First, EWHAs have very limited fitting capabilities. The patient’s ear canal must be of a certain size, shape and direction. Those with narrow, short or highly angled canals need not apply. Another drawback is that these instruments are only appropriate for those who have very mild hearing losses.

Patients wearing EWHAs may experience unintended medical complications. Measuring the ear canal for proper placement of the device requires that the fitter touch the eardrum lightly with a probe. It is not uncommon for this to cause a slight hematoma on the eardrum, or, in the worst cases, a perforation which requires surgical repair. In addition, EWHAs occlude the ear canal, creating a barrier that prevents air from circulating freely. This condition may cause moisture to accumulate in the canal, which in turn makes it more likely that fungal infections will develop.

Since EWHAs should not be removed and reinserted by the patient, battery replacement is not as simple as it is with conventional hearing aids. These devices are powered by a battery that lasts about two months. When the battery fails, the EWHA must be removed by a hearing care professional and replaced with a completely new device. This procedure is necessary six or more times per year.

The price of EWHA fitting is also a drawback. Currently, EWHAs cannot be purchased. Manu-facturers offer them for lease at a cost of about $1,600 annually for one device and $3,200 for two. Therefore, patients must reinvest in the technology every 12 months in order to continue using the product.

EWHAs are in their infancy, but you should be aware that the hearing aid industry is working enthusiastically to advance this technology and to solve the problems outlined above. Only when they have evolved to meet higher standards will I offer them to my patients.