an increase in the intensity and clarity of vocal resonance that may result from an increase in lung tissue density, such as in the consolidation of pneumonia. Assessed by having the patient repeat a phrase such as 99 during auscultation. Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said.
Moderate - Moderate - Inspiration = expiration - Mixed - Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in first and second intercostal spaces
Loud, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but will reappear shortly—sounds like opening a Velcro fastener. Inhaled air collides with secretions in the trachea and large bronchi. Clinical ex: Pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill who have a depressed cough reflex.
Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing; you can simulate this sound by rolling a strand of hair between your fingers near your ear, or by moistening your thumb and index finger and separating them near your ear. Inhaled air collides with previously deflated airways; airways suddenly pop open, creating crackling sound as gas pressures between the two compartments equalize. There are late inspiratory crackles, early inspiratory crackles, and Posturally induced crackles (PICs).
Sounds like fine crackles but do not last and are not pathologic; disappear after the first few breaths; heard in axillae and bases (usually dependent) of lungs. When sections of alveoli are not fully aerated, they deflate and accumulate secretions. Crackles are heard when these sections re-expand with a few deep breaths. Found in aging adults, bedridden persons, or in persons just aroused from sleep.
"voice of a goat." a change in the voice sound of a patient with pleural effusion or pneumonia as heard on auscultation. When the patient is asked to make ē-ē-ē sounds, they are heard over the peripheral chest wall as a long ä-ä-ä sound, particularly over an area of consolidated or compressed lung above the effusion.
a dry, grating sound heard with a stethoscope during auscultation. It is a normal finding when heard over the liver and splenic areas. caused by the beating of the heart against an inflamed pericardium or lung pleura.
Pleural friction rub
A very superficial sound that is coarse and low pitched; has a grating quality as if two pieces of leather are being rubbed together; sounds just like crackles, but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory. Caused when pleurae become inflamed and lose their normal lubricating fluid; their opposing roughened pleural surfaces rub together during respiration; heard best in anterolateral wall where greatest lung mobility exists. Clinical Ex. Pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae).
an abnormal sound heard on auscultation of an airway obstructed by thick secretions, muscular spasm, neoplasm, or external pressure. The continuous rumbling sound is more pronounced during expiration and characteristically clears on coughing, whereas gurgles do not.
a high-pitched inspiratory crowing sound heard without the stethoscope, occurring with upper airway obstruction (e.g., croup, foreign body aspiration, or acute epiglottitis). Louder in neck than over chest well. Originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body.
Low - Soft - Inspiration > expiration - Rustling, like the sound of the wind in the trees - Over peripheral lung fields where air flows through smaller bronchioles and alveoli
High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord); predominate in expiration but may occur in both expiration and inspiration. Air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors; the passageway walls oscillate in apposition between the closed and barely open positions; the resulting sound is similar to a vibrating reed. Clinical ex: Diffuse airway obstruction from acute asthma or chronic emphysema.
Sonorous rhonchi (wheeze)
Low-pitched; monophonic single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing. Air flow obstruction as described by the vibrating reed mechanism above; the pitch of the wheeze cannot be correlated to the size of the passageway that generates it. Clinical ex: Bronchitis, single bronchus obstruction from airway tumor.
Voice sound that is faint, muffled, and almost inaudible. Assess by asking person to whisper a phrase like "one-two-three" as you auscultate.
High - Loud - Inspiration < expiration - Harsh, hollow tubular - Trachea and larynx