Cardiac Auscultation Essays - Home

References on Stethoscope Performance

Key Points

Stethoscope Comparisons

Abella M, Formolo J, Penney DG. Comparison of the acoustic properties of six popular stethoscopes. J Acoust Soc Am 1992 Apr;91(4 Pt 1):2224-8
Department of Internal Medicine, St. John Hospital, Detroit, Michigan 48236.

This study evaluated stethoscope acoustics by using a sound frequency generator and an active artificial ear. Six popular, currently available stethoscopes were compared in their various modes involving bells, diaphragms, etc.: Littmann Classic II, Littmann Cardiology II, Littmann Master Cardiology, Hewlett-Packard Rappaport-Sprague, Tycos Harvey Triple Head, and Allen Medical Series 5A RPS Binaural. The transfer function was measured from 37.5-1000 Hz, the range where nearly all heart and lung sounds are found. Sound in the low-frequency range (37.5-112.5 Hz) was in most cases amplified by the bells and attenuated by the diaphragms; however, there were no significant differences. Both bells and diaphragms attenuated sound transmission in the high range, and this increased with frequency. The Tycos Harvey Triple Head ribbed diaphragm attenuated sound transmission to a significantly greater extent than the other diaphragms (P less than 0.01). The results show that the bell and diaphragm for a given stethoscope usually have different transmission characteristics, particularly at low frequencies. The Littmann Classic II is an exception. The Hewlett-Packard and Tycos Harvey stethoscopes showed the greatest differences in low frequency response between the bell and the diaphragm. While the differences found in sound transmission between stethoscopes were in most cases small, the Littmann Cardiology II, bell and diaphragm, appears to possess the best overall performance by this study design.

Electronic Stethoscope for Low Frequency Sounds

Lukin A, Polic S, Rumboldt Z, Bagatin J, Rakic D, Kuzmanic A. [Comparison of auscultation findings using a classic stethoscope (Litmann 2120) and electronically amplified stethoscope (Medmax2)] Lijec Vjesn 1996 May-Jun;118(5-6):127-8 [Article in Serbo-Croatian (Roman)]
Klinika za unutarnje bolesti, KBC Split.

Heart auscultation has one of the key roles in beside diagnosis, especially in patients with cardiovascular diseases. Sometimes, because of the human ears' low sensitivity, a problem emerges in the proper evaluation of heart sounds and murmurs of lower frequencies. Our study compared two stethoscopes, the classic acoustic stethoscope (Littmann 2120) and an electronic one with the sound amplifier and the noise filtering system (Medmax2) in 10 patients examined by 10 physicians. Significantly better detection of low frequency sounds was found in favour of electronic stethoscope (chi 2 = 17.9; p < 0.0001). It is concluded that the selective amplificator improves the stethoscope performance and has its place in everyday bedside practice, especially in departments of cardiology.

  1. Kindig J.R., Beeson T.P., Campbell R.W., Andries S., Tavel M.E. Acoustical performance of the stethoscope: a comparative analysis
    Am. Heart J., August 1982, pp 269-275.
  2. Groom D., Chapman W. Anatomical variations of the auditory canal pertaining to the fit of stethoscope earpieces
    Circulation, Vol. 19, April 1959, pp 606-608.
  3. Groom D. Comparative efficiency of stethoscopes
    Am. Heart J., August 1964, pp 220-226.
  4. Ertel P.Y., Lawrence M., Brown R.K., Stern A.M. Stethoscope acoustics I. The doctor and his stethoscope
    Circulation, Vol. 34, November 1966, pp 889-898.
  5. Ertel P.Y., Lawrence M., Brown R.K., Stern A.M. Stethoscope acoustics II. Transmission and filtration patterns
    Circulation, Vol. 34, November 1966, pp 899-909.
  6. Howell W.L., Aldridge C.F. The effect of stethoscope-applied pressure in auscultation. A new instrument for improving discrimination
    Circulation, Vol. 32, September 1965, pp 430-434.
  7. Hampton C.S., Chaloner A. Which stethoscope?
    Br. Med. J., 1967, 4, pp 388-390.

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Daniel Shindler M.D.