It’s really interesting to me reading all these comments on what seems to be a debate over an ITE device v a RIC. Everyone loves AI. we must have all the AI. we must have all the amazing RIC features. None of you have mentioned directionality, which you lose with a RIC. I’ve said many times on posts here before, if you stick a RIC on your head, the mics are in the wrong place to take advantage of your ear anatomy. Close your eyes, set the phone ringing and try and find it wearing RICs. It can be done for sure, but it’s hard and fuzzy. I agree most people aren’t in the situation I’m in, but I do think more people would benefit from directionality to assist their eyes. Wearing RICs also makes wearing different styles of headphones inconvenient.
RICs are cheaper to make, easier to fit, have all the features described above, but as a totally blind person who relies on using my ears as ears, I really think this huge push towards RICs is a bit scued from what our bodies are naturally designed to do. I do completely get the annoyance of acclusion BTW, that is a pain.
I’m not saying anyone is wrong with any of the arguments above as to why ITE or CIC devices are wrong, just that I think ultimately the push should be to solve the in ear device problem. Make a Lyric type device with an adjustable band set and bluetooth and I think a lot more people would go for them.
I have always wondered/thought that about the RICs. The microphones are behind your ear, in fact many of the microphone ports are facing behind you.
That is just one reason why I prefer my Eargo units over my P90s. The IIC units make use of your natural ear design to allow you to directionally hear things. As well allow for over the ear head phones or noise canceling head phones. Use of a telephone like normal. You can lay your head down on a pillow on your ear and not crush a RIC into yourself (and take it off to feel comfortable). You can put on and remove glasses without fumbling with the RIC. Same goes for masks if you are wearing them.
The eargos aren’t a hearing aid, they are a PSAP.
Where do you find the Eargo 5, 6 or 7 series declared a PSAP? I see Eargo clearly states that they are not a PSAP but both an OTC and prescription hearing aid and identified as such by the FDA.
I’m not an audiologist, but when I watch a video showing a REM session with the Eargo 6 aids, it seems to be correctly working in specific frequencies based upon the fitting test and not an across the board amplification (approx 8m30s in this video https://youtu.be/E1QcwnRm9OI?si=j_XsHiLNYx8ytOt6).
As I said, it is 50/50 with people loving or hating the Eargo products. I have both my P90s and Eargo 7s and use them for different situations. But find I use the Eargos 2 to 3 times as much as the P90s.
But I would be interested to see where they have been declared a PSAP or even tested and found to be a PSAP and not a frequency based aid.
Anyhoo, this is kind of changing the OP thread. Back to his original question about options for IIC and CIC devices, I simply offered the Eargo. I am looking forward to when I am able to trial and most likely switch to the Lyrics. That I think is the best solution available.
Ah, thanks, looks like I’m behind. They used to not really be so adjustable. I don’t follow DTC devices closely as they aren’t allowed yet in Canada.
My take is that this site tends to focus on the latest and the greatest and that tends to emphasize 1)speech recognition and for some 2)Advanced Bluetooth capabilities. As you’ve heard from others if one opts for CIC/IIC and to a lesser extent ITE one gives up a lot of that. It sounds like what you want is a basic CIC with any remaining features turned off. If you want Bluetooth then you’ll need to be pickier.
Actually they have directional microphones, which the CIC don’t, there’s no conclusive evidence that CIC/ ITE are “better” in this regard, but ReSound does have the M&RIE for RIC models, and your right that they should do more into getting CIC ,ITE features the same.
https://pro.resound.com/en-us/research/features-explained/microphone-and-receiver-in-ear
When I talk about directionality I’m not talking about directional mics. Maybe I need a new word to explain it. What I mean is, the binaural sense of in front, behind and proper left and right with degrees of seperation is lost with RICs. I’ve not tried resound I@m really interested in this. Someone mentioned the platform is old but yeah I’m really curious to see what kind of devices they are.
RICs in my experience really don’t simulate a natural field of sound like something in your ear. The deeper the ITE is, the better the experience of whatever this word is, directionality etc.
My google search came up with this, perhaps it is what you are referring to?
The human ear achieves natural acoustics and directionality primarily through the unique shape of the outer ear (pinna), which reflects sound waves in a way that varies depending on the sound source’s direction, allowing the brain to interpret the subtle differences in sound reaching each ear and pinpoint the sound’s location; this process is further enhanced by the slight time difference and intensity variations between the ears when a sound originates from the side.
