FigureOur practice has always believed that well-fitted behind-the-ear (BTE) hearing aids are less visible than many in-the-ear (ITE) products for pediatric and adult patients alike. Further, BTE instruments often incorporate features (dual programs or microphones, better feedback control, etc.) not available in their smaller ITE counterparts. Nevertheless, many hearing aid users—adults and children, and their parents—ask for smaller, “invisible” instruments. BTEs remain the standard protocol for infants and young children and also for fitting hearing loss in the severe and profound range. In our practice, we see a full range of patients, primarily older children and adults, and over 40% of our fittings are BTE instruments. Following are some of our experiences in making behind-the-ear products an attractive and functional choice in a society focused on cosmetics. BTEs BECOMING smaller First, the same technologies that have made completely-in-the-canal hearing aids possible have also made many BTE products smaller. While maintaining all the benefits of BTEs, this miniaturization makes them more comfortable for the user and improves their appearance. Trying the downsized BTE products with adolescents who want to “upgrade” to the ITE style often causes them to discover the greater comfort they afford. We also find that matching the BTE case to hair color results in improved cosmetics. Further, coupling small BTEs with small earmolds whose material blends well with the color of the concha produces a fit that is functional and attractive. But, you may ask, are small earmolds appropriate for kids? What about retention? Shouldn't children wear full-shell molds? What about earmolds with the color swirl options? Don't all kids want custom-colored molds? At one time, full-shell molds were necessary with all power instruments to control feedback. But, in the early 1990s, we were introduced to the concept of smaller molds for power fits. In fitting a new programmable BTE, the manufacturer suggested the Emtech Patriot earmold to control feedback in a product without a volume control. We found that this mold was designed for the severe and profound hearing loss range and came in half-shell and canal-lock styles. This amazed us, and even more amazing was that it worked with power fits! Patients who had always worn extra-thick, extra-long-canal, full-shell earmolds achieved good hearing (without additional feedback) with a mold half the usual size. Plus, smaller earmolds were easier to insert and more comfortable to wear, especially for people who use their hearing aid 16 or more hours a day. While we feel the Patriot mold remains a good choice for small molds, we have found that the Invisiear, also made by Emtech Labs, of Roanoke, VA, can provide fittings without feedback even when 60 to 70 dB of gain is required. For mild to moderate gain fittings, the canal-only version virtually disappears when worn. OFFER OPTIONS Our philosophy with kids is to present options, and to appreciate that as young people grow, their tastes and concerns change. About the time that Barbie dolls, Lego sets, and action figures give way to the “right” clothes, hairstyles, and music, children may want to trade their swirl earmolds and purple hearing aids for something a little less noticeable. Finally, cosmetics are just one part of a hearing aid fitting. The more important component, the quality of hearing improvement, should not be compromised for cosmetics. This takes patient and persistent counseling. Pediatric clients, especially adolescents, as well as their parents, need to fully understand the benefits and advantages of BTE instruments (not to mention FM usage) and be presented with a variety of cosmetic options. Otherwise they may believe that BTEs represent old-fashioned technology.
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