Pre-swallow sounds

Medical definition / Lay definition
Normal or vesicular breathing / Normal, good, unlabored respiratory pattern, sometimes known as quiet breathing or resting respiration(1)
Vesicular breath sounds are soft and low pitched during inspiration and even softer during expiration(2) / When the inspiration and expiration sequence sounds clear(3)
Wet breathing / Breathing has a wet sounding quality / Breathing sounds wet
Rattly chest / Rhonchal fremitus (bronchial fremitus) is a palpable vibration produced during breathing, caused by partial airway obstruction.(4) / A vibration perceptible on palpation or auscultation(5) or ‘rattly chest’ to touch when hands are placed on the infant’s chest/back.
Grunting / A repetitive, low to medium pitch, short, explosive sound which is produced by vocal cord closure during expiration(6) / Vocalisation heard with expiratory breath(7)
Crackles - fine / Inspiratory crepitations(7) / Similar to sound of wood burning in a fireplace or the sound of cellophane being crumpled(2)
Brief, discontinuous, popping sounds that are high pitched. More during inspiration.
Crackles - coarse / Low in pitch, bubbling sound(7) / Similar to sound when strands of hair are rolled between your fingers near your ear(2)
Discontinuous, brief, popping sounds. Similar to the sound of Velcro being pulled apart. A bubbling sound. More during inspiration.
Stridor / Harsh, monophonic, predominantly inspiratory noise. Can be expiratory or biphasic(7) / A harsh, high-pitched, vibratory noise in the throat, particularly when breathing in. Can be when breathing in or out or both(8)
Wheeze / Continuous, high-pitched adventitious lung sounds which are superimposed on the normal breath sounds(9) / Flow of air through an airway sounds turbulent(7)
Coughing / A cough that sounds barking/brassy, honking, paroxysmal, staccato or wet.(10) / Expeling air from the lungs suddenly with a harsh noise
Throat clearing / A acute expelling of sound from the throat

Swallow sounds

Description / Listening tips
Crisp & clear ‘distinct’ / Sounds clear(11)
Quick / Swallow occurs within 1 s
Loud / Sound is strongly audible / May vary depending on whether the texture is a fluid, puree or solid.
Initial discrete sound (IDS) / Click(12) / Soft , short sound similar to initial sound heard when ears are ‘unblocked.’
Bolus transit sound (BTS) / Food or fluid flushing sound(12) or
Flow sound related to turbulences of the fluid(13) / May vary depending on whether the texture is a fluid, puree or solid. Will be more audible on a fluid bolus.
Final discrete sound (FDS) / Click(12) / Soft , short sound similar to initial sound heard when ears are ‘unblocked.’
May vary depending on whether the child is taking a single swallow or multiple swallows. Should be more identifiable on single swallows. May occur at the end of a swallow series for continuous drinking or multiple swallow (nor after each swallow) where the airway remains closed until the end of the swallow sequence.
Glottal release (GRS) / Short expiration burst of air(11) / May vary depending on whether the child is taking a single swallow or multiple swallows. Should be more identifiable on single swallows. May occur at the end of a swallow series for continuous drinking or multiple swallow (or after each swallow) where the airway remains closed until the end of the swallow sequence.
Co-ordinated / Ordered sequence of IDS, BTS +/- FDS and GRS. Sequence occurs within 1s.
Unco-ordinated / Disordered sequence of IDS, BTS +/- FDS and GRS
and/or missing sound component

Post-swallow sounds

Medical definition / Lay definition
Normal or vesicular breathing / Normal, good, unlabored respiratory pattern, sometimes known as quiet breathing or resting respiration(1)
Vesicular breath sounds are soft and low pitched quality during inspiration and even softer during expiration(2) / When the inspiration and expiration sequence sounds clear(3)
Wet breathing / Breathing has a wet sounding quality / Breathing sounds wet
Rattly chest / Rhonchal fremitus (bronchial fremitus) is a palpable vibration produced during breathing, caused by partial airway obstruction.(4) / A vibration perceptible on palpation or auscultation(5) or ‘rattly chest’ to touch when hands are placed on the infant’s chest/back.
Grunting / A repetitive, low to medium pitch, short, explosive sound which is produced by vocal cord closure during expiration(6) / Vocalisation heard with expiratory breath(7)
Crackles - fine / Inspiratory crepitations(7) / Similar to sound of wood burning in a fireplace or the sound of cellophane being crumpled(2)
Crackles - coarse / Low in pitch, bubbling sound(7) / Similar to sound when strands of hair are rolled between your fingers near your ear(2)
Stridor / Harsh, monophonic, predominantly inspiratory noise. Can be expiratory or biphasic(7) / A harsh, high-pitched, vibratory noise in the throat, particularly when breathing in. Can be when breathing in or out or both(8)
Wheeze / Continuous, high-pitched adventitious lung sounds which are superimposed on the normal breath sounds(9) / Flow of air through an airway sounds turbulent(7)
Coughing / A cough that sounds barking/brassy, honking, paroxysmal, staccato or wet.(10) / Expeling air from the lungs suddenly with a harsh noise
Throat clearing / A acute expelling of sound from the throat

References

1. Stedman's Medical Dictionary. 28 ed. Baltimore, Maryland: Lippincott Williams & Wilkins; 2006. p. 677.

2. Easy Auscultation. 2010 [16.01.12]; Available from: http://www.easyauscultation.com.

3. Rommel N. Diagnosis of oropharyngeal disorders in young children [Doctor of Philosophy]. Kindergeneeskunde: Katholieke Universiteit Leuven; 2002.

4. Dorland's Illustrated Medical Dictionary. 32 ed.

5. Encyclopedia and dictionary of medicine, nursing and allied health. 7 ed2003.

6. Poole SR, Chetham M, Anderson M. Grunting respirations in infants and children. Pediatr Emerg Care. 1995;11(3):158-61.

7. O'Callaghan C, Stannard W. Paediatric Respiratory Examination: BMJ books; 2001.

8. Weir K. Children's Feeding Skills Questionaire. In: Hospital RCs, editor. Brisbane2005.

9. Meslier N, Charbonneau G, Racineux J-L. Wheezes. Eur Respir J. 1995;8(11):1942-48.

10. Chang AB, Landau L, Asperen P, Glasgow N, Robertson C, Merchant J, et al. Cough in children: definitions and clinical evaluation. Position statement for the Thoracic Society of Australia and New Zealand. Med J Aust. 2006;184:398-403.

11. Cichero JAY, Murdoch BE. Acoustic signature of the normal swallow: characterization by age, gender, and bolus volume. Ann Otol Rhinol Laryngol. 2002;111(7 Pt 1):623-32.

12. Vice FL, Heinz JM, Giuriati G, Hood M, Bosma JF. Cervical auscultation of suckle feeding in newborn infants. Dev Med Child Neurol. 1990;32(9):760-8.

13. Moriniere S, Boiron M, Alison D, Makris P, Beutter P. Origin of the sound components during pharyngeal swallowing in normal subjects. Dysphagia. [Research Support, Non-U.S. Gov't]. 2008;23(3):267-73.

Can cervical auscultation improve the diagnosis of aspiration in children?

Sounds definitions sheet_v1_27JAN2012

Queensland Children’s Medical Research Institute