Stethoscope

A stethoscope is one of the most important tools in a healthcare professionals diagnostic kit. The stethoscope helps to diagnose heart problems before they become life threatening, and identify breathing issues before they turn into a full blown pulmonary dysfunction.

Nearly all emergency medical technicians and doctors will tell you the stethoscope is their most used tool – that’s why you never see an emergency room doctor without a stethoscope hanging around their neck.

After all, your patient’s heart and lungs are their most vital organs, and the only way to get any sort of preliminary diagnosis for further testing is to listen to what’s going on in that area.

You’ve come here looking for advice on how to choose the right stethoscope for the job. In the paragraphs that follow, you’ll find a long list of virtually everything medical professionals need to know about choosing, using and taking care of this most important diagnostic instrument.

Types of Stethoscopes

Understanding how the different types of stethoscopes out there work will help narrow down which is best for you, given your preferences and career. While all types are explained below, a standard acoustic or electric stethoscope is the most common for physicians of all kinds.

Acoustic

Acoustic stethoscopes are the most common type used by physicians, paramedics, veterinarians, and EMTs. They’re also considered by most healthcare professionals to be the most reliable, because they don’t require any additional equipment other than a trained set of ears to use them.

The diaphragm/bell end is placed on the patient’s chest, where vibrations transfer to the bell that sits inside it, then the sound travels from the diaphragm/bell up the tube to the physician’s ears.

Some acoustics are equipped with a tunable diaphragm that uses pressure variances to amplify sound.

Electronic

Electronic stethoscopes are much more effective at picking up low frequency sounds, though are limited in use because they require batteries to work. Instead of the mechanical diaphragm found on the acoustic, an electronic stethoscope has an electromagnetic diaphragm.

The diaphragm picks up the noise, magnifies it, and sends the sound to the earpieces. For the most part, electronic stethoscopes are only found in emergency rooms and specialist’s offices due to their extremely steep price.

Fetal

Fetal stethoscopes are very simple in their design. They resemble a trumpet or horn. The diaphragm end is placed on an expecting mother’s belly and the faint sound of the baby’s heartbeat travels up the tube.

This type of stethoscope only has one use and therefore is rarely seen outside an OBGYN or family doctor’s office.

Cardiology

A cardiology stethoscope is designed much in the same way an acoustic is. The main difference being the diaphragm on these models can be extreme fine-tuned, to dial into even the most faint sounds. They’re used specifically by cardiologists for picking up the sound of heart abnormalities such as murmurs and arrhythmia.

Cardiac stethoscopes aren’t practical for professionals who work in loud conditions, such as paramedics and doctors working busy walk in clinics, as the device requires concentration and relative silence to perform as intended.

Pediatric

Pediatric stethoscopes are designed in much the same way an acoustic or cardiac design is. The main difference isn’t in the design, but rather the size. The diaphragm and bell inside it are much smaller, allowing the device to pick up on the much softer tone of an infant and toddler’s heartbeat.

Some physicians prefer to use their regular acoustic while assessing this age group, while healthcare professionals like ER doctors, EMTs and paramedics consider this essential gear to have on hand. With that said, most acoustic brands will offer an ultra sensitive diaphragm for use with infants and toddlers, so keep that in mind when making a purchase.

Doppler

A Doppler stethoscope is entirely electronic and rarely seen outside an emergency room or specialist’s office. This type of device picks up on ultrasound waves to detect even the most subtle of heartbeats.

How to Pick a Quality Stethoscope

Intended Use

What’s the primary use of your stethoscope going to be?

If the answer is some basic blood pressure work and sporadic examinations, then you don’t need to go take out a loan to get the latest and greatest electronic or fine-tunable stethoscope.

If you’re a family doctor, primary care provider, veterinarian, or emergency medical professional, you’re going to likely want multiple sized diaphragms, maximum ambient noise isolation, and a headset designed with maximum comfort in mind.

Chest Piece

There are many types of different chest pieces containing a bell and diaphragm design. Most experienced professionals know what they like and where to get it. If you’re unsure, it’s far better to spend less on your first purchase or two and experiment with brands that offer 2 or 3 different kinds of diaphragms in their packaging – or offer diaphragm add-ons to your order.

Some professionals prefer a cheap, standard fixed diaphragm, while others like a tunable model that varies its sound response based on the input (pressure) placed on it. Others, particularly those with hearing issues or specialists, may prefer electronic stethoscopes or a tunable model from a reputable manufacturer.

If in doubt, make sure whatever you buy has a double-headed diaphragm (one side domed, the other flat) so you can at least fine tune somewhat on noises in each spectrum: low, medium, and high pitched.

Last, very few patients will enjoy having the cold tip of your diaphragm being placed on their chest, back or arm. Give preference to models promising a non-chill diaphragm design.

Leaf Spring

Cheap stethoscopes usually don’t usually take the leaf spring that controls the tension of the headset tube very seriously. Weight of material and adjustability are two things you’ll want to consider.

Those with a tight, non-adjustable headset might not suit professionals with large heads very well. While those with fairly loose tension may not snug up to your ears very well if you have a smaller head, thus making diagnosis difficult when there’s a lot of ambient noise around you.

Spending a little more will get you a headset that’s both acoustically superior and comfortable in that it can be adjusted to fit inside your ears perfectly while not risking puncture to your ear drums (or creating difficulty hearing).

