Walk down any hospital hallway and you’ll see nurses, MDs, physician assistants and other health care providers walking around with stethoscopes wrapped around their necks. A stethoscope is just one of the “tools of the trade” in the practice of healthcare.
These devices are used for listening to the innards of the body. Your physician routinely listens to your heart for any sort of dysfunction. A nurse uses a stethoscope to help read your pulse when taking a blood pressure reading. A veterinarian might listen to your pet’s digestive tract for sounds that the dog DID eat your slipper.
In other words, a stethoscope is a critical tool in the delivery of health care services. It amplifies sounds within the body – sounds that couldn’t be heard without the aid of this critical, medical tool.
The problem is what about medical professionals who experience hearing loss – mild to severe? Are there stethoscopes that amplify for persons with mild hearing loss who don’t wear hearing aids? For persons who do wear hearing aids, how can they use a stethoscope? Or, in cases of profound hearing loss, how can the practitioner use a stethoscope with cochlear implants?
It’s a common problem, one faced by many medical professionals. And finding the right solution isn’t always easy.
Stethoscope and Hearing Loss IssuesHearing aids amplify certain sounds at certain frequencies. A medical professional might have hearing loss in the higher frequencies, missing the high notes. Or, the hearing loss can be at the lower end of the sound spectrum – low-frequency sounds.
Today’s sophisticated digital hearing aids are programmed specifically to address hearing loss at specific frequencies, providing varying levels of amplification across frequencies based on the hearing loss. However when the use of a stethoscope enters the picture, issues can occur.
Consider the problems:
- The medical professional wears hearing aids and, depending on type, sticking the earpieces of a stethoscope into the medical professional’s ear canals is going to get in the way of the hearing aid parts.
- A person who wears hearing aids can take their hearing aids out and use an amplified stethoscope; however, this is cumbersome and the stethoscope may not be enough of a boost for the professional to hear the sounds.
- Heart and breath sounds are low-frequency (between 20-650 Hz). Hearing aids traditionally are not set to amplify these low of frequencies by default, thus a specialized program may be required in order to properly boost low frequency sounds.
For stethoscope use and hearing loss, the association identifies two critical aspects of successful stethoscope use in medical professionals:
- proper tuning of the hearing instrument by the hearing professional, with special emphasis on low frequency boost.
- Hearing aids programmed to emphasize low frequencies
- Cochlear implant maps created to reduce room noise, emphasize low frequencies and lower the threshold for sound detection
- selecting the best stethoscope and/or interface to use with the hearing aids or cochlear implant.
On average amplified stethoscopes amplify between 15-50 dB gain depending upon the product, according to Dr. A.U. Bankaitis – Vice President and General Manager of Oaktree Products in an article on AudiologyOnline.
There are several brands of amplified stethoscopes available such as: E-Scope II, Welch Allyn Master Elite, and the 3M Littman, Electromax.
Most amplified stethoscopes are designed for persons who need extra amplification but do not wear hearing aids. The consequence of this for persons who wear hearing aids is they may find these types of stethoscopes simply do not provide enough boost for them when used alone and will not be tuned specifically for their hearing loss.
Hearing Aids and StethoscopesFor medical professionals who do not want to remove their hearing aids and use of an amplified stethoscope is required, the amplified stethoscope must be reconfigured with additional adaptors/accessories in order to work with the hearing aids.
Stethoscope options for persons who wear hearing aids will vary based on the type or style of hearing aids the medical professional wears.
Hearing aids come in two basic general styles: custom in-the-ear hearing aids or behind-the-ear (BTE) hearing aids.
BTE Hearing Aids
BTE hearing aids with a telecoil are able to connect to certain stethoscopes by the use of induction loop technology which will connect with the hearing aids telecoil in order to transfer sound from the stethoscope to the hearing aids. The sounds will then be amplified via the hearing aids for the professional.
For BTE hearing aid users who do not have a telecoil, the use of direct audio input (DAI) is an option if the BTE hearing aids are DAI compatible. DAI connects the stethoscope directly to the BTE. DAI boots will need to be placed on the BTE hearing aids in order for the adaptor to be plugged into the hearing aids.
The ability to directly link the stethoscope to hearing aids through telecoil or direct audio input does often result in the best outcome.
Another method for use with BTE hearing aids reported by AMPHL is referred to as the Applebaum method and involves placing the stethoscope earpieces into a second vent created in the hearing aid user’s earmolds. This method requires the ability to drill a large enough vent on the earmold and the user must have fairly good hearing in the low frequencies. This method may be used with a standard stethoscope or an amplified stethoscope.
Custom Hearing Aids
According to Dr. Bankaitis adaptors are available to use with in-the-canal (ITC) and completely-in-the-canal (CIC) hearing aids. The adaptors are called stethomate tips and couple non-amplified stethoscopes with canal hearing aids. Stethomate tips can also be used with amplified stethoscopes as long as the earpieces can be replaced with these tips. Bankaitis reports roughly a 30% success rate using these adaptors, thus they do not work for everyone.
AMPHL reports stethoscopes can be used with CIC or other canal hearing aids by using headphones that couple with the stethoscope. These headphones sit on the outside of the ears while the hearing aids remain inside the ear canals. An adaptor is required to connect the headphones to the stethoscope.
No matter what style of hearing aid that is worn, the bottom line is there are options. It is important to work closely with your audiologist or hearing aid professional to find the stethoscope solution that best fits your hearing loss and hearing aid style. Different configurations may need to be tried before finding which one works best for you.
Stethoscopes and Cochlear Implants
|Software allows to display visual readings on a PDA. Photo source: Stethographics|
The E-Scope II attaches to the Clarion Platinum speech processor via a simple patch cord. Plug and play, so to speak. There are other options. There are highly sensitive stethoscope amplifiers that connect to cochlear implants via a patch cord, so the health care professional can hook up once and not have to worry about connectivity or quality of sound (and diagnosis) for the entire shift.
For those medical professionals with profound hearing loss, visual output devices can be connected to the stethoscope, which will provide a visual read-out of what’s going on inside the patient. These devices are the size of a large cell phone or pda (personal data assistant) so are small enough to conveniently carry in a pocket through out the day.
The Important Part? Keeping Medical Professionals at Work Helping OthersThe best news for patients and medical professionals is that there are solutions for connecting stethoscopes, hearing aids or cochlear implants. In fact, many medical professionals have found the ideal solution to enable them to continue to deliver their invaluable services.
Our health professionals are a valuable resource – one we need in place today. Hearing loss – even profound hearing loss – should not prevent these health care providers from continuing to delver services to their patients.
Thanks to today’s hearing aids, cochlear implant and stethoscope technology, it’s simply a matter of finding the best combination of tools to address both the hearing loss and amplification needs.
As a medical professional, see a hearing professional if you experience even minor hearing loss. And if you’re a patient, you can have confidence that a medical professional with hearing loss delivers the quality of service you demand.
For more information and additional resources visit: Association of Medical Professional with Hearing Loss
Bankaitis, AU (2006, May 22). Stethoscope Solutions for Hearing Aids. AudiologyOnline, Ask the Expert. Retrieved March, 2010, from the Ask the Expert archives on http://www.audiologyonline.com
Atcherson, S. (2009, July 20). Options for Using Stethoscopes with Hearing aids. AudiologyOnline, Ask the Expert. Retrieved March, 2010, from the Ask the Expert archives on http://www.audiologyonline.com