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PubMed1996

Classification of temporomandibular joint sounds based upon their reduced interference distribution.

Temporomandibular joint (TMJ) sounds were recorded in 98 orthodontic retention patients, mean age 19 +/- 8.6 (s.d.) years, by interview, auscultation and electronic recording. Sounds were found by auscultation in 41% and by interview in 32% of the subjects, more often in females than in males (P < 0.05). A new method for time-frequency analysis, the reduced interference distribution (RID), was used to classify the electronic sound recordings into five subclasses, RID types 1-5, based upon location and number of their energy peaks. RID types 1-3 had a few energy peaks close in time. RID types 4-5, typical of subjects with crepitation, had multiple energy peaks occurring close in time for a period of 20-300 ms. RID type 1, found in 45% of the subjects, typical of patients with clicking, had its dominant energy peak located in a frequency range < 600 Hz and was significantly more common in the female than in the male subjects (P < 0.01). RID type 2, found in 68% of the subjects, with the dominant peak in the range 600-1200 Hz, and RID type 3, found in 38% of the subjects, with the peak in the frequency range > 1200 Hz, were found to have a similar gender distribution. RID type 4, found in 49% of the subjects, had the energy peaks distributed in the frequency range < 600 Hz. RID type 5, found in 43% of the subjects, more often in females than in males (P < 0.05), had the peaks distributed over the whole frequency range from about 30 Hz up to about 3000 Hz. In conclusion, a more detailed classification could be made of the TMJ sounds by displaying the RIDs than by auscultation. This suggests that RID classification methods may provide a means for differentiating sounds indicating different types of pathology.

Adolescent↗
PubMed1989

Accuracy of the Takeda TM-2420 ambulatory blood pressure monitor.

1. The accuracy of blood pressure measurement with the Takeda TM-2420 ambulatory blood pressure monitor and the TM-2020 data recorder have been assessed by comparison with simultaneous measurements taken using auscultation and direct femoral artery measurements. 2. Systolic blood pressure was underestimated by the TM-2420 by a mean of 10 mmHg (s.d. = 6, 95% confidence interval (CI) = -13 to -7) over the range of pressures measured by auscultation. It was underestimated by 23 mmHg (s.d. = 12, 95% CI = -28 to -18) compared with direct femoral artery measurements. 3. Diastolic pressure measurements were similar to those obtained by auscultation. When compared with direct femoral artery recordings, diastolic pressure was overestimated by about 5 mmHg (s.d. = 4, 95% CI = 3.4-6.6), which is consistent with indirect readings, taken with a 'standard' cuff (inflatable bladder 23 cm X 12 cm). 4. The TM-2420/2020 is thus suitable for ambulatory measurements of blood pressure when diastolic pressure is the criterion of interest.

Angiocardiography↗
PubMed2007

Transmission of lung sounds through light clothing.

BACKGROUND: Doctors are exhorted to always place the stethoscope directly on the skin and never to auscultate through clothing. Nevertheless, casual observation reveals that doctors and even pulmonologists often violate this principle. OBJECTIVES: This study was designed to evaluate the sensitivity of two common stethoscopes when used through clothing. METHODS: Littmann Classic and Littmann Master Cardiology stethoscopes were studied under conditions of light (60-100 g), medium (240 g) and heavy (555 g) force when placed on a lung sound test platform with one or two layers of cloth (T-shirt material and flannel) interposed between the stethoscope and the test surface. The test platform was designed to mimic the acoustic and mechanical properties of the chest wall and was driven by amplified white noise. The recorded amplitude spectra were compared over a range of 150-1,000 Hz. RESULTS: Compared to the sensitivity on a bare test platform surface, either fabric in single or double layers attenuated the sounds by a mean of 5-18 dB under light pressure. This attenuation was nearly abolished by the addition of either medium or heavy force on the stethoscope head. CONCLUSIONS: The deleterious effect of one or two layers of indoor clothing on lung sounds acquired through a stethoscope can be negated by force on the stethoscope head making effective auscultation possible. Nevertheless, auscultation through clothing remains problematic due to the hindrance to inspection and percussion and the risk of acoustic artifacts caused by clothing.

