A Conversation About Ready-to-Wear CICs: A New Niche in Hearing Care

Brian Taylor, Senior Director of Audiology for WS Audiology, discusses completely-in-the-canal (CIC) style hearing aids and why they should be part of a clinician’s treatment repertoire.

 

AudiologyOnline: It seems like CICs are declining in popularity. Can you speak to that?

Dr. Brian Taylor: If you look purely at the numbers, it is easy to come to that conclusion. After all, in 2021, Karl Strom reported (Strom, 2021) that about 3% of hearing aids sold in the US were CIC. And it’s correct, RICs are, by far, the most popular hearing aid style. This point was highlighted in a 2022 industry survey (Bott, 2022) of more than 23,000 hearing aid wearers in which only 1% of them self-reported they wore CIC devices, while 89% said they wore RIC-type devices.

AudiologyOnline: Doesn't this evidence support that CICs aren’t really too relevant or interesting?

Dr. Brian Taylor: Even though they have fallen out of favor over the past few decades, I wouldn’t equate their lack of popularity with ineffectiveness. I remember back in the mid-to-late 1990s when more than 20% of all hearing aids sold were CICs, as Karl’s 2021 article illustrates (see Figure 1 below). As I recall, some clinics back then even specialized in dispensing CICs.

I also think the CIC style might be about to experience a bit of a resurgence. I say this because so many people now use wireless earbuds to listen to music and podcasts. A ready-to-fit hearing aid that looks like – or is even smaller than – a wireless earbud is a natural extension of this consumer audio technology. I think it’s possible that individuals who want no part of a behind-the-ear RIC device would find a ready-to-wear CIC appealing.

 

 

 

 

 

 

 

 

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.

AudiologyOnline: It looks like all the in-the-ear type devices (CIC, ITC, and ITE) sharply declined through the 2000s.

Dr. Brian Taylor: Yes, and as you can see, RIC devices quickly ascended to be, undoubtedly, the most popular hearing aid style. Even though the data in this graph ends in 2013, I think we can agree that the upward projection of RIC has continued. Again, I want to emphasize that just because CICs have lost popularity, it doesn’t mean we should neglect their advantages.

AudiologyOnline: You mentioned a survey, published in 2022, that said CICs represent just 1% of the total market. Can you explain your statement that they might experience a resurgence in popularity?

Dr. Brian Taylor: Resurgence is too strong a word, but I do believe there is an important, largely untapped niche for CICs. A niche that can be leveraged by savvy clinicians who want to grow their business.

Before we go any further, however, let me emphasize that RICs do offer several advantages. They are slim, nearly invisible, and comfortable. An added bonus of RICs, of course, is that they are easy for clinicians to stock, and because of this, they can be fitted on the same day as the evaluation. It’s not surprising, given those advantages, that close to 90% of hearing aids sold in the US today are the RIC style. RICs, however, were never intended to be fitted on all patients, and CICs do offer some distinct advantages, and as I already mentioned, they might be appealing to individuals who refuse to wear a RIC because, even though they are slim, they look like traditional hearing aids.

AudiologyOnline: You’ve used the term ready-to-wear CIC. What do you mean by that?

Dr. Brian Taylor: A ready-to-wear CIC hearing aid is pre-manufactured in standard sizes so it can be worn immediately without custom ear impressions. Of course, there is a difference between ready-to-wear and customized CICs. Customizable CICs require an ear impression or scan. I also want to point out that we use the terms ready-to-wear and ready-fit interchangeably.

Like RICs, ready-to-wear CICs typically can be sized, fitted, and adjusted on the spot and worn the same day. It’s important to note that ready-fit, in-the-ear devices have been around for decades, but over the past few years, they have gotten smaller. In fact, in some cases, they are so small that some refer to them as IICs – invisible-in-canal hearing aids. Regardless of the terminology, all CICs and IICs are designed to fit behind the tragus on the ear.

