ITEs – New ways to delight your clients

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Zerena BTE hearing aids have been on the market with their new technology and improved sound quality. But now Zerena is available in custom In-the-Ear (ITE) devices too! A full selection of Bernafon styles can be offered to clients from the powerful B105 BTE to a tiny discreet Invisible-in-the-Canal (IIC) device. You might ask what is so exciting about ITEs when the majority of clients choose open-fit BTEs and are satisfied with them. This is a good point, and open-fit BTEs are great, but all clients are not the same, and some people will prefer to use an ITE. As a previous clinician that typically did not sell a lot of ITEs, I would have asked the same question. However, the results from the validation testing have made me take a fresh look at ITE devices.

Before releasing any products to the market, we perform validation testing with volunteer end users at our headquarters in Bern. For the validation testing we use people that are experienced hearing aids users and select those with appropriate hearing loss for the tested device. For the ITE validation we tried to select end users with hearing loss configurations that would benefit from an ITE – meaning end users that had hearing loss in the low frequencies as well as the high frequencies. Normal or mild hearing loss in the low frequencies may cause end users to feel that they hear better without a hearing aid due to the ITE blocking the natural sound that they are still able to hear, and which is normally allowed to enter the ear with an open-fit BTE.

There were some test participants that had better low frequency thresholds than we would have liked, but we included them in the study anyway as they were eager to participate. The participants wore the hearing aids during a field test of approximately 10 days and completed lab testing in the clinic. The lab testing included speech testing in three conditions: unaided, aided with a Zerena 9 miniRITE BTE, and aided with the Zerena 9 ITE. They answered questionnaires concerning their experiences during the field testing with the ITEs, and at the end of the trial, they were asked to choose a preferred device – BTE or ITE. I was surprised by the number of participants that chose the ITE. These included some end users that I was nervous about fitting with ITEs and thought that they would not enjoy them due to their mild hearing loss in the low frequencies.

The experience of the testing reminded me that people are all different, and that we can’t always rely on rules or standard practices for fitting clients with hearing aids. The participants that chose the ITE did so for various reasons. Some found them more comfortable, others enjoyed the sound perception of the ITEs, and some that wear glasses appreciated not having something else over their ear. Now that you have the opportunity to offer all styles of Zerena hearing aids it’s important to remember to actually determine what priorities they have concerning hearing aids. With that in mind I’d like to highlight the new Counseling Matrix developed at Bernafon as an ITE sales counseling tool.


The tool is color coded to match the various ITE styles and can quickly illustrate to a client which styles are possible for them. The triangle points refer to the three main categories that determine which style or size of hearing aid is needed. The fitting level is the most important as you don’t want to fit a client with a receiver that can’t provide the gain that they need. With the tool it’s easy to see that if a client needs more power than an 85 receiver, an IIC or CIC will not be an option for them. An article by Winkler et al. (2015) offers helpful advice when fitting hearing aids. The author reminds us that the hearing loss should always be the main factor that determines the vent size, gain, and feature settings, but that the HCP must also consider the specific needs of the patients.

The options should be discussed with the clients. It is exciting to now offer 2.4 GHz wireless technology in the ITEs. This allows the ITEs to act like a stereo headset. Phone calls, music, and sounds from other wireless devices can stream directly through the hearing aids. Adding wireless connectivity is one of the 6 technical options from which to choose. There are also options such as a push button and telecoil. However, as more options are added more room is needed to build the hearing aid. This Counseling Matrix shows that by choosing all 6 options a full ITE will most likely be needed to accommodate everything. These are choices that the client must make. If they want the smallest device possible they must be willing to reduce the options that will come with the hearing aids. The matrix will help to visually reinforce this idea and help clients see the potential to manipulate their choices better than a simple verbal description would.

The ITEs are now available for ordering so try fitting some on your next clients. Many of our test participants had never tried ITEs before, and it was fun to see them excited about wearing something different to their BTEs. It’s always a great feeling to satisfy the clients and improve their hearing but also give them some enjoyment from using hearing aids.

For more information about the new Zerena ITEs, go to our Topics in Amplification (TiA) Unparalleled variety in custom products in the Bernafon Library.


Winkler, A., Latzel, M., and Holube, I. (2015). Open versus closes hearing-aid fittings: a literature review of both fitting approaches. Trends in Hearing, 20, 1-13.


About the author:

Julie Tantau
Julie Tantau, AuD Doctor of Audiology A.T. Still University, Mesa Arizona, USA. MA Audiology. California State University, Long Beach, USA.
Julie is a Research Audiologist at Bernafon. She contributes to various aspects of the development process including running clinical trials to validate the end product before it’s released to the market. Before moving to Switzerland to work for Bernafon in 2012 she worked as a Clinical Audiologist in the United States treating patients with hearing and balance problems. In her private time, Julie enjoys baking and travelling with her family.