Auscultation: Treatment, Effect & Risks

Auscultation represents one of the most important basic techniques of medical examination. Hardly any thorough diagnosis takes place without the aid of this method.

What is auscultation?

Auscultation is colloquially known as listening. In this process, the examiner records body sounds through his or her ear; if necessary, he or she uses additional aids such as a stethoscope. The word “auscultation” has its origin in the Latin word “auscultare”, which means “to listen attentively”. This is exactly what happens during auscultation, which is also known colloquially as listening. The examiner records bodily sounds via the ear, if necessary using additional aids such as a stethoscope. The auscultation method has been used since ancient times to diagnose various organ diseases. Initially, by simply placing the ear on the skin of the organ in question, the sounds of the latter were listened to. This is also called direct auscultation. Then, in the 19th century, indirect auscultation became possible, as it was during this time that ear trumpets first appeared. The founder of this technique was the French physician René Laënnec, who as personal physician was responsible for the health of Napoleon Bonaparte. The devices for indirect auscultation were continuously improved, resulting in the stethoscope as we know it today. Through the installation of modern membrane, a differentiated assessment of many organs such as the heart, lungs or abdomen is now possible with this.

Function, effect and goals

Cardiac and pulmonary auscultation are the most commonly used. These are usually part of the basic medical examination. During pulmonary auscultation, lung sounds are recorded, as well as any secondary sounds. This can provide clues for further diagnostic procedures. For the auscultation of the lungs, the patient takes a seat on a height-adjustable stool and undresses his upper body. He is then asked to breathe in and out deeply with his mouth open. The examiner should follow a fixed pattern so as not to forget any areas. The procedure from cranial to caudal and first dorsal, then ventral is widely used. In layman’s terms, this means that auscultation is performed from top to bottom and first posteriorly and then anteriorly. So that lateral differences can be perceived, auscultation is always performed first on the left and then on the right at the same height. Inhalation and exhalation sounds are waited for in order to be able to fully assess the ventilation conditions. During cardiac auscultation, the heart sounds are recorded. In healthy adults, two heart sounds are audible. They mark the beginning and end of systole, i.e. the ejection phase of the heart. In children, there may be two additional heart sounds. If these are found in adults, this always indicates a pathological condition. The heart murmurs must be distinguished from the heart sounds, which are always pathological and must therefore be further clarified. For auscultation of the heart, the patient can sit, stand or lie down. Standard auscultation is performed at five different points on the chest wall. At each of these points, the sound of one of the four heart valves can be heard particularly well. An exception to this is the Erb point, which is located at the level of the third intercostal space parasternal to the left. Here, all valves can be heard at the same volume. Therefore, the examiner can get an overview of the cardiac function here. In order to detect a possible pulse deficit, the examiner palpates the radial pulse, i.e. the pulse at the wrist, parallel to auscultation. Diseases of the abdominal cavity are diagnosed with the aid of abdominal auscultation. The abdomen is divided mentally into four quadrants, which are then listened to one after the other with the stethoscope. Particular attention should be paid to bowel and vascular sounds. Both missing and too strong sounds are indications of diseases. In this case, intestinal obstruction is often the cause. However, flow sounds can sometimes also be auscultated. These are an indication of pathological changes in the aorta, i.e. the main artery. In pregnant women, auscultation of the abdomen also serves to detect fetal heart sounds. Finally, there are other areas in which auscultation can be helpful. For example, scratch auscultation is used to determine organ boundaries.Carotid auscultation is also possible. This can be used to assess the condition of the carotid arteries.

Risks, side effects, and hazards

Especially cardiac and pulmonary auscultation are still standardly used methods to perform a basic medical examination. Advantages are mainly that the methods have practically no side effects, are noninvasive as well as inexpensive, and still provide a lot of information that is well suited for planning further diagnostics that may be necessary. Auscultation of the abdomen also plays an important role in the primary diagnosis of sometimes life-threatening diseases. However, today the diagnosis is almost always supplemented by advanced methods, since a number of types of instrumental diagnostics are now available. In most cases, when pathology is detected, an ultrasound examination is ordered directly, which allows the examiner to get a much more accurate picture of the condition at hand. Techniques such as scratch auscultation are even rarely performed nowadays, as sonography serves the same purpose while being much more precise. Auscultation of the carotids is also often dispensed with and instead a sonographic examination is performed directly, because this provides a more meaningful picture of the vessel wall condition and blood flow. Nevertheless, auscultation is still considered one of the basic medical techniques because of its numerous advantages and is frequently used in everyday clinical practice.