respiratory sounds
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{{Infobox medical condition (new)
| name = Respiratory sounds
| synonyms = Breath sounds, lung sounds
| image = Lungs diagram detailed.svg
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| field = Respirology
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Respiratory sounds, also known as lung sounds or breath sounds, are the specific sounds generated by the movement of air through the respiratory system.{{Cite web|title=Breath sounds: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/article/007535.htm|access-date=2021-11-11|website=medlineplus.gov|language=en}} These may be easily audible or identified through auscultation of the respiratory system through the lung fields with a stethoscope as well as from the spectral characteristics of lung sounds.{{cite journal|last=Sengupta|first=Nandini|author2=Sahidullah, Md|author3=Saha, Goutam|title=Lung sound classification using cepstral-based statistical features|journal=Computers in Biology and Medicine|date=August 2016|volume=75|issue=1|pages=118–129|doi=10.1016/j.compbiomed.2016.05.013|pmid=27286184}} These include normal breath sounds and added sounds such as crackles, wheezes, pleural friction rubs, stertor, and stridor.
Description and classification of the sounds usually involve auscultation of the inspiratory and expiratory phases of the breath cycle, noting both the pitch (typically described as low (≤200 Hz), medium or high (≥400 Hz)) and intensity (soft, medium, loud or very loud) of the sounds heard.
Normal breath sounds
Normal breath sounds are classified as vesicular, bronchovesicular, bronchial or tracheal based on the anatomical location of auscultation.{{Cite book|last=Bickley|first=Lynn S|title=Bates' Guide to Physical Examination and History-Taking|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|year=2013|isbn=978-1609137625|pages=311–312|language=English}}{{Citation|last1=Zimmerman|first1=Barret|title=Lung Sounds|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK537253/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30725938|access-date=2021-11-11|last2=Williams|first2=Donna}} Normal breath sounds can also be identified by patterns of sound duration and the quality of the sound as described in the table below:
| class="wikitable"
|+ !Name !Location where heard normally !Quality of sound !Sound duration !Example |
| tracheal
|over the trachea |very loud |expiratory sound duration is equivalent to inspiratory sound | |
| bronchial
|over the manubrium |loud, high pitched |expiratory sound duration is longer than inspiratory sound | |
| bronchovesicular
|anteriorly between the 1st and 2nd intercostal space; posteriorly in-between the scapulae |intermediate |expiratory sound duration is about equivalent to inspiratory sound | |
| vesicular
|over most of both lungs |soft, low pitched |expiratory sound duration is shorter than inspiratory sound | |
Abnormal breath sounds
Common types of abnormal breath sounds include the following:{{Cite journal|title = Fundamentals of Lung Auscultation|last = Bohadana|first = Abraham|date = February 20, 2014|journal = New England Journal of Medicine|doi = 10.1056/NEJMra1302901|pmid = 24552321|volume=370|issue = 8|pages=744–751| s2cid=17871815 |url = https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1060&context=internalmedicine_facpub}}
| class="wikitable" |
| Name
! Continuous/discontinuous ! Frequency/pitch ! Inspiratory/expiratory ! Quality ! Common Causes ! Example |
|---|
| Wheeze or rhonchi
| continuous | high (wheeze) or lower (rhonchi) | expiratory or inspiratory | whistling/sibilant | Caused by narrowing of airways, such as in asthma, chronic obstructive pulmonary disease, foreign body. | {{listen | filename = Wheeze2O.ogg | title = Wheezing | description = The sound of wheezing as heard with a stethoscope. | format = Ogg }} |
| Stridor
| continuous | high | inspiratory, expiratory, or both{{Cite journal |last1=Leung |first1=Alexander K. C. |last2=Cho |first2=Helen |date=1999-11-15 |title=Diagnosis of Stridor in Children |url=https://www.aafp.org/afp/1999/1115/p2289.html |journal=American Family Physician |volume=60 |issue=8 |pages=2289–2296 |pmid=10593320 |issn=0002-838X}} | whistling/sibilant |epiglottitis, foreign body, laryngeal edema, croup | {{listen | filename = Stridor NP OGG 2.ogg | title = Stridor | description = Inspiratory and expiratory stridor in a 13-month child with croup. | format = Ogg }} |
| Inspiratory gasp
| continuous | high | inspiratory | whoop | pertussis (whooping cough) | see New England Journal of Medicine, [http://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMp038243&aid=NEJMp038243_attach_1&area= Classic Whooping Cough sound file], Supplement to the N Engl J Med 2004; 350:2023-2026 |
| Crackles (rales)
| continuous | high (fine) or low (coarse) | inspiratory | cracking/clicking/rattling{{Cite web |title=Breath sounds: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/007535.htm |access-date=2022-05-06 |website=medlineplus.gov |language=en}} | pneumonia, pulmonary edema, tuberculosis, bronchitis, heart failure | {{listen | filename =Crackles pneumoniaO.ogg | title = Crackles | description = Crackles heard in the lungs of a person with pneumonia using a stethoscope. | pos = right | format = Ogg }} |
| Pleural friction rub
|discontinuous |low |inspiratory and expiratory |many repeated rhythmic sounds |inflammation of lung linings, lung tumors |not available |
| Hamman's sign (or Mediastinal crunch)
| discontinuous | | neither (heartbeat) | crunching, rasping | pneumomediastinum, pneumopericardium | not available |
| Grunting
|Continuous |low |expiratory |snoring | |
=Continued=
- Rales: Small clicking, bubbling, or rattling sounds in the lungs. They are heard when a person inhales. They are believed to occur when air opens alveoli. Rales can also be described as moist, dry, fine, and coarse.{{Cite web |title=Breath sounds: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/007535.htm |access-date=2022-05-30 |website=medlineplus.gov |language=en}}
- Rhonchi are coarse rattling respiratory sounds, usually caused by secretions in bronchial airways. The sounds resemble snoring. "Rhonchi" is the plural form of the singular word "rhonchus".
