Using a stethoscope while wearing a hearing instrument has always been and continues to be a particularly challenging problem. We at Westone have worked on this for years in an effort to find a solution. Heres some valuable insight and information that we think will help you in dealing with this issue.
In-The-Canal (ITC) and Completely- In-The-Canal (CIC) Hearing Instruments: Custom Fit
With an ITC or CIC, the challenge is to isolate the faceplate to create a sound path to the microphone.
In this case, the solution is the Style #28B vinyl earpiece. This style requires an impression that is taken with the ITC or CIC in the patients ear. Simply use a small piece of tape or plastic wrap to cover only the microphone port, not the entire faceplate. Then fill the ear with impression material as you normally do, making sure not to under fill the antihelix and helix lock area at the top of the ear. Because of the pressure exerted by the stethoscope, this area will help lock in the earpiece. This approach will leave a negative indentation of the faceplate of the hearing instrument on the impression. At this point, care must be taken to precisely mark the location of the microphone port and any switches or removal pulls that are present. The resulting earpiece will then replicate these faceplate features and will help to direct the sound to the microphone port and reject ambient noise. Also, due to the ball and socket attachment, the stethoscope must be sent to Westone for installation of the ball.
In-The-Canal (ITC) and Completely- In-The-Canal (CIC) Hearing Instruments: Generic Fit
Westone also manufactures a generic product known as a Steth-O-Mate, which is a cup-shaped, hollow
silicone ear tip to replace the hard tip that is found on most stethoscopes. The idea is, again, to isolate the faceplate on the hearing instrument. Two sizes are available: A .450 inch diameter for CICs, and a .700 inch for ITCs. Please specify if you are using a 3M Littmann stethoscope.
Behind-The-Ear(BTE) Hearing Instruments
This design is a variation of the Style #6, full shell acrylic earpiece. Its made with an indentation, called a stetho-
cut, designed to accept a stethoscope ear tip. The stetho-cut is placed in the center of the earpiece where the
sound tube is normally located. Because of this, the sound bore and tube are put at the bottom of the earpiece where the vent would normally be found. The full shell design of the earpiece is necessary because of the force that the stethoscope exerts on the earpiece. Consequently, no smaller style is available. With this earpiece, the sound from the stethoscope will be directed through, what is essentially, the vent of the earpiece. The stetho-cut is usually fitted with an MVP system, to allow for proper venting.
Anesthesiology Earpiece/Amplified Stethoscope Earpiece
This is essentially a Style #1, snap ring earpiece, typically used with body-worn hearing instruments. A special
metal adapter, called an Adapt-A-Scope, is inserted into the snap ring coupler. This adapter has a nozzle tip designed to accept large scope tubing (3.175 mm inside diameter) that in turn attaches to the equipment used by an anesthesiologist. This earpiece, adapter and scope tubing, can also be used to attach directly to a precordial stethoscope chest piece to monitor a patients heart rate and breathing during an in-office procedure requiring sedation. Medical professionals with hearing loss can use this same earpiece setup to facilitate the use of an amplified stethoscope fitted to one ear, while using a hearing instrument in the other.
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Receiver-In-Canal (RIC) and Open Fit (slim/thin acoustic tube) Hearing Instruments
RICs and slim/thin tube hearing instruments are the greatest challenge. Because of their design, there really isnt a practical way to create an earpiece that isnt cumbersome and occluding. Again, the force that the stethoscope exerts on the earpiece is the problem. As a result, there are only two practical options. One is to lessen the force that the stethoscope exerts on the ear by systematically adjusting (bending) the
tension spring that is attached between the ear tip arms. However, care must be taken when bending
this spring because it is possible to make the stethoscope too loose. If done properly, this will allow the stethoscope to rest just at the entrance to the ear canal and not displace the slim/thin tube or receiver wire of the hearing instrument from its normal position. The other alternative is to utilize the T-Coil available on most hearing instruments, to take advantage of the newest electronic stethoscopes that are compatible with either a neck loop or direct audio input.