Auscultation↗
PubMed1979

Prevalence of mitral valve prolapse in presumably healthy young men.

We determined the prevalence of mitral valve prolapse (MVP) in presumably healthy young men by studying 107 male house officers and medical students with cardiac auscultation in the supine, sitting and standing positions. Echocardiograms were performed at rest in the supine position before and after amyl nitrite inhalation and were obtainable in 101 subjects. Eleven of the 101 subjects had abnormal findings on auscultation: four had an isolated click and seven had a click and late systolic murmur. Correlation of the independent auscultatory and echocardiographic data in the 101 subjects showed that all seven of the subjects with a click and a murmur had echocardiographic evidence of prolapse. None of the 90 subjects with normal auscultation or the four with an isolated click had an abnormal echocardiogram. All seven subjects with MVP had thoracic skeletal abnormalities, but only one was symptomatic. These data suggest that the prevalence of MVP in healthy young males is similar to the reported 6-10% prevalence in healthy young females.

Auscultation↗
PubMed1999

Clinical examination reliably detects intrinsic positive end-expiratory pressure in critically ill, mechanically ventilated patients.

Critically ill patients requiring mechanical ventilation often develop intrinsic positive end-expiratory pressure (PEEPi). Methods for its detection include an expiratory flow waveform display (not always available), an esophageal pressure transducer (invasive), or a relaxed or paralyzed patient. We sought to determine the accuracy of clinical examination for detecting PEEPi. Examiners blinded to waveform analysis assessed patients for the presence of PEEPi by inspection/palpation and auscultation. If either inspection/palpation or auscultation demonstrated PEEPi, it was said to be present by clinical exam. Clinicians with various levels of experience (attending, resident, student) made 503 observations of 71 patients. Sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were determined for inspection/palpation, auscultation, and clinical exam. PEEPi was present during 69.8% of observations. SENS, SPEC, and PPV of clinical exam were 0.72, 0.91, and 0.95 respectively for the examiners as a whole. Likelihood ratio for PEEPi detection by clinical exam was 8.35. Attending intensivists displayed SPEC and PPV of 1.0. NPV was only 0.58 (likelihood ratio 0.31). We conclude that the clinical exam is very good for detecting PEEPi at all experience levels; and further, that the clinical exam is only modestly useful for ruling out PEEPi, therefore, other tests should be used if PEEPi is not detected by clinical exam.

Adult↗
PubMed1991

Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis.

STUDY OBJECTIVE: Determine why crackles on chest auscultation are characteristic of most interstitial lung diseases, but may not be heard in sarcoidosis. DESIGN: All patients with sarcoidosis or cryptogenic fibrosing alveolitis seen during a four-week period were studied. In a second study to relate ausculatory findings to anatomy, patients with fibrotic changes on their chest roentgenogram were studied. SETTING: Patients were recruited from outpatient clinics. PATIENTS: In the first part, all patients seen over the course of one month were studied. In the second study, patients with pulmonary fibrosis seen on chest roentgenograms were studied. INTERVENTIONS: For the first study, two independent observers performed auscultation on five sites for crackles and reviewed four roentgenogram quadrants for changes. For the second study, patients underwent VC measurements, auscultation, and high resolution computer tomography scans. MEASUREMENTS AND RESULTS: For the first study, crackles were noted at greater than 2 sites in all 11 CFA patients, but only one of 17 SARC patients (p less than 0.001). Roentgenogram changes were seen in greater than 2 quadrants in nine of 11 CFA patients and eight of 17 SARC patients (p = ns). In the second study, the VC was similar in the two groups: SARC: 1.96 +/- .90 L (means +/- SD), 58 +/- 20.4 percent predicted; CFA: 1.81 +/- .33 L, 59 +/- 9.2 percent predicted). Only two of 14 SARC patients had crackles in greater than 1 area, while all 14 CFA patients had crackles at greater than 2 sites. The HRCT studies were read by a radiologist unaware of the diagnosis. The presence and degree (0 to 3 scale) of subpleural and peribronchial fibrosis were scored. Twelve SARC patients had peribronchial changes (mean score 1.9 +/- 1.08), while only eight had subpleural fibrosis (mean score .6 +/- .52). There was a significantly different pattern in the CFA patients, where eight had peribronchial fibrosis (mean score = .9 +/- .78, p less than 0.05) and all 14 had subpleural fibrosis (mean score = 1.6 +/- .73, p less than 0.01). CONCLUSIONS: We conclude that crackles are more frequent in fibrosing alveolitis than in sarcoidosis; this difference may be due to the distribution of parenchymal fibrosis.

