Hearing aids + stethoscope

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Hello all,
Soon to graduate 4th year medical student going into emergency medicine here. I've actually posted about this topic in the past in other forums but haven't gotten a lot of really helpful advice, and my audiologist, while great, isn't that savvy when it comes to this sort of thing. Figuring maybe you folks are a little more in tune with current tech. Basically, I have mild-moderate hearing loss, currently using an open fit Dot^2 by ReSound. I technically can use a conventional stethoscope with the hearing aids in and hear a bit, but the fit isn't great and in particular, I have a difficult time hearing breath sounds, so I usually just take them off before using the stethoscope. Unfortunately, this isn't really so much an option in certain scenarios (ie. traumas). I also have an electronic stethoscope with headphones that I haven't used in a long time due to it being a pain to carry around and keep charged, and poor audio quality. I'm wondering if there's any model hearing aids or hearing aid tech that's out there that might be helpful.

Thanks!

Great question! You can order an amplified stethoscope. I can't recommend any specific ones, but I would say just do your research. Good luck!

I have an amplified electronic stethoscope, as I mentioned. The main problem isn't the volume- I can hear just fine with a conventional stethoscope- it's the fit.

Ah, I didn't catch the part about the amplified stethoscope. Maybe you should call Westone and find out if they can do a custom stethoscope (make sure they know it's for humans, not for hearing aids).

Originally Posted by Aesculapius

Hello all,
Soon to graduate 4th year medical student going into emergency medicine here. I've actually posted about this topic in the past in other forums but haven't gotten a lot of really helpful advice, and my audiologist, while great, isn't that savvy when it comes to this sort of thing. Figuring maybe you folks are a little more in tune with current tech. Basically, I have mild-moderate hearing loss, currently using an open fit Dot^2 by ReSound. I technically can use a conventional stethoscope with the hearing aids in and hear a bit, but the fit isn't great and in particular, I have a difficult time hearing breath sounds, so I usually just take them off before using the stethoscope. Unfortunately, this isn't really so much an option in certain scenarios (ie. traumas). I also have an electronic stethoscope with headphones that I haven't used in a long time due to it being a pain to carry around and keep charged, and poor audio quality. I'm wondering if there's any model hearing aids or hearing aid tech that's out there that might be helpful.

Thanks!

I can't imagine a stethoscope would be very comfortable with receiver-in-the-canal hearing aids in place! But that doesn't mean you need to give up on this style. I wonder if a "streamer" is the way to go.

Even big BTE hearing aids are too small to accommodate a bluetooth receiver. So the hearing aid companies have come up with streamers that can still communicate with the HAs wirelessly, but not via bluetooth. The streamer contains the bluetooth receiver, so with a cell phone, for example, the bluetooth signal goes from phone to streamer, and then using a different wireless frequency and protocol, from streamer to hearing aids. And you can also connect audio devices to the streamer through a wired connection. I don't know what the electronic stethoscope is like, and what kinds of input/output jacks it has, but if you could plug it into a streamer like one can connect an iPod... Here are directions for the Oticon streamer: http://oticonusa.com/Oticon/Professi...amer/iPod.html I am not familiar with what ReSound has in this regard -- maybe they have something similar?

This way, you would not have to have anything on your ears besides your hearing aids, just the streamer hanging around your neck, plugged into the stethoscope. (Of course if the audio quality is lousy to begin with, maybe this is not such a great idea, but maybe there are better ones out there?)

And I am guessing you've probably already googled and found this, but here's an interesting article:
http://www.healthyhearing.com/conten...e-hearing-aids
and also from the Association of Medical Professionals with Hearing Loss:
http://www.amphl.org/stethoscopes.php

Kitska, thanks a lot for your reply. Hadn't heard of streamers before, but that sounds like it would be a good solution. And yes, I have seen those articles before.

Disregard. Missed your aid manufacturer..

Just to add to what everyone has already mentioned... If you have an audiology program connected to your university they may be able to help you (for free or a very reduced price!) figure out what products may work. My first year in the audiology program I had a client who was in the same position as you. We gave that person many options and let them try out a few different products before making an investment into the products. Unfortunately, I was not able to be there when they came back and made their decision; however, I know that they were able to find a solution since they were able to borrow products to test out. Hope this helps!

