A New Niche in Hearing Care: The Clinical and Technical Case for Ready-to-Wear CICs

Course Overview

This course explores the evolving landscape of Completely-in-Canal (CIC) hearing aids, with a specific focus on the emerging niche of ready-to-wear devices. While Receiver-in-Canal (RIC) devices currently dominate the market, technological advancements and shifting consumer preferences regarding aesthetics and stigma are creating new opportunities for CIC use. Participants will examine the acoustic advantages of deep microphone placement and the implementation of binaural directional microphone technology in non-custom devices to improve speech understanding in noise.

Learning Outcomes

• After this course, participants will be able to define a ready-to-wear CIC hearing aid.
• After this course, participants will be able to describe the acoustic and cosmetic benefits of ready-to-wear CIC hearing aids.
• After this course, participants will be able to discuss the market segment that might fit ready-to-wear CICs appealing.

The Evolution of Hearing Aid Styles

Thirty years ago, completely-in-the-canal (CIC) hearing aids were a dominant style in the hearing care industry. However, the introduction and subsequent popularity of Receiver-in-Canal (RIC) devices significantly shifted the market. According to reports from 2021, CIC devices accounted for only about 3% of hearing aids sold in the United States. A 2022 industry survey of over 23,000 hearing aid wearers further illustrated this disparity, with 89% of respondents reporting the use of RIC-type devices, compared to only 1% wearing CIC devices.

Figure 1. Percentage of the US market by style of hearing aid, from 1994-2013, with RICs as the light blue line and traditional BTEs in dark blue. Strom KE. (2021) Trends in Hearing Aid Styles. The Hearing Review. 28(7):6,31. Reprinted with permission of Melanie Hamilton-Basich, Chief Editor, The Hearing Review.

Despite the decline in popularity, the lack of market share should not be equated with a lack of clinical ineffectiveness. During the mid-to-late 1990s, CICs represented more than 20% of the market, and many clinics specialized in their fitting. There are indications that the CIC style may be poised for a resurgence, or at least the development of a significant niche market, driven by the ubiquity of wireless earbuds used for consumer audio. A ready-to-fit hearing aid that mirrors the form factor of a wireless earbud is a natural extension of consumer audio technology.

Understanding Ready-to-Wear CICs

A ready-to-wear CIC—also referred to interchangeably as a "ready-fit" CIC—is a hearing aid that is pre-manufactured in standard sizes. Unlike traditional customizable CICs, which require an ear impression or a digital scan, these devices can be worn immediately. This allows clinicians to size, fit, and adjust the device on the same day as the initial evaluation, a logistical advantage previously reserved primarily for RIC devices.

Over the past several years, these ready-fit in-the-ear devices have decreased in size, leading some to categorize them as "invisible-in-canal" (IIC) hearing aids. Regardless of the specific label, these devices are designed to fit behind the tragus of the ear. For patients who refuse to wear behind-the-ear styles because they look like traditional medical devices, the ready-to-wear CIC offers a more modern, earbud-like appearance that may be more appealing.

Stigma and Patient Choice

Hearing aid use continues to be strongly associated with negative stereotypes regarding aging and disability. Research suggests that stigma remains a significant factor in why individuals may avoid hearing healthcare. A 2024 review of research suggests that offering patients a choice in device style is crucial for successful adoption (Taylor & Jensen, 2024).

Ready-fit CICs provide an essential alternative for patients who might otherwise reject hearing aids entirely. Beyond the cosmetic benefit of being nearly invisible, these devices offer several practical advantages. They are often easier to insert and remove from the ear compared to RICs. Furthermore, since they are housed entirely within the ear canal, they are less likely to be displaced during physical activities or sports. Finally, CICs can provide increased comfort for patients who frequently use eyeglasses, oxygen tubing, or face masks.

Acoustic and Performance Advantages

The performance advantages of CIC hearing aids are primarily derived from the physics of microphone placement deep within the ear canal. By sitting deep in the canal, the device takes advantage of the ear's natural shape, preserving the natural resonance created by the pinna and concha. This maintains natural ear canal resonance, which enhances speech cues and assists in understanding speech in noisy environments.

In contrast, RIC devices have microphones located above the ear, which necessitates electronic simulation to replace lost pinna effects. Furthermore, because the CIC microphone is tucked inside the canal, wearers typically experience significantly less wind noise interference compared to those wearing RIC devices. The natural shape of the ear is also leveraged to improve localization abilities.

Advancements in Directional Technology: OneMic Directionality

While RIC devices have traditionally outperformed CICs in noise due to their use of dual-microphone directional systems, new technology has bridged this gap. Signia has pioneered the use of directional microphone technology in a ready-fit CIC device through "OneMic" technology.

Directionality in hearing aids typically depends on the spatial separation of microphones. The Binaural OneMic Directionality 2.0 system achieves this by using two devices (one in each ear), each containing a single microphone. These devices communicate via near-field magnetic induction (NFMI). This wireless transmission is exceptionally fast—occurring in milliseconds—and consumes very little power, which is essential for the small batteries used in CIC devices. By sharing data between the two ears, the system provides directionality that exceeds what the pinna can achieve alone.
 

Figure 2. Wireless communication between left and right single-mic hearing aids to provide OneMic Directionality 2.0.
 

Technical and Clinical Evidence

To validate the effectiveness of Binaural OneMic Directionality 2.0, technical measurements were conducted using a sequential Directivity Index (sDI) on a KEMAR (Knowles Electronic Manikin for Acoustic Research). This measures the average signal-to-noise ratio (SNR) improvement from multiple angles.

Figure 3. sDI measured at 1/3 octave frequencies for Signia Insio Charge&Go CIC IX with OneMic Directionality on and off, as well as four other competitor CIC devices.
 

When calculating these results using the Speech Intelligibility Index Directivity Index (SII-DI), the OneMic Directionality 2.0 showed a 7 dB improvement over traditional CICs. Further clinical validation involved seventeen participants fitted with Signia Silk Charge&Go IX devices. Using a modified American English Matrix Test, researchers measured the Speech Reception Threshold (SRT80)—the SNR at which a participant achieves 80% accuracy.

Figure 4. Comparison of results for omni-directional and Binaural OneMic Directionality 2.0 settings with a modified American English Matrix Test.

Clinical Implications

The combination of ready-to-wear convenience and advanced binaural processing allows clinicians to offer a highly cosmetic solution that does not compromise on the ability to understand speech in noise. As the industry continues to evolve, these devices represent a valuable tool for expanding a clinic's portfolio and reaching patients who are motivated by both discretion and performance. Ultimately, the ready-fit CIC serves as a natural extension of the consumer audio trend, bridging the gap between high-performance hearing care and modern user expectations.

References

Hörtech (2019). International Matrix Tests: Reliable speech audiometry in noise. Report from HörTech gGmbH. 

Strom, K. E. (2021, July 23). Trends in hearing aid styles. Hearing Review, 28(7), 6, 31.

Bott, A., Piechowiak, T., Groth, G., & Thunberg Jespersen, C. (2022). What big data has to say about individual differences in hearing aid use: insights from GN online services (Gnos). AudiologyOnline, Article 28295.

Ekberg, K., & Hickson, L. (2025). To tell or not to tell? Exploring the social process of stigma for adults with hearing loss and their families: Introduction to the special issue. International Journal of Audiology, 64(sup1), S1–S11.

Taylor, B. & Jensen, N. (2024). Accentuating the positive: overcoming the complexities of stigma through thoughtful product design & more-effective person-centered communication. AudiologyOnline, Article 28940.