Auscultation↗
PubMed1992

Histamine challenge in young children using computerized lung sounds analysis.

The use of the histamine challenge test (HCT) for the diagnosis of asthma has so far been limited to older children who can perform spirometry consistently. Recently, wheeze detection by tracheal auscultation with analog recording into a tape recorder has been utilized in young children in place of spirometry. Wheezing can also be identified using computerized lung sounds analysis (LSA) by a typical pattern on spectral analysis. Our aim was to develop a practical computerized system in which the response to histamine could be identified in an objective manner and documented on hard copy. Lung sounds were recorded with a Hewlett-Packard HP 21050A contact sensor placed over the right upper anterior chest. Sounds were amplified, band-filtered (50 to 2,000 Hz), and digitized at a sampling rate of 5.5 kHz into a Macintosh SE computer, and spectral LSA was performed. To validate our method, six older children (ages 9 to 16 years) with mild or moderate asthma underwent HCT. The identification of typical wheezing pattern (discrete, high-amplitude power peaks) on LSA was compared to 20 percent fall in FEV1 (PC20) and symptoms (cough, wheeze, chest tightness). In five children, the histamine concentration required to produce the characteristic wheezing pattern on LSA was half that required to produce a 20 percent fall in FEV1. In the sixth patient, wheezing on LSA and PC20 occurred at the same histamine concentration. To determine the technique's applicability to young children, we then studied six young asthmatic children (age 2 to 5 years). All children showed the wheezing pattern at a histamine concentration of 25 percent or 50 percent (one or two steps prior) to that producing symptoms (cough, wheeze, chest tightness) or wheezing on tracheal auscultation. Six age- and sex-matched nonasthmatic children (control subjects) did not show this pattern on LSA and had no symptoms or tracheal wheeze with HCT. We describe a sensitive method enabling application of HCT to young children who are unable to perform spirometry. This method is as sensitive as, and often more sensitive than, conventional PC20 with spirometry or tracheal auscultation.

Adolescent↗
PubMed1997

A new method for evaluating small intestinal motility using duplex Doppler sonography.

