Stethoscope acoustics

Abstract

For over 200 years, stethoscopes have been used to diagnose disease by listening to the sounds from the human body. However, the physics of how stethoscopes work remains poorly understood, mainly because their performance depends not only on the stethoscopes themselves, but on the coupled system that forms when the hand of a clinician presses the device against the chest of a patient. We develop an experimental setup that allows us to characterise the effect of each constituent part on the behaviour of the coupled system. By using a suitably instrumented ‘chest phantom’ we are able to quantify the response of stethoscopes in a repeatable manner and account for the effect of the phantom on the response. We provide a theoretical framework for understanding the acoustics of the coupled stethoscope system and propose a low-order lumped-element model that captures the effects of the key design choices. For example, minimising the air cavity volume inside the stethoscope maximises the response, while a stethoscope’s tubing significantly attenuates the response and introduces distorting standing-wave resonances. Using a diaphragm attenuates the response and shifts the resonances to higher frequencies. However, it also allows the air cavity volume to be minimised, which can offset the attenuation. We dispel several misconceptions, such as that the stiffness of diaphragms leads to an amplification of higher frequencies or that the dimensions of the rim and the mass of the chestpiece play no role in stethoscope performance. We hope that this paper will help to optimise the design of stethoscopes.