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In canal aids? why these over RIC aids? (phonak Virto, etc.)

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as I’m contemplating my new slimtip molds + the very likely need to get new aids in the coming year or so…
I started wondering about the fully in-ear aids, such as Phonaks’s Virto

I was given aids to trial and fitted with a pair about 5 years ago, and so far in my hearing aid “journey” I’ve only focussed on that type of aid. Just accepting that this is the way to go.

and it does seem to be the most popular, short of maybe the behind the ear ones with tubes for folks with worse hearing than mine is…

Anyway, I’m starting to think that if I need a mold anyway, why not go with something like the Virto?
I know that particular one isn’t the latest and greatest sphere tech… but what if I just want good aids?

Seems like in the canal puts the microphones closer to the location that God intended, using the ear shape to gather sound

The only down sides that jump out at me intuitively is
limits to smaller batteries
and likely cost for the custom nature of the mold. But if you’re paying for molds anyway, that might be less of a factor

What else would I give up going with say a Virto vs an equivalent RIC aid such as the Lumity or a non-sphere infinio?

13 people in this conversation14 min readJump to latest

I’m guessing you have decent sized vents in your current molds considering your good low frequency hearing. That might be difficult to match in the Virtos and occlusion might be a problem. I don’t know the specifics of differences between Virtos and other Phonak other than Phonak’s vaunted Sphere noise reduction isn’t available in the Virto (which might be less effective if your molds are well vented)

I switched from mCIC to because at that time any aid only had one mic and I found the two mics with their separation performed better for me. That’s the only reason. The mCIC performs better in wind and sports, and everything else of that nature, in my opinion. Even if they do have multiple mics in larger canal aids, they still can’t get them as far apart and directionally focused as an external aid.

In reply to @MDB

Looks like my slimtip vent is approx Ø2mm, and the hole runs full thickness, so it a 2mm pipe approx 1/2 inch long

I have no confidence that these are overly optimized for me, in fact I’m pretty sure they aren’t right. The receiver seems like it might not be positioned well. Also, I really wonder if the could and should be set a bit deeper in my canal.

Regardless, interesting point. I’m mostly just curious about the “why” for that type of aid, generally. I’m not seriously wanting these things so I’m not willing at this point to take the time to dig deep, but a quick search indicates that venting is possible at least with the Ti version. Not sure how much though…

In reply to @JeffBowser

well that’s interesting, thanks for posting. Has my wheels spinning a bit now!
I would have thought that located IN the canal they would only need one microphone… to emulate God’s design.
That speaks to one of the reasons that the behind-the-ear types seem less than ideal in my thinking
My Marvel aids have two microphones on each aid… so I have four microphones. I can understand that with some computer processing things can be done with that information…
but the thing is that all four microphones are pointing behind me when my head is upright. That is exactly the wrong direction!
and none of the microphones are using the external ear shape to funnel the sound where it needs to go.

God’s original design didn’t include hearing loss. I can only hear out of one ear, so it doesn’t do me any good having one mic inside my canal, I need the extra processing help. As for where they point on a , on mine, one points forward and the other backwards. (Widex SmartRIC 440)

In reply to @bradw

@bradw said:

all four microphones are pointing behind me when my head is upright. That is exactly the wrong direction!

@JeffBowser said:

As for where they point on a RIC, on mine, one points forward and the other backwards.

Those mics are omnidirectional, and the two mics on each aid pick up the same sound (as long as the aid is positioned within allowed tolerances). The firmware creates directionality by detecting the phase difference caused by the distance between the mics.

Another consideration - and what I think is the biggest push for - is time/labor/serviceability. My first aids, almost 30 years ago, were with acrylic skeleton molds. Had to have the molds remade twice to get a good fit, which was annoying but not insurmountable. Each time took a couple of weeks, and I eventually settled for molds that I hated less than the others.

My next aids were (too much hearing loss for ). I had to have them remolded 4 times to get a good fit. Each time I had to go to the audiologist to “pick them up”, only to find that the fit wasn’t right, and then another 3-4 week wait to try again.

My third set were Oticon RIC. The audi slapped some power domes on them and I was out the door. When my hearing deteriorated, he switched the receivers to 85db models while I waited, updated the programming and sent me on my way.