OBJECTIVE: Many techniques currently used to study motility of the small intestine are too complex for large-scale use; other techniques provide information that is nonspecific and nonquantitative. The aim of the present study was to verify whether intestinal peristalsis can be seen and quantitatively assessed by means of duplex Doppler sonography. SUBJECTS AND METHODS: We prospectively studied 152 normal fasting subjects using sonography, duplex Doppler sonography, and stethoscopic auscultation or phonocardiographic registration of bowel sounds in three abdominal sites. In each subject, we positioned the sample volume near the intestinal wall and then recorded Doppler signals of different amplitude and duration that related to bowel motility. Studies were repeated after ingestion of water (n = 55) and after a standard test meal (n = 73). The number of peristaltic waves and the number of bowel sounds revealed by the different imaging techniques were compared and statistically evaluated by Student's t test. RESULTS: Intestinal movements were classified as peristaltic or nonperistaltic (mixing movements) based on amplitude and duration of Doppler signals. The mean number of peristaltic waves revealed by Doppler sonography was three per minute in fasting subjects, with no significant increase after ingestion of water (3.78 per min) or the test meal (3.92 per min). The mean number of bowel sounds obtained with auscultation and phonocardiographic recordings was significantly higher in fasting subjects (8.7 per min) and after ingestion of water (9.55 per min) or the test meal (12 per min). CONCLUSION: Intestinal contractions produce Doppler signals of different amplitudes and duration, thus potentially allowing differentiation between peristaltic and nonperistaltic movements. This differentiation is not possible with auscultation or phonocardiographic registration because similar bowel sounds are produced by nonprogressive, mixing movements as well as by true peristaltic movements. Duplex Doppler sonography allows graphic visualization of intestinal movements that can be subjected to qualitative and quantitative analysis and may be suitable for the noninvasive study of small-bowel motility.

Auscultation↗
PubMed2006

Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope.

Rene Theophile Hyacinthe Laënnec (1781-1826) was a French physician who, in 1816, invented the stethoscope. Using this new instrument, he investigated the sounds made by the heart and lungs and determined that his diagnoses were supported by the observations made during autopsies. Laënnec later published the first seminal work on the use of listening to body sounds, De L'auscultation Mediate (On Mediate Auscultation). Laënnec is considered the father of clinical auscultation and wrote the first descriptions of bronchiectasis and cirrhosis and also classified pulmonary conditions such as pneumonia, bronchiectasis, pleurisy, emphysema, pneumothorax, phthisis and other lung diseases from the sounds he heard with his invention. Laënnec perfected the art of physical examination of the chest and introduced many clinical terms still used today.

France↗
PubMed1999

The medical and legal risks of the electronic fetal monitor.

Electronic fetal heart monitoring (EFM) is the most widely used method of monitoring the fetal heartbeat for possible signs of distress during delivery. Soon after its development in the 1960s, EFM replaced intermittent auscultation as the standard of care in the obstetrical community. However, Margaret Lent argues that the widespread use of EFM is both medically and legally unsound. Lent points to a series of clinical trials that demonstrate that EFM does not reduce fetal mortality, morbidity, or cerebral palsy rates. These studies suggest that EFM has a very high false positive rate, and that EFM usage correlates strongly with a rise in cesarean section rates. Similarly, EFM provides no protection in the courtroom. Though obstetricians believe that they should use EFM because its status as the standard of care will protect them from liability, Lent argues that it may in fact expose them to liability given its failings. Instead, she argues that auscultation is equally, if not more, safe and effective, and is more likely to protect physicians from liability. Lent concludes that obstetricians have an obligation to their patients and to themselves to adopt auscultation as the new standard of care.

Auscultation↗
PubMed2005

[Long term prognosis in relation to the presence of systolic heart murmurs in healthy middle-aged men].

BACKGROUND: The long-term prognostic value of systolic murmurs revealed by heart auscultation has previously not been published. In this survey the prognostic value of systolic murmurs has been studied in relation to coronary heart disease and aortic valve operations. MATERIAL AND METHODS: During 1972-75, a cohort of 2014 apparently healthy men (40-59 years) from five companies in Oslo, Norway underwent heart auscultation under standardized conditions. Systolic murmurs were graded from I to VI. The men were prospectively followed up for 21.5 years in order to study the frequency of aortic valve operations, myocardial infarctions and coronary bypass operations. RESULTS: Modest systolic murmurs (grade I-II, n = 441) were associated with an unadjusted relative risk of 5.4 (95% CI 2.1-14.0), and moderate to strong murmurs (grade III-IV: n = 32) with a relative risk of 114.6 (95% CI 44.9-292.1) for aortic valve operation over the course of 21.5 years. The incidence of myocardial infarctions did not show any significant relationship to murmurs. Among those who underwent aortic valve surgery and who had a baseline murmur > or = III, a fourfold increase in bypass operations was observed. INTERPRETATION: Apparently healthy middle-aged men with systolic murmurs grade III or IV revealed by heart auscultation should be followed up carefully with regard to future need for aortic valve surgery. The increased frequency of coronary bypass operations among those with systolic murmur grade III or IV is possibly a result of aortic valve and bypass surgery being performed simultaneously.

