An objective research method based on listening to natural sound phenomena that occur in the body and are inaudible at a distance.
This method was discovered by René Laennec in 1816. He also invented the stethoscope.
In Russia, the method was put into practice in the 60s of the 20th century. Filatov offered a stethoscope.
Auscultation methods:
- Direct
- Mediocre (using a stethoscope)
Stethoscopes: hard (used in obstetrics) and soft.
Conditions observed during auscultation
- Silence
- Temperature (18-24)
- Exposing the patient to the waist
- Moisten the chest hair in men
- Comfortable vertical position of the doctor and the patient, supporting the patient with his left hand
- Carry out auscultation during quiet breathing (with the mouth closed)
- Maintaining the sequence (from the healthy side to the sick side, or from right to left, front to back)
Places of lung auscultation
Above the collarbones
Under the collarbones
2nd intercostal space along the midclavicular lines
4th intercostal space by 1 cm. outward from the midclavicular line
Laterally in the depths of the axillary fossae
4th intercostal space along the mid-axillary lines
6th intercostal space along the mid-axillary lines
Behind – all the same points as during percussion
Main and secondary breath sounds
Basic:
- Vesicular or alveolar respiration
- Bronchial or laryngotracheal
Side effects:
- Wheezing
- Crepitus
- Pleural friction rub
The main breath sounds are heard during quiet breathing. A healthy person has vesicular breathing throughout the entire surface of the lungs. It is formed in the alveoli as a result of the rapid straightening of their walls. When air enters and begins to collapse on exhalation. Heard throughout the entire inhalation and the initial third of the exhalation
The sound is reminiscent of a soft blowing noise, reminiscent of pronouncing the letter “f” while inhaling.
The standard for listening is the 2nd intercostal space along the midclavicular line and below the angles of the scapulae.
Varieties of vesicular breathing: weakened, increased (puerile), hard, intermittent (saccade) breathing.
Weakening of vesicular respiration is normal: with a thickening of the subcutaneous fat layer and a well-developed muscle layer.
In patients without lung pathology: in weakened individuals, with chest pain, with elevation of the diaphragm (ascites, flatulence).
For respiratory pathology:
- With a decrease in air flow into the alveoli (swelling of the larynx, vocal cords, narrowing of the trachea and main bronchus);
- When the lungs lose their elasticity – pulmonary emphysema;
- In case of inflammation of the alveolar septa (focal pneumonia, the initial stage of lobar pneumonia);
- With the accumulation of fluid and air in the pleural cavity;
- With obstructive atelectasis;
Increased vesicular respiration
- During physical and muscular work
- In asthenics, with poor development of the subcutaneous fat layer and muscle layer
- In children under 3 years of age - puerile
In case of pathology: with the development of a pathological process on one side, it is heard from the healthy lung (exudative pleurisy, lobar pneumonia)
Hard breathing:
Coarser, harder breathing, with exhalation being ½ or more of the exhalation phase (bronchitis, bronchopneumonia)
Intermittent (saccade) breathing:
The inhalation is uneven, intermittent, the exhalation is uniform.
Bronchial breathing
- Formed in the larynx and trachea when air passes through the glottis
- Bronchial breathing spreads along the bronchial tree, but is not normally carried out to the chest. The auscultation point is not normally audible. Heard throughout the entire inhalation and exhalation phase
- Reminds me of pronouncing the letter “x” while exhaling
- Normally, you can listen above the larynx and trachea, that is, in the places of their projection: the jugular fossa in front, at the level of the spinous process of the 7th cervical vertebra, and 3-4 thoracic vertebrae in the back
Pathological bronchial breathing
Conditions of occurrence: lung diseases in which the lung tissue becomes denser, but the patency of the conducting bronchus is preserved (stage 2 lobar pneumonia, pulmonary tuberculosis, pulmonary infarction); with compensated atelectasis; if there is an air cavity in the lung communicating with the bronchus (abscess, cavity in the lung); with open pneumothorax.
