A Guide to BTE (Behind the Ear) Hearing Aids

Behind the Ear Hearing Aids or BTE feature a plastic case and an ear mold connected to each other via a clear tube.  When worn, only the ear mold goes inside the ear, the rest of the components are worn behind the ear.

Despite being the oldest hearing aid style and the most visible due to its large size, BTEs are still widely used today due to their durability. Since most of the major components are worn outside the ear, they typically last longer as they are not exposed to ear moisture and ear wax.

How it Works

The plastic case that is worn externally contains all the major components of the hearing aids including the battery, microphone, microchip/digital chip, the amplifier, and the controls. In digital BTEs, the microphone receives the sound and converts it to electrical signals to be sent to the amplifier. The sound is delivered via the clear plastic tube to the ear mold, which sends the sound to the ear. The ear mold is custom made to suit the ears of the wearer.

Behind the Ear Hearing aids are the most widely used because they can accommodate mild to profound hearing loss. They are also recommended for kids because they are easier to clean and maintain.

Benefits of BTEs

While BTEs are the most visible type of hearing aids, they offer many benefits over other hearing aid styles.

  • Durability

They are generally more durable because they have larger components and they are not worn inside the ear limiting the possibility of moisture damage. It is also much easier to replace the batteries in BTEs compared to other hearing aids.

  • Better Sound Quality

BTEs also provide the least feedback since the components are located farther apart from each other (i.e. the microphone and receiver are located far from each other).

  • Suitable for all degrees of hearing loss (mild to profound)
  • Ideal for All Ages

BTEs are the only style that is recommended for kids (especially very young children). Since the ear mold can be replaced, it can accommodate the growing ears of kids without having to replace the entire hearing aid.  BTEs are also a lot safer for kids since most of the components are located externally.


Compared to other styles of hearing aids, BTEs have the least disadvantages when it comes to listening experience and quality. The only major disadvantage of BTEs is that they are often large and bulky.

Modern varieties, however, are becoming much smaller and less visible. There is also a wider range of styles and designs of BTEs available today, giving consumers more options. Modern BTEs are barely visible especially when covered with one’s hair.

BTEs that come with ear molds also pose a bit of a disadvantage compared to those with ear buds. Ear molds may require periodic replacement and retubing to ensure optimum performance and to help maintain their acoustic seal.

Mini BTEs (Open-Fit)

There is a new type of behind the ear hearing aids that features a finer clear tube and a silicone dome (ear bud) replacing the traditional ear mold. This type of BTE is less visible than the traditional BTE as they are smaller. Mini BTEs offer increased comfort for the wearer since the tube is narrower and leaves the ear canal open. They are suitable for people who have frequent problems with earwax buildup. Many people also prefer open-fit BTEs because they reduce the sensation of being “plugged up” especially when they hear the sound of their own voice.

Since Mini BTEs offer listening and aesthetic advantages, many adults prefer them to the traditional ones.

Behind the Ear hearing aids are suitable for people of any age and degree of hearing loss. Prices of advanced BTEs can range from $1300 to $2700 or higher, depending on their available features.

Signs and Symptoms of Hearing Loss in Children

Hearing loss can affect anyone regardless of age and children are no exception to this. In the US alone, 2 to 3 out of every 1000 children have some degree of hearing loss and 12% of children between the ages of 6 to 19 years old suffer from noise-induced hearing loss.

While it is standard procedure in all hospitals in the US for newborn infants to undergo newborn hearing screening, many children with congenital hearing loss fail to receive proper treatment. Children who lose their hearing later on are at risk of living their life with undetected hearing loss, which is why it is important for parents and caregivers to know what to look for.

Signs and symptoms of hearing loss in children may vary depending on the age of the child and the circumstance. It may be harder to notice hearing loss in kids who develop hearing loss before they are able to speak. Since children are expected to reach certain developmental milestones at different stages in their life, observing any issues or problems with their hearing in relation to their age is the best way to detect any signs of possible hearing loss.

Below are some of the common signs and symptoms of hearing loss in children by age:

Infants and Babies

From birth to 4 months, infants can already process different sounds around them. Observe how your child reacts to different sounds. Does your child get startled when he or she hears loud noises? Does your child respond to the sound of your voice?

