Intermediate Lung Sounds

Vesicular – Diminished

As the name indicates, the vesicular diminished lung sounds are of a low pitch than the vesicular sounds. These also have less density as compared to the vesicular sounds. This is most commonly encountered in people of old age. In old age, breathing becomes more shallow. A less volume of air is moved 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 is transferred abnormally through 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 this voice will be heard as a muffled sound. It will not be distinctive. In a healthy state, the bronchophony is supposed 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 is asked to utter the word ninety-nine repetitively. If this sound is heard clearly while auscultation, then the bronchophony test is considered 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 caused due to solidification of the tissue around the lungs or due to wide bronchi.

Egophony – e

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 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, the whispered sounds are not heard 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 is asked to say “1-2-3” repetitively to notice the whispered pectoriloquy. Normally only faint sounds are heard due to 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, the whispered sounds are heard 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 is asked to say “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 the sound of wheezing is heard only when the air is exhaled out of the airway. Expiratory wheezing is more common than inspiratory wheezing. It is less severe than the 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. Expiratory wheezing can be treated 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 heard continuously when a person inhales, exhales, or both. The term monophonic is used 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 encountered in asthma patients. Although monophonic wheezes are common in asthma, they can also be heard in diseases like bronchomalacia and tracheomalacia.

Wheeze – Polyphonic

Polyphonic wheezes are also loud and continuous. They can be heard while inhalation, exhalation, or during both. The polyphonic wheezes also have a musical pattern. They can be auscultated on the front of the chest, posterior walls of the chest, and laterally. Polyphonic wheezes are heard in respiratory diseases like severe forms of asthma and COPD. Polyphonic wheezes are like continuous sounds of a musical nature. They are most generally caused by the narrowing down of different small airways. Polyphonic wheezes are high pitched as compared to monophonic wheezes and are also called sibilant wheezes.

Crackles – Early Inspiratory (Rales)

The early inspiratory crackles or rales are observed 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. Early inspiratory crackles are auscultated in the lower lobes. They are of low pitch. Scanty sounds can be heard 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 transmitted to the mouth, and they are less in number compared 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 are most commonly auscultated in the lower zones of the chest. They can also be heard in the mid or upper chest zones in advanced 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 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 caused by extrathoracic airway obstruction. The airway is most commonly obstructed due to blockage in the larynx or trachea. Stridor is also called musical breathing because a musical tone can be interpreted. Stridor is commonly encountered in children due to the narrowing down of the upper airway. It is less common in adults. Developmental defects in the organs like the larynx, trachea, or throat can lead to stridor production. Inspiratory stridor is considered a medical emergency.

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