Adult↗
PubMed1991

[Methods for ensuring correct tracheal intubation. A review].

To confirm correct intubation of the trachea, the literature mentions the following methods: Auscultation of thorax, the sensation of normal ventilation, gastric and thorax movement, condensation of water vapor in the tube lumen, external palpation on the patient's neck of the tube and the cuff, tactile palpation through the patient's mouth of the tube, x-ray of thorax and detection of hemoglobin oxysaturation with pulse oximetry. These methods can be used, but cannot be recommended, because they are not reliable. The following methods are recommended in the literature as reliable: Repeated laryngoscopy when there are direct visualization of the vocal cords, fiberoptic bronchoscopy, suction on the tube with a 60-ml syringe, auscultation of the upper abdomen and lungs and end-tidal carbon dioxide measurement. For the daily routine, control, of the endotracheal tube placement, by auscultation over the epigastrium, then in the right and left axilla, and continuous measurement of carbon dioxide in the expired air are recommended.

Auscultation↗
PubMed1984

[Pseudostenosis sounds and angiographic findings].

The suspicion of a carotid interna stenosis a short distance above the bifurcation because of a clear stenotic bruit on auscultation of the neck area proved to be unjustified in several cases, when angiography control was performed. In most cases, the superior thyroid artery was atypically developed (struma). An arterio-venous fistula of A. occipitalis was also wrongly suspected to be a carotid interna stenosis a short distance above the bifurcation, even when examined by Doppler ultrasonography, because of increased murmur of blood flow. When auscultating carotid bifurcation, proximal murmur from the heart must be excluded as well as venous hum. The later occurs mostly in hemodialysis patients and children. In approximately 10-20% of stenotic bruit cases in the neck area no stenosis could be detected. On the other hand, in more than 70% of all cases of carotid stenosis a short distance above the bifurcation no flow murmur could be detected by auscultation. The statistics show, however, that in every case of stenotic bruit, a generalised atherosclerosis must be suspected. Every such patient should therefore be carefully examined.

Auscultation↗
PubMed1981

[How Kergaradec listened to the fetus (author's transl)].

Laennec wrote in the second edition of his Treaty on Auscultation (1826, II, 457) : "I never thought of applying auscultation to studying the phenomena of pregnancy. This fortunate idea came to my compatriot and friend Monsieur le docteur de Kergaradec." It was in fact on the 26th December 1821 that Kergaradec read his "Memoire on Auscultation as applied to the study of pregnancy" and posed the vital question : "Would it not be possible to judge the state of health or illness of the fetus from the variations in the strength and frequency of the fetal heart beat?" The answer 160 years later, after so much work has been done by innumerable authors is : yes, the fetal heart does make it possible to judge as to the vitality or the distress of the fetus! It is right that today obstetricians should stop a little and think about Kergaradec's existence on earth and on the everlastingness of his inspired prophecy, for he was the first to think of it.

Female↗
PubMed1993

Diagnosis of obstructive airways disease from the clinical examination.