By 4 to 9 months, your child should already be familiar with the different sounds he hears everyday. Babies, at this age, already respond to familiar sounds, babbles often, and you may also notice differences in the way your child cries for different needs.  If your child does not seem to respond when called or does not appear startled in the presence of a loud sound, you should consult your doctor right away, as these are common signs of hearing loss in infants.


From 9 to 15 months, children are already capable of saying one to two-syllable words like “mama” or “dada”, can respond to simple requests, and responds when their own name is called.   By this point, your child will also already use different sounds to get attention.

At around 15 to 24 months, your child will already be capable of saying different words. Children, at this age, enjoy listening to music, stories, and nursery rhymes. They are also familiar with the names of some objects.

If your child does not respond to sounds or does not show any of the aforementioned developmental milestones, it is best to consult your pediatrician so that you can be referred to an expert if hearing loss is suspected to be causing the developmental delays. While hearing loss may not necessarily be causing these developmental delays, it is best to be sure so your child can receive appropriate treatment at the earliest possible time.

Hearing Loss in Older Kids (Preschool age and up)

It is easier to detect hearing loss in older kids than it is in toddlers and infants but it can still remain undetected especially since most hearing loss happens gradually. The following symptoms may indicate hearing loss in older kids:

  • Watches TV or listens to music in very high volume
  • Does not respond when called
  • Often asks for things to be repeated or has difficulty following conversations
  • Shows speech problems or language delays
  • Complains about hearing noises in their head
  • Complains about pain in the ears
  • Does not answer questions properly
  • Frequently watches people and imitates what they are doing

These are just some of the common symptoms of hearing loss in older kids. While showing any or most of these symptoms may not necessarily mean that your child has hearing loss, it is still worth undergoing a hearing test just to be safe.

If you suspect that your child has hearing loss, seek medical help right away so that you can be referred to an audiologist for a proper hearing evaluation. Children can be tested for hearing loss at any age but the type of test may vary depending on their age and current developmental level.

If left undetected, children who lose their hearing before or during the crucial stages of language development may have a difficult time adapting to their condition. If left untreated, your child may suffer from permanent speech impairment and learning and language delays. Early medical intervention can make a significant difference in your child’s life and development even if their hearing cannot be restored.

Ringing in Your Ears: Is it Tinnitus?

Tinnitus is the perception of sound without any actual sound. It is more commonly known as “ringing in the ears” or sometimes referred to as “head noise. Tinnitus is not limited to actual “ringing” in the ears, as it can also manifest in the form of buzzing, hissing, pulsing, screeching, the sound of crickets, or even music in some cases. The sound can be heard in either one ear or both ears.

Tinnitus affects 1 in 5 people but the severity varies per case. Since the most common cause of tinnitus is exposure to loud sounds, older adults aged 65 and above have a higher risk of developing tinnitus.

Tinnitus is fairly common; around 10% of people in the US have experienced tinnitus to some degree but in most cases, the sound goes away on its own after a few minutes. If, however, the sound persists, it is best to see an ENT or an audiologist so you can be tested for hearing loss. Your doctor may also test you for other conditions commonly associated with tinnitus.

It is worth noting that Tinnitus itself is not a disease, it is usually a symptom of an underlying condition.

Common Causes of Tinnitus

  • Hearing Loss

Majority of hearing loss cases is preceded by Tinnitus. This is true for 90% of hearing loss cases, particularly hearing loss that is noise-induced.

  • Exposure to loud noises

Constant exposure to loud noises or a one-time exposure to a very loud sound can cause tinnitus instantly. In some cases, it goes away but it can also become a permanent condition as a direct result of noise exposure.

  • Stress
  • Ear Infection
  • Foreign objects in the ear
  • Ear wax build-up
  • Fluid build-up in the ear
  • Physical injury, particularly head injuries or trauma
  • Diseases such as Meniere’s disease, Anemia, otosclerosis, and acoustic neuroma.

If you experience ringing in your ears or hearing any kind of sound that is not coming from an external source, you should observe its duration. If it goes away after a few hours, then you don’t necessarily need to seek medical help. However, if it does not go away on its own or if you notice other symptoms that come with it, it is best if you seek medical help as soon as possible.


