The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the chest, and two tubes connected to earpieces. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins. In combination with a sphygmomanometer, it is commonly used for measurements of blood pressure. Less commonly, "mechanic's stethoscopes", equipped with rod shaped chestpieces, are used to listen to internal sounds made by machines (for example, sounds and vibrations emitted by worn ball bearings), such as diagnosing a malfunctioning automobile engine by listening to the sounds of its internal parts. Stethoscopes can also be used to check scientific vacuum chambers for leaks, and for various other small-scale acoustic monitoring tasks. A stethoscope that intensifies auscultatory sounds is called phonendoscope.
The stethoscope was invented in France in 1816 by René Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural. Laennec invented the stethoscope because he was uncomfortable placing his ear on women's chests to hear heart sounds. He observed that a rolled notebook, placed between the patient's chest and his ear, could amplify heart sounds without requiring physical contact. Laennec's device was similar to the common ear trumpet, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a "microphone". Laennec called his device the "stethoscope" (stetho- + -scope, "chest scope"), and he called its use "mediate auscultation", because it was auscultation with a tool intermediate between the patient's body and the physician's ear. (Today the word auscultation denotes all such listening, mediate or not.) The first flexible stethoscope of any sort may have been a binaural instrument with articulated joints not very clearly described in 1829. In 1840, Golding Bird described a stethoscope he had been using with a flexible tube. Bird was the first to publish a description of such a stethoscope but he noted in his paper the prior existence of an earlier design (which he thought was of little utility) which he described as the snake ear trumpet. Bird's stethoscope had a single earpiece.
In 1851, Irish physician Arthur Leared invented a binaural stethoscope and, in 1852, George Philip Cammann perfected the design of the stethoscope instrument (that used both ears) for commercial production, which has become the standard ever since. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible. By 1873, there were descriptions of a differential stethoscope that could connect to slightly different locations to create a slight stereo effect, though this did not become a standard tool in clinical practice.
Somerville Scott Alison described his invention of the stethophone at the Royal Society in 1858; the stethophone had two separate bells, allowing the user to hear and compare sounds derived from two discrete locations. This was used to do definitive studies on binaural hearing and auditory processing that advanced knowledge of sound localization and eventually lead to an understanding of binaural fusion.
Rappaport and Sprague designed a new stethoscope in the 1940s, which became the standard by which other stethoscopes are measured, consisting of two sides, one of which is used for the respiratory system, the other for the cardiovascular system. The Rappaport-Sprague was later made by Hewlett-Packard. HP's medical products division was spun off as part of Agilent Technologies, Inc., where it became Agilent Healthcare. Agilent Healthcare was purchased by Philips which became Philips Medical Systems, before the walnut-boxed, $300, original Rappaport-Sprague stethoscope was finally abandoned ca. 2004, along with Philips' brand (manufactured by Andromed, of Montreal, Canada) electronic stethoscope model. The Rappaport-Sprague model stethoscope was heavy and short () with an antiquated appearance recognizable by their two large independent latex rubber tubes connecting an exposed leaf-spring-joined pair of opposing F-shaped chrome-plated brass binaural ear tubes with a dual-head chest piece.
Several other minor refinements were made to stethoscopes until, in the early 1960s, David Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models and had improved acoustics. In the late 1970s, 3M-Littmann introduced the tunable diaphragm: a very hard (G-10) glass-epoxy resin diaphragm member with an overmolded silicone flexible acoustic surround which permitted increased excursion of the diaphragm member in a Z-axis with respect to the plane of the sound collecting area. The left shift to a lower resonant frequency increases the volume of some low frequency sounds due to the longer waves propagated by the increased excursion of the hard diaphragm member suspended in the concentric accountic surround. Conversely, restricting excursion of the diaphragm by pressing the stethoscope diaphragm surface firmly against the anatomical area overlying the physiological sounds of interest, the acoustic surround could also be used to dampen excursion of the diaphragm in response to "z"-axis pressure against a concentric fret. This raises the frequency bias by shortening the wavelength to auscultate a higher range of physiological sounds.
In 1999, Richard Deslauriers patented the first external noise reducing stethoscope, the DRG Puretone. It featured two parallel lumens containing two steel coils which dissipated infiltrating noise as inaudible heat energy. The steel coil "insulation" added .30 lb to each stethoscope. In 2005, DRG's diagnostics division was acquired by TRIMLINE Medical Products.
