Intermediate Lung Sounds

Vesicular – Diminished

As the name indicates, the vesicular diminished lung sounds are of a low pitch than the vesicular sounds. It is one of the intermediate lung sounds. These also have less density as compared to the vesicular sounds. This is most common in people of old age. In old age, breathing becomes more shallow.

A less volume of air moves through the airway of elderly patients. These patients show vesicular diminished breathing or vesicular diminished breath/lung sounds. The vesicular diminished lung sounds are less sturdy and full than vesicular sounds. These diminished sounds can occur due to the accumulation of some fluid or air around the lungs.

Bronchophony – Healthy

Bronchophony is an abnormal condition in which the sound transfers abnormally through the bronchi and lungs. In the state of health, this sound is masked or very diminished. The patient is asked to say the word “ninety-nine” in his normal voice to perform the bronchophony test.

If the patient is healthy, the result of auscultation will be that we will hear this voice as a muffle sound. It will not be distinctive. In a healthy state, the bronchophony is to be negative, i.e., when the patient says the word 99, the sound should be faint. In a healthy person, bronchophony is absent.

Bronchophony – Abnormal

It is a peculiar behavior. It is a sign of an abnormality in the lungs where the sound is transferred through the lungs and bronchi. To perform the bronchophony test, the patient utters the word ninety-nine repetitively. If we hear this sound is clearly while auscultation, then the bronchophony test is positive.

This positive bronchophony test is associated with lung consolidation when there is an increased density of the lung tissue due to fluid accumulation, i.e., blood or mucus. Bronchphony can also be due to the solidification of the tissue around the lungs or due to wide bronchi.

Egophony – e

We can hear the increase in the resonance of voice while auscultating which is egophony. Conditions like lung consolidation and fibrosis lead to egophony. There is an increase in transmission of high-frequency sounds across the fluid around the lungs in abnormal lung tissue, and the low-frequency sounds are masked. This leads to the production of a distinctive nasal sound.

While listening to the breath/lung sounds with the help of a stethoscope, the person is asked to say the vowel “e.” In a normal and healthy person with a healthy lung, the same “e” sound or “beet” is heard. This phenomenon is called egophony-e or a positive egophony.

Egophony – a

The increase in the resonance of voice heard while auscultating is called egophony. Conditions like lung consolidation and fibrosis lead to egophony. There is increased transmission of high-frequency sounds across the fluid around the lungs in abnormal lung tissue, and the low-frequency sounds are masked.

This leads to the production of a distinctive nasal sound. While listening to the breath/lung sounds with a stethoscope, the person is asked to say the vowel “e.” In an unhealthy person with a problematic lung, the “e” sound or “beet” is transformed into “a.”This phenomenon is called egophony-a or a positive egophony.

Whispered Pectoriloquy – Healthy

Whispered pectoriloquy is a condition in which there is an increased loudness of whispering noted while auscultating a person on the torso. Usually, in a healthy state of lungs, we can hear these sounds by the clinician while auscultating the lung field. In the state of health, when the person says “1-2-3”, the soft vowel sounds and the sounds of high frequencies are masked.

The patient says “1-2-3” repetitively to notice this intermediate lung sound. Normally only faint sounds are heard due to the dampening of these sounds, which indicate that there is no problem with the lungs.

Whispered Pectoriloquy – Abnormal

Whispered pectoriloquy is a condition in which there is an increased loudness of whispering noted while auscultating a person on the torso. In an unhealthy state of lungs, we can hear these sounds by the clinician in a distinctive way while auscultating the lung field.

When the person says “1-2-3”, the soft vowel sounds and the sounds of high frequencies are not masked and can be heard loudly. The patient says “1-2-3” repetitively to notice the whispered pectoriloquy. Whispered pectoriloquy is positive in the patient with lung diseases like the presence of a solid mass of lung or a malignancy.

Wheeze – Expiratory

The expiratory wheezing means that we can hear the sound of wheezing only when there is the exhalation of air out of the airway. Expiratory wheezing is more common than inspiratory wheezing. It is less severe than inspiratory wheezing. Wheezing heard during the expiration only shows some mild obstruction in the airway due to some blockage.

Two common diseases causing mild airway obstruction include COPD and asthma. The treatment of Expiratory wheezing can be by some home remedies such a steam inhalation, taking immunotherapy, anti-allergens, use of humidifiers and hot drinks, etc. The use of air filters and eliminating the trigger factors are also beneficial.

Wheeze – Monophonic

Monophonic wheezes are loud sounds which we can hear continuously when a person inhales, exhales, or both. The term monophonic is in use because these loud continuous sounds’ consistent pitch seems like a musical tone. This tone has a lower pitch when compared to other adventitious lung sounds.

A monophonic wheeze means there is a single tone, and it indicates the obstruction or blockage of a larger airway due to the narrowing of a central airway. Monophonic wheezes are most commonly present in asthma patients. Although monophonic wheezes are common in asthma, we can also hear in diseases like bronchomalacia and tracheomalacia.

Wheeze – Polyphonic

Polyphonic wheezes are also loud and continuous and are one of the intermediate lung sounds. We can hear them while inhalation, exhalation, or during both. The polyphonic wheezes also have a musical pattern. Their auscultation can be on the front of the chest, posterior walls of the chest, and laterally.

We can hear Polyphonic wheezes in respiratory diseases like severe forms of asthma and COPD. Polyphonic wheezes are like continuous sounds of a musical nature. They are most generally due to the narrowing down of different small airways. Polyphonic wheezes are of the high pitch as to the monophonic wheezes and are also sibilant wheezes.

Crackles – Early Inspiratory (Rales)

The early inspiratory crackles or rales are present in patients with a severe respiratory obstruction or lack of aeration. This happens due to the increase in bronchial compliance. The early inspiratory crackles arise in the larger and proximal airways. Auscultation of Early inspiratory crackles is present in the lower lobes. They are of low pitch.

We can hear scanty sounds during auscultation. The early inspiratory crackles or rales do not change their nature while coughing or by the change in posture. Early inspiratory crackles are frequently on transfer to the mouth, and they are less in number in comparison to late inspiratory crackles or rales.

Crackles- Late Inspiratory (Rales)

Late inspiratory crackles are more diffused and profuse. They consist of an end-inspiratory wheeze. Late inspiratory crackles auscultation occurs most commonly in the lower zones of the chest. we can hear late inspiratory crackles in the mid or upper chest zones in advance diseases.

In contrast to the early inspiratory crackles, the late inspiratory crackles or rales undergo a change in their nature by coughing or change in position in the early stages of the disease. In the late or severe stages of the disease, the late inspiratory crackles do not change with a change in the position of the patient or coughing.

Stridor

Stridor is a special type of high-pitched wheezing sound produced due to the disturbance in the airflow. It is due to extrathoracic airway obstruction. The airway obstruction is most commonly due to blockage in the larynx or trachea. Stridor is also musical breathing because there can be an interpretation of musical tone.

Stridor is commonly present in children due to the narrowing down of the upper airway. It is less common intermediate lung sounds in adults. Developmental defects in the organs like the larynx, trachea, or throat can lead to stridor production. Inspiratory stridor is a medical emergency.

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