Paramedic turned student doctor -- stethoscopes

Hearing Aids
#1

Hello all,
I have lurked these forms from time to time seeking advice and reviews and have received a lot of helpful information over the years, but I am currently at a cross-roads and a loss for how to continue.
I have worn hearing aids since I was 3 months old (currently going on 30). I have been a paramedic for the past 8 years. When I first started as an EMT I used to take my hearing aids out and use a standard stethoscope which worked well-enough. When I became a paramedic I decided I no longer wanted to take my hearing aids out and risk contamination with bodily fluids so I purchased and used a Cardionics E-Scope I which worked AMAZINGLY well with my hearing aids at the time, a pair of Starkey IQ9 ITC. They also worked well with Starkey IQ9 CIC that I started with, I eventually changed to the ITC because I wanted to fit a telecoil in (a feature I later deemed USELESS). Almost two years ago I switched to a BTE-RIC with full shell RIC Costco KS5. These HA’s have been more trouble than anything I have previously used in my life, and they have never played nice with my stethoscope. I have tried everything from a streamer, to using over the ear headphones, to eventually giving up and taking my hearing aids and reverting to a traditional analog stethoscope. I was recently accepted to medical school and will be attending in the fall (woohoo!). This new chapter of my life leads me with new hearing related challenges–I am now going to need to listen for heart murmurs and other difficult to hear body sounds that I did not need to hear as a paramedic. Therefore I am currenly in the market for new HA’s and a new stethoscope, and I would love some help from the medical professionals on this page whose comments I have read numerous times.
Many previous posters have found luck with open-fit style domes. This is not an option for me as my hearing loss is too severe for that.
I thought I found quite the novel solution recently with bone-conducting headphones that I could plug into my stethoscope. That idea fell flat. The consumer technology is just not there yet and the “bone conduction” is realistically just a speaker outside the ear (yes there is some bone conduction occuring as I can feel it, but it is minimal compared to sound transference. My wife could hear the audio across the room with background noise on better than I could w/o HA on).
My main issue is:

  1. Resign to removing my HA’s (and stick with BTE for easy removal) and switch to standard stethoscope (although I would likely still get an amplified one) OR
  2. Try to find a HA that will allow me to use an electronic stethoscope over the HA or stream to the HA.

I would vastly prefer option 2, but from what I have read it is very difficult for HA to reproduce the frequency range I would require for heart murmurs (sub 200Hz).

This is a few years old audiogram and it was done hastily, but gives a pretty good idea:

<tbody> </tbody>
250 500 1k 2k 4k 6k
RIGHT 45 55 85 75 60 55
LEFT 35 55 65 75 60 60

Thank you in advance for any thoughts/suggestions.
-Peter

#2

I have been using a Thinklabs stethoscope with open fit RIC aids and the system works well for me. The stethoscope can be adjusted for both volume and frequencies. I use the Beats earbuds which are standard but over the ear headphones are available. There is also a link to a smartphone app which is meant for teaching but might be adapted for your needs. The people at Thinklabs are very responsive, try calling or emailing them (Thinklabs.com).
Good luck at Med school. Some schools handle students who have life experience better than others.

#3

I have good hearing in the lower frequencies so I am able to use an acoustic cardiology stethescope with my receiver in canal HAs. I have to mute the HAs to do this and sometimes it can be uncomfortable when the stethescope presses on the receiver wires. The biological sounds are in the low frequencies.

I too have been considering the Thinklabs One as it seems to be the only electronic stethescope which is truly tailored for those of us with hearing loss. The other advantage is that you can view a graphic representation of what you are hearing via a smart phone app and connection. The best time to learn how to interpret that is in medical school which would be ideal for you. The only thing which has stopped me so far is no local support in Australia. They have a great website so you can look at their advice for different types of HAs and setup.

Good luck and do report back on what setup you finally decide on.

