Stethoscopes

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

A.U. Bankaitis, Ph.D.

A.U. Bankaitis, Ph.D.

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.

Stethoscopes1

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).

8 Responses to Stethoscope Options for Hearing Aid Users

  1. Frank DiMotta,MD says:

    just purchased Starkey halo instruments. They stream to my iPhone, but cannot stream to a stethoscope. Adding this capability, would be a boon.Perhaps this situation is similar to an “orphan drug”. Since there are so many iPhone app’s that have less than commercially useful applications, a collaboration between Apple and Starkey might be successful.

  2. diana says:

    I am an NP, using BTE’s for ten years, and have never had difficulty hearing hear or lung or any sounds with regular stethascope- with or without the aids in place. Pethaps the sounds are not in the range of high freq loss, I also (have always) used wide soft tips on stethascopes for comfort, and the do not press on the H.A.’s.
    But, I think if I were listening for BP’s all day, rather than getting elec auto reads, that I would start to experience some discomfort. As is, I do not.
    But may try Lyric the next time a unit goes bad (or gets crunched in my car door) all ins. on them has run out….

  3. Linda Keyes, RN says:

    Having hearing loss with hearing aids into my late 30’s, becoming completely deaf overnight in my late 30’s and having a successful career as an RN, the Starkey ST3 stethoscope was the absolute best stethoscope on the market. I was able to use it before Cochlear implants AND after. It is a shame and a huge disappointment Starkey labs is no longer making this product. The quality-clarity and quality was outstanding. After my last one died I felt no other product met the quality of the Starkey causing me to leave an area of nursing that I Ioved. Thankfully, there are always other areas of nursing to expand to. It is my hope with as technology improves they will find a way to create one similar to that quality!

  4. Wayne Staab says:

    Have you tried to contact Starkey to see if they have a battery compartment? If I had to guess, it would be that they do, but it is only a guess.

  5. Patti Hooks says:

    I have had my6 starkey ST3 for many years, the other day the battery compartment fell out of the back and I cannot find it…..I cant find a replacement compartment for it…..gracious Im lost without it.

  6. Dixie McCrory says:

    I’m not alone! I too have held on to my old ailing Starkey ST3. The newer electronic stethoscopes are simply not as effective for me. My Starkey was just sent out for repairs but it seems it is time to retire it. When that happens I may have to switch careers. How can we band together to convince Starkey to start manufacturing their stethoscopes again? I wrote them a single email but no success.

  7. Bridget B. Pham, RN says:

    I too have the Starkey ST3 & it is the BEST for us hearing impaired medical professionals!! But, sadly to say, my volume button has a bad glitch & doesn’t always work like it should. I agree with you, Carmen June that SOMEONE should step up to the plate for us & manufacture THIS product again!!! So glad someone feels the same as I do too!!!
    Best wishes in finding one that works… I also have an Electromax, but it takes SO MANY (expensive) batteries each time you need to replace them!!! :(
    BRING BACK THE ST3 !!!

  8. Carmen June says:

    Here’s a solution for many hearing impaired health care providers like myself. Bring the ST3 stethoscope by Starkey back. The ST3 Stethoscope worked for me. Sadly, the company no longer manufactures this stethoscope. I have spent over one year trying to find a stethoscope that works for me. Many companies proclaim to make stethoscopes for the hearing impaired…not true. A stethoscope that provides 20 or 30 db amplification is simply not enough. I need 55 db amplification. I, like many others, have given up the dream of attending medical school, simply because not one single company in the US, let alone in the world, can make a simple stethoscope like Starkey did. What a shame!