The intensity is great, the pitch is high, the distinctness is well marked, the thrill is also well marked. It is heard over the larynx and trachea. <Callout type="important" title="Critical for Diagnosis">Understanding these voice qualities helps in diagnosing respiratory issues accurately.</Callout> 2. Pulmonary Voice. — The quality is pulmonary, the intensity is feeble, the pitch is low ; it is not at all distinct — there is but a moderate thrill. The intensity and the thrill are more marked in persons who have a sonorous and vibrating voice. It is heard all over the lungs. In the right infra-clavicular region the intensity of the voice is usually greater, the pitch higher, and the thrill more marked than in the corresponding region on the left side. In both inter-scapular regions the intensity is greater, the pitch higher, the distinctness and the thrill more marked than over the rest of the chest. 3. Increased Vocal Resonance. — The quality remains pulmonary, the intensity is increased, the pitch is higher, the thrill is more marked. It is heard over lung consolidated by pneumonia or phthisis, over lung compressed by fluid, over cavities, sometimes with emphysema. <Callout type="risk" title="Potential Misdiagnosis">Increased vocal resonance can indicate serious conditions like pneumonia or tuberculosis.</Callout> 4. Diminished Vocal Resonance. — The intensity and the thrill of the voice sounds are diminished. This is the case over small collections of fluid, with obstruction of the bronchi, over pleuritic adhesions, sometimes over consolidated lung. 5. Suppressed Vocal Resonance. — There is no voice sound transmitted through the chest. This occurs with large collections of fluid in the pleural cavities, with intrathoracic tumors, sometimes over consolidated lung. 6. Bronchophony. — The quality is bronchial, the pitch is high, the intensity varies, the distinctness is more marked, the thrill varies in amount. The quality is usually better appreciated by the ear than by the stethoscope ; it may be better marked when the patient whispers than with his full voice. Bronchophony is heard over consolidated and over compressed lung, and over cavities. 7. CEdophony is a modified bronchophony, differing from the latter only in its quality. The quality is of a peculiar tremulous character, and has been compared to the bleating of a goat. It can only be heard well in persons who have a vibrating voice, and it is necessary to make them say some word which brings out this vibrating character of the voice, such as 'rant,' 'brant,' etc. CEdophony is heard over lung compressed by fluid, just at the level of the fluid. 8. Pectoriloquy. — In pectoriloquy not only the sound of the voice, but the articulation of words is transmitted through the chest. This can often be best appreciated when the patient whispers. Pectoriloquy is heard over cavities and over solidified lung. 9. Amphoric Voice. — This resembles bronchophony, but the voice has a peculiar quality, like that of amphoric breathing. The quality is often best heard when the patient whispers. The amphoric voice is heard over large cavities and with hydro-pneumothorax. 10. The Metallic Tinkle. — This is a physical sign, heard both with the voice and with the breathing. It consists in a series of tinkling sounds of a high-pitched or metallic tone. It occurs irregularly at variable intervals. It is usually a sign of pneumothorax with perforation of the lung, but may be heard over large cavities. 4 i6 PHYSICAL DIAGNOSIS BRONCHITIS. THE PHYSICAL SIGNS WHICH ACCOMPANY THE DISEASES OF THE LUNGS. Bronchitis. 1. Acute Bronchitis affecting the larger tubes. Palpation may give a feeling of thrill in the wall of the thorax, transmitted from the bronchi. This is especially the case in children. Percussion, as a rule, gives the same sounds as in health ; rarely there is diminished resonance over a circumscribed area due to plugging of one or more bronchi. Auscultation during the first twelve or twenty-four hours of the disease may give us nothing but respiration of a harder quality than the normal. After this there are usually rales, coarse and subcrepitant. Not infrequently there is also sibilant and sonorous breathing. The rales and the sibilant and sonorous breathing may cease for a time and then recur. In chronic bronchitis we hear the same coarse and subcrepitant rales, with or without sibilant and sonorous breathing.
Key Takeaways
- Different voice qualities indicate various respiratory conditions such as pneumonia or pleurisy.
- Bronchophony, pectoriloquy, and amphoric voice are specific signs of lung compression or consolidation.
- Physical examination techniques like percussion and auscultation help diagnose bronchitis.
Practical Tips
- Use whispering to enhance the clarity of certain diagnostic sounds (e.g., CEdophony).
- Listen for metallic tinkling which can indicate pneumothorax with lung perforation.
- Percussion over fluid-filled areas will produce dullness or tympanitic resonance.
Warnings & Risks
- Diminished vocal resonance may be a sign of small collections of fluid in the lungs, indicating potential obstruction.
- Suppressed vocal resonance can occur with large fluid accumulations and tumors, necessitating immediate medical attention.
Modern Application
While this chapter's diagnostic techniques are foundational for understanding respiratory conditions, modern imaging technologies like X-rays and CT scans have greatly improved accuracy. However, the historical methods described here remain valuable in resource-limited settings or as initial screening tools.
Frequently Asked Questions
Q: What does bronchophony indicate?
Bronchophony indicates that sound is transmitted over consolidated lung tissue and cavities, suggesting conditions like pneumonia or emphysema.
Q: How can you diagnose pleurisy with fluid accumulation?
Pleurisy with fluid accumulation can be diagnosed by detecting dullness on percussion above the fluid level, absence of breathing sounds below it, and CEdophony at the fluid level.
Q: What is the significance of amphoric voice in medical diagnosis?
Amphoric voice indicates large cavities or hydro-pneumothorax, suggesting significant lung pathology such as emphysema or severe pneumothorax.