Double or Single Tube?

This question is a major point of contention among professionals who use stethoscopes on a consistent basis. Double wall tubing is obviously thicker and designed specifically to help isolate the sound coming from the diaphragm, through the tubes, to your ears.

However, there are many recommendations out there suggesting that single wall tubes are superior in every way. If you’re in training or just starting your career, this is yet another reason to consider spending less on your first set or two, perhaps buying a single wall and double wall at the same time to experiment with which works best for you and your patients.

Hand Polished Tubing?

Hand crafted stethoscopes aren’t necessarily better, but they can be if the manufacturer has a reputation for delivering quality with their products. The biggest factor effected by poor craftsmanship at the hands of the end manufacturer is in the form of the tubing. Many will outsource the diaphragm manufacturing to one of a select few in the medical space who specialize in delivering quality items at an affordable price.

While a poor polish on the outer surface of the tubing just plain looks bad; a poor polish (or none at all) on the inside will result in poor acoustic performance and more difficulty in diagnosing patients properly. However, when it comes to the tubing – be it metal or copper material – that responsibility falls to the manufacturer themselves.

Look for “hand polished” in the product description to ensure you’re getting the best acoustics possible in your stethoscope.

Eartip Design

Eartips aren’t something you want to skimp on, regardless of how often you use them. Soft-sealing silicone eartips will ensure you’re always comfortable. You’ll want the material to be made for regular disinfection, without drying out or cracking.

Keep in mind that some manufacturers make it so you can only use their brand of eartips.

Read lots of reviews and ask your colleagues for their opinions prior to purchase. When in doubt of your ideal size, contact the manufacturer to see if they can send you both small and large varieties with your purchase.

Materials Used

The materials used are very important. Cheap materials are just fine, provided you’re purchasing an FDA approved stethoscope and don’t care how long it lasts. However, stainless steel tubing and antimicrobial plastics are best for all round performance and durability. The slight weight increase is well worth what you get in return.

Copper is also a great lightweight alternative, but less resistant to bacteria. While steel may be a little heavier (though not much if the stethoscope is hand or precision CNC crafted) it’s far more resistant to bacteria and can withstand more consistent cleanings.

In general, harder materials like stainless and titanium are better at picking up and transferring sound. The tube, chest piece and diaphragm should be constructed of the same materials for best performance. Avoid choosing diaphragms that use aluminum in their construction as the softness of the metal is far too hollow to give consistent, accurate readings.

Parts for Life

Several, but not all manufacturers will offer medical professionals the option to receive “consumable” parts for their stethoscopes free of charge for as long as you own it.

This offer usually includes eartips, non-chill rings, diaphragms, retaining rings and ID tags. You’re usually required to register your product when you purchase it. However, the worst that can come from giving your information is they may contact you now and again to ask if you’re happy with your purchase.

Reviews

Look for reviews from established professionals that have been practicing for some time. All reviews are important, but like any professional giving their opinion on such an essential tool as this, the more experience they have using different stethoscopes, the more sound their opinions on quality and comfort will be.

How to Use a Stethoscope Properly

The following tips are offered purely for educational purposes. Not as a replacement for training under qualified professionals.

1. Always start by tapping the earpiece to confirm there are no holes or cracks in the tubing or earpiece, and to ensure the diaphragm is seated properly.
2. The earpiece should always be facing forward, otherwise you won’t be able to hear anything.
3. Adjust, if applicable, the headset so the eartips fit snugly and block out all ambient noise.
4. Position the patient so they’re comfortable and you’re able to place the stethoscope where assessment is needed.
5. Use the diaphragm side of the chest piece for medium and high pitched sounds; while the flat side should be used for low pitched noises.

How to Take Proper Care of Your Stethoscope

Here are a few tips to help make your stethoscope maintain accuracy while lasting several years (some doctors can make their stethoscope last their entire career!) Whether they’re low end or very expensive, the stethoscope is one of your most important diagnostic tools:

• Never leave your stethoscope in extreme temperatures (hot or cold). All parts of a stethoscope are sensitive to hot and cold and the damage done may not always be visible, rather sound quality can gradually (or abruptly) be compromised.
• Don’t use household or commercial cleaning supplies on your stethoscope. Use soapy water on a rag to remove oils and a 70% isopropyl mixture to decontaminate it.
• When in doubt ask your hospital or clinic’s cleaning staff supervisor what can and can’t be used to clean it. Or consult the manufacturer’s included cleaning and care instructions to avoid damaging the device.
• To properly sterilize your stethoscope, the only safe way to do this is low temp gas sterilization.
• Don’t immerse your stethoscope in any liquids, even for a short time. This is most true for cheap brands containing parts that may rust or warp, but even high-end stethoscopes aren’t designed for this kind of abuse.
• Avoid folding and/or stuffing your stethoscope in your pocket. Allowing them to clamp themselves around your neck, or draping them lengthwise across your shoulder blades is best when not in use.

Summary

As you’ve undoubtedly had drilled into your subconscious during medical training, the stethoscope is one of the most powerful life-saving tools a medical professional has at their disposal.

As mentioned, you don’t have to spend hundreds to get years of quality diagnostics; but you do have to be hyper-vigilant in choosing a model known for quality craftsmanship.


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