There is currently no treatment for Tinnitus but if the underlying cause is discovered, your doctor may recommend treating the cause, which may then improve your tinnitus or get rid of it completely.

If the underlying cause is not found or if there is no available treatment for the cause, your doctor will recommend ways to manage your condition.

The management plan will depend on the severity of your condition. Most people have mild tinnitus that may be slightly annoying but does not otherwise interfere with their day-to-day lives but for about 2% of Tinnitus sufferers, the sound can be so loud that it can be difficult to concentrate on anything else.

Doctors usually recommend counseling and in some cases, talk therapy to help the person cope with their condition and learn to live with it. There are also devices that can help with tinnitus management including wearable sound generators and tabletop sound generators, which are devices that produce soft, pleasant sounds to cover the tinnitus. These devices can play soft music or other soft sounds that the user is comfortable with.

Those who have severe tinnitus may benefit from a new management technique called acoustic neural stimulation. This technique involves sending broadband acoustic signals to the brain through the use of headphones. While acoustic neural stimulation does not get rid of tinnitus, it can help desensitize people from their tinnitus by stimulating changes in the brain.

Currently, there are no medications that have been proven to help control or ease the loudness of tinnitus but in some cases; doctors may recommend anti-anxiety medications and antidepressants to improve the general mood of the person suffering from tinnitus.

Those who suffer from tinnitus along with hearing loss are usually prescribed with hearing aids. In severe cases, cochlear implants are recommended.

While Tinnitus is not a harmful condition, it can be a debilitating one especially in severe cases. If you frequently experience tinnitus or if your tinnitus has persisted for quite some time, it is best to consult your doctor so that an appropriate management plan can be recommended and to detect any serious condition that may be causing your tinnitus.

What Are the Common Causes of Hearing Loss?

Hearing loss can happen to anyone regardless of age. Different types of hearing loss have different causes depending on which part of the ear is not functioning properly. The causes of hearing loss will determine its duration (i.e. temporary or permanent).

Below are the common causes of hearing loss based on their duration: Continue reading “What Are the Common Causes of Hearing Loss?”

Hearing Test: Exam to See if You Suffer From Hearing Loss

There are several tests that determine whether a person has hearing loss. These tests also determine the configuration (i.e. unilateral or bilateral, low-frequency or high-frequency) and degree of hearing loss (i.e. mild, moderate, profound, severe).

Pure-Tone Testing

The most basic test is performed using an audiometer, which is used to determine the level of hearing a person has across frequencies.

If you suspect that you have hearing loss, it is best that you consult an audiologist so that you can undergo a proper hearing evaluation. Before administering the hearing test, your audiologist will first go through your hearing and medical history. Your audiologist will also have to check your ears for anything that may affect the results of the hearing test.

What to Expect During a Hearing Test

The method by which a hearing test is conducted depends on the age of the person. Adults normally go through a regular pure-tone hearing test setup where they wear headphones attached to an audiometer inside a soundproof booth. Headphones or earphones are necessary to be able to test each ear.

Sounds will be played at selected frequencies and you will be asked to respond in a certain way if you hear the sound. For instance, you may be asked to raise a finger, press a button, or respond by saying a word whenever you hear a sound. The results are presented through an audiogram; a graph that shows the type, configuration, and degree of hearing loss in cases where hearing loss is detected.

Younger kids, however, might refuse to wear headphones during a hearing test. In which case, the sounds will have to be played using speakers inside a soundproof booth. The challenge that this setup poses is that it is difficult to record the results for each ear so unilateral hearing loss (hearing loss in one ear) might not be detected.

When conducting tests for kids as young as 2 to 5 years old, the audiologist typically uses play audiometry where the child being tested is asked to perform a series of activities when he hears a sound. Activities typically include using blocks, pegs, and rings to obtain a response from the child.

Other Types of Hearing Tests

Middle Ear Testing

In some cases, additional tests may be necessary to determine if the middle ear is functioning properly or if the problem lies in the middle ear. Tympanometry is a type of middle ear test where a small probe is placed inside the ear to push air pressure into the ear canal so the audiologist can see how the middle ear is functioning. Through this test, an audiologist can determine whether there are problems with how the eardrum moves or if there is a hole in the eardrum.