AudiologyOnline: It sounds like the stigmatizing effects of hearing loss and aging continue to preclude some individuals from wearing behind-the-ear style hearing aids. Is that true?

Dr. Brian Taylor:  Yes, I think so. Stigma is a complicated topic, and we are still learning about its effects as it relates to aging, hearing loss, and hearing aid use. The good news is that there does appear to be a renewed interest in stigma among researchers in our field. For instance, the International Journal of Audiology recently devoted a special issue (Ekberg & Hickson, 2025) to stigma. My WSA colleague, Niels Søgaard Jensen, and I tried to summarize much of this current research on stigma and hearing aid use in this 2024 AO article (Taylor & Jensen, 2024).  If there is a theme to the findings of this research, it is this: Hearing aid use continues to be strongly associated with stereotypes of aging and disability. Consequently, it is important to offer patients a choice in the style of hearing aid they would be willing to wear.

This is one advantage of adding ready-fit CICs to your product portfolio.  They offer patients a choice. It might be the only style that some individuals are willing to wear.

AudiologyOnline: Related to the small size of CICs, what are their advantages that some might find appealing?

Dr. Brian Taylor:  Besides the obvious fact that ready-to-wear CICs – when they are properly sized and fitted by the hearing care professional -- fit inside the ear canal, making them oftentimes less visible than RICs, they can be easier to insert and remove from the ear compared to RICs. Also, since they’re fully within the ear, they are less likely to get knocked off during sports or other physical activity. A bonus of CICs is that they can be more comfortable for people who wear eyeglasses, oxygen tubing, or frequently use facemasks. However, I think the most appealing aspect of the small, modular style of ready-fit CICs is that they look like small consumer audio earbuds. Individuals who wear earbuds to listen to music or their favorite podcasts should find ready-fit CICs to be an attractive option.

AudiologyOnline: What about the performance advantages associated with CICs?

Dr. Brian Taylor: There are several acoustic advantages related directly to the microphone location. A CIC’s placement in the ear canal takes advantage of the ear’s natural shape, often improving localization ability. As you’ll remember, because of a RICs microphone location being above the ear, we must electronically replace those lost pinna effects -- we don’t have to perform any electronic sleight of hand to restore pinna effects with CICs.  Also, because the microphone is tucked inside the ear canal, CIC wearers typically experience less wind noise interference than RIC wearers.

AudiologyOnline: Thanks for reminding us about those performance advantages. I recall from my graduate school days that CICs had some performance advantages related to hearing in noise. Can you elaborate on that?

Dr. Brian Taylor: Sure. Those performance advantages of CICs for hearing in background noise are related to the physics of microphone placement deep in the ear canal. When the microphone sits deep in the ear canal, it preserves the natural resonance created by the pinna and concha. Maintaining this natural ear canal resonance enhances the audibility of speech cues, which greatly assists in understanding speech in the presence of noise. In contrast, RICs and other behind-the-ear devices can distort these natural effects; thus, RICs rely on digital simulation to restore these natural effects. Of course, CICs do not always outperform RICs in noise. This is because RIC devices employ well-designed directional microphone systems. However, CICs provide natural acoustic advantages that digital algorithms cannot fully replicate. If your readers really want to get into the details of all the acoustical advantages of CICs, I would recommend picking up a copy of Marshall Chasin’s 1997 CIC Handbook on Amazon.

AudiologyOnline: So, it sounds like CICs accomplish many of the advantages in noise of RICs but without directional microphones. Tell me more about that.

Dr. Brian Taylor: Well, that’s not exactly true. Signia has pioneered the use of directional microphone technology in CIC devices. We are the only manufacturer that uses this technology in a ready-fit CIC-type device. I have an idea….

Brian Phones a Friend

Dr. Brian Taylor: I am going to give my friend and colleague a call. Eric Branda has been with Signia for more than 20 years. He can provide the details on directional mics in CIC-type devices.

