Auscultation

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Auscultation is listening to the body. Auscultation is one of the basic procedures of a physical examination, along with inspection (viewing), palpation (palpation) and percussion (tapping). Read here how the doctor can use auscultation to determine heart, lung and intestinal diseases and when the examination is necessary.

What is an auscultation?

Auscultation is a useful and quick examination, especially of the chest and abdomen, in which the doctor can hear the noises of the organs better with the help of a stethoscope and thus draw conclusions about the state of health. The stethoscope consists of two ear hooks, a tube and a chest piece with a membrane that is placed on the skin. The membrane is set into vibration by acoustic waves (noises from inside the body) and transmits the noises via the tube to the ear hooks in the ears of the examiner. Healthy and natural sounds are called physiological, and pathological sounds are called pathological.

When do you do an auscultation?

The lungs, heart and intestines are among the most frequently auscultated organs, as particularly here pathological noises give the doctor quick and easy information about possible diseases: With a heart auscultation, damage and diseases of the heart valves and the heart can be diagnosed. Lung auscultation is used when pneumonia is suspected, diseases such as asthma and COPD or lung collapse and pleural effusion. Bowel noises can also be auscultated well. This helps the doctor, for example, to differentiate between a mechanical and a paralytic bowel obstruction.

What do you do with an auscultation?

As a rule, auscultation during the visit to the doctor follows the anamnesis (recording of the medical history in the doctor-patient conversation) and the inspection. So that the doctor can listen to your heart, lungs and / or intestines, he will ask you to clear the top.

Cardiac auscultation

In cardiac auscultation, a distinction is made between physiological heart sounds, which are caused by opening and closing of the heart valves, and pathological heart sounds, which indicate valve diseases. For a more precise diagnosis, the doctor orients himself to the so-called auscultation points on the heart. The “Erb's point”, which lies between the third and fourth ribs immediately to the left of the sternum, provides an initial overview. If the doctor hears a valve sound, he can differentiate the affected valve by listening to other points.

Pulmonary auscultation

The doctor auscultates the lungs on the back, since the middle of the three lobes that make up the right half of the lung can only be listened to here. The stethoscope is put on from top to bottom and alternately left and right. At each point, both inhalation and exhalation are auscultated. Physiological here are tracheal breathing via the windpipe (Latin: trachea = windpipe), bronchial breathing via the bronchi and vesicular breathing in the peripheral areas of the lungs.

If the doctor suspects abnormal lung tissue (for example pneumonia), he can perform bronchophony. In this procedure, the patient whispers the number “66” while the doctor listens to the lungs with the stethoscope. In places with inflammatory infiltrates (fluid in the lung tissue) he can hear the number louder and more clearly than over healthy lung tissue. The number can be heard weaker if, for example, the lungs are over-inflated (emphysema) or collapsed (pneumothorax). Water around the lungs (pleural effusion) also reduces the conduction.

A similar method is vocal fremitus, in which the doctor places his palms on the right and left side of the patient's chest wall. Now the patient has to say the number “99” loudly and in a deep voice. The doctor feels the deep vibrations in the chest and can determine changes in side-by-side comparison. In the case of pulmonary fibrosis, pulmonary edema or pneumonia, i.e. compressed lung tissue, sound conduction is improved so that the vibrations can be better felt at this point. Conversely, an increased air content in the lungs (pulmonary emphysema), a pleural effusion and a pneumothorax reduce vocal fremitus.

Bowel auscultation

The auscultation of bowel noises takes place while lying down. The abdomen is divided into four quadrants (upper and lower abdomen and right and left respectively), which the doctor listens for several minutes. Slight chuckles and gurgles are completely normal. The "dead silence" is a sign of intestinal paralysis. Abnormally high-sounding intestinal noises, on the other hand, suggest a mechanical intestinal obstruction, for example due to a tumor.

In addition, if the main artery or renal arteries are narrowed, the doctor can auscultate a flow noise at the respective points.

Interpretation of the results

The experience of the examiner plays an important role in the interpretation: Physiological sounds must be distinguished from pathological ones. In order to rule out misdiagnosis, the doctor will usually not rely on auscultation alone, but will carry out further examinations - such as an ultrasound examination of the heart (heart echography, echocardiography) as a supplement to cardiac auscultation or an X-ray examination in addition to lung auscultation.

What are the risks of auscultation?

As a non-invasive examination method, auscultation does not involve any risks.

What do I have to consider when performing an auscultation?

Before auscultation, you should describe your symptoms to your doctor as precisely as possible. Also tell him the medication you are taking, as these can, for example, have an impact on the heart's function. If you have any questions before, during or after the auscultation, do not hesitate to ask your doctor about them.

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