To determine the type of hearing loss, audiologists use acoustic reflex measures where a person’s acoustic reflex to loud sounds is observed. The type of hearing loss is determined by checking if an acoustic reflex occurs when a loud sound is played and how loud the sound has to be before the acoustic reflex occurs.

Auditory Brainstem Response Test

ABR tests the inner ear and the brain for possible causes of hearing problems in children and adults who cannot respond properly to regular hearing evaluations. It is also used in newborn hearing screening. Electrodes are placed on the head to record brain wave activity related to sounds.

Otoacoustic Emissions Test

This test is often used as a part of the newborn hearing screening, as it is able to determine whether there is blockage in the ear canal, damage to hair cells, or fluid in the middle ear. Everyone releases otoacoustic emissions (sounds produced by the inner ear as a response to external sounds). During an OAE test, the sound produced by the inner ear is recorded through the use of a small probe. People with hearing loss typically don’t produce these sounds.

During a basic hearing evaluation, people only undergo pure-tone hearing tests unless the audiologist recommends further testing to determine the degree and type of hearing loss.

Hearing Loss Symptoms: How to Tell if You Have Hearing Loss

Since hearing loss happens gradually in most cases, some people might not notice that they are having trouble hearing right away. Most of those who do start noticing that they have hearing loss may choose not to do anything about it. As a result, a lot of people with hearing loss don’t get the medical help they need. Some take as long as several years before deciding to get help. If you have been having trouble hearing properly or you know someone close to you who has hearing problems, it’s best to seek medical attention as soon as possible.

When your hearing loss progressively gets worse overtime instead of happening instantly, it’s easy to get used to your current level of hearing and not notice that you actually have hearing loss. Knowing the most common symptoms to watch out for can help with early detection and medical intervention.

Symptoms of Hearing Loss

While there are different types of hearing loss, the symptoms are generally the same. Unless it is a case of sudden sensorineural hearing loss where the loss of hearing happens instantly, most hearing loss symptoms can happen gradually and not occur all at the same time.  Below are some of the most common symptoms of hearing loss:

  • Tinnitus (ringing in the ears)

Tinnitus or ringing in the ears in the absence of actual sound is usually a precursor to hearing loss. A lot of people who develop hearing loss later report having experienced tinnitus in varying levels of intensity before they lose their hearing. While most people will experience tinnitus at some point or another, it is usually just brief and goes away on its own.

Tinnitus, however, is also one of the most common symptoms of hearing loss as it may indicate any of the following: ear infection, noise-induced hearing loss, presence of foreign objects in the ear or impacted ear wax, and Meniere’s disease. If you notice that you have been experiencing tinnitus a lot or that the sound in your ears is becoming worse overtime, it’s best to see an audiologist to get tested.

  • Dizziness and Loss of Balance
  • Difficulty following conversations especially when two or more people are talking.
  • When talking to someone, words may start to appear slurred or mumbled.
  • Difficulty hearing sounds that are coming from behind you.
  • Turning up the television or radio volume much louder than usual.
  • Difficulty hearing in noisy environments.
  • Difficulty hearing and focusing on higher-pitched sounds.

In some hearing loss cases, especially when it is sensorineural hearing loss, people have trouble hearing higher-pitched sounds compared to lower-pitched ones. As such, you might find it easier hearing a man’s voice over a woman’s voice and you might not be able to tell the difference whenever you hear higher pitched letter sounds like “s” or “th”.

  • Noticeable pressure in the ear.

This may indicate conductive hearing loss, as pressure is usually caused by fluid build-up.

  • Some sounds may appear too loud.

This is because loss of hearing can happen in different frequencies. For instance, those with low frequency hearing loss can hear higher pitched sounds better than lower pitched ones and vice versa.
A lot of older adults who lose their hearing often end up in denial so they might start blaming other people for not “speaking loud enough”. Since hearing loss is mostly gradual, friends and family members might notice the problem first before the person experiencing it does. People also end up in denial to themselves and to others because of the stigma surrounding hearing loss and being deaf. They might think that it’s better to just focus extra hard than to be called deaf or to have to wear hearing aids. Dealing with hearing loss can be physically, mentally, and emotionally taxing but with medical help and the right assistive technology, things can eventually get better.