#4

I don’t have any specific scope suggestions for your situation, but just two pieces of steth-related advice. First, check your med school’s course schedule. It’s very possible you won’t even be needing a stethoscope until well into your second year. I didn’t need one until Intro. to Clinical Medicine at the bottom of my second year. First year and most of second year are predominantly lecture/lab, and cadavers don’t have pulses so… and as you said, consumer tech isn’t there yet and who knows what will be available in two years. The second piece of advice would be, when you do get a stethoscope, especially an expensive one, don’t lend it to anyone (unless it’s your chief resident or attending, the two people you’re not allowed to say “no” to, but don’t let them out of your sight with it), hang it outside an operating theater with your white jacket, or otherwise leave it lying anywhere that’s not on your person. Put it in your locker before you scrub in. Stethoscopes are probably the-most stolen item reported by hospital staff. I personally lost two 3M Littmann Cardiologys, and switched to a cheaper Classic II SE (that never got stolen, go figure) after the second one.

Edit: Actually before the II SE I bottomed out with a $10 no-name sprague type, but after finding out I couldn’t hear jack in the trauma bay with the hard tips and having my glasses sent flying by the tubing clips one too many times, THEN I got a II SE. lol…

#5

Thank you all for the replies. I think it is worth considering the ThinkLabs stethoscope even if I can’t find hearing aids that work well with them. I’m curious if anyone else out there has any experience regarding what hearing aids will give me the best frequency response in the low end that would also meet my needs? I know hearing aids tend to suck in the lower frequencies…
Open fit style hearing aids are typically out of the question for my loss, but I’m game to try anything. Psocoptera- do you use open fit RIC or do you have molds? I’m curious how well sound would transfer through a hard mold, I’ll give my buddies electronic Littmann a try when I can.
Kwythe- that’s a good point about not needing one yet, I will check my course schedule. Through my experience in EMS I’ve learned that trial by fire for hearing aid and stethoscope combos does not work well, so ideally I’d like to find a solution well before I need to use it, and I figured while I’m still working as a paramedic is a great chance to trial in real world setting. I too learned to hold onto my ears, I once lent my Littmann to an RN I was working with and it walked away. Amazing how inanimate objects grow legs. Thankfully no one can rock my Cardionics EScope (nor would they want to because my headphones–like everything else in the field–are quite worse for wear, but still function perfect!) since I have yet to encounter another person have one. I also noticed you have fairly bad hearing in the high frequencies as well, an I correct in assuming you use a hard mold as well? if so, do you currently take your HA out or have some other method?
Thank you everyone. This is very helpful for me!
Peter

#6

Peter,
I wear open domes with receiver in canal Phonak Audeo V90s so I use my natural hearing for the stethescope use. Since you have access to listening to patients as a paramedic, I would advise listening to every heart, lungs and abdomen you can so you get a feel for what you are listening to and try out all the possibilities. The graphic representation with the Thinklabs apparently takes a bit of learning but may offer a better result for you. Perhaps a combination of listening and the graphic representation would work better. You may need to experiment. Both the Thinklabs site and some available apps will give you sample murmurs/heart sounds etc. to try. It depends on both your hearing loss and the range of your HAs and every combination is different. The Thinklabs can connect to HAs via some streamers but it is not always the best solution. Over the ear headphones are reccommended for most but again it all depends on how well your Aids reproduce the sounds. Make use of any free trials to work this out. You probably want to do a bit of research about what you are listening to also so you know what you should be hearing. Littman’s Sound Builder app is one source on iOS if you have access. Merk Sharp and Dohme have had a good set of heart sound simulator CDs in the past so you can probably get those in a commercial downloadable version by now. They covered all the heart sounds and murmurs and teach you what to listen for. If your medical school has experience with hearing impaired students they may be able to offer advice or assistance also so do ask.
Back when I did my medical clinical finals (before my hearing loss) I was given a short case. I reported my findings to the examiners and told them my diagnosis but confessed that I could not hear the expected cardiac murmur. They asked me to describe what I expected to hear and then moved me on to the next case. One of the examiners took my stethescope and disappeared. He came back and informed me that he couldn’t hear the murmur with “that thing” either and told me to get a new stethescope. I passed and bought my Littmans cardiology stethescope. I have two in case I lose one but they have always found their way back to me somehow - so label yours well.

#7

Hi Peter, Did you get this matter resolved?
I’m a flight paramedic and recently switched to Resound Linx 9 h/a with a Unite external bluetooth mic option. I believe that the 3.5mm jack plug on a Thinklabs One stethoscope will plug directly into the 3.5 mm input jack of the Unite mic and feed everything direct to my hearing aids.
I’m just holding off buying the Thinklabs One just yet as some users are experiencing reliability problems. I suspect its probably rough handling, but at almost NZ$900 its a lot of money. My Littmans 3000 steth is just not cutting it any more unfortunately.