If an audiologist happens to have appropriate RIC aids in stock, it is possible that you could go in for a first hearing test and then go home with new hearing aids the same day. Likewise, if your existing aids need to go in for service, they can have you in a loaner setup in minutes.

Not to say that RIC aids are the best - there are things that I definitely don’t like about mine - but they do seem to be the easiest.

I much prefer the in-ear virto for comfort and sound. Getting the perfect fit did used to take multiple visits but Phonak now has this fancy laser scan that seems to have solved the problem. Also, to get all the new features and Bluetooth you need the larger shell. The new Infinio should be coming out soon. I’m on the wait list.

I think it’s worth trying the earmold from a deep impression (5 mm from the second bend of the ear canal) first:

  1. with the open-jaw technique during the entire curation of the impression
  2. with high-viscosity silicone.

The technique described above is primarily applies specifically to // hearing aids.

If the earmold is long enough to reach the bony part of the ear canal, it is possible to have a smaller vent and still have little occlusion effect. However some patients have high sensitivity of the skin in the bony part of that canal.

a couple of intersting learning side thoughts for me in your post

  1. the open jaw technique. When I recently was molded for my slimtips, I remember her telling me to open my mouth when she pulled out the impression after it cured, but otherwise, I sat and chatted. I wonder if that’s why they don’t seem to fit well.

  2. I don’t know how deep she made them but I have the feeling they aren’t very deep. Maybe the sensitivity in the bony part is why she just didn’t go there…out of experience. I think my slimtips might just about get to a bony part, and I think the tip of the receiver is contacting that area when I dip my chin… that’s what gives me the idea that the receiver isn’t centered and positioned well.

I know my slimptips aren’t the same thing as these in canal aids and the topic of this thread, but it does speak to me about the difficulty in getting a good fit with the aids.

@bradw said:

the open jaw technique.
(…)
, but otherwise, I sat and chatted. I wonder if that’s why they don’t seem to fit well.

This is why it is recommended to use a bite block during the whole procedure (from inserting otoblock to full curation). I even prepared one to keep 2.5 cm open between the upper and lower incisors.

However, for the majority of patients with less ear canal mobility, a bite block has no special significance.

Many don’t want to make deep impressions if they think this is riskier.

@bradw said:

I think my slimtips might just about get to a bony part, and I think the tip of the receiver is contacting that area when I dip my chin…

Probably you have them at the same depth as mine. The most mobile part of the ear canal during jaw movement is between the first and the second bend of the ear canal.

I’m not sure what you want specifically. If you want better retention, go for a skeleton style (like mine), but you should put off an (like I do) to lean on the pillow. If you want to get the target gain, especially in higher frequencies, the earmold should be a bit occluded (I don’t know about target gains with current slim tips).

There are always tradeoffs, such as with leaning and pillows.

@Bimodal_user said:

I’m not sure what you want specifically. If you want better retention, go for a skeleton style (like mine), but you should put off an HA (like I do) to lean on the pillow. If you want to get the target gain, especially in higher frequencies, the earmold should be a bit occluded (I don’t know about target gains with current slim tips).

You mentioned the area between the 1st and second bend… I wish I had a copy of the mold she took, or at least a photo of it. I was surprised at how irregular the shape was but I really don’t remember enough detail
I’m coming from open domes and really only wanted to understand my daughters better. I was just becoming less satisfied with the set-up I had. For that we started exploring better coupling options. I asked out of curiosity about slimtips, based on many comments I read in this forum.

I didn’t specify anything really to my audi, but she ordered them with what someone here called a “canal lock”… for retention I suppose. So far I’ve found it to be a bother…yes leaning and pillows like you said, but mostly it’s just another surface to annoy with chafing, pressure points, etc. Also, it’s too early for me to be sure but I think that they might be holding the tips in place too well and not allowing the tip to move with my canal as I move my jaw, nod my head, etc…

What I suspect is that the receiver is planted at a bad angle and too close to a bony tun in the canal
and I’ve gathered from a few comments that it’s better for the receiver to be deep to reduce the occluded effect of hearing my own voice. I feel like mine isn’t very deep and so far I’d say it’s not horrible and I can get used to it, but it’s not ideal

is better than Virto because

It is easier to maintain, if the receiver breaks, it is easy to replace it.
It has more memory, more microphones, a better processor that processes sound, and a better battery.
And if I’m not mistaken, the virto has versions without bluetooth, not all Virtos have bluetooth.

