Question
I have a moderate to severe high frequency sensorineural hearing loss in both ears. I am an RN who needs to use a stethoscope daily. I am having trouble adapting my hearing aids for this. We've been working on this problem for 6 months. We switched from in-the-ear to behind-the-ear hearing instruments. They have bored holes in the molds twice but I still can't hear. They even tried programming a 3rd program, with no luck. Would a special ear tip on the stethoscope allow me to hear or do I need to give up and order an electronic stethoscope. I can hear without the hearing aids, but it is difficult in my profession to be taking them in and out.
Answer
This is a commonly asked question, but unfortunately, there is no short and simple answer. Healthcare professionals who must rely on hearing aids for communication typically have one of two primary choices for using stethoscopes: (1) take the hearing aids out prior to using the stethoscope or (2) come up with a way to interface or "couple" the stethoscope with their hearing aids. The former choice is the easiest choice, but often the one most undesirable because it is seen as an inconvenience to the practitioner having to go between the hearing aids and the stethoscope, and because a standard (unamplified) stethoscope just may not have enough amplification to warrant its use.
The latter option involving interfacing or coupling is often the best choice, but it can be quite cumbersome and frustrating for both the practitioner and the audiologist. The manner of coupling that you described in your question is a solution Applebaum (2003) has suggested—that is—preventing one from having to take the hearing aids out before stethoscope use. However, one would have to have reasonably large vent in the earmold (0.5 cm diameter per Applebaum) and good low frequency hearing for this to work well. A diameter of 0.5 cm is unusually large for earmolds, and I have to wonder how small vents affect the acoustics of low frequency sounds entering the ear canal via vents from a standard stethoscope. This may be one of the reasons why you aren't getting any benefit with this method. Realize that coupling a stethoscope to the earmolds offers no additional amplification because the sound is not passing through the hearing aid circuitry.
When Applebaum's method of coupling isn't enough, an amplified (electronic) stethoscope is usually the next step. Unfortunately, there aren't many electronic stethoscopes on the market to choose from, each with both pros and cons. For example, most amplified stethoscopes are designed for people who need the added amplification, but do not wear hearing aids. In this way, the amplified stethoscope is used in the same manner as one would use a standard stethoscope. (In fact, I have heard from some practitioners with mild hearing losses that they enjoy being able to listen to their patients through the amplified stethoscope because it functions like a hearing aid!) If a practitioner must always wear her hearing aids, then there are two final options available, both of which involve a sound output port on the amplified stethoscope. This is usually a 2.5 mm headphone jack. Either your audiologist can help you figure out a way to create a direct-audio-input (DAI) connection between your hearing aids and the amplified stethoscope, or you could try one of several ways to make use of a telecoil within the hearing aids (e.g., induction, FM, or wireless with blue tooth). Several of these methods are described on the Association of Medical Professionals with Hearing Losses website www.amphl.org.
A final word of caution though. Hearing aids weren't designed to amplify sounds below 150 Hz where heart sounds are expected to be. Should you opt to use an amplified stethoscope that works through your hearing aids, your ability to truly detect subtle abnormalities in the very low frequency range may be compromised.
Suggested Reading:
Applebaum, S. (2003). Stethoscope use without behind-the-ear hearing-aid removal. Journal of the Association of Medical Professionals with Hearing Losses, 1(3). amphl.org/articles/applebaum2003.pdf
Fabry, D.A. (1993). Clinical and Communication Access through Amplification for a Medical Student with Severe Hearing Loss: Case Report. J Am Acad Audiol 4, 426-431
Rennert, N., Morris, B., and Barrere, C.C. (2004, February). How to cope with scopes: Stethoscope selection and use with hearing aids and CIs. The Hearing Review, 34-75.
www.amphl.org/stethoscopes.php
Samuel R. Atcherson, Ph.D. is Assistant Professor at the University of Arkansas at Little Rock and the University of Arkansas for Medical Sciences, and is Clinical Director of Audiology for the UALR Speech and Hearing Clinic. He received his Bachelors and Masters degrees from the University of Georgia and his Ph.D. from the University of Memphis. Dr. Atcherson's research and clinical interests are in the areas of auditory electrophysiology and electrodiagnostics, central auditory processing, and hearing assistive technology. He is former President of the Association of Medical Professionals with Hearing Losses (AMPHL), a proud colleague of a thriving group of practicing and student hard-of-hearing audiologists, board member of the Arkansas Hands & Voices chapter, and contributing author and speaker for the Post-Secondary Education Programs Network (PEPNet): a federally-funded organization that improves transition services and educational access for students who are deaf or hard of hearing including those with co-occurring disabilities, thus enhancing educational opportunities.