#8

I am hopefully returning to the nursing world at some point in the next few months and am thinking I need to get a new stethoscope. I have a Littman Cardiology 3, which worked really well for me when I only had a mild hearing loss in my right ear, and slight-to-no hearing loss in my left ear. But now with both ears having a loss, I’m guessing I may need something else. Because I use an ear mold in my right ear and an open fit dome in my left, I’m thinking that I won’t be able to use the Littman anymore. Thoughts? I honestly don’t know how to assess what I do and do not hear with my current stethoscope…how does one know what they’re not hearing? I don’t want to be taking my aids in and out of my ears to use the stethoscope. I’m just not sure I want to spend the money on a Thinklab scope when my new job will likely be working with an ENT, and, inasmuch, won’t likely ever require the use of a stethoscope once I’ve done my upgrading hours to re-license. So, does anyone think there is any way to continue on with my Cardiology 3 Scope, or should I just bite the bullet and purchase a Thinklabs scope?
Carol, you mentioned using a regular scope with your open-dome aids muted. How does that work? How do you have the confidence that you are actually hearing everything you need and/or want to hear with your aids and a regular scope?
Thanks for your help!
Kerry

#9

I haven’t been able to practice for over a year due to various health issues, so I haven’t used my Thinklabs. Congrats on getting back to work. Take a look at the Thinklabs web site. They offer a 30 day trial for hearing impaired users. They also talk about connecting the scope to a streamer. Even in an ENT office, on the rare occasions that you need a stethoscope, you really ​need it.
Good luck.
Diana

#10

Thank you, Diana. I have messaged ThinkLabs as I’m unsure how I would best use their scope given that my hearing is significantly different between ears and use one ear mold and one dome. I’m hesitant to use any method which would require me to remove my hearing aids, but at this point, I just need to make sure I can do my job well, so I want ThinkLabs’ recommendation before going ahead and ordering one. I’m not back at work yet… I’m appealing the return to practice procedure from my regulatory licensing body. I have a hearing to attend in mid-June. If they approve me to return to practice, I will be required to find and start a nursing position within 30 days of notification of licensure, so I won’t have much time between finding out my license has been reinstated and starting work, hence the reason I’m looking into things now. I want to be on top of this now rather than scrambling at the last minute!
I’m sorry to hear that you are no longer practicing. I hope your health improves! I have always gotten the impression, from reading your posts, that you loved your job!
Kerry

#11

Thanks Kerry. There’s a certain amount of bending and twisting involved when you try to examine uncooperative children, and my fused spine just can’t do it so I am pretty much retired. :frowning: I do miss it, but am finding lots of things to do that I never had time for.
Good luck in your quest to get back.

#12

Hi Kerry,

All the biological sounds are 600 Hz or less (heart sound around 200 Hz and less). I use my natural hearing with open fit RIC aids - open domes. Sometimes the pressure from the stethoscope pushes the wires deeper in my ear canals which is annoying but it is not for long and if needed I just remove the wire and reinsert when that happens. Any solution should work for your left ear but the right would probably do better with a streamed signal and closed fit aid. If you need a bit of amplification on the left you might want to look at the Littman’s electronic stethoscopes as they seem to be more robust and will probably last better. But the problem with straight out amplification is that they amplify the same amount on both sides. Your right ear would need a sound level too loud for your left so if you want to hear the sounds in both ears then streaming to HAs via the thinklabs would be required. If I were you I would try just using the best solution for your left ear. Going through a lot of set up hassle and money for occasional use does not seem worth it. Have you tried getting out your old stethoscope and trying to listen to your own heart and breath sounds? I find that the cheap bedside stethoscopes at my work are not any good but my Littman’s cardiology is fine with my minimal loss in the low frequencies.

Hope this helps and good luck with your return to work.