Sudden Sensorineural Hearing Loss: Causes and Treatments

Sudden Sensorineural Hearing loss is a type of hearing loss that happens very quickly. SSHL happens almost instantly but it can also progress within a period of up to three days and in most cases, it only affects one ear.

People who experience sudden sensorineural hearing loss may notice a popping sensation before their hearing disappears but others have also reported experiencing tinnitus (ringing in the ears) before they lose their hearing.

Is it Permanent?

Sudden sensorineural hearing loss is usually not a permanent condition, as there is a good chance of recovery for most people who experience it. Some people who experience SSHL recover within a period of three days without medical help but others may require up to two weeks for recovery. Unfortunately, there are some people who never recover from SSHL. Recovery and treatment will depend on the diagnosis of your physician or audiologist.

How is SSHL diagnosed?

When checking for SSHL, doctors will examine your medical history and hearing history first. This is important so that any underlying causes can be ruled out. You will then be asked to take a hearing evaluation or a pure-tone hearing test to determine if there is a hearing loss. SSHL is diagnosed when there is a hearing loss of at least 30 decibels in three frequencies.

Causes of Sudden Sensorineural Hearing Loss

There are many factors that can cause sudden sensorineural hearing loss but in most cases, the exact cause is not identified. As such, SSHL is classified as an idiopathic condition (a condition with an unknown cause). Viral infections are presumed to be the cause of most SSHL cases, although doctors usually base their diagnosis on a patient’s medical history. Some of the most common causes of SSHL include:

  • Viral Infections
  • Illness or disease

Diseases that can cause SSHL include autoimmune disease, otosclerosis (abnormal bone growth that affects the middle ear), and HIV/AIDS, among others.

  • Head Trauma or Physical Injury

A person who experiences serious head trauma is susceptible to tinnitus and hearing loss. Head injury can damage either the ear directly or some parts of brain that process auditory information.

  • Ototoxic Medication and Chemicals

Some medications are ototoxic (toxic to the ear). There are over 200 types of medicines that are known to cause damage to the ear, including some over-the-counter drugs and prescription drugs. While some hearing problems caused by ototoxicity usually go away when the medication is discontinued, there are some that may cause irreversible damage. Some of the most commonly used medications that are known to cause hearing loss include aspirin (in large doses), medication for heart disease like loop diuretics, some antibiotics, NSAIDs including ibuprofen and naproxen, as well as medicines used to treat serious infections and cancer.

  • Circulatory problems
  • Multiple Sclerosis
  • Meniere’s Disease
  • One-time exposure to a very loud noise (e.g. gun shots, explosion)
  • Psychological factors (e.g. stress)

Treatments for Sudden Sensorineural Hearing Loss

Before a treatment plan can be prescribed, doctors will try to look at the underlying causes first. If a specific cause is identified, SSHL is addressed by treating the underlying cause (usually with antibiotics).

In cases where the hearing loss is caused by medication, doctors may simply advise the patient to discontinue its use.

In cases where no specific cause is found, the patient may be treated with steroids, particularly corticosteroids like cortisone, a hormone naturally released by the adrenaline gland as a response to stress. Cortisone is usually administered to treat inflammation and pain. It also helps patients with immune system problems.

Oxygen infusion or Carbogen (mixture of oxygen and carbon dioxide) inhalation is also a common treatment, as it is also believed that SSHL can happen when the inner ear does not receive enough oxygen. Carbogen inhalation can help improve airflow and blood flow in the inner ear.

It is worth noting that not all patients respond to these treatments. Treatment becomes especially challenging when the exact cause is not known and in about 15% of cases, sudden sensorineural hearing loss leads to permanent and progressive loss of hearing.

If you suspect that you have SSHL, it is important to seek medical help right away. The faster you seek medical intervention, the higher the chances of recovery. You can go to your physician or straight to the emergency room for medical help.

Oticon’s “Focus on the People” Awards

Oticon Hearing Aids are featuring a “focus on the people” awards contest that features inspiring individuals with hearing loss. An earlier post of ours featured Samantha Brownlie, a 7-year-old who wrote, illustrated, and narrated her book on YouTube about getting her hearing aids. She has been nominated for the award, so if you get a chance go on over and vote!

For more information, visit her Focus on the People – Awards page to cast a vote!