Stethoscope use for individuals having hearing loss, both with and without use of hearing aids, continues to be problematic for many individuals. This guest post, by Dr. Bankaitis, provides scenarios and options, depending on the needs of the stethoscope user. Dr. Bankaitis is Vice President and General Manager of Oaktree Products, Inc., a multi-line distributor of audiology and hearing-related products, based in St. Louis, MO. As a clinical audiologist, Dr. Bankaitis has been involved in educating colleagues about various practical clinical aspects of a practice including infection control, cerumen management, and hearing assistance technology. She founded A.U. Bankaitis’s Audiology Blog in 2010 and posts audiology-related topics on a weekly basis. Wayne J. Staab, Ph.D., Editor
Stethoscopes for Hearing Instrument Users: What Are the Options?
A.U. Bankaitis, Ph.D. FAAA
What options are currently available to hearing instrument wearers who use stethoscopes to listen to breath and/or heart sounds as part of their routine job procedures? The answer depends on several things including: 1) whether or not the medical professional wants to keep their hearing instruments in the ears during auscultation procedures, 2) the type of hearing instruments worn (i.e. BTE vs custom), and 3) features of the hearing instrument (i.e. t-coil equipped, streamer). While there is no one-size-fits-all solution, the provided scenarios list potential options for audiologists to consider when working with their patients. None come attached with a guarantee for a successful outcome, however, all should be considered and readily available at the time of the appointment since successful outcomes remain unpredictable. Editor’s Note: The photos shown here are referenced in this post.
Scenario 1: Medical professional does NOT want to wear wearing hearing instruments during auscultation procedures This represents the most straightforward, hassle-free scenario associated with the quickest and highest rate of success. Any commercially-available amplified stethoscopes equipped with traditional earpieces (Adscope, E-Scope II with standard earpieces, 3m Littmann, or the ThinkLabs Ds328+) represent potentially viable solutions.
Scenario 2: Medical professional wants to keep hearing instruments in the ears, custom hearing instrument wearer, no t-coil, no streamer Three potential options to consider: Replace the tips of the traditional stethoscope earpieces with stethomate tips. Keep in mind that the success rate for this solution remains low for a number of reason and other options need to be readily available at the time stethomate tips are attempted. Order special earmolds (Westone) designed to interface between the CICs or ITCs and stethoscope earpieces Invest in the modified E-Scope II with standard headphones or with oversized headphones. Hearing instruments remain in the ears and headphones are placed over ears during auscultation procedures. Appreciate the fact that many patients may initially reject this solution from the perspective of aesthetics.
Scenario 3: Medical professional wants to keep hearing instruments in the ears, RIC or Open-Fit BTE wearer, no t-coil, no streamer Try current stethoscope or any of the stand-alone amplified stethoscopes previously mentioned in Scenario 1 while leaving hearing instruments in the ears to see if patient can tolerate this configuration. Invest in the modified E-Scope II with headphones. Hearing instruments remain in the ears and headphones are placed over ears during auscultation procedures. If feedback is an issue, the modified E-Scope with oversized headphones is also available.
Scenario 4: Medical professional wants to keep hearing instruments in the ears, ITC or BTE wearer with t-coil, no streamer For ITC wearer, consider trying stethomate tips knowing another option should be readily available during the patient appointment time. For either ITC or BTE wearer, invest in the modified E-Scope II with headphones; hearing instruments remain in the ear while headphones placed over ears during auscultation procedures. If feedback is an issue, The E-scope II with oversized headphones is an option. For either the ITC or BTE wearer, since the hearing instrument is t-coil equipped, rather than using a standard or oversized headphone, the modified E-Scope II without earpieces may be ordered along with an induction earhook accessory (monaural or binaural Silhouette). This configuration sends auscultation signals directly to the t-coil of the hearing instrument. For the BTE wearer, the modified E-Scope II without earpieces may interface directly with the hearing instruments via direct audio input (DAI). This configuration will require additional accessories including either a monaural or binaural E-Scope II DAI cable as well as an audio boot/shoe from the hearing instrument manufacturer.
Scenario 5: Medical professional wants to keep hearing instruments and use their streamer to send signals wirelessly to hearing instruments This scenario generates the most confusion because some amplified stethoscopes with Bluetooth capabilities have been found to work intermittently or have limited Bluetooth capabilities. For example, the Audiologist’s Choice Bluetooth Amplified Stethoscope is a commercially available stethoscope designed to wirelessly transmit auscultation signals directly to a hearing instrument user’s streamer. Despite initial promise, the product has been plagued with signal transmission issues that either interfere with proper pairing between the AC-Scope’s amplifier and the hearing instrument streamer or, even when successfully paired, result in intermittency sufficient to interfere with performing clinical procedures. In other instances, a product offers a Bluetooth feature that has nothing to do with hearing instrument streamer configuration abilities. The 3M Littmann Amplified Stethoscope features Bluetooth capabilities, however, the feature is liimited to wirelessly transmitting recorded signals to a Bluetooth enabled PC. To date, there have no reports of successful pairing of the 3M Littmann to a hearing instrument streamer. Unfortunately, the mere mention of an amplified stethoscope with “Bluetooth capabilities” often results in leaps and bounds in terms of product capabilities. The key in this scenario is to establish realistic expectations without overpromising what can be delivered. At this time, the above scenario is associated with the following potential options: Invest in the E-Scope II with headphones along with the necessary E-Scope patch cord to hardwire the E-Scope II directly to the streamer. This configuration will require the use of a standard audio-in cable typically packaged with the hearing instrument’s streamer. If the above option yields unsatisfactory results, consider by-passing streamer capabilities and approaching the fit with one of the previously recommended suggestions based on whether the hearing instrument is a BTE or custom device. Recently, anecdotal reports with the ThinkLabs DS32a+ stand alone amplified stethoscope indicates that the device can wirelessly transmit signals directly to Phonak iCom streamer when a Bluetooth transmitter like the Jabra A120a or ClearSounds Q-link is used. This configuration is currently being assessed.
For more information on amplified stethoscope options, access the free-to-view webinar Amplified Stethoscope Options for Hearing Instrument Wearers at www.aubankaitis.com and click on the Amplified Stethoscope link from the upper horizontal menu. Additional information is also available in the Amplified Stethoscope section of A.U. Bankaitis’ Audiology Blog (www.aubankaitis.com).