![]() In cases of diffuse wheezing, it is most often in the form of bilateral wheezing, of various tonalities, heard especially at the end of expiration and encountered in instances of bronchial asthma. ![]() In cases of localized wheezing, it can be heard during inspiration or during both phases, with similar pitch, caused by partial obstruction of the trachea or bronchi, due to the presence of a tumor or foreign body. They include inspiratory wheezes, as well as sibilant wheezes heard during both phases of breathing. Of bronchial origin and variable intensity, wheezes are heard at a distance from the patient. ![]() The lung is collapsed by the pressure of fluid or air in the pleural cavity, such as in cases of pneumothorax or pleurisyĪbsence of ventilation in the affected lung area, for example, in cases of lung compression, especially in atelectasis with retractionĪfter pneumonectomy, on the operated side. ![]() The vesicular murmur is weakened in the following circumstances:Įxtensive thickening of the wall, for example, in obesity), for example, in cases of emphysema (chest hyperinflation. Very soft noise, audible throughout the entire phase of inspiration and during early expiration.ĭetected in antero-lateral areas of the chest and in the back, it consists in a continuous, soft low intensity murmur, heard throughout inspiration Type of lung sounds according to international nomenclature Table 1 gives a description of various auscultatory findings - normal breath sound, namely the vesicular murmur, and abnormal (pathological) - use clinically according to international literature. In terms of respiratory pathology, it should be emphasized that, only a small number of sounds are currently well identified and documented in regard of physical characteristics ( for review see the reference ). It is generally accepted that the frequency of lung sounds ranges between Hz, while tracheal sounds can reach up to 4000 Hz. These sounds are characterized by a wide spectrum of different sounds - the average frequency depends on the site of auscultation. īreath sounds or noises are produced by airflow in the respiratory system as well as the work of the breathing apparatus. Thus, as we have hypothesized, the new intelligent communicating stethoscope systems will also possibly contribute to a new auscultatory semiology, based on reliable methods of signal analysis and on visual display, and will be complementary to the acoustic signals perceived by the practitioner. The precise definition of these physical characteristics and the availability of new visual representations of sounds constitute exciting perspectives for teaching and pedagogy, as we shall see later in this chapter. Whilst conventional stethoscope auscultation is subjective and hardly sharable, the characterization and identification of sounds by computer-based recording and analysis systems provide objective and early diagnostic help along with better sensitivity and reproducibility. The original Laennec stethoscope, in wood, retains in the Museum of the History of Medicine, in Paris, France. Note the handwritten Latin dedication to his uncle Guillaume Laennec in Nantes: “ A mon excellent oncle, mon autre père” ("To my great uncle, my other father"). Front cover of the first edition of the “ Traité de l’Auscultation Médiate”, Paris, France, 1819. Portrait of René Théophile Hyacinthe Laennec. This chapter aims to review recent technological advances, evaluate promising innovations and perspectives in the field of auscultation, with a special focus on the development of new intelligent communicating stethoscope systems in clinical practice, and in the context of teaching and telemedicine. The availability of novel representations of the sounds, with phono- and spectrograms, also opens interesting perspectives in the context of diagnostic aids, but also in education and pedagogy. More recently, we have seen advances in the techniques used to process auscultatory signals as well as in the analysis and clarification of the resulting sounds. Over the past two decades, much of the progress made in this area has resulted primarily from improvements made to the stethoscope itself. However, the ability to differentiate between normal and abnormal sounds or noises (vesicular sounds, wheezes, crackles, etc) remains essential in clinical practice for correct diagnosis and management. Laennec ( Traité de l’Auscultation Médiate, Paris, 1819 ) and over the years very few changes have been made to both the stethoscope itself and the way in which it is used. The stethoscope and the semantic of auscultatory findings were invented more than 200 years ago by Dr.
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