auscultation

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1. The act of listening.
2. Medicine. The act of listening for sounds made by internal organs, as the heart and lungs, to aid in the diagnosis of certain disorders.

[Latin auscultātiō, auscultātiōn-, from auscultātus, past participle of auscultāre, to listen to.]

Auscultation is the act of listening to sounds generated within the body, generally for the purpose of diagnosis of disease. It may be done directly with the unaided ear (immediate auscultation) or with a stethoscope (mediate auscultation).

Immediate auscultation was practised in ancient times. In both the Hindu and the Greek medical traditions, physicians listened carefully to the sounds which could be heard emanating from within the thorax. The Sanskrit medical texts mention the use of the sense of hearing to determine whether the contents of an abnormal cavity were gaseous. The Hippocratic writings describe the technique of succussion — shaking the patient to ascertain whether splashing noises could be elicited within the chest. Aretaeus the Cappadocian, in the second century ad, described how, in ascites, fluid could be heard fluctuating in the abdomen as the patient shifted position, whereas tympanites (gas in the abdomen) could be distinguished by the drum-like sound produced if the abdomen was struck with the hand.

In the eighteenth century, the great Italian physician/anatomist, Giovanni Morgagni, valued auscultation, pointing out that attending to the noises made by fluid fluctuating in the abdomen or thorax was useful in the identification of dropsy. The precise location and character of the noises could enable differentiation between the various forms of dropsy. For instance, the otherwise difficult diagnosis of ‘dropsy of the pericardium’ could be made confidently when the physician could ‘distinctly hear the agitation of the water itself in the pericardium’. In 1761, Leonard Auenbrugger, a Viennese physician, published a pioneering account of the related technique of thoracic percussion. The character of the sound elicited when the chest wall was tapped with a finger was indicative of the pathological condition of the underlying tissues.

At the end of the eighteenth century and the beginning of the nineteenth, in a series of developments principally associated with the Paris School, a new approach to internal disease was developed. The holistic, humoral pathology of earlier centuries was gradually replaced by a conception which localized disease in the solid structures of the body. The ‘anatomico-clinical’ perspective was based, as its name suggests, upon the twin pillars of pathological anatomy, which revealed the structural features of disease after death, and clinical observation, which sought to comprehend the structural features of disease in the living patient. Within this conceptual framework, techniques of physical examination were revived and their diagnostic potentialities systematically explored. A notable pioneer of the clinical use of the ear was the French physician, Jean-Nicolas Corvisart

, whose Essay on the Diseases of the Heart contained much that was new in the understanding of cardiac and aortal disorders.

Corvisart's preferred diagnostic technique was percussion, but both he and his Parisian colleague, Gaspard Bayle, experimented with applying the ear directly to the patient's chest. In 1816, Rene Laennec, who had been a student of Corvisart and who knew of Bayle's work, invented the stethoscope, which made examination of the chest much more convenient for both physician and patient. In 1819, Laennec published his great treatise On Mediate Auscultation. It has been fairly said that virtually everything that Laennec wrote on auscultation was new at the time, but is now familiar to every medical student. Laennec painstakingly described the normal sounds of the lungs and then identified a large number of abnormal sounds — bronchophony, pectoriloquy, egophony, the metallic tinkling, the cracked pot sound, a variety of ‘râles’, and so on. The most substantial section of the work is on tuberculosis, which provided him with ideal clinical material upon which to display the utility of auscultation of the lungs. Laennec also investigated the sounds of the heart in health and disease, describing, for the first time, the file, rasp, and bellows sounds, and a variety of murmurs. He showed, among much else, that valvular disease of the heart could be diagnosed by ear in the living patient. Applications for the new instrument were also found in the diagnosis of fractures, of bladder stones, and of liver abscesses. Laennec's investigations with the stethoscope, correlated always with post-mortem findings, laid the foundations of the modern procedures of physical diagnosis.

