I've just taken a closer look at the smaller side of the business today and read around the detail of the smallest and most deep fitting aids.
Customers who still have such a hang-up about cosmetics are out there, but you get into a host of issues based around the customer experience of the mini CIC style of aids.
Traditionally failure rates for these aids are a problem; initial candidacy, lack of features and general flimsiness seem to be just as great barriers. That's before you even get into issues of manual dexterity and the like.
Of the three latest entrants I've only fitted the Soundlens (to a 33 year old Lawyer) who was adamant about the need for the aid to be hidden. He's an experienced wearer with a flat 40dB SN loss. He's also worn CIC for years - we tried to fit binaurally but his left canal was too small. This basically seems to be true of all the systems - you need a fairly unbroken 9x7mm oval cross section running cleanly down the canal or they just won't fit. In terms of average candidacy that pushes the 'people who can' figure under 50% before you start.
Next you have to consider the ability to handle and clean, the propensity for wax ingress at the mic and battery manipulation: all of which deteriorates from your forties. Or to look at it another way you've just carved another half from the 50% of your market, so we're down to 25%.
Acoustically and clinically, the claims of the output are varied and variable - the driver/receiver at the end of a Soundlens is going to really struggle to deliver the maximum output in a large ear canal. That's before you've even considered the issues with occlusion, potential for infection and awkwardness of insertion.
Then there's the final aspect of price: the aids are going to have to be fitted with a reasonable margin as service work is highly likely over their life. The Soundlens launch pricing was right at the to of the high-end product range, though there are lesser models out now.
Putting all of this together it sums out at possibly one or two percent of the average customers fitted here will be interested and can afford this sector. With the growing popularity of the ever reliable RIC products combined with their fancy features, one wonders why the manufacturers are still heavily pushing the mini-CIC products. Perhaps they have heavily invested in the production line technology to make them, or is it a nod to the American market where the CIC (and ITE in general) has a greater foot-hold.
And, in any case it's counter-productive from an industry marketing point of view: as long as people continue to hide their loss with hidden CIC, the less widely accepted proper hearing aid solutions will be.