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ITE means In Ear Hearing Aid, they are included ITC, IIC, CIC hearing aid. Most of them are small and tiny. Because of their sizes, we hard to find them when people wear on it. Whilst smaller hearing aids might be more discreet, you may find that some of the larger in-ear styles easier to put in place or remove especially of you may be experiencing dexterity problems. This can also make in-ear hearing aids easier to clean and maintain. And the IIC is the smallest hearing aids are so small they sit inside the ear canal where no one can see. ITC or CIC hearing devices are small possible hearing loss solutions. They are entirely contained in small cases that fit partially or completely inside the ear canal. Many people like these because they can be used easily by the telephone. However, IIC, CIC and ITC devices are difficult to handle and adjust due to their small size. Additionally, they may not fit in smaller ears, and they are only recommended for adults with mild to moderate hearing loss.
The Difference with BTE Hearing Aid
No matter ITC, IIC, CIC, even ITE hearing aids, because of their way of wearing, they are really different with BTE style. Many people prefer a hearing device that sits entirely in the ear. This style is referred to as an ITE or "In the Ear" device. Millions of people are wearing this style with great success. It is often the first choice of a new hearing device wearer because some of the ITE choices are considered a less visible design.
When we fit patients with BTE "Behind the Ear" models, we are able to put more power (more amplification) into the hearing device. This is often needed as a patients hearing loss is increased over time. This design also has the added benefit of controlling feedback (that annoying whistling) that is sometimes experienced in the ITE design.
USE ITE or BTE hearing aids depend on your own clients' needs, ITE style is more invisible and BTE style is more amplification but more visible. Generally speaking, we recommend that children can use BTE type and adult use BTE and ITE type.
In-the-ear (ITE) hearing aids (see Figure 3-9) are classified into ITE-full shell hearing aids located in the entire ear cavity according to their position in the ear. There are three types of ITE-half shell hearing aids and ITE-low profile hearing aids in some ear nail cavity. In-the-ear hearing aid
The hearing aid belongs to the most widely used custom-made hearing aid at present, and the hearing aid needs to be customized with different shells according to the ear models of different patients.
There are also some ear-nail cavity hearing aids as finished hearing aids. The size of such hearing aids is fixed. The wearer must make a matching ear mold, and then embed the hearing aid in the ear mold and wear it in the ear.
The basic structure of the in-the-ear type and the in-the-ear type hearing aid are similar, and they are composed of a housing, a microphone, an integrated circuit amplifier, a potentiometer, and a receiver (see Figure 3-10).
Both in-ear and in-canal hearing aids are a shell customized according to the shape of the patient's ear canal (in-ear also includes the ear cavity), and the hearing aid movement is housed in the shell. The material of the casing is required to be non-toxic, does not cause allergic reactions, is stable in nature, is not easily affected by temperature, etc., is not easy to age, and has a smooth surface without impurities.
The earphone type hearing aid housing of the analog line is also equipped with a volume regulator, a tone adjustment file, a maximum sound output adjustment file, and the like, and some programmable in-ear or ear canal hearing aids are also equipped with program switching buttons. In addition, some hearing aids are also equipped with a pull cord on the outer side, and a sound baffle is also installed on the sound outlet.
Figure: In-the-ear hearing aid
1-Volume control potentiometer
Figure : Structure of in-ear and in-canal hearing aids
Due to the larger form of in-ear and in-canal hearing aids, dual microphones can be installed. Full ear canal hearing aids are difficult to install with dual microphones.
3． Integrated circuit amplifier
Due to the miniaturization of electronic components and the increase in electronic integration, integrated circuit amplifiers for hearing aids are becoming more sophisticated. In particular, the digital signal processing is applied, which can add many functions without adding additional components and occupy the limited space of the hearing aid. This provides the conditions for making smaller and better fully in-canal hearing aids.
In-ear hearing aids usually use A13 batteries, in-ear hearing aids usually use A312 batteries, and full-in-ear hearing aids use A10 or even A5 batteries.
1. Changes in Formal Frequency of External Ear Canal
The resonance frequency of the adult external auditory canal is about 2000 to 4000 Hz. The theoretical average is 3359 Hz for males and 3440 Hz for females. The adult external ear resonance frequency measured by Bu Xingkuan is (2583 ± 323) Hz, and the peak gain effect of the external ear canal resonance frequency at 2500 Hz can reach 11-12dB.
When the patient wears an in-ear hearing aid, the frequency of the highest peak value of the sound gain at the microphone is at 5118 ~ 5638Hz, indicating that the in-ear hearing aid still has a certain effect on the ear canal formant shift, but it is basically maintained at the normal human ear canal form. Frequency position, plus their ability to compensate for high frequencies. Therefore, wearing such hearing aids can improve the patient's speech intelligibility.
