Let´s begin with a bit of History…
Auscultation has been along the years a fundamental tool to listen to the sounds and its relation to lung diseases. Already the great Hippocrates introduced new terms such as the description of the characteristic noise produced by the air-liquid interface that is perceived when a patien with hydroneumothorax is vigorously shaken.
The Hippocratic school dates back to the 4th century BC and was characterized by the constant search for information obtained by placing the ear directly on the patient’s back wall.
But it was not until the discovery of the stethoscope by Läennec in 1816 that this technique was instrumentalized, and consequently there began to be an interest in respiratory sounds, giving it a spectacular weight and importance in the assessment of respiratory conditions.
What does it give us as physical therapists?
Auscultation should be considered as an effective tool that allows the physiotherapist to carry out an objective exploration and diagnosis of the clinical state of the patient with respiratory alteration, without being invasive and without any economic cost (J Prim Health Care 1998).
The European Respiratory Society (ERS) thought about this when in 2000 it elaborated a guide of respiratory noise to agree on a semantic level and to be able to categorize them according to their physical-acoustic properties, contributing a more objective and scientific character to the auscultation.
Being of vital importance in the field of pediatrics where it acquires an essential character since it is very difficult to objectify the bronchial obstruction in children.
Therefore, pulmonary auscultation together with pulse oximetry are the only two objective tools available to physiotherapists …..
But …. is only useful for evaluating?
Auscultation is useful for much more.
In addition, it allows a control of the clinical follow-up and an assessment of whether the treatment applied to the patient is effective.
At TMPI we are very aware of the importance of this powerful assessment and treatment instrument, so the auscultation sequences and protocol are carried out in an exquisite manner, as it is the basis of our treatments in respiratory pathology.
Now that you know about the richness of auscultation…., do you dare?
Start with these 3 tips:
- Auscultate any being that crosses your path.
- Start in quiet places …. to gradually awaken your ear.
- Always start from the base to the apex of the lung…and always in a symmetrical way; and compare if they are the same.
A word of advice: CARE FOR YOUR EARS SO THAT YOU CAN LISTEN!
Bibliography
- Roguin A.Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope. Clin Med Res. 2006 Sep;4(3):230-5
- Sovijärvi A.R.A., Vanderschoot J. Earis J.E.Standardization of computerized respiratory sound analysis. Eur Respir Rev 2000; 10:77,585
- Melbye H,Aaraas I, Hana J, Hensrud A. Improving pulmonary auscultation as a tool in the diagnosis of bronchial obstruction: results of an educational intervention. Scand J Prim Health Care. 1998 Sep;16(3):160-4
- Koff RS. Fundamentals of lung auscultation. N Engl J Med. 2014 May 22;370(21):2053. doi: 10.1056/NEJMc1403766. PMID: 24849098.
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