Dr. Brian Taylor: Hi, Eric. How are you doing? 

Dr. Eric Branda: I’m doing well. How can I help you?

Dr. Brian Taylor: I am here with the folks at AudiologyOnline, talking about ready-fit CICs, and the topic of directional mics in CICs came up. You are the perfect person to talk about Signia’s One-Mic technology.

Dr. Eric Branda: Sure. It never ceases to impress me how we work with the pinna and its effects on sound.  Years ago, we were talking about recreating pinna effects to help BTEs and RICs sound more natural since the microphones in those cases are located outside the pinna.  With OneMic technology, we can use our knowledge of the pinna effect and essentially enhance it.  If we consider that directionality in hearing aids depends on the spatial separation of the microphones, it sets a foundation for what Binaural OneMic Directionality 2.0 does.  Instead of using two mics on one device, it uses two devices, each with one mic.  Importantly, each of those hearing aids can communicate with the other via near-field magnetic induction.  This wireless signal is efficiently transmitted between devices.  The transmission is fast…milliseconds…and consumes very little power, meaning that even with small batteries, we can maintain steady communication without notable compromises to battery life.

With OneMic Directionality 2.0, we can use our knowledge of anatomical properties of the head, along with the wireless communication between the devices, and provide directionality with these single-mic devices.  I’ll share an illustration (Figure 2) that helps describe this communication between the devices. The directionality shown in this illustration exceeds what the pinna alone is doing.

 

 

 

 

 

 

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

 

AudiologyOnline: What evidence do you have that says this technology is effective?

Dr. Eric Branda: I like to address Signia’s claims and technology with multiple approaches. First, I think technical measurements are an important way to show a controlled measurement of what the technology can do.  And secondly, I think it is necessary to show study data using human participants to give an indication of the benefits experienced by the wearer.

For technical measurements, we conducted a sequential Directivity Index (sDI) measurement. This is essentially an average signal-to-noise ratio (SNR) improvement calculated from measurements of a target signal compared to a competing signal from multiple angles around a KEMAR.  These measurements were compared to those of standard CIC devices, which do not have beamforming but rather reflect the pinna effect.

As expected, the traditional CICs all showed a similar sDI of around 2-4 dB, depending on the frequency.  The sDI for the OneMic Directionality 2.0 was considerably higher, showing differences of 8 to 9 dB at some frequencies compared to the traditional CICs.  The measurement differences can be seen in Figure 3.  And when we calculate these results using the Speech Intelligibility Index Directivity Index (SII-DI) we see a 7 dB improvement with OneMic Directionality 2.0 over traditional CICs.
 

 

 

 

 

 

 

 

 

 

 

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.

 

Dr. Eric Branda: Now, as I mentioned, we also like to assess human performance with these types of directional hearing aids.  In another study with seventeen participants fitted with the Signia Silk Charge&Go IX, which uses the OneMic Directionality, we measured results from a modified American English Matrix Test (Hörtech, 2019).  Participants repeated Matrix sentences presented from 0° azimuth with competing matrix sentences and babble noise coming from four other speakers spaced at 45°, 135°, 225° and 315° azimuths at 67 dBA.  The SRT80 was determined by finding at what SNR each participant could achieve 80% accuracy.  Comparing measurements with OneMic Directionality 2.0 both on and off, we saw a significant 1.3 dB improvement in the SRT80 (Figure 4).

 

 

 

 

 

 

 

 

 

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

 

When we consider both sets of data, it demonstrates a clear advantage for Binaural OneMic Directionality 2.0 to improve the SNR for the wearer.  If we take it a step further, it helps to show how CICs and IICs can provide very cosmetic solutions that also address the well-established difficulties of understanding speech in noise.  Ultimately, clinicians have improved options to help care for their patients.

Dr. Brian Taylor: Thank you, Eric. I am so happy you were available to join me today.  

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.