by Neil Bauman, Ph.D.

A doctor explained,

I am a pediatrician with progressive hearing loss, due primarily to loud noises, and also a mild congenital deficit. I have been in practice for 33 years. An unavoidable part of my job includes very loud, screaming children. It is especially loud when I look in their ears! As my hearing loss worsened I developed hyperacusis. I learned to use my stethoscope as earplugs for noise protection while examining uncooperative young children. I went to hearing aids, but could not find relief from the screamers, nor could I use my stethoscope for protection. I abandoned them. There is also need for amplification of the stethoscope itself. Any suggestions?

When kids scream in your ears, don’t you just wish you could “put a sock in it”?

You may have hyperacusis, but since you have significant hearing loss, you will also have some degree of recruitment—when sounds rapidly become too loud as the volume increases. Whether you have recruitment and/or hyperacusis, the result is basically the same—loud sounds are now much too loud. In such situations using amplification (hearing aids) can be torture.

Using your stethoscope as ear plugs helps, but as you found, it only goes so far. Now you need more help. Here’s what I think I’d do if I were in your place.

First, you need hearing aids (I’d suggest behind the ear [BTE] aids) that have really good compression so you can limit all sounds above your recruitment threshold. Be warned that “screwing down” the compression will affect discrimination so you won’t understand speech as well this way—but at least the babies screaming shouldn’t hurt you anymore. There is a fine line you’ll have to find between the degree of compression you need that avoids the pain of loud sounds and how much amplification you need in order to be able to understand speech.

Second, I’d use non-vented full-shell ear molds so outside sounds can’t get in (like screaming kids). Essentially, the ear molds will act as wonderful ear plugs. The downside to having occluding ear molds is that voices will sound like you are talking in a barrel. Again, a trade-off. You might find you’d like a tiny vent in your ear molds—enough to help prevent occluding, but not enough to let much screaming through. (I have ear molds with a large vent hole—and a series of plugs with different sized vents in them so I can go from nil to small to large vents all with the same ear molds.

Third, I’d get hearing aids with good t-coils and have the t-coils set up properly (this is seldom done, unfortunately).

Fourth, I’d get an amplified stethoscope that can use silhouettes, Music Links or a neckloop so you can listen via the t-coils in your hearing aids. (We carry a couple of these kinds of stethoscopes).

What I’d do is switch my hearing aids off as needed so you’ll not hear the screaming kids nearly as loud (only via bone conduction since your ear canals are blocked by the occluding ear molds). You can then examine screaming-kids ears in peace as your ear molds are now essentially acting as ear plugs. You switch your aids back on when you want to talk to the parents (and if the child is still pretty loud, the compression should make the sound level bearable.)

When you want to use your amplified stethoscope, you hang the silhouettes on your ears, plug them into your stethoscope, switch your hearing aids to t-coil mode and hear via the t-coils in your hearing aids. This way you won’t hear much else since the microphones are off and the ear molds block sounds coming in. This leaves you free to concentrate on the sounds through your amplified stethoscope.

This solution won’t be perfect, as I’ve explained above, but I think you’ll find it ever so much nicer than what you are experiencing now.