- Lucia Blasco
- BBC World News
Your body is full of sounds. Some are noticeable and even unpleasant; others, almost inaudible and strange. But all of them can be heard magnified through a device that was invented more than 200 years ago: the stethoscope.
Created in 1816 by the French physician René Laënnec, the initial wooden tube evolved into the membrane with the two rubber tubes that we now know. Thanks to this diagnostic tool, we have unusual access to the internal sounds of the human body (and animal, by the way).
Laënnec said that his apparatus was used to “listen to the sounds of the chest and other parts of the body.”
However, the cultism with which we define it today (stethoscope) only collects the first part of that definition: from ancient Greek stethos, what does it mean chest, Y kickone, What does it mean to explore (stethoscope is perhaps more faithful to its functionality: sound= sound; endo= internal).
“It is a fundamental instrument for clinical medicine, since it allows making diagnoses based on the physical examination, which includes inspection or observation, palpation, percussion and auscultation. The latter is where the stethoscope participates,” José Carlos tells BBC Mundo Cueto González, a specialist in pediatric neurology at La Salle University, in Mexico.
“Stethoscope guides the diagnosis as a presumption and tells what tests to do“, adds the doctor.
Raúl Rivas González, Professor of Microbiology at the University of Salamanca, Spain, explains in an article for The Conversation that the stethoscope “has become, with the passage of time, a symbol of medical practice and is probably the device that we used to associate with the image of a doctor.”
And yes, we know that it serves to listen to the heartbeat …
But what other sounds do doctors hear thanks to the stethoscope and what information do they bring to doctors?
More than heartbeats
When they do a cardiac auscultation, they are listening to your heart. Or rather, the heart sounds that are produced with the closing of the valves or at the beginning of the great arteries.
There are four heart sounds, although not always all are perceived.
“Normal heart sounds are produced in pairs,” says the Texas Heart Institute, which specializes in cardiovascular health.
There are usually two noises separated from each other by two silences (which are called small and great silence, respectively). Sometimes there is a third noise. And less frequently a quarter.
Getting more technical, the Texas Heart Institute explains it like this:
“Heart sounds are often described as a constant ‘lub-dub, lub-dub’. The first ‘lub-dub’ is the sound that the mitral and tricuspid valves make when closing. The second ‘lub-dub’ is the sound that the aortic and pulmonary valves make as they close immediately afterward. “
“But if there is a problem, other than this normal ‘lab-dab’, you can occur a murmur. By listening to the heart with a stethoscope, the doctor can determine if the abnormal sound indicates turbulence. This is called a “heart murmur,” and it usually produces a hissing, screeching, or harsh noise.
“At the cardiac level, we can identify the two cardiac cycles (diastole and systole). If the closure of the heart valves were inadequate, murmurs would be heard. If there were fluid in the outermost layer of the heart, we would hear a noise that we know as rubbing. appreciate heart rate and diagnose a possible arrhythmia, that we would validate with a eelectrocardiogram“, explains Dr. Cueto González.
Do you breathe
Another organ that doctors listen carefully to with the stethoscope is the lungs … and the air that passes through them.
By listening to breath sounds – those made in the structures of the lungs during breathing – they can gain a lot of information about them. To do this, they slide the device over various parts of the thorax.
Normal lung sounds occur everywhere in the thoracic area; for example, above the clavicle and the lower part of the rib cage, and in that process, the doctor can detect abnormal breath sounds.
“In relation to the respiratory, with auscultation it is possible to diagnose whether there are noises or not and towards what they are directed”, says Dr. Cueto Gondález.
“The normal noise of the lung is called vesicular murmur and is like the wind passing through a forest. The absence of it may indicate a pleural effusionl (accumulation of fluid), a pneumonia (the infection of one or more lungs) or possible emphysema (damage to the air sacs of the lungs) “.
“If other sounds appear, such as rales (small clicking noises when inhaling), wheezing (high-pitched noises from narrow airways), or stridor (similar to wheezing), they may suggest in the same order pneumonia, asthma, or laryngeal disorders“.
In the stomach
Abdominal sounds are the noises produced by the intestines.
Because the intestines are hollow, the sounds when they push food echo through the abdomen, just as you would hear water passing through pipes. That is why sometimes your guts “ring” (the technical word is “gurgling”).
The vast majority of these sounds are normal; they simply mean that the digestive tract is working. However, some abnormal abdominal sounds may indicate a problem, from liquids and gases, to obstructions and blockages. And they can be heard with a stethoscope.
By listening to the abdomen, the doctor can also know if the strength, tone or regularity of stomach sounds is adequate or if your bowel activity has decreased.
“In the abdomen we look for whether the air-fluid noises (borgorithms) are increased, decreased or absent, and their location can lead us to an intestinal obstruction or to appendicitis-like inflammatory process“, says the pediatrician.
How does your skull sound?
And beyond the heart, abdomen, or lungs, there are other noises that the stethoscope can detect in other parts of the body, such as the neck and even the skull.
“We can also auscultating blood vessels, like those of the neck, looking for murmurs that could orient us towards vascular disorders, or even murmurs in the thyroid gland “, says Dr. Cueto González.
“And we can auscultate the skull, in ocular, temporal and parietal areas, ruling out murmurs that could orient a vascular malformation (a type of birthmark) “, explains the doctor.
“Auscultation of the skull is not a routine exam, but there are cases in which it should not be ignored. It is done in both temples and above the eyeballs”, explains Dr. Matías Candioti Busaniche in a report published by the National University of the Litoral, Argentina.
Whether it’s to listen to the heart, blood, lungs, or stomach, a stethoscope is essential.
“We don’t leave home without one,” Dr Sarah Clarke, a consultant cardiologist at Papworth Hospital in Cambridge, UK, told the BBC.
“If you are a doctor, you cannot replace what you hear. The skill is in interpretingthe; this is the key to the diagnosis. “
For Dr. Cueto González, it is a key tool in clinical medicine when it comes to guaranteeing “a clinical orientation towards diagnosis, an adequate doctor-patient relationship and the application of specific tests to support the clinical diagnosis.”
“Although 200 years have passed since the invention of the stethoscope, auscultation of the lungs is still a cornerstone in the diagnosis of asthma and other lung, heart and intestinal disorders“, says Rivas González.
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