Reprinted with permission by Becky Morris, President of Effective Communication Solutions, Inc. and BeyondHearingAids.com

"HOW TO COPE WITH SCOPES"
or
'Stethoscopes and Hearing Aids - What are the Options?'

By Rebecca Morris

Stethoscope Use is a Critical Job Function


In general, people can be slow to recognize their hearing loss. When there is fear that a job is on the line, some individuals are even more reluctant to self-identify. The inability to use the stethoscope (or the misperception that someone who wears hearing aids should not be a nurse, etc.) can mean loss of job responsibilities or maybe even the job!

Choosing the most effective way to interface a hearing aid to a stethoscope can be challenging. But the payoff is big. Finding a successful solution means more experienced medical professionals can retain their jobs and more students with hearing loss can enter nursing and medical programs.

"One Size Does Not Fit All"


The purpose of this report is to present 'commercially available' options in a practical format so that consumers, hearing health care providers and employers have enough information to provide an effective accommodation. The individual's level of hearing loss and the hearing aid style they use will determine which solution may be most beneficial.

"Options by Type of Hearing Aid"


Not a Hearing Aid User


There are several amplified stethoscopes on the market. Individuals who do not wear hearing aids may find one of these stethoscopes adequate. As with all assistive devices, one unit may provide better benefit than another, depending on the individual's level of loss.

· E-Scope Electronic Stethoscope
This stethoscope is designed for a wide frequency range with a high level of amplification. Standard stethoscope eartips can be chosen, or optional headphones can be chosen. Push button on/off switch with 2 minute auto shut off.

· Electromax Stethoscope
This stethoscope features a push button to power the unit. You must press the entire time you are listening to engage the stethoscope. Some professionals prefer this type of push button control to eliminate skin and clothing movement sounds from being amplified while positioning the stethoscope.

· Starkey ST3 Amplified Stethoscope
This electronic stethoscope features two listening modes; "H" for Hearing Aid mode and "S" for Stethoscope mode. This is useful to listen to environmental sounds in "H" mode and then switch to "S" mode to use the stethoscope.

· Stethos Electronic Stethoscope This stethoscope features a sleek design and simple push button control to change modes without interrupting auscultation. Its' advanced microelectronic features provide hand-tremor and ambient-noise filtering with auto-impact noise muting, and auto shut-off for extended battery life.

These are stethoscopes with which we have the most experience. Other stethoscopes do exist.

Completely In-the-Canal (CIC) or In-The-Canal (ITC) Hearing Aid Users


Several options are available for individuals who wear CIC aids and find it uncomfortable placing the stethoscope directly in the ear over the hearing aid. Westone Laboratories, Inc. has extensive experience dealing with stethoscopes. They have published useful information on these products and we use them regularly as a resource.

· Westone offers an earmold designed to seat over a CIC aid and is retained in place by the features in the bowl of the ear. The eartip of the standard stethoscope is placed in the recession. A sound bore is drilled directly over the microphone opening. Mixed accounts of feedback have been noted.

· Another option by Westone is an earmold designed to sit on the ear over an ITC instrument. The stethoscope eartip is replaced with a screw-on replacement ball that will snap into the corresponding socket in the earmold. The earmold sits over the instrument when in use but remains attached to the stethoscope when not in use. (Other earmold manufacturers offer similar specialty earmolds.)

· Steth-O-Mates by Westone are silicone earpieces that replace the hard plastic earpieces found on most stethoscopes. It has a plunger shaped head that rests over the hearing aid. The large size works best on ITCs and the small size is for CICs. We have about a 60% success rate with these tips. (Other manufacturers offer similar eartips).

In-The-Ear (ITE) Hearing Aid Users


This is the most challenging group to accommodate. If the person experiences feedback with their ITE aids when using the telephone, they may have difficulty with a stethoscope with headphones. If a trial of the stethoscope with headphones produces unfavorable results, the only suitable option may be to take out the hearing aids to use the stethoscope.

· Using Headphones The E-Scope is a promising stethoscope that uses a walkman style headphone plugged into the audio output jack of the unit instead of the standard earpieces. It has high output gain so care must be taken when turning the unit on. This unit may be the only solution for ITE aids on the market and success depends on the tendency of feedback with the aid. Turning the volume down on the aid and/or the stethoscope may produce better results.