If you have a hearing loss in the low frequencies too, then CICs will do fine. The only problem could be the tinnitus, but you won’t know without trialing.
If you don’t have a low frequency hearing loss, then you need IICs.
The technology is very important, but the quality of the shell is even more crucial.
For IICs, I can only recommand you Starkey Signature / Genesis IIC HA because they make the best shells in the market, BUT the ear impressions need to be very deep (well after the 2nd bend).
If not Starkey, then Oticon Own IICs (new chip should be available soon, Q1 or Q2 2025).
For CICs, Oticon / Starkey / Phonak / Signia are fine. From my experience, GN have nothing special at the moment sadly (same could be said about RICs except for Auracast).
REM are necessary for every HAs type, and every patient. If you have to ask your HCP to do it because he/she wouldn’t have done it otherwise, then he/she won’t be used to do it and it won’t be done properly, so no point in it…
If someone has normal low frequency hearing, an open fit RIC is going to be better at maintaining localization. You lose the pinna effect for sure, but the pinna effect is not as powerful as inter-aural time and intensity differences. If you need to close the ears, if you are trying to maintain a pinna effect then you need a CIC/IIC or M&RIE mic, although pinna effects are >2kHz, so depending on the loss they may not be restorable anyway (although IIRC someone in this thread is reverse slope, so it would be more salient for them). ITDs and IIDs are impacted by hearing aids regardless of the style if it’s not an open fit, although hearing aids do various things to try to support them. Some care to compression is certainly important for IIDs.
This is great info, thanks!
Do you have any further info on the upcoming 2025 Oticon Own IIC chips? (Are you an HA provider/Audiologist?)
Is it safe to say that most IIC/CIC share the same chips within their brands? IE; an Own 1 IIC and CIC will have the same chip, and same for the other brands correct?
I am pretty sure I do not have low frequency hearing loss (I believe it’s a highs/mids issue, having problems with speech clarity), but I will know for sure tomorrow after my Costco appointment. I’ll make sure to get and upload my audiogram here.
Btw do most standard audiograms/hearing tests do an REM or is that something specific that must be requested from the HA provider?
“None of you have mentioned directionality, which you lose with a RIC. I’ve said many times on posts here before, if you stick a RIC on your head, the mics are in the wrong place to take advantage of your ear anatomy.”
Yeah I did.
Also, you don’t understand how directional mics work: or the degree of pinna effect.
No, it’s mainly by the phase differential/time between the ears.
I do not have secret info on upcoming devices, no. Though everything within the same line shares essentially the same chip regardless of their form factor. I’m an audiologist, yes.
I can no longer remember whether people were saying this in this topic or another CIC topic, but if you have normal low frequency hearing there is a good chance a CIC won’t be appropriate for you.
REM is done at the hearing aid fitting and it is a mystery to me at this point how standard it is. It should be standard, as it has been preferred practice since the 80s. There is often a “30% of clinics” number thrown around, but it seems like it has been the same for years and I feel like REM uptake in Ontario is much higher. I’ve gotten the idea that it tends to be pretty high in Canada and Australia, and decent in the USA and the UK? Maybe better than that in the UK, I don’t know. In all of these places it should be 100% for pediatrics. Outside of these places I think it gets harder to access. I would hope that the Northern European countries where the manufacturers are located would be pretty good?
Re: Costco, I know that rules have been developed for Costco specifically originating from a particular idealistic audiologist in Ontario and radiating out from there. For a long time in Ontario all of our Costcos were staffed by only audiologists, though that has changed. REM became a requirement, but then outside of Ontario they had trouble with a lot of clinicians doing it but not using it (e.g. doing it quickly to meet the company standard, but not actually adjusting with it, not doing it well, or not really understanding how to do it) and they started putting in new requirements to document deviations from target, use probe guides, etc. So I know that it is DONE at Costco, but I don’t know how successfully it is used in all places. I also know that a lot of my local hearing instrument specialist programs are pretty strong on REM, but my understanding of the situation in the USA is that the quality of hearing instrument specialist training can vary wildly state to state? I would feel fairly comfortable sending a loved one to Costco in Ontario, and fairly uncomfortable sending a loved one to Costco in another province or in the USA unless the clinician was an audiologist or unless I knew them. That said, a lot of Americans on this board have had success at Costco.
I think a lot of hearing instrument specialists would struggle to put REM into place without a strong mentor if it wasn’t something that was taught well in their training program.
Yes I am an audiologist in Europe.
