 

Your hearing loss

Over-the-counter hearing aids are suited for those with mild to moderate hearing loss. Those with severe hearing loss are more likely to need a doctor's support to address their communication needs. 

Ease of use

Over-the-counter hearing aids are a relatively new idea, and with new things come new technology capabilities. Many of the best OTC hearing aids have mobile apps that allow you to adjust the volume and sound filtering setting of your hearing aids. Some people love the idea of being able to adjust from their phones. However, other people prefer to adjust the volume from their devices. 

Most of the over-the-ear hearing aids that we've tested have volume up and down buttons that everyone can recognize. In-ear and in-canal hearing aids often aren't as straightforward when adjusting your hearing experience. Some don't have buttons and are completely dependent on the app.  

Too long; didn't read?

The over-the-counter hearing aid market is flourishing, with new features and advances happening regularly. Which hearing aid style is best for you is largely dependent on your preferences. Choose in-the-ear or in-canal hearing options for a more discreet hearing experience. However, these tend to be the most expensive of the three. 

There are many things to consider when buying an OTC hearing aid. But your option is out there. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.