Types of bronchial breathing:
- Amphoric breathing (cavity in the lungs)
- Quiet bronchial breathing (with compression atelectasis);
- Methodical breathing (open pneumothorax);
- Stenotic breathing (with narrowing of the trachea or large bronchus) resembles the sound of a saw.
Adverse breath sounds:
Wheezing, crepitus, pleural friction noise.
Wheezing is divided into dry and wet. Wheezing is heard in both phases of breathing.
Dry wheezes - are formed only in the bronchi and are divided depending on the diameter of the bronchus into whistling (narrow-channel) and phase (low-channel) - formed in large and medium bronchi.
Whistling (treble)
The main condition is a narrowing of the lumen of the bronchi.
Reasons for narrowing:
- Smooth muscle spasm
- Swelling of the bronchial mucosa due to inflammation
- Accumulation of viscous sputum in the lumen of the bronchi: located parietally, in the form of strands, threads.
Bass (low-pitched, buzzing)
They are formed in large and medium-sized bronchi due to the accumulation of viscous sputum in the lumen of the bronchi, which in the form of cords and threads vibrates like strings.
Occurs in bronchitis, bronchopneumonia, bronchial asthma, pneumosclerosis.
Wheezing heard at a distance - remote (during an attack of bronchial asthma). In cardiac asthma - moist rales - boiling samovar syndrome.
Wet wheezing
They are formed in the bronchi, trachea and cavities when liquid secretions accumulate in them.
Depending on the caliber of the bronchi in which they are formed, they are distinguished:
- fine bubble
— Medium bubble
- large bubble
Depending on sonority:
- sonorous (consonant) - abscess, bronchopneumonia
- silent - for bronchitis, pulmonary edema.
Crepitus
Crepitus - "crackling" sound. It occurs in the alveoli when there is a small amount of secretion in them (secretion of surfactant decreases) and during exhalation the walls of the alveoli stick together. On inspiration - crepitus.
If the alveoli are completely filled with secretion, then crepitus does not form.
It resembles the sound of rubbing a strand of hair over your ear. Crepitation is heard only on inspiration.
It is observed with lobar pneumonia in the initial and final stages, with infiltrative tuberculosis.
In older people without lung diseases, during the first deep breaths after lying in bed.
Distinctive signs of crepitus from fine bubbling moist rales.
- Crepitation is heard only during inspiration, and wheezing in both phases.
- Moist rales intensify or disappear after coughing, but the crepitus does not change.
- Crepitus is always homogeneous, wheezing is heterogeneous.
Pleural friction rub
More often it resembles the crunch of snow underfoot, or the rustling of silk fabric. Normally, the pleural layers move without noise, because smooth and moistened with a small amount of transudate. Sometimes this noise can be felt by the hand. It is heard along the axillary and scapular lines.
Reason for formation: with dry pleurisy, the presence of adhesions of pleural leaves (fibrin deposition), in the initial stage of effusion pleurisy, or dryness of the leaves with dehydration, with uremia.
Difference between friction noise and fine bubbling rales.
- When coughing, wheezing may disappear or change its character, but the pleural friction noise does not disappear or change.
- With strong pressure with a stethoscope, the pleural friction noise intensifies, but wheezing does not.
- Test for imaginary breathing: close the mouth and nose, ask the patient to inhale and then exhale, the pleural friction noise remains, and other noises disappear.
- More often, pleural friction noise is accompanied by pain.
Inflammatory lung infiltration syndrome.
Includes inflammatory infiltration syndrome, focal compaction syndrome of pulmonary tissue, obstructive atelectasis, compression atelectasis syndrome, emphysema syndrome, bronchial obstruction disorders, lung cavity syndrome, pneumothorax syndrome.
Syndromes associated with compaction of lung tissue.
Inflammatory infiltration syndrome - manifests itself against the background of lobar pneumonia, occurs in 3 stages: 1. Flushing (exudation); 2. Hepatization (gray-red); 3. Permissions.
Pathogenesis. As a result of the inflammatory process, exudative fluid rich in fibrin enters the alveoli - the influx stage. Which is organized during the hepatization stage, the lung becomes dense. As a result of the production of proteolytic enzymes, fibrin dissolves, partially coughs up, and partially resolves (resolution stage).