Stethoscopes are often considered as a symbol of healthcare professionals, as various healthcare providers are often seen or depicted with stethoscopes hanging around their necks. A 2012 research paper claimed that the stethoscope, when compared to other medical equipment, had the highest positive impact on the perceived trustworthiness of the practitioner seen with it.
The advent of practical, widespread portable ultrasonography (point-of-care ultrasonography) in the late 1990s to early 2000s led some physicians to ask how soon it would be before stethoscopes would become obsolete. Others answered that they thought the relationship of the various tools (stethoscopes and digital devices) would change but that it would be a long time before stethoscopes were obsolete. A decade later, in 2016, the same two sides of the coin were still recognized. One cardiologist said, "the stethoscope is dead", but a pediatrician said, "We are not at the place, and probably won't be for a very long time", where stethoscopes were obsolete. One consideration is that it depends on the segment of health care (emergency medical services, nursing, medicine) and the specialty. "Stethoscopes retain their value for listening to lungs and bowels for clues of disease, experts agree."
There are some smartphone apps that can use the phone as a stethoscope. At least one uses the phone's own microphone to amplify sound, produce a visualization, and e-mail the results. These apps may be used for training purposes or as novelties, but have not yet gained acceptance for professional medical use.
The first stethoscope that could work with a smartphone application was introduced in 2015
A fetal stethoscope or fetoscope is an acoustic stethoscope shaped like a listening trumpet. It is placed against the abdomen of a pregnant woman to listen to the heart sounds of the fetus. The fetal stethoscope is also known as a Pinard horn after French obstetrician Adolphe Pinard (1844–1934).
A Doppler stethoscope is an electronic device that measures the Doppler effect of ultrasound waves reflected from organs within the body. Motion is detected by the change in frequency, due to the Doppler effect, of the reflected waves. Hence the Doppler stethoscope is particularly suited to deal with moving objects such as a beating heart. It was recently demonstrated that continuous Doppler enables the auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations while classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior in the detection of impaired ventricular relaxation. Since the physics of Doppler auscultation and classic auscultation are different, it has been suggested that both methods could complement each other. A military noise-immune Doppler based stethoscope has recently been developed for auscultation of patients in loud sound environments (up to 110 dB).
===3D-printed=== A 3D-printed stethoscope is an open-source medical device meant for auscultation and manufactured via means of 3D printing. The 3D stethoscope was developed by Dr. Tarek Loubani and a team of medical and technology specialists. The 3D-stethoscope was developed as part of the Glia project, and its design is open source from the outset. The stethoscope gained widespread media coverage in Summer 2015.
The need for a 3D-stethoscope was borne out of a lack of stethoscopes and other vital medical equipment because of the blockade of the Gaza Strip, where Loubani, a Palestinian-Canadian, worked as an emergency physician during the 2012 conflict in Gaza. The 1960s-era Littmann Cardiology 3 stethoscope became the basis for the 3D-printed stethoscope developed by Loubani.
Stethoscopes usually have rubber earpieces, which aid comfort and create a seal with the ear, improving the acoustic function of the device. Stethoscopes can be modified by replacing the standard earpieces with moulded versions, which improve comfort and transmission of sound. Moulded earpieces can be cast by an audiologist or made by the stethoscope user from a kit.
* Doppler fetal monitor * Speaking tube
* [http://www.med.ucla.edu/wilkes/intro.html The Auscultation Assistant], provides heart sounds, heart murmurs, and breath sounds in order to help medical students and others improve their physical diagnosis skills * [http://depts.washington.edu/physdx/heart/demo.html Demonstrations: Heart Sounds & Murmurs] University of Washington School of Medicine * [http://dig.library.vcu.edu/cdm/search/collection/mar/searchterm/stethoscopes/field/subjec/mode/all/conn/and/order/title VCU Libraries Medical Artifacts Collection: Stethoscopes] * "The invention of the stethoscope: A milestone in cardiology", analysis of Laennec's text (1819) on [http://www.bibnum.education.fr/sciencesdelavie/medecine-clinique/de-l-auscultation-mediate BibNum] [click 'à télécharger' for English version].
Category:French inventions Category:Medical equipment Category:Medical testing equipment Category:Medical tests Category:Sound technology Category:1816 introductions