#13

Hi Carol;

I have been using my Littman Cardiology 3 stethoscope since the onset of hearing loss. With it, I can definitely hear my own, my hubby’s, and my childrens’ heart beats without my HAs in. The Cardiology 3 has a great baseline amplification! My daughter has a very faint heart murmur and I can still hear that with my stethoscope. I guess my biggest concern is that I have no way of knowing what I’m not hearing. But in the practice setting I’m likely to be working in (an ENT surgeon’s office), I really don’t think I’ll be using it much, other than to take HRs and BPs for pre-op medicals. I believe the process to get my RN license back will involve at least one practicum, so I will likely need the stethoscope for that, but afterwards, I really won’t have a tonne of use for it. I’m fairly confident the surgeon I will be working with would have no issue purchasing an automatic BP cuff, especially since he knows that I am HOH and use hearing aids.

Maybe what I’ll do is start listening to the lungs and hearts of everyone who walk through my front door. (I get a lot of company these days with play dates and such, so in theory, I could get a lot of practice!) If I do that, I should be able to determine if I will need a better scope. I have a friend with bad asthma who lives close by, too, so perhaps her rales and rhonchi will be a good test for me. I’m also going to check out the Littman electronic scope. I had read about it previously but had since forgotten about it.

Thank you for your advice and well wishes.

Kerry

#14

Kerry,

I think trying out your current stethoscope is a great way to go. Wheezes are probably the most high pitched of the biological sounds along with stridor so if you can hear all the basics you should do fine. Let us know how it all goes.

#15

For anyone still looking for a stethescope solution there is a new player in the field - the Eko Core. It comes as either a stand alone scope which can be used in acoustic or digital mode or a kit to convert your own compatible acoustic stethescope. It has Bluetooth connectivity and both iOS and android apps for recording and visual representation. The scope still works as analog if the rechargable battery runs out. Amplification is up to 40X. I have not tried this product but it does look more robust than the thinklabs one. It also looks much simpler. It can interface with electronic health records to allow archiving.

#16

Thank you for this information, Carol. Do you know of anyone who has tried it?
I did message ThinkLabs about their scope, and they didn’t really give me a satisfactory answer when I told them I use one HA with an ear mold and the other with a dome. They responded to all of my questions as if I wear two ear molds. I’m actually thinking that for now, I will simply remove my left HA while using my Cardiology III stethoscope, and listen only with the one ear. I will check out the Eko Core, too, because I would like to have something useful to use for the long haul.

Kerry

#17

Kerry,

I don’t have first hand reports but learned about it via the AMPHL (American Medical Practitioners with Hearing Loss). They have posted a comparison table for stethescopes on their website and tweeted about it recently. I like the idea of converting my Cardiology stethescope to digital and being able to still use it as a simple acoustic scope as I choose. Great for if the battery runs out too.

#18

Quick Update: I found a job and will be returning to work as a RN in 1.5 weeks! Yay! It’s both exciting and daunting. I still haven’t figured out how using a stethoscope is going to work but having spoken with the lady who will be my manager, she said the nurses in her clinic don’t use stethoscopes at all. I find that a bit hard to believe, but I guess I’ll find out shortly. My current plan is to bring my old scope in, and, if I find I can’t use it with just the one ear, I will probably order a ThinkLab scope within the next month or so.
Carol, I spoke with Eko Core after I read your message. They weren’t that helpful as they were unsure how (or IF) things would work while using one ear mold and one dome. I’m starting to think I will get an ear mold for my left ear within the next year or so. I’m guessing that with the LF loss in that ear, a mold is going to be the best option sooner rather than later. Having two matching receivers may make the professional aspect of my life less complicated in terms of purchasing modified diagnostic equipment, especially since I am hoping to regain my NP license again within the next 2 years.

#19

Great to hear you are going back to work! Most hospitals and even GP offices now use automatic BP/Sats/HR measuement machines but they still use manual measurements when the BP is low and the machines can’t cope and ICU nurses still listen to breath sounds. In an outpatient clinic setting this would be rarely needed and the automated machines would do a good job the great majority of the time. It’s still good to have your stethescope for use with a manual BP cuff for that occasional need. I wouldn’t spend a fortune on a solution you only end up using rarely. I’m still going with my cardiology stethescope but I’m due for a hearing test so I’ll reassess my options when I see the results. Hope you enjoy your return to work.

Carol

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#20

Great that you are able to go back to work. Good luck.