2. Frequency response curve of in-ear hearing aid
The highest peak of the frequency response curve of an in-ear hearing aid is about 2500-2700Hz, which is close to the resonance peak of the external ear canal in a normal person. Gao Jianlin and others believe that the frequency range of the frequency response curve of in-ear hearing aids is about 200 ~ 7500Hz, and the frequency range is wide, which almost covers the language area of the human ear. The frequency response curve fluctuates slightly, and the curve is relatively smooth, which is in line with the human ear. The auditory response is similar, so it can enhance hearing effects.
Gao Jianlin's experiments show that the hearing compensation at 1000Hz, 2000Hz, and 4000Hz for in-ear hearing aids and ear canal hearing aids is 25-33dB, while the hearing compensation at 250-500Hz is 20-24dB. The former's hearing compensation ability is greater than the latter.
3． Sound gain at the microphone position
There are many rolls on the outer side of the auricle of a person, which form the same group of concave mirrors. They can reflect and refract the sound coming from the outside world, thereby increasing the sound pressure of the sound coming from the outside world at the microphone position. Compared with behind-the-ear hearing aids, the microphone of the in-ear hearing aid is located in the ear, and its hearing aid effect is enhanced by this principle. The anatomical positions of the earnails and / or the external ear canal occupied by the in-the-ear and in-the-ear hearing aids are different, and the microphone positions of different types of in-the-ear hearing aids are different, so their sound gains are also different. Gao Jianlin also found in the experiment that the sound gain at the microphone of the in-the-ear hearing aid is 5.94 to 6.46dB SPL, with an average of (6. 29 ± 1.09) dB SPL; the in-ear hearing aid is 6.90-9. The average is (8. 08 ± 1.83) dB SPL; the complete ear canal hearing aid is 8. 80 ～ 9. 30dB SPL, and the average is (9. 01 ± 1.73) dB SPL. There are significant differences between the three.
This shows that the sound gain at the microphone position of the full ear canal hearing aid is the largest, followed by the ear canal hearing aid, and then the in-ear hearing aid. Since this value is obtained when the hearing aid is not output, the sound gain at the microphone position is related to the anatomy, physiological characteristics of the auricle, and the style of the hearing aid, and has nothing to do with the power of the hearing aid.
The advantages of in-ear hearing aids compared to in-ear and full-ear hearing aids are:
① The range suitable for hearing loss is wide and the output power is large.
② Can easily install additional components such as dual microphones, pickup coils.
③ It is easier to replace the battery and adjust the volume than the ear canal hearing aid and complete ear canal hearing aid.
Disadvantages of in-the-ear hearing aids include:
④ Because the ear canal of a child is not developed and shaped, the shell needs to be replaced regularly, so it is not suitable for use.
②Compared with the behind-the-ear hearing aid, the microphone is located closer to the outlet of the receiver, and it is easier to generate acoustic feedback.
③ For the elderly and those with less flexible hands, it is not convenient to change the battery and adjust the volume.
④ Although it is located in the ear, its shape is still too large and it is easier to see.
⑤ Cerumen is easy to enter the hearing aid through the sound hole, resulting in damage to the internal movement.
⑥ The ear nail cavity hearing aid fills the entire ear nail cavity, and some patients may feel uncomfortable because of too much skin being closed.
⑦ As with the BTE hearing aids mentioned earlier, ear plugging can easily occur
The power range of in-the-ear hearing aids is generally 40 to 110 dB. Combining its acoustic characteristics and advantages and disadvantages, in-the-ear hearing aids are generally suitable for patients with moderate to severe hearing loss but are unwilling to wear behind-the-ear hearing aids. In addition, because they can easily install more auxiliary parts, they are more suitable for hearing aid performance High patients; for middle-aged and elderly people or patients with flexible hands and severe hearing loss, you can also consider the option of in-ear hearing aids.
An ear canal hearing aid refers to a type of hearing aid that is customized to the patient's external auditory canal and starts in the ear cavity and stops near the second curve.
In-the-canal (ITC) hearing aids (see Figure 3-11) are also custom-made hearing aids. Unlike in-ear hearing aids, in-ear hearing aids are located in the patient's ear canal. According to the size, ear canal hearing aids can be further divided into ear canal (ITC), small ear canal (small ITC or mini-canal), and complete ear canal
(CIC) three types of hearing aids. Complete ear canal hearing aids have two standards. Only when these two standards are met can they be called complete ear canal hearing aids, and the best gain and output can be obtained. First, the side part of the ear canal hearing aid shown in Figure 3-11 should be at least close to the outer ear canal or 1 to 2 mm inside the ear canal; second, the medial part should be within 5 mm from the upper part of the eardrum.