- Stridor: Wheeze-like sound heard when a person breathes. Usually it is due to a blockage of airflow in the windpipe (trachea) or in the back of the throat.{{Cite web |title=Stridor: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/003074.htm |access-date=2022-05-30 |website=medlineplus.gov |language=en}}
- Wheezing: High-pitched sounds produced by narrowed airways. They are most often heard when a person breathes out (exhales). Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.{{cite web | url=https://www.nlm.nih.gov/medlineplus/ency/article/007535.htm | title=Breath sounds: Medline Plus | publisher=NIH | access-date=5 May 2015}}
Other tests of auscultation
File:Physical Exam - Stethoscope.jpgPectoriloquy, egophony and bronchophony are tests of auscultation that utilize the phenomenon of vocal resonance. Clinicians can utilize these tests during a physical exam to screen for pathological lung disease. For example, in whispered pectoriloquy, the person being examined whispers a two syllable number as the clinician listens over the lung fields. The whisper is not normally heard over the lungs, but if heard may be indicative of pulmonary consolidation in that area. This is because sound travels differently through denser (fluid or solid) media than the air that should normally be predominant in lung tissue. In egophony, the person being examined continually speaks the English long-sound "E" (/i/). The lungs are usually air filled, but if there is an abnormal solid component due to infection, fluid, or tumor, the higher frequencies of the "E" sound will be diminished. This changes the sound produced, from a long "E" sound to a long "A" sound (/eɪ/).
History
In 1957, Robertson and Coope proposed the two main categories of adventitious (added) lung sounds. Those categories were "Continuous" and "Interrupted" (or non-continuous).{{cite journal|last1=Robertson|first1=A|title=Rales, rhonchi, and Laennec|journal=Lancet|date=1957|volume=2|issue=6992|pages=417–23|doi=10.1016/S0140-6736(57)92359-0|pmid=13464086}} In 1976, the International Lung Sound Association simplified the sub-categories as follows:
:Continuous
::Wheezes (>400 Hz)
::Rhonchi (<200 Hz)
:Discontinuous
::Fine crackles
::Coarse crackles{{cite journal|last1=American Thoracic Society Ad Hoc Committee on Pulmonary Nomenclature|title=Updated nomenclature for membership reaction|journal=ATS News|date=1977|issue=3|pages=5–6}}{{cite journal|last1=Loudon|first1=R|last2=Murphy|first2=R|title=Lung Sounds|journal=Am Rev Respir Dis|date=1984|volume=130|issue=4|pages=663–73|doi=10.1164/arrd.1984.130.4.663|doi-broken-date=1 November 2024|pmid=6385790}}
Several sources will also refer to "medium" crackles, as a crackling sound that seems to fall between the coarse and fine crackles. Crackles are defined as discrete sounds that last less than 250 ms, while the continuous sounds (rhonchi and wheezes) last approximately 250 ms. Rhonchi are usually caused by a stricture or blockage in the upper airway. These are different from stridor.
See also
References
{{reflist}}
{{cite journal |doi=10.1007/BF02345450|title=Pneumothorax detection using computerised analysis of breath sounds|year=2002|last1=Mansy|first1=H. A.|last2=Royston|first2=T. J.|last3=Balk|first3=R. A.|last4=Sandler|first4=R. H.|journal=Medical & Biological Engineering & Computing|volume=40|issue=5|pages=526–532|pmid=12452412|s2cid=7413897}}
External links
{{Medical resources
| DiseasesDB =
| ICD10 = R06
| ICD9 = {{ICD9|786.7}}
| ICDO =
| OMIM =
| MedlinePlus = 007535
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| eMedicineTopic =
| MeshID = D012135
}}
- [https://www.ontheward.com/respiratory-sounds OnTheWard Respiratory Sounds] - Multiple recordings of various respiratory sounds
- [http://respwiki.com/Breath_sounds Audio Breath Sounds] {{Webarchive|url=https://web.archive.org/web/20201215121532/http://respwiki.com/Breath_sounds |date=2020-12-15 }} - Multiple case studies with audio files of lung sounds.
- [http://www.rale.ca/Recordings.htm R.A.L.E. Repository] - Sound files of breath sounds
- [https://web.archive.org/web/20100112111621/http://www.mediscuss.org/content/respiratory-auscultation-tips-audio-mp3-examples-71.html MEDiscuss] - Respiratory auscultation with audio examples
- {{cite journal |vauthors=Wilkins R, Dexter J, Smith J |title=Survey of adventitious lung sound terminology in case reports |journal=Chest |volume=85 |issue=4 |pages=523–5 |year=1984 |pmid=6705583 |doi=10.1378/chest.85.4.523}}
- Lehrer, Steven. Understanding Lung Sounds. Elsevier 2002.
- [http://www.practicalclinicalskills.com/lung-sounds.aspx Lung Sounds] - 20 recordings and waveforms
{{Circulatory and respiratory system symptoms and signs}}
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