He remembered that a few days before, while walking in the Tuileries garden in Paris, he had seen children scraping a stick of wood and listening to the other end. Because percussion was technically difficult (given the large size of the woman’s breasts) and since direct auscultation (i.e., placing the physician’s naked ear over the patient’s naked chest) was, in Laënnec’s own words, “inadmissible” (given the young lady’s age and gender), Laënnec came up with a totally different approach. In the fall of 1816 (a year after the battle of Waterloo), he was summoned to the bedside of a young woman with a chest illness. The hero of this rediscovery was an introverted, diminutive, very asthmatic, very prudish, and very tuberculotic Breton physician, named René Théophile Hyacinthe Laënnec. It took a lot of serendipity (and plenty of shyness) to rekindle it as indirect auscultation, that is, one “mediated” by a newly invented cylindrical instrument, the stethoscope. by the sound they make.” Yet, during the 18th and early 19th centuries, direct auscultation fell rapidly out of favor, being replaced by a newer diagnostic modality: chest percussion. He wrote, “Who knows? It may be possible to discover the motions of internal parts. The hypochondriacal Robert Hooke, an assistant to Robert Boyle and one of the first scientists to use the word cell (1664), even had a good insight in describing heart sounds. Since then, chest auscultation was mentioned by Caelius Aeralianus, Leonardo Da Vinci, Ambroise Paré, William Harvey, Giovanni Battista Morgagni, Gerhard Van Swieten, William Hunter, and many others. In fact, Hippocrates himself taught and practiced auscultation, advising physicians to apply their ears to the patient’s thorax in order to detect various diagnostic sounds. 1400–1200 BC), and the Hippocratic writings (4th century BC). References to breath sounds first appeared in the Ebers papyrus (c. It is best heard in the lower anterior lungs and lateral chest, during both inspiration and expiration.Auscultation of the direct or immediate variety (that is, without the use of the stethoscope) has actually been around for a long time. Potential causes include tuberculosis and pneumonia. The sound quality is considered a harsh grating or creaking. The pleural rub sound results from the movement of inflamed pleural surfaces against one another during chest wall movement. Fine crackles sound quality is like hair rubbing near the ear and may be heard in congestive heart failure and pulmonary fibrosis. Coarse crackles sound quality is low-pitched and moist it may be heard in pulmonary oedema and bronchitis. Crackles can be further categorised as coarse or fine. It is commonly heard in the bases of the lung lobes during inspiration. The cause of crackles can be from air passing through fluid, pus or mucus. The sound crackles create are fine, short, high-pitched, intermittently crackling sounds. It may be heard in asthma, emphysema and chronic bronchitis.Ĭrackles are also known as alveolar rales.

It is commonly heard in the lungs during expiration. Alternately, what we often refer to as rhonchi is the sonorous wheeze, which refers to a deep, low-pitched rumbling or coarse sound, as air moves through tracheal/bronchial passages in the presence of mucus or respiratory secretions.

This refers to the high-pitched, whistle-like sound. The classic wheeze may be referred to as a sibilant wheeze. This is caused by air passing through an obstructed, narrow airway. The sound of a wheeze is a high-pitched, continuous musical sound. It’s typically loudest over the anterior neck, as air moves turbulently over a partially-obstructed, upper airway. Stridor may be heard in conditions such as croup and foreign body obstruction. The cause of this sound is generally the partial obstruction of the larynx or trachea. Stridor is a continuous, high-pitched, crowing sound heard predominantly on inspiration.

Copd adventitious breath sounds