Clinic syndrome. Hot flash stage – complaints of a dry cough or discharge of a small amount of fibrinous sputum, high temperature, chest pain on the affected side, aggravated by deep breathing and coughing. On general examination, herpetic rashes on the lips and wings of the nose, feverish blush on the affected side. Examination of the chest: tachypnoe, lag of the affected side in the act of breathing, palpation confirms the lag, vocal tremor on the affected side is somewhat stronger, excursion of the chest is limited.
Comparative percussion: dull tympanic sound in the affected area.
Topographic percussion: limited mobility of the lower edge of the lung on the affected side. The affected area corresponds to the lobe of the lung.
Auscultation: weakened vesicular breathing and silent crepitus in the affected area, bronchophony increased.
Diagnostic value of bronchophony data.
Bronchophony - determination of the conduction of a sound wave from the vocal cords to the surface of the chest, determined by a phonendoscope, while asking you to pronounce hissing sounds.
EXAMPLE OF DESCRIPTION OF AN OBJECTIVE STUDY OF THE RESPIRATORY ORGANS IN THE EDUCATIONAL HISTORY OF A DISEASE
BRONCHOPHONIA
Bronchophony is one of the methods for studying the respiratory organs, which consists of analyzing the conduction of whispered speech on the surface of the chest.
Bronchophony is the equivalent of a palpable vocal tremor. The mechanisms of bronchophony and vocal tremor are the same. However, bronchophony has advantages before vocal tremor, which is not always felt by the hand, in weakened patients with a quiet voice, in people with a high voice, most often in women, and does not change with a small magnitude of the cytological process. Bronchophony is more sensitive.
Technique The definition of bronchophony is as follows: the cut of the phonendoscope is applied to the chest in strictly symmetrical areas (where auscultation is performed). After each application, the patient is asked to whisper words containing hissing sounds (for example, “cup of tea” | “sixty-six”).
NB! Normally, bronchophony is negative. The whisper is transmitted very weakly to the chest (the words are indistinguishable and are perceived as an unclear hum), but equally on both sides at symmetrical points.
\/ Reasons for increased (positive) bronchophony the same as vocal tremors: compaction of the lung tissue, a cavity in the lung communicating with the bronchus, open pneumothorax, compression atelectasis.
Upon examination The chest is regular in shape and symmetrical. The supraclavicular and subclavian fossae are moderately pronounced. The course of the ribs is normal, the intercostal spaces are not widened. Respiration rate is 16-20 per minute, breathing movements are rhythmic, of medium depth. Both halves of the chest are evenly involved in the act of breathing. Abdominal (difficult in women) or mixed type of breathing predominates. The ratio of the duration of the inhalation and exhalation phases is not disturbed. Breathing is silent, without the participation of auxiliary muscles.
On palpation The chest is elastic and pliable. The integrity of the ribs is not damaged, pain in the ribs and intercostal spaces is not detected. Voice tremors are moderately expressed, the same in symmetrical areas of the chest.
With comparative percussion A clear pulmonary sound is detected over the entire surface of the lungs.
(If changes in percussion sound are detected, indicate their nature and location).
With topographic percussion:
a) the lower borders of the lungs along the midclavicular lines pass along the VI rib (not determined on the left), along the anterior axillary - along the VII rib, along the middle axillary -
along the VIII rib, along the posterior axillary - along the IX rib, along the scapular - along the X rib, along the paravertebral - at the level of the spinous process of the XI thoracic vertebra;
b) excursion of the lower pulmonary edge along the middle axillary lines - 6-8 cm on both sides;
c) the height of the apices of the right and left lungs in front - 3-4 cm above the collarbones, in the back - at the level of the spinous process of the VII cervical vertebra;
d) the width of the apices of the lungs (Krenig's fields) is 4-7 cm on both sides.
On auscultation Visicular breathing is detected above the lungs on both sides (laryngo-tracheal breathing can be heard in the upper part of the interscapular space to the level of the IV thoracic vertebra). Adverse respiratory sounds (crepitation, pleural friction noise) are not heard.
