Everyone is familiar with a stethoscope, the tool that is the symbol of healthcare facilities and healthcare professionals. Technically, a stethoscope is described as a device used for auscultation or listening to sounds made by the internal organs of the body. Primarily stethoscopes are used to listen to the heart, flow of blood in the peripheral veins, lungs, and intestinal tract. Stethoscopes are also used to listen to the heart beat of the developing foetus in pregnant women.
Description of a stethoscope
Stethoscopes consist of the following basic parts:
- the ear pieces
- the binaural, which is a metallic component connecting the two ear pieces
- the tubing
- chest piece
The ear piece transfers body sounds from the other end into the ears and should fit into the ear canals snugly, omitting outside ambient noise. The ear pieces should not be made of a hard material else they will cause discomfort to the physician. The ear tips should also be cleaned regularly. The metallic binaural connects the ear pieces to the tubing.
The tubing could consist of a single tube or two tubes from both ear pieces beside each other. Usually tubes are 26 to 28 inches long and this length is optimum to examine patients accurately. It is vital that the tubing should be thick and insulated to keep out external unwanted noises. The diameter within the tubes should be approximately 1/8 inch which greatly improves the acoustics. The only drawback with two tubes is that they rub against each other causing greater ambient noise and interfering with the sounds made by the body.
The chest piece is the component that comes in contact with the patient’s body. It usually consists of two components –a plastic disc like diaphragm and a hollow cup like bell. The diaphragm amplifies and transmits high frequency sounds and the bell amplifies and transmits low frequency sounds. Both these can be turned over depending on the sounds that are to be heard. Most stethoscopes now have a tunable head that can switch from the diaphragm mode to the bell mode without lifting the head piece. On pressing the head lightly the stethoscope switches to bell mode to catch low frequency sound waves and on pressing a little firmly it switches to diaphragm mode to hear high frequency sound waves. The chest piece also consists of an anti-chill ring that is attached to the diaphragm and bell. This ring protects the patient from directly getting in touch with the cold metallic chest piece and is primarily for the patient’s comfort. The anti-chill ring also allows better suction and thus transmits clear and loud sounds from the body of the patient.
Apart from this, the stethoscope should also be light in weight so that it can be carried by physicians and nurses easily around their neck.
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History of Stethoscope
The first stethoscope was actually a wooden ear trumpet like instrument placed against the patient’s body from one end to hear sounds of the body from the other end. It was developed by French physician, Dr René Laënnec (1781-1826) at the Necker-Enfants Malades Hospital in Paris, France. Various modifications to this design were made and George Cammann in 1852 perfected a standard model for commercial production. Rappaport and Sprague, in the 1940s, developed a two-sided stethoscope for evaluation of respiratory system as well as cardiovascular system. The present model of stethoscope we are familiar with was created by David Littmann in the 1960s. This model was light weight and had improved acoustics.
Types of Stethoscopes
Stethoscopes are basically categorised into four types
This stethoscope was developed by Rappaport and Sprague and is the standard stethoscope used predominantly. It consists of the basic chest piece with diaphragm and bell to hear high and low frequency sounds respectively. The acoustics of this type of stethoscope is not good and the sounds transmitted are not very clear.
The electronic microscope or stethophone uses electronic transducers to amplify the sounds heard. The sound waves are converted to electrical signals by the transducers and are amplified for better auscultation. The noise-cancelling electronic stethoscopes also consist of an equaliser, an extended range and a noise filter. The equaliser enables physicians to adjust the sound waves to numerous parameters. The noise filter picks up only the desired sounds. High and low frequencies can be picked up due to the extended range.
The electronic stethoscope is wireless and can also record sounds. These recordings can be stored as audio and visual outputs and can be shared for further evaluation. Electronic stethoscopes can be used from a distance too for remotely monitoring the patient.
Recording stethoscope is a type of an electronic stethoscope that records the audio output and to print a graph of the sounds from the heart and lungs with the help of a software. Changes in the heart beat or murmurs can be picked up from the recordings and used for evaluation and consultation at a later time. This stethoscope brings healthcare facilities to remote locations too.
