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Respiratory sounds

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Respiratory sounds are the specific noises made by air moving through the respiratory system. These sounds are often called lung sounds or breath sounds. Clinicians listen to these sounds to understand how a person's breathing is functioning. They can hear these sounds directly with their ears or through auscultation. Auscultation is the medical act of listening to sounds from the body. This is usually done using a stethoscope over the lung fields. By studying the spectral characteristics of these sounds, medical professionals can learn a great deal about health.

Physical Exam - Stethoscope
Physical Exam - Stethoscope

When assessing these sounds, clinicians focus on two main properties: pitch and intensity. Pitch describes how high or low a sound is. It is measured in hertz (Hz). A low pitch is typically 200 Hz or less, while a high pitch is 400 Hz or more. Intensity describes the volume, ranging from soft and medium to loud or very loud. Doctors also observe the breath cycle. They listen during the inspiratory phase, which is breathing in, and the expiratory phase, which is breathing out. Noting the duration of the sound during these two phases provides vital information.

Normal breath sounds are categorized by where they are heard in the body. Tracheal sounds are heard over the trachea and are very loud. In these sounds, the expiratory duration is equal to the inspiratory duration. Bronchial sounds are heard over the manubrium and are loud and high-pitched. For these, the expiratory phase lasts longer than the inspiratory phase. Bronchovesicular sounds are heard between the first and second intercostal space or between the scapulae. These have an intermediate intensity and similar durations for breathing in and out. Finally, vesicular sounds are heard over most of the lungs. These are soft, low-pitched, and the expiratory phase is shorter than the inspiratory phase.

Sometimes, the body produces adventitious sounds, which are added or abnormal sounds. These are often divided into continuous and discontinuous types. Continuous sounds last approximately 250 ms or longer. Examples include wheezes, which are high-pitched whistling sounds caused by narrowed airways. Rhonchi are lower-pitched, coarse rattling sounds that resemble snoring. These are often caused by secretions in the bronchial airways. Stridor is another continuous sound that is high-pitched and whistling. It usually occurs due to a blockage in the trachea or the back of the throat. An inspiratory gasp, like the "whoop" in pertussis, is also a continuous high sound.

Discontinuous sounds are also common and are defined as discrete sounds lasting less than 250 ms. Crackles, or rales, are a major type of discontinuous sound. They can be fine or coarse and often sound like clicking, bubbling, or rattling. These may occur when air opens the alveoli, which are tiny air sacs in the lungs. A pleural friction rub is another discontinuous sound. It consists of many repeated rhythmic sounds caused by inflammation of the lung linings. There is also Hamman's sign, which is a discontinuous crunching or rasping sound. This is related to the heartbeat and occurs during pneumomediastinum or pneumopericardium. Grunting is a low-pitched, continuous expiratory sound often linked to surfactant deficiency.

The way we classify these sounds has changed over time. In 1957, researchers Robertson and Coope proposed two main categories for adventitious sounds. They called them "continuous" and "interrupted" sounds. Later, in 1976, the International Lung Sound Association simplified these categories. They established that wheezes are continuous sounds above 400 Hz. They defined rhonchi as continuous sounds below 200 Hz. They also categorized crackles into fine and coarse types. This standardized system helps clinicians communicate clearly about what they hear.

Clinicians also use special tests involving vocal resonance to find disease. Vocal resonance is how sound travels through different tissues. In whispered pectoriloquy, a patient whispers a two-syllable number. Normally, a doctor should not hear this over the lungs. If the whisper is audible, it may indicate pulmonary consolidation, where lung tissue becomes denser. In egophony, a patient says a long "E" sound. If the lungs contain fluid or a tumor instead of air, the sound changes. The high frequencies diminish, making the "E" sound appear to be an "A" sound. These tests show how sound moves differently through air versus solid or fluid media.

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File:Physical Exam - Stethoscope.jpg
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