Laennec's innovation was adopted widely and quickly. The remainder of the nineteenth century saw considerable refinement of stethoscopic technique and design, and improved understanding of the pathological basis of abnormal sounds. Further applications were found for the instrument in the monitoring of pregnancy, of bowel function, and in the measurement of blood pressure. In the twentieth century, however, the ear has been displaced, to some extent, by the eye in physical examination. The invention of radiographic imaging demoted the stethoscope from its place of supreme authority in lung disorders; the ultrasonic scanner threatens the same in disorders of the heart. Blood flow can also now be visualized using Doppler ultrasound. Other imaging modalities provide clear, detailed pictures of all the body's cavities. Yet a trained sense of hearing remains an indispensable aid to the examining physician, and all medical students still have to strive to educate their ears along the lines first set out by Rene Laennec.

— Malcolm Nicolson

See also diagnosis; heart sounds; lungs.

The examination procedure of listening for sounds produced by the body to detect or judge an abnormal condition.

For more information on auscultation, visit Britannica.com.

Listening for sounds produced within the body, chiefly to ascertain the condition of the thoracic or abdominal viscera; it may be performed with the unaided ear (direct or immediate auscultation) or with a stethoscope (mediate auscultation).

• abdominal a. — for the purpose of listening to the sounds created by the movement of gas and fluid in the intestines, and in the forestomachs in ruminants. The presence or absence of sounds is valuable in assessing the motility of the gut.
• cardiac a. — auscultation of the cardiac area with special attention to location and size of the heart, the rhythm and intensity of the heart sounds, the presence of abnormal sounds and the relationship of the heart sounds to the occurrence of the pulse waves.
• a. with percussion — auscultation of one part of the region while percussing elsewhere. Used in examining the chest for areas of consolidation, or the bovine abdomen when searching for the displaced abomasum or the distended colon or duodenum.
• pulmonary a. — auscultation of both sides of the chest with the objective of ascertaining the state of the lungs and air passages. Points observed are the rhythm and depth of breathing, quality of the breath sounds and the size and disposition of the area over which they can be heard.
• thoracic a. — includes auscultation of the lungs and air passages, the pleural cavity including the presence of extraneous organs such as intestines, and the heart and pericardial sac. The principal rule in the examination is the absolute necessity of auscultating both sides of the chest.
• tuning fork a. — the tip of a tuning fork is placed over the area to be auscultated and the stethoscope applied nearby. Consolidated lung transmits the sound, normal lung muffles it. See also coin test.

For the ancient monasterial worker, see Auscultare

Laennec auscultates a patient before his students

Auscultation is the technical term for listening to the internal sounds of the body, usually using a stethoscope; based on the Latin verb auscultare "to listen". Auscultation is performed for the purposes of examining the circulatory system and respiratory system (heart sounds and breath sounds), as well as the gastrointestinal system (bowel sounds).

The term was introduced by René-Théophile-Hyacinthe Laennec. The act of listening to body sounds for diagnostic purposes has its origin further back in history, possibly as early as Ancient Egypt. Laënnec's contribution was to refine the procedure, to link sounds with specific pathological changes in the chest, and inventing a suitable instrument (the stethoscope) in the process . Originally, there was a distinction between immediate auscultation (unaided) and mediate auscultation (using an instrument).

Auscultation is a skill that requires substantial clinical experience, a fine stethoscope and good listening skills. Doctors listen to three main organs/ organ systems during auscultation: the heart, lungs, and the gastrointestinal system. When auscultating the heart, doctors listen for abnormal sounds including heart murmurs, gallops, and other extra sounds coinciding with heartbeats. Heart rate is also noted. When listening to lungs, breath sounds such as wheezes and crackles are identified. The gastrointestinal system is auscultated to note the presence of bowel sounds.

Electronic stethoscopes can be a recording device, and can provide noise reduction and signal enhancement. This is helpful for purposes of telemedicine (remote diagnosis) and teaching.

See also

• Pericardial friction rub
• Heart sounds
• Breath sounds
• Triangle of auscultation
• Percussion (medicine)

External links

• The Auscultation Assistant, - "provides heart sounds, heart murmurs, and breath sounds in order to help medical students and others improve their physical diagnosis skills"
• Traditional Chinese medicine - Auscultation of Traditional Chinese medicine
• Blaufuss Multimedia - Heart Sounds and Cardiac Arrhythmias
• http://www.andries.com - Commercial site, online auscultation training and a test instruction
• Thinklabs - Commercial site, digital stethoscopes
• Independent Stethoscope Review - Comparative review of stethoscopes, including frequency response graphs.

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