I will know more in January but yes Oticon has hinted that there will be new shapes of Oticon Intent, so BTE and customs. So IICs should benefit from their DNN 2.0 but not from the 4D sensor as they call it.
Honestly, if you have to ask for REMs, then the professional will probably try to do it but won’t be convinced of the benefit of it, therefore he won’t master it and the results might be even worse than before doing it.
So if you have to ask for it, find another professional… As other have mentionned, if it’s not the best service with standard REMs then you better go to Costco so you don’t overpay for the same quality of fitting…
The audiologist is way more important than the hearing aids.
Well I am in Toronto, so that’s perfect! 
I will probe at Costco for the REM, and ask if CIC is appropriate for my results.
Sorry, we weren’t clear about that I guess. Being a CIC candidate only depends on your hearing loss. REMs are at the fitting appointment. So you have to ask if it will be done at the first fitting appointment.
When I was learning, I had heard from so many providers that REM was unnecessary and NAL-NL2 was too loud. Most everyone would fit to proprietary fitting targets.
When I was on my own more, I would fit people according to REM and NAL-NL2 targets and I had countless people coming back to tell me that they were the best hearing aids they ever had. Many of these people went to places that would be considered “top tier” and have excellent reputations (as far as hospitals go). When the situation permits, I will connect to their previous hearing aids or perform a transition fitting to evaluate their previous hearing aids and the results are usually disappointing.
I can tell you anecdotally that from what I see (USA) is that the majority (50-70%) don’t fit to REM targets, or fit to the targets because it’s required/requested, and then reset to the manufacturers predicted targets.
It’s such a shame because without REM, it’s impossible to know if you are over or under the amplification you intend to provide.
When it comes to CIC/IIC/custom hearing aids in general, the manufacturers fitting ranges are worthless until verified with REM. Often feedback becomes an issue well before those ranges can be reached. Or, like a recent fitting, even with a high power receiver on an ITE device with the MPOs at maximum, the measures MPO sweep peaks at 95 and is somewhere near 85 to 90 until 2khz. Looks good on paper but not when measured. Makes it tough on new providers, let alone on informed consumers trying to compare devices. I’m not telling you anything new; just sharing to the forum in general.
I think the forum is lucky to have you who will give important information and insights.
I think I’m using the wrong word for directionality. I do understand how directional mics work and I do understand that timing is supposed to play a key role in the pinna effect. however, with respect, I don’t think sighted people fully understand the degree to which blind people like myself use the pinna effect and how we achieve a sense of directionality through that effect. When I have Lyrics in my ears, I can use the full pinna and shape of my ear to image the room around me. I can walk in a room and hear the walls, hear where things are placed as I move around it, by listening to the very subtle echos. You and I have actually talked about this before on the phone so you understand that I have a good degree of understanding of how hearing aids work 
You get somewhat of a binaural effect wearing RICS, but it’s very poor stereo at best. At least that’s how it sounds to me. maybe others find it better but I’d be willing to bet money that if you plug someones ears with custom molds locked on to RICs, close their eyes and then ask them to point specifically at a sound source in the room, a lot would struggle.
even the best headphones like Turtle beech which strive for a true binaural effect rarely actually achieve this. My impression is that it really varies from person to person. I know that the deeper those mics are in my ear, the better I can immage the world around me. I don’t think it’s all about timing. I think it is about timing plus the unique shape of a persons ear and the unique way their brain understands the shape of their ear. Even using a binaural dummy with shaped ears doesn’t quite give that binaural effect, because you don’t have the same ears as the dummy and then you lose a lot in the translation to headphones. I think probably each persons unique ear shape is like a key that only their brain can unlock to give that natural and understandable sense of space.
I’ll try to give an example: When I put Lyrics in my ears at the audiologists, I pointed to a big… something in the room that I could hear. Said something was not making a noise by the way. It just sat there as a huge sound shadow. I asked what it was. The audi was utterly amazed and said that’s the microscope. I then pointed to a wall about 3 foot in front of me and guessed the distance. I then spun around and pointed directly at his head without him making a noise. This isn’t magic, it’s just using sound shadows and echos.
this is why I am always banging on about devices in the ears. I completely get all the drawbacks everyone has mentioned here of course. I’m not even sure I’d use ITEs for all the reasons given. I do think though this is ultimately the best way for the body to translate sound. The problem of course is that tech hasn’t caught up yet and devices with this much power can’t be shoved in the ears without causing problems.