| Bronchophony | |
|---|---|
| Other names | Bronchiloquy [1] |
 | |
| Front view of cartilages of larynx, trachea, and bronchi. | |
| Specialty | Respirology |
Bronchophony is the abnormal transmission of sounds from the lungs or bronchi. Bronchophony is a type of pectoriloquy.
It is a general medical sign detected by auscultation.
The patient is requested to repeat a word several times while the provider auscultates symmetrical areas of each lung. The numbers "ninety-nine" or "sixty-six" are traditionally mentioned. The choice of "ninety-nine" is the result of a literal translation. The test was originally described by a German physician who used the phrase "neun und neunzig" (pronounced [ˈnɔʏnʊntˈnɔʏntsɪç]), which he found would cause maximum vibration of the chest. The translation, "ninety-nine", has fewer vowels and is less effective in evoking the phenomenon. Better phrases in English include "toy boat”, "Scooby Doo", and “blue balloons". [2]
Normally, the sound of the patient's voice becomes less distinct as the auscultation moves peripherally; bronchophony is the phenomenon of the patient's voice remaining loud at the periphery of the lungs or sounding louder than usual over a distinct area of consolidation, such as in pneumonia. This is a valuable tool in physical diagnosis used by medical personnel when auscultating the chest.
Often, the patient does not have to speak for the provider to hear signs of bronchophony. Rather, the normal breath sounds are increased in loudness – referred to by doctors as "increased breath sounds" – over the affected area of the lungs is indicative.
Bronchophony may be caused by a solidification of lung tissue around the bronchi – which may indicate lung cancer – or by fluid in the alveoli, which may indicate pneumonia. However, it may also have benign causes, such as wide bronchi. As such, it is usually an indication for further investigation rather than the main basis of a diagnosis.
Other tools used in auscultation include listening for egophony, whispered pectoriloquy, crackles, rhonchi or wheezing. Percussion is also often used to determine diseases of the chest.
René-Théophile-Hyacinthe Laennec was a French physician and musician. His skill at carving his own wooden flutes led him to invent the stethoscope in 1816, while working at the Hôpital Necker. He pioneered its use in diagnosing various chest conditions. He became a lecturer at the Collège de France in 1822 and professor of medicine in 1823. His final appointments were that of head of the medical clinic at the Hôpital de la Charité and professor at the Collège de France. He went into a coma and subsequently died of tuberculosis on August 13, 1826 at age 45.
The stethoscope is a medical device for auscultation, or listening to internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the skin, and one or two tubes connected to two earpieces. A stethoscope can be used to listen to the sounds made by the heart, lungs or intestines, as well as blood flow in arteries and veins. In combination with a manual sphygmomanometer, it is commonly used when measuring blood pressure.
Shortness of breath (SOB), also medically known as dyspnea or dyspnoea, is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing the intensity of its distinct sensations, the degree of distress and discomfort involved, and its burden or impact on the patient's activities of daily living. Distinct sensations include effort/work to breathe, chest tightness or pain, and "air hunger". The tripod position is often assumed to be a sign.
Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. Turbulent blood flow is not smooth. The sound differs from normal heart sounds by their characteristics. For example, heart murmurs may have a distinct pitch, duration and timing. The major way health care providers examine the heart on physical exam is heart auscultation; another clinical technique is palpation, which can detect by touch when such turbulence causes the vibrations called cardiac thrill. A murmur is a sign found during the cardiac exam. Murmurs are of various types and are important in the detection of cardiac and valvular pathologies.
Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days. The cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks. Some have symptoms for up to six weeks.
Crackles are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation. They are usually heard only with a stethoscope. Pulmonary crackles are abnormal breath sounds that were formerly referred to as rales.
Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or the elderly may have less clear symptoms.
Auscultation is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems, as well as the alimentary canal.
Pulmonary fibrosis is a condition in which the lungs become scarred over time. Symptoms include shortness of breath, a dry cough, feeling tired, weight loss, and nail clubbing. Complications may include pulmonary hypertension, respiratory failure, pneumothorax, and lung cancer.
Pneumonitis describes general inflammation of lung tissue. Possible causative agents include radiation therapy of the chest, exposure to medications used during chemo-therapy, the inhalation of debris, aspiration, herbicides or fluorocarbons and some systemic diseases. If unresolved, continued inflammation can result in irreparable damage such as pulmonary fibrosis.
In medicine, the cardiac examination, also precordial exam, is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination.
A respiratory examination, or lung examination, is performed as part of a physical examination, in response to respiratory symptoms such as shortness of breath, cough, or chest pain, and is often carried out with a cardiac examination.
Respiratory sounds, also known as lung sounds or breath sounds, refer to the specific sounds generated by the movement of air through the respiratory system. 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. These include normal breath sounds and adventitious or "added" sounds such as crackles, wheezes, pleural friction rubs, stertor, and stridor.
Pneumomediastinum is pneumatosis in the mediastinum, the central part of the chest cavity. First described in 1819 by René Laennec, the condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways, or bowel into the chest cavity. In underwater divers it is usually the result of pulmonary barotrauma.
A pulmonary consolidation is a region of normally compressible lung tissue that has filled with liquid instead of air. The condition is marked by induration of a normally aerated lung. It is considered a radiologic sign. Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood. Consolidation must be present to diagnose pneumonia: the signs of lobar pneumonia are characteristic and clinically referred to as consolidation.
Egophony is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is due to enhanced transmission of high-frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out. It results in a high-pitched nasal or bleating quality in the affected person's voice.
Fremitus is a vibration transmitted through the body. In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall and/or heard by a stethoscope on the chest wall with certain spoken words, although there are several other types.
Whispered pectoriloquy refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso.
In medicine Imaging Lung Sound Behavior with Vibration Response Imaging (VRI), is a novelty computer-based technology that takes the concept of the stethoscope to a more progressive level. Since the invention of the stethoscope by René-Théophile-Hyacinthe Laennec France in 1816, physicians have been utilizing lung sounds to diagnose various chest conditions. Today auscultation provides physicians with extensive information on the examination of the patient. The skills of the examiner however, vary, as seen in a clinical study that was conducted on the diagnosis of pneumonia in 2004.
The cardiovascular examination is a portion of the physical examination that involves evaluation of the cardiovascular system. The exact contents of the examination will vary depending on the presenting complaint but a complete examination will involve the heart, lungs, belly and the blood vessels.