Acoustics on breath/lung and heart sounds is below 2kHz with most DDx info below 500Hz.

The OP is wearing open fit aids. You're never going to get volume below 1kHz no matter what you do with the aid or getting the signal to the aids. Actually 1k is a generous offer.

OP: what's your actual audio. Only way you're going to have benefit from those aids is to plug your ears up with either a mold or an ITE style device. This may or may not be appropriate based on your loss. You're not the only one who has complained about crappy sound quality in amplified scopes.

-D

Originally Posted by DrAudio

Acoustics on breath/lung and heart sounds is below 2kHz with most DDx info below 500Hz.

The OP is wearing open fit aids. You're never going to get volume below 1kHz no matter what you do with the aid or getting the signal to the aids. Actually 1k is a generous offer.

OP: what's your actual audio. Only way you're going to have benefit from those aids is to plug your ears up with either a mold or an ITE style device. This may or may not be appropriate based on your loss. You're not the only one who has complained about crappy sound quality in amplified scopes.

-D

That makes a lot of sense -- thanks for posting (I find this all helpful review for the Praxis!). Maybe the streamer is not such a hot idea, then, though I do know people with normal hearing or mild loss who use open fit with streamers for handsfree phone use (These are people who get the HAs for free because they work in the field as reps or dispensers, otherwise, there are cheaper ways to achieve handsfree!) But there is probably more info in the higher frequencies in speech compared with what you are listening for with a stethoscope.

DrAudio: If you're asking me what my hearing loss is- it's sensorineural, worse at higher frequencies. I don't know much more than that- I'd have to ask for my record. If I understand what you said correctly, do you mean that the volume from the stethoscope is too low, or the frequency is too low, or what?

I do want to note that I previously had CIC and tried using the non-molded stethoscope tips, which did not work at all, so if anyone else has a similar issue, I would not recommend that approach.

Originally Posted by Aesculapius

DrAudio: If you're asking me what my hearing loss is- it's sensorineural, worse at higher frequencies. I don't know much more than that- I'd have to ask for my record. If I understand what you said correctly, do you mean that the volume from the stethoscope is too low, or the frequency is too low, or what?

I do want to note that I previously had CIC and tried using the non-molded stethoscope tips, which did not work at all, so if anyone else has a similar issue, I would not recommend that approach.

I will try to put together a reasonably concise response when I get home from work tonight explaining what I mean.

If your previous audio was done at whatever hospital you're currently working at get those results. Always a good idea to keep copies of your medical records.

-D

Originally Posted by DrAudio

Acoustics on breath/lung and heart sounds is below 2kHz with most DDx info below 500Hz.

The OP is wearing open fit aids. You're never going to get volume below 1kHz no matter what you do with the aid or getting the signal to the aids. Actually 1k is a generous offer.

OP: what's your actual audio. Only way you're going to have benefit from those aids is to plug your ears up with either a mold or an ITE style device. This may or may not be appropriate based on your loss. You're not the only one who has complained about crappy sound quality in amplified scopes.

-D

Thank you for posting this. Great info for the Praxis.
It seems like OP's main complaint is comfort. If hearing is fine with a conventional stethoscope, I assume OP doesn't want to be constantly taking the aids in and out to use it. Can you comment on using a streamer in this case? I'm not sure what ReSound has out there, but I've heard of people plugging a direct audio cable into an e-scope and being able to listen through the aids. The streamer wouldn't be useful for anything else after cranking up the lows (which may not be enough as you've already mentioned).. But again, the main problem is fit and comfort. At my current placement, we've had recent success fitting phonak nano's for a few using amplified telescopes. I need to remember that most settings require a bit more than a co-pay to make this stuff happen. :/

Ok, here goes..... OP, I don't know how much hearing science background you have but it's all fairly straight forward and easy if you're used to it. If you need further explanation, feel free to ask. Also, please excuse the lousy photoshop skills and cell phone pictures.

Also, aud students, what have you been taught as far as fitting to max gain levels? I tend not to fit above about 30dB as I find most patients complain of ambient sounds too much. Any arguments to this?

So assuming primary F(0) of a lung being approximately 300Hz.....