Bronchophony negative on both sides. (If pathological auscultatory phenomena are detected, it is necessary to indicate their nature and location).
X-ray research methods are widely used in the diagnosis of respiratory diseases.
X-ray And radiography allow us to determine the airiness of the lungs, detect foci of shading (inflammation, tumor, pulmonary infarction, etc.), cavities in the lungs, fluid in the pleural cavity and other pathological conditions (Fig. 83). X-ray can determine the nature of the fluid in the pleural cavity: if the fluid is inflammatory (exudate), the upper limit of the darkening is located along an oblique line (from the side down to the mediastinum); if it is a transudate, the top level of darkening is horizontal.
Rice. 83. Radiographs:
a - right-sided upper lobe pneumonia, b- bronchogenic lung cancer, V- left-sided exudative pleurisy
Tomography allows you to determine the exact localization (depth) of the pathological process, which is of particular importance before surgery.
bronchography used to study the bronchi and makes it possible to identify dilations, protrusions of the bronchi in bronchiectasis (Fig. 84), bronchial tumor, narrowing, foreign body, etc.
Fluorography carried out for the primary detection of lung pathology.
Endoscopic methods are used to diagnose bronchitis, bronchiectasis, bronchial tumors, central lung abscess, erosions, ulcers of the bronchial mucosa (bronchoscopy), as well as for examining the layers of the pleura, separating adhesions between them (thoracoscopy), taking material for biopsy, etc. Functional methods for diagnosing the respiratory system (spirometry, spirography, pneumotachometry, peak flowmetry) make it possible to identify respiratory failure at the onset of its first symptoms, as well as evaluate the effectiveness of the therapy.
Laboratory research methods have a great banner in the diagnosis of respiratory pathology.
UAC is carried out for all patients and makes it possible to detect signs of various pathological processes:
V leukocytosis with a shift to the left, increased ESR - with pneumonia, chronic bronchitis, suppurative lung diseases;
V leukocytosis, lymphopenia, monocytosis, increased ESR during tuberculosis;
V anemia - with lung cancer;
V leukopenia and increased ESR - with influenza pneumonia;
V erythrocytosis, increase in hemoglobin and slowdown of CO") ■
with emphysema.
Analysis of sputum, pleural fluid contains a lot of useful information about the patient’s illness. The interpretation of the data from these studies was given in Chap. 3.
To quickly cure cough, bronchitis, pneumonia and strengthen the immune system, you just need...
Auscultation of the lungs is carried out to determine the nature of body sounds and study bronchophony.
Before starting the procedure, the chest area should be treated with fat, and the hair should be shaved off. Then the patient takes a standing or sitting position, after which the doctor begins the examination, following the accepted algorithm of action.
What is auscultation and what is it used for?
Auscultatory examination is prescribed to detect various diseases of the bronchi, lungs, circulatory system and heart. To do this, an assessment of secondary and main breathing sounds is carried out. Bronchophony is also assessed.
The obtained indicators are subsequently compared with normal ones, and on the basis of this the doctor makes a conclusion about the absence or presence of diseases.
By performing auscultation, you can detect the following pathologies that occur in children and adults:
- Pneumonia;
- Tumor in the lung;
- Pulmonary infarction;
- Pulmonary edema;
- Pneumothorax;
- Tuberculosis;
- Heart failure;
- Accumulation of fluid in the pleural cavity.
The main signs by which such a diagnosis is performed are the types of noise that can be detected during the procedure.
Breathing types:
- Vesicular respiration . This type of noise is uniform and soft, and should be continuous when inhaling. It sounds similar to the sound “f” or “v”.
- Bronchial breathing . Observed during the inhalation/exhalation phases, reminiscent of the sound “x”. When you inhale, this noise is less harsh than when you exhale.
- Mixed breathing can be called intermediate, since it has features inherent in the first two options.
In addition to the main ones, the doctor may also hear additional noises that are signs of pathologies:
- Wheezing. Can be wet or dry. They appear in the form of a buzzing, whistling or buzzing sound (dry) or sound like bursting bubbles (wet).