If a complete ear canal hearing aid fails to achieve the above two points, it can only obtain the advantages of a partial complete ear canal, and it can only be called a small ear canal hearing aid. The ear canal hearing aid is also located in the ear canal, but it is slightly larger than the full ear canal and small ear canal hearing aids.
The ear canal hearing aid not only has the aforementioned acoustic characteristics of the in-ear hearing aid, but also more accords with the physiological acoustic characteristics of the human ear, and its hearing enhancement effect is better.
1. Changes in Formal Mouth Frequencies
When a patient wears an ear canal hearing aid, the frequency of the highest peak value of the sound gain at the microphone is at 4733-5179 Hz, which is closer to the frequency position of the resonance peak of the external ear canal in normal people.
2. Changes in resonance effect after ear canal obstruction
The external auditory meatus is a hollow blind tube. According to acoustic theory, a closed tube has a resonance amplification effect on the sound waves of 4 times the length of the tube. For example, the length of the tube is 2.5 cm, and the acoustic wavelength of the resonance frequency is 10 cm, according to the speed of 344 m. / s calculation, the resonance frequency is 3440Hz. The air column in the tube resonates to the sound wave of this frequency, so that the sound pressure of the sound at the frequency at the blind end of the tube increases.
The ear canal hearing aid "blocks the tube" of the external auditory canal, shortens the length of the external auditory canal, and moves the formant frequency forward. In this case, the sound information of the speech frequency is effectively amplified, so that the auditory resolution is significantly improved.
3． Aura-preserving resonance effect and sound source localization
The main physiological function of the auricle is to orient, locate, collect and amplify external sounds. The normal auricle has the function of collecting sound, and the uneven structure on the surface of the auricle produces different reflections on sound sources from different orientations and heights, and has a resonance amplification effect on sound of a certain frequency. This function of the auricle can produce a filtering effect, which is considered to play an important role in sound source localization. The ear canal hearing aid is located in the ear canal and retains more of the normal structure of the auricle, so it helps to naturally amplify the sound and locate the sound source.
4． Effect of sound hole close to eardrum on sound gain
First, because the distance between the hearing hole of the hearing aid and the eardrum is shortened, the amplified sound can directly act on the eardrum, so the distortion is small. Second, the ear canal hearing aid is placed in the ear canal, resulting in a reduction in the volume of the external ear canal. According to the inverse relationship between volume and pressure, volume decreases and pressure increases. Therefore, when wearing an ear canal hearing aid, its sound pressure will increase.
Compared with behind-the-ear and in-the-ear hearing aids, the advantages of ear canal hearing aids include:
① The shape is small, which can basically meet the aesthetic requirements of patients, and is more comfortable to wear.
② Located in the ear canal, it retains the normal structure of the auricle, which is more in line with the physiological and acoustic characteristics of the human ear, and helps to improve sound gain and sound source localization.
Disadvantages of an ear canal hearing aid include:
① As with in-ear hearing aids, since the ear canal of a child is not developed and shaped, the shell needs to be replaced regularly, so children should use it with caution.
② The ear canal hearing aid is only suitable for patients with mild or moderate hearing loss. At present, the ear canal hearing aid with the highest power is only suitable for patients with an average hearing threshold of 90 to 95 dB.
③ The battery and volume adjuster of the in-ear hearing aid are smaller than the in-ear hearing aid, so it is more difficult to operate.
④ As mentioned earlier, due to the smaller internal space, the ear canal hearing aid is more likely to generate acoustic feedback, and it cannot be connected to the FM system.
⑤ As with in-ear hearing aids, in-ear hearing aids are located in the ear canal and are more susceptible to the effects of radon.
⑥ As with in-ear hearing aids, they can also produce ear plugging effects.
At present, the power of commonly used ear canal hearing aids is generally below 80 dB, and some brands of some models of high power ear canal hearing aids can reach 90 to 100 dB, but clinical applications are not widespread. Hearing aids are currently commonly used in the following groups:
① Patients who are younger, have mild to moderate hearing loss, and have higher requirements for hearing aids.
② Middle-aged and elderly people with mild to moderate hearing loss, flexible hands and high requirements for hearing aid effect and appearance.
③ The average hearing loss is below 80-85dB. For patients with a descending hearing curve with low frequency and high frequency hearing loss, the ear canal hearing aid can give more high frequency gain compensation.
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