Let's say we have three audio's. All very likely. On two of the audio's you'd be ok fitting RIC/RITE style devices with open domes because you don't care so much about gain below about 1kHz (essentially normal hearing). However, given the low frequency bleed on an open fit you'll lose ALL gain below 1k-1.2kHz without a mold. This is the same as building a subwoofer without a rear baffle if anyone ever tried it. That said, even if you bother to figure a way to stream the information to the aids alls you're going to get, if you're LUCKY, are 3rd harmonics starting around 1500Hz based on a 300Hz f(0). Ok, I realize it's actually going to be a 1400Hz harmonic. My shoddy mental math has run away for the night. But look where most of the dx information is (yellow). WELL below anything the aid will give you in the primaries of the asculatation. But it'd be completely inappropriate to occlude this person just for the sake of giving them heart sounds cause the rest of the fitting will fail.






On the third audio you need gain from 250 through 6kHz. Obviously on the third audio you could get low frequency gain any number of ways but lets just assume in this case the patient is a physician who uses a stethoscope regularly and prefers an ITE style device. IMO a Lyric or Soundlens device would probably be ideal assuming there's enough real estate in the canal as opposed to a traditional CIC. The nice thing about this loss is you'd be fitting for lows in the first place and not worry about occlusion. So you'd be getting the necessary gain <1kHz to pick up ddx from heart/lung sounds. That's why the "only" issues you'd need to worry about was getting the signal to the aids (streamer is fine, you guys are right) and physical fit (can be a bitch when device is fully seated past second bend).



I hope I've made that reasonably muddy. OP, that's why it's important to know the actual audio rather than just saying I've got a mild-mod SN loss.....

Making sense to anyone??

-D

Well the Dot2 doesn't have T-coils so you can't use a blue tooth to T-coil device to use something like an e-scope.

Most likely you would need to upgrade your hearing aids if you wanted to use them to use your stethoscope.

The new Resound Alera hearing aid you can use the bluetooth phone clip with a bluetooth stethoscope to stream it directly to your hearing aids for an added boost and have your audiologist add a program with expansion off to increase the low frequency sounds for better vitals listening so you could just change to the program when you needed to use your stethoscope. As someone mentioned, you won't get a whole lot of low frequency sound into the ear without closing off the ear (you could try tulip domes if you don't mind the occlusion a little or a pair of custom receiver in the ear micromolds to wear at work could help.

The dot2 would be a tough one to pair a stethoscope with since it doesn't have wireless capabilities and doesn't accept a boot for DAI.

Your best bet would be to buy the high end E-scope amplified stethoscope for the time being and use it with a small set of tips on it so you won't have to take your hearing aids off. Your audiologist can turn on the mute button so you can hold the program button down for 3 seconds and mute the mics of your hearing aids so you can hear the vitals.

I feel for you. I have high frequency hearing loss and with my tinnitus and mild high frequency loss I struggle to hear breath sounds on the floor even with my high end littman stethoscope!

spot reserved for comment after comps..

Originally Posted by DrAudio

You're not the only one who has complained about crappy sound quality in amplified scopes.

This makes me hesitant to recommend an amplified stethoscope to patients... is there just a specific price-point for when quality begins? Is it the stethoscope that's causing the bad quality, or could higher quality headphones (like Etys) be a fix? What's different about a streamer... I mean, wouldn't you still need an electronic stethoscope and risk bad quality?

Originally Posted by rEliseMe

This makes me hesitant to recommend an amplified stethoscope to patients... is there just a specific price-point for when quality begins? Is it the stethoscope that's causing the bad quality, or could higher quality headphones (like Etys) be a fix? What's different about a streamer... I mean, wouldn't you still need an electronic stethoscope and risk bad quality?

I wouldn't recommend an amplified stethoscope. They are built as an afterthought - a bandaid.

As to using a streamer, it would again of course depend on the thresholds. If the streamer has a DAI and the stethoscope has an output you shouldn't have a problem. I wouldn't think. I've never done it.

But AGAIN, in this case (s)he's wearing open fit aids. Doesn't matter what you stream to them, they're just not going to give the patient any gain where the heart/lung sounds are.

-D