· Taking Out the Hearing Aids If you must take out the hearing aid, then any of the options in the section "Options for Non Hearing Aid Users" may be useful. Use the information on the 'Technical Specifications Page' to help choose the stethoscope that may be right for your needs.

Behind-The-Ear (BTE) Hearing Aid Users


Individuals with BTE aids often derive negligible benefit from an amplified stethoscope because the amplification is inadequate for their level of loss. The breath and bowel sounds are low frequency sounds and often someone with a sloping severe loss can benefit from an amplified stethoscope if they have better hearing in the low frequencies. Several options do exist but additional testing and tweaking may be necessary, depending on the loss.

· Earmold Modifications An earmold can be modified with a dimple (or well) in the heel of the earmold that will accept the stethoscope eartip. It centers the sound outlet of the stethoscope with the vent hole in the earmold so sound goes more directly into the ear canal. For severe loss or if feedback occurs, the user may be able to turn the volume down on the hearing aids to reduce the feedback.

· Using Direct Audio Input The Starkey ST3 stethoscope has an output jack and cord that connects to standard 'Euro' style plugs on audio shoes. This provides a direct connection to the hearing aid. Amplification may still not be adequate in the low frequency ranges of breath and body sounds, but some individuals may be able to pick up overtones to aid them.

"The information in this report is not all-inclusive."


This is simply a brave attempt to document and present information that will help medical professionals retain their job. Many hearing healthcare professionals and consumers are not aware of the many options that are available. They can now more confidently address this issue armed with alternative solutions.

We have compiled the technical specifications of the scopes described in this report into one list for reference use. The list and photos of the stethoscopes are on pages 5 and 6.

· Taking Out the Hearing Aids If you must take out the hearing aid, then any of the options in the section "Options for Non Hearing Aid Users" may be useful. Use the information on the 'Technical Specifications Page' to help choose the stethoscope that may be right for your needs.

"What's on the Horizon ?"


Some engineers have rebuilt or modified amplifiers to meet the gain needed by a specific individual. Other work that has been tested includes building a transmitter into the stethoscope to transmit via FM to a hearing aid. Another project allows interfacing to a cochlear implant speech processor.

These projects are usually limited because of funding. They are typically performed on a case-by-case basis. No known published documentation has been found but it is likely that other solutions and projects exist.

Currently, hearing aids don't amplify sounds in the low frequencies needed for heart and breath sounds. If a hearing aid can amplify the low frequencies needed, the issue remaining is how to couple the aid to a stethoscope. Many feel this solution would be ideal.

A stethoscope has been developed that digitally transposes heart sounds to higher frequencies where audiotry thresholds are lower and dynamic range of hearing is broader using software for a computer based stethoscope. See reference number 8 below.

Other References:


1) 'ALDs and the Medical Professional' identifies typical issues and possible solutions to the communication demands on the job. Available at www.beyondhearingaids.com
2) This "How to Cope with Scopes' report is available online at www.beyondhearingaids.com
3) Manufacturer Product literature
· Starkey Labs
· Agilent Technologies
· Cardionics, Inc.
· Graham-Field, Inc.
· Westone (Tech Tips for Specialty Earmold style #28, Stetho-O-Mates, and BTE Earmold Modifications)
4) Compton, C: The Scoop on Scopes (Stethoscopes and Hearing Loss). 1995
5) Morris, R: Coping On-the-Job, How Nurses deal with their hearing loss. 1996
6) Morris, R: Technical Report - Audible Signals in Hospital Settings Create Concern. 1996
7) Ross, M: Research and Technology, Hearing Loss. Nov-Dec 1996. 33:35
8) Dolan, T: Stethoscopes: Real-ear measurements and digital frequency transposition. Hearing Journal. Jan.2001. 36:44

For technical specifications and a look at some of the amplified stethoscopes marketed today, click here for the PDF file of this report.

Rebecca Morris, President of Effective Communication Solutions, Inc. and BeyondHearingAids.com , specializes in ALDs for consumers and professionals working with people with hearing loss. She performs hundreds of communication assessments and draws on these experiences to share practical information with professionals. If you have comments or solutions based on your experiences of if you need a resource, contact her at:

Effective Communication Solutions, Inc.
1030 Clubhouse Dr. Independence, KY 41051
bmorris@one.net
859-371-9203 (voice/tty)
859-371-1363 (fax)