- Crepitus. This phenomenon is a creaking, jerky sound.
- Pleural friction rub . If this noise is detected, then we can assume that its source is close to the surface. The sound is reminiscent of the rustling of paper or the crunch of snow.
For the diagnosis to be correct, the doctor must take into account both the existing extraneous noise and the features of the main noise. In addition, it is necessary to read the symptoms named by the patient, the individual characteristics of his body, and much more.
Carrying out manipulation
The sequence of actions, rules of conduct and diagnostic value during auscultation are similar to comparative percussion. The doctor first listens above and below the collarbones, then to the third rib on the left side in the region of the heart and on the right side to the edge of the hepatic dullness.
To examine the sides of the patient's chest, he must place his hands behind his head. Then the interscapular space is auscultated. For this purpose, the patient bends forward a little, crossing his arms and lowering his head. In this position, the areas around the shoulder blades and the lower edge of the lungs are examined.
At the beginning, the patient should breathe through his nose. In this position, the doctor listens to all auscultation points in at least 2-3 inhalations/exhalations. The purpose of these actions is to determine the characteristics of the main respiratory noise and compare it with the same area of the second lung.
The doctor must determine:
- Noise volume;
- Timbre pitch;
- Duration;
- Uniformity;
- Consistency;
- Belonging to the phases of breathing;
- Prevalence.
If adverse respiratory sounds were detected at the initial stage, the doctor repeats the procedure, but now the patient must inhale through the mouth. The specialist may also ask the patient to cough and use the “imaginary breathing” method.
If it is necessary to more carefully examine the sounds of the central regions of the lungs, the patient, lying on his back or side, should place his hand behind his head, and it is important that he does not take too frequent breaths, since this can cause hyperventilation fainting.
Basic noises are normal
The normal state for any person is basic breathing sounds.
According to perception vesicular respiration should be continuous and soft. This is the sound that the alveoli make when the lungs fill with air. It is complemented by vibrations that occur when air passes through the smallest bronchi. With the beginning of exhalation, the noise is supplemented by vibrations of the trachea and larynx, and the noise of relaxation of the alveoli.
Breathing is somewhat different in children and adolescents. The nature of the noise is sharper and louder, slightly resonating with exhalation. It should be remembered that this phenomenon puerile breathing, is not normal for an adult and is observed in cases of fever.
Another type of normal noise is laryngotracheal breathing. Its cause is the movement of air flow through the glottis, bifurcation points and trachea. This noise is similar to the sound of "x" and is observed throughout the entire breathing cycle. During exhalation, the sound is longer and more sonorous, which is explained by the structure of the vocal cords.
Signs of pathology
If the patient has diseases of the respiratory system, during auscultation of the lungs the specialist will hear pathological noises.
A short, barely audible inhalation and barely perceptible exhalation are a sign of weakened vesicular breathing. This effect is a manifestation of pulmonary emphysema, in which the elasticity of tissues and the opening of the organ when inhaling decreases.
Another reason is a disorder of the airway, as well as a decrease in the depth of breathing due to the following reasons:
- Weakening of the patient;
- Damage to the nerves and muscles responsible for breathing;
- Ossification of costal cartilages;
- Dry pleurisy;
- High intra-abdominal pressure;
- Rib fractures.
The weakening or disappearance of vesicular noise is caused by the accumulation of fluid or air in the pleural cavity. In the case of pneumothorax (filling with air), the effect of attenuated sounds can be seen from the side of the congestion over the entire chest. Filling with liquid causes noise to be attenuated only over those areas where liquid has collected.
Local disappearance of vesicular respiration is caused by blockage of the lumen of the bronchi in the case of obstruction by inflamed lymph nodes or a neoplasm. The reason for this effect is also the thickening of the pleura and adhesions.
Problems with the alveoli
Side sounds
These are noises that are superimposed on the main ones. These include whistling and buzzing dry wheezing(manifest in bronchial diseases).
Moist rales (wheezing) observed as a result of the passage of air flow through liquid secretion accumulated in the bronchi and voids.