OBJECTIVE: To determine the operating characteristics of history and physical examination items for pulmonary airflow obstruction. DESIGN: Prospective observational study. SETTING: Medical Preoperative Evaluation Clinic at the Durham Veterans Affairs Medical Center. PATIENTS/PARTICIPANTS: Consecutive patients referred for outpatient medical preoperative risk assessment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Number of years the patient had smoked cigarettes, patient-reported wheezing [LR+ (likelihood ratio for finding present) = 3.1; LR- (likelihood ratio for finding absent) = 0.58], and auscultated wheezing (LR+ = 12; LR- = 0.87) were independent predictors of obstructive airways disease from the history and physical examination. Forced expiratory time and peak expiratory flow rate, both measured by the clinician at the bedside, were additional independent predictors of airflow obstruction. A nomogram using patient-reported wheezing, number of years the patient had smoked, and auscultated wheezing was developed and validated (area under receiver operating characteristic curve = 0.78; p = 0.0001) for the bedside prediction of obstructive airways disease. Peak expiratory flow rate can be substituted for auscultated wheezing with similar predictive ability. CONCLUSIONS: The results of bedside clinical examinations predict the presence of obstructive airways disease. A nomogram based on a combination of four bedside findings predicts airflow obstruction as well as clinicians' overall clinical impressions.

Aged↗
PubMed2002

Detection of swallowing sounds: methodology revisited.

Cervical auscultation is in the process of gaining clinical credibility. In order for it to be accepted by the clinical community, the procedure and equipment used must first be standardized. Takahashi et al. [Dysphagia 9:54-62, 1994] attempted to provide benchmark methodology for administering cervical auscultation. They provided information about the acoustic detector unit best suited to picking up swallowing sounds and the best cervical site to place it. The current investigation provides contrasting results to Takahashi et al. with respect to the best type of acoustic detector unit to use for detecting swallowing sounds. Our study advocates an electret microphone as opposed to an accelerometer for recording swallowing sounds. However, we agree on the optimal placement site. We conclude that cervical auscultation is within reach of the average dysphagia clinic.

Acoustics↗
PubMed1980

Pediatric follow-up of a randomized controlled trial of intrapartum fetal monitoring techniques.

A controlled prospective study was conducted to evaluate possible effects of the use of three intrapartum fetal monitoring techniques on the offspring of high-risk mothers in labor after at least 34 weeks' gestation. Six hundred and ninety women were randomly assigned to one of the three monitoring groups: auscultation alone, electronic monitoring alone, and electronic monitoring with option to obtain fetal scalp pH. There were no significant differences among the three groups of offspring with respect to neonatal mortality or morbidity, Apgar scores, cord blood gas values, or Brazelton examinations at ages 2 to 3 days. Assessment of the infants at 9 months revealed no significant differences in their growth and development as assessed by physical examination. Bayley Scales of Infant Development, and Milani-Comparetti tests. The frequency of delivery by cesarean section was significantly higher in the electronically monitored group than in the auscultated group. This study failed to show beneficial effects of electronic fetal monitoring over auscultated monitoring for high-risk but relatively mature fetuses.

Clinical Trials as Topic↗
PubMed1992

Discrepancies in recording systolic blood pressure of elderly persons by ambulatory blood pressure monitor.

Agreements between auscultatory blood pressure measurements and recordings of the Suntech Accutracker II ambulatory blood pressure monitor (ABPM) were examined in 103 participants ages 23 through 91 to estimate influence of age on accuracy of automated recordings. Simultaneous auscultation by two technicians and recording by the ABPM were compared. Technicians demonstrated close agreement in auscultation of blood pressure. Mean systolic blood pressure measured by ABPM was 5.6 mm Hg lower and mean ABPM diastolic blood pressure was 6.3 mm Hg lower than average auscultatory blood pressure measured by technicians (P less than .0001). Discrepancies in systolic blood pressure measurements between technicians and ABPM were associated with age and systolic blood pressure. The age effect, controlled for gender and race, was a 0.15 mm Hg increase in systolic blood pressure discrepancy per year of age. Discrepancies in diastolic blood pressure measurements were associated with race but not with age or body size measurements. Automated recordings of blood pressure by this ABPM may have systematic bias compared to auscultation which exceeds current standards for ABPM instrumentation. For systolic blood pressure, this bias increases with age and may affect interpretation of ABPM recordings in elderly persons.

Adult↗