You have to ask yourself why you want Virto, are you ashamed to wear a bigger hearing aid? You also have to ask yourself, what is more important to you, the quality and the maximum that the hearing aid can give you or hiding the hearing aid in the ear.
When I was in society, where there is noise, there were situations when I could not hear well and understand others, and then I thought that I would like the maximum that a hearing aid can give.
It would be good to get Virto on a trial basis, so that you can decide for yourself what is more important to you after trying it for several weeks. If not, you can always switch back to RIC later, only the wallet will be thinner later.

@markoo355 said:

You have to ask yourself why you want Virto, are you ashamed to wear a bigger hearing aid? You also have to ask yourself, what is more important to you, the quality and the maximum that the hearing aid can give you or hiding the hearing aid in the ear.

To be clear, when I started this thread it’s not at all about me wanting or liking the Virto. It’s speaking more to what you said there… why do they exist? (In-Ear aids I mean)

I gather from the few posts so far that most folks consider the “form factor” to be substandard when compared to or aids

advantages:

  1. vanity?
  2. simplicity in one integral unit?
  3. maybe a little more durable in that there no delicate wires and connections?
  4. Design better emulating the natural ear?

disadvantages:

  1. custom required
  2. hard to get a good fit
  3. hard to modify
  4. limited size means limited battery, limited features, etc.
  5. hard to maintain
  6. longer lead times
  7. fewer microphones
@bradw said:

advantages:

  1. vanity?
  2. simplicity in one integral unit?
  3. maybe a little more durable in that there no delicate wires and connections?
  4. Design better emulating the natural ear?

disadvantages:

  1. custom required
  2. hard to get a good fit
  3. hard to modify
  4. limited size means limited battery, limited features, etc.
  5. hard to maintain
  6. longer lead times
  7. fewer microphones

I would add one thing to your advantages list (and the one thing that I miss about the aids that I had) - the ability to use a phone as it is designed to be used, with or without .

When I had the “in the ear” aids, because they lived within the natural structure of my ear, I could just hold my cell phone where anyone else would. The phone’s earpiece speaker was just powerful enough to activate the telecoil and it gave me a “normal” phone experience.

When I switched to aids, I paid extra for the TC option and found it to be less than useless. I needed to hold the phone in a very unnatural position and in exactly the right spot. I asked my audiologist tp disable the function after a couple of months to make it easier to switch between the other modes.

I use my cell phone a lot during my workday, and my current solution is to use a Blueparrot B450-XT headset. This one is made for truck drivers and can get loud enough that I don’t need my . It goes over the outer part of my ear and pushes the sound right past my power domes.

bradw, I’m no audi, but I’m kind of surprised the Virto would be an option for someone with your sloped hearing loss? Does the Virto have the frequency range and maximum power output () of perhaps a 312-battery Phonak Lumity Life aid?

When I had MUCH worse hearing loss than you, one very young, 30-something audiologist told me he could fit me with the Lyric. I’m SO GLAD I didn’t go there. Not only would I have the hassle of app’t-required battery changes (try doing that while overseas on a trip and a faulty battery goes kaput!), but I was leery of the possibility of otitis from the “foreign object” being in my canal day and night - through showers and sweaty workouts, etc.

On top of which I simply feel that my hearing loss (a flat 60db range back then) would have been too much for the tiny Lyric to really be optimal. What does your audiologist recommend? I’d at least keep an open mind till you get a professional opinion.

@1Bluejay said:

bradw, I’m no audi, but I’m kind of surprised the Virto would be an option for someone with your sloped hearing loss?

I’m not considering it or being told to get something like it. It’s just a general curiosity question about the form factor.

In New Zealand during Covid when people wore masks, the insurance companies were hit with a large increase in people losing their hearing aids - as mask loops went around the back of the ears, it was all too easy to accidentally pull off an RIC hearing aid.
So many people switched to In Canal hearing aids (when they got the replacements) so they would not lose their hearing aids again.
A valid reason to use In Canal hearing aids but a bit of an outlier, except perhaps for medical workers?

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