Depending on the size of the bronchi in which they appear, bubbly wheezing can be:
- Finely bubbly;
- Medium bubbly;
- Large bubbles.
They are also divided into consonant (sonorous) and non-consonant (silent). The former are characterized by compaction of lung tissue or appear in cavities with denser walls. The latter appear with pulmonary edema and bronchitis.
Fibrous pleurisy
Symptom pleural friction rub may manifest itself in cases of severe dehydration, uremia and the appearance of cancer metastases. The reason for this noise is the drying out of the pleura, as well as the formation of uneven thickenings and pleural layers on the walls of the pleura.
Crepitus- a specific noise, similar to the rustling of cellophane. This phenomenon is most typical for the early stage of lobar pneumonia.
Crepitus allows you to diagnose diseases such as:
- Hamman-Rich disease;
- Allergic alveolitis;
- Pulmonary infarction;
- Systemic scleroderma.
Positive and negative bronchophony
After determining auscultatory and pathological symptoms, local changes in voice tremors, the doctor performs bronchophony, listening to the symmetrical points of the lungs in order to get an idea of the movement of sound through the bronchi.
The patient, without the participation of the vocal cords, whispers words that contain hissing sounds. If the words cannot be understood and only a hum is heard, negative bronchophony is recorded. If the doctor can easily understand what words are being spoken, the bronchophony is positive.
This may be evidence of one of these pathologies:
- Pulmonary infarction;
- Incomplete compression atelectasis.
Positive bronchophony is caused by compaction of the lung tissue in the listening area or a large cavity with compacted walls.
The doctor uses a stethoscope to listen to various symmetrical areas of the lung, while the patient pronounces in the lowest possible voice words containing the letter “p” (eg “thirty-three”), and with pronounced compaction of the lung tissue, words containing hissing sounds can be heard ( n.p., “cup of tea”), spoken in a whisper. A necessary condition for bronchophony (as well as bronchial breathing) is the patency of the bronchus lying in the compacted tissue.
Normally, there is no bronchophony. Bronchophony is an early and sometimes the only sign of compaction of the lung tissue, since compacted lung tissue is a good conductor of sounds and the words spoken by the patient will be clearly audible. Academician F.G. Yanovsky pointed out that bronchophony in pneumonia appears earlier than other physical symptoms.
Bronchophony can be determined above air-containing cavities (cavities) with a dense capsule due to resonance phenomena. In this case, bronchophony over the cavities often acquires a loud, amphoric character and is called amphorophony. Sometimes it can have a metallic tint, which is called pectoryquivia. Bronchophony can be detected above the area of compression atelectasis formed as a result of compression of the lung by pleural effusion; it is heard at the upper border of the pleural effusion and may have a rattling, nasal sound. It is called egophony.
Bronchophonia is noted when bronchial breathing and increased vocal tremors can be determined by physical conditions.
6. Questions for self-control of knowledge. Test control tasks.
1. Mixed breathing may be heard at:
a) focal pneumonia;
b) bronchitis;
c) incomplete compression atelectasis;
d) in the jugular fossa;
e) above the apex of the right lung.
2. For hard breathing the following are typical P signs:
a) heard during bronchitis;
b) heard only during inspiration;
c) due to a slight narrowing of the lumen of the bronchi;
d) all answers are correct.
3. Consonant wet wheezing is heard when:
1) pneumonia;
2) bronchitis;
3) lung abscess;
4) dry pleurisy;
5) cavernous tuberculosis.
Correct: A - 1, 2, 3. B - 2, 3, 4. C - 1, 3, 5. D - 1, 2.
4. Indicate where moist rales may form:
a) alveoli;
b) bronchi;
c) trachea;
d) pleural cavity;
e) cavities.
5. The causes of pathological bronchial breathing are:
a) pulmonary emphysema;
b) acute bronchitis;
c) lobar pneumonia;
d) tuberculous lung cavity;
e) compression atelectasis;
e) valve pneumothorax.
6. Moist, sonorous rales over the lungs are heard when:
a) pulmonary edema;
b) during the height of acute bronchitis;
c) pneumonia;
d) lung abscess;
e) in all of the above cases.