Also known as a fetoscope, this trumpet shaped stethoscope is used to listen to the heart beats of a developing foetus by placing the instrument on the expecting mother’s abdomen. This stethoscope is also called as Pinard’s stethoscope or pinard after being invented by Adolphe Pinard, a French obstetrician.
Stethoscopes are further classified as paediatric or cardio stethoscopes depending on the specific function they are used for.
Electronic Stethoscopes-The Future
Electronic stethoscopes are the future and are gradually replacing the traditional acoustic stethoscopes. The main advantage of an electronic stethoscope is that it amplifies sounds by ten times or more compared to an acoustic stethoscope.
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The electronic stethoscope surpasses the acoustic stethoscope with its features such as noise reduction technology, both ambient and friction, exam recording, adjustable amplification and Bluetooth connectivity. These features cut out any ambient noises, amplify the frequencies which can be adjusted to various parameters as well as record the findings. The wireless connectivity helps to share the patient data. Though electronic stethoscopes are more beneficial for physicians with hearing problems, they can be used wisely by all physicians to optimise their practise.
Physicians benefit significantly from an electronic stethoscope. They can pick up even a slight murmur or abnormal sound immediately and can help to get to an accurate diagnosis quickly.
In the future handheld stethoscopes that can work as real time ultrasound machines or brain stethoscopes are also envisioned. The cost of electronic stethoscopes is its biggest drawback but with progresses being made every day, affordable electronic stethoscopes will soon be available.All in all, electronic stethoscopes are the next big thing with their ambient noise reduction, digitized audio outputs and amplified sounds.
The cost of stethoscopes varies from different brands to the type of stethoscope. A physician or doctor will require an advanced stethoscope with more features and with great acoustics and he will be willing to pay for an expensive model. A medical student on the other hand will be looking for a cheap and durable stethoscope that has all the features. Nurses might look for an all purpose stethoscope that is friendly on the pocket and still has several features whether to examine a toddler or an elderly patient.
Among doctors too, there are various types of specific stethoscopes manufactured by the leading stethoscope producing company 3M, which makes Littmann stethoscopes. Littmann categorises stethoscopes according to their functionality, so an anaesthesiologist has access to a stethoscope with greater acoustic capabilities to hear even in a busy operating room, and a general practitioner or family physician has access to stethoscopes with enviable acoustics to listen to the heart, lungs or intestinal tract, a cardiologist or emergency physician has access to electronic stethoscopes with noise reduction technology and small sensors and nurses can use stethoscopes suitable for all age groups and medical students can use affordable basic models in various colours.
A doctor can choose any electronic stethoscope from the Littmann 3200, ADC Adscope 657, Thinklabs ds32 and the Cardionics E-scope where the Adscope model costs approximately $150, the Thinklabs costing approximately $200 and the high end E-scope and Littmann 3200 costing more than $300 dollars. They can even choose from acoustic stethoscopes like the 3M Littmann Cardiology III stethoscope or 3M Littmann Master Cardiology stethoscope which costs approximately $200 dollars or less.
A nurse can work efficiently with a great acoustic stethoscope like the 3M Littmann Classic II S.E. Stethoscope or 3M Littmann Master Classic II Stethoscope or a Welch Allyn Tycos Professional Stethoscope (Model 5079-135) all of which are priced under $100 dollars. we do not share any of your personal information with third parties . so feel free to comment on this blog.
A medical student also has a wide variety of affordable acoustic stethoscopes to choose from like the 3M Littmann Lightweight II S.E. Stethoscope or the ADC Platinum Edition Adscope 615 that are priced under $50 dollars. The ADC Adscope 609ST Stethoscope and Omron Sprague Rappaport Stethoscope are priced less than $30 dollars and the ADC models come with a lifetime warranty and can be replaced anytime making it even more attractive for medical students.One can thus choose from a wide range of stethoscopes.