7. Bronchophony is detected when:
a) pulmonary emphysema;
b) pneumonia;
c) bronchitis;
d) bronchial asthma;
e) none of the above options.
8. What additional noise heard during hydropneumothorax:
a) wet rales;
b) the sound of a falling drop;
c) saccadic breathing;
d) the sound of Hippocrates splashing;
d) all answers are correct.
9. Distinctive features crepitus:
a) heard only during inspiration;
b) changes when coughing;
c) intensifies when pressing on the chest with a stethoscope;
d) accompanied by chest pain;
e) none of the above.
10. Pathological weakening Vesicular respiration is observed with:
a) bronchitis;
b) pneumothorax;
c) hydrothorax;
d) pulmonary emphysema;
e) in all of the above cases.
11. To the main features fine bubbling rales include all except:
a) arise in small bronchi and bronchioles;
b) arise in the alveoli;
c) heard during inhalation and exhalation;
d) intensify when the stethoscope is pressed on the chest;
d) change after coughing.
12. The sound of a falling drop can listen above the chest To taphole at:
a) lobar pneumonia;
b) focal pneumonia;
c) pulmonary edema;
d) pneumothorax;
e) hydropneumothorax;
f) a large lung cavity containing viscous pus.
Bronchophonia (bronchophonia), i.e. voice conduction lies in the fact that when the lung is condensed, the latter conducts well the sounds generated when the patient pronounces individual words, which under these conditions can be heard directly by placing the ear to the chest, or through a stethoscope. Under normal conditions, if you put your ear to the chest or attach a stethoscope, the words spoken by the patient will be perceived as an unclear, quiet, sometimes difficult to catch, muttering, while individual words cannot be understood at all.
Technically, bronchophony should be determined by listening directly to the chest of the ear or through a stethoscope, which should be applied to strictly symmetrical places on the right and left sides of the chest. At the same time, the patient pronounces, in as low a voice as possible, individual words that preferably have the letter “o”, for example: “one, two, three”; “thirty-three”, etc. With severe condensation of the lungs, words spoken in a whisper can also be heard.
Novinsky proposed an original method for determining bronchophony, which consists in taking two phonendoscopes and removing one rubber tube from each, plugging the place from which they were removed with cotton wool. Then the examiner simultaneously places phonendoscopes on symmetrical areas of the chest, listening to each side with a separate phonendoscope.
When the lung tissue becomes denser, due to the fact that the latter becomes a good conductor for the sounds pronounced by the patient, the words will be clearly audible, which is called bronchophony.
In some cases, with pronounced bronchophony, clearly audible words are also characterized by a certain metallic tint. This is pectoryquia, i.e. chest talking, the highest degree of voice conduction (bronchophony).
Thus, bronchophony has great diagnostic value. It indicates pockets of compaction in the lungs due to inflammatory infiltration or other reasons. Consequently, bronchophony is noted when bronchial breathing can be heard under physical conditions, and usually corresponds to increased vocal tremor.
However, bronchophony has an advantage over vocal tremors in the greater accuracy of the method, in the ability to detect small foci of compaction in the lungs with its help.
Outstanding Therapists M. V. Yanovsky, K. K. Degio, K. G. Tritshel, Yu. T. Chudpovsky and others highly valued bronchophony and emphasized its importance for the early recognition of pneumonia, “when dullness is little expressed, breathing is of an uncertain nature, and the voice is already strengthened” (N. I. Kotovshchikov). Prominent Russian clinician F. G. Yanovsky pointed out that bronchophonia in pneumonia usually appears earlier than other physical symptoms. It is also determined above the cavities due to the fact that the latter are surrounded by compacted tissue. Bronchophony over the caverns, similar to bronchial breathing, often acquires a soft amphoric character, which is called amphorophony, sometimes it has a metallic tint (pectoriquia). In some cases, bronchophony acquires a rattling character with a somewhat nasal tone, reminiscent of a goat's bleat. This is egophony, usually heard at the upper border of the pleuritic effusion. However, egophony is sometimes heard when the lung tissue becomes denser.
