This text refers to the 2001 version of Learning Lung Sounds. A new and improved edition is now available .

Learning Lung Sounds: Interactive Multimedia Course

by R. L. H. Murphy and M. A. Murphy, one CD-ROM, requirements: Windows 95/98/Me/XP/NT/2000 or Macintosh Operating Systems with Internet Explorer or Netscape browser, $49, Westborough, Mass, Stethographics, 2001

JAMA. 2003;289:1443-1444.

An assortment of pulmonary physicians at various levels of expertise and computer literacy tested Learning Lung Sounds from Stethographics, Inc for this review.

The product is delivered on a self launching CD-ROM. Once the CD is placed in the drive, the product launches automatically to a home page with easy and intuitive navigation. No downloads or installations were required on the five different computers it was tested on, which were sound card enabled, Pentium 3 PCs with Windows 95, 98, Me, XP, 2000, and NT. The instructions are clear but minimal and could provide more depth for different types of student user on how to derive maximal benefit from the CD. The course is clearly divided into four sections: "Introduction," "Common Lung Sounds," "Sound Patterns," and "Cases."

In "Common Lung Sounds," sounds are described and time amplitude plots are displayed, with convenient buttons for listening. Sound quality is good via computer speakers but exponentially more realistic with a $10 dollar headset. Narrative description allows one to listen to sounds as text is read. This and color coded graphics make comprehending sounds simple. A concise chart of description, location, and commonly associated conditions would have enhanced the content. A description of the stethoscope, with a note on bell vs diaphragm and hints for optimal use, would also have been valuable for the beginner.

The "Sound Patterns" section is very helpful for understanding sounds associated with different diseases. Sound patterns are illustrated with tracings of actual patients, recorded using a multichannel lung sound analyzer. The graphic displays of sounds at different locations on the chest show how sounds are distributed in various disease processes. This distribution is further clarified by a unique three-dimensional graphic animation with superimposed lung sounds. This "3-D Model" animation is a unique innovation in education on lung sounds. It would be helpful to have more explanation, more graphic realism, and some orientation to the display since few have seen such a teaching tool before. Also, too many channels are labeled on the illustration, making it difficult to remember which channel is located where. This is not a problem in subsequent illustrations on crackles and wheeze frequencies, for which locations are summarized by "lung base," "apex," and so forth.

The cases are simple and easy to understand. At or beyond the resident level, the diagnosis will be evident from the history. The illustrations of sound patterns will bias the student to auscultate abnormal areas. It might be better not to display the graphics initially, so that students could auscultate the whole chest and form an opinion before seeing the sound distribution.

A few technical notes are in order. The program may play two or more audio files at once unless the user closes the first file before listening to the second. The overlap can be used to advantage for contrast, but all reviewers found it confusing and annoying as they raced through the program. Automatic closing would be preferable to avoid confusion. Support for the CD is available by e-mail and is not immediate (a response for clarification on one technical issue was never received). No phone number was found on the product, packaging, company Web site, or through directory assistance. Fortunately, the product seems technically sound and easy to use.

As mentioned, the product misses the chance to teach proper use of the stethoscope for optimizing examination of the patient. Given the expertise and technological assets of the company, its staff, and its other products, we were disappointed that it does not feature information on use of an electronic stethoscope for the medical record, in telemedicine consultation, or in interpretation with the phonocardiogram and a handheld computer. These drawbacks noted, the reviewers strongly recommend the product as an excellent resource for self-paced or instructor-led instruction on breath sounds. It far exceeds other efforts in sound quality, graphics, and simplicity of use. It is well worth the money for allied health professionals, medical students, and residents struggling with interpretation of sounds in the chest. We would encourage the student to purchase a two-ear headset to allow close approximation of actual stethoscopy. The product illustrates subtleties of breath sounds that we—a fellow in pulmonary medicine and a clinician with 20 years of practice—had not previously appreciated. For price, ease of use, and interest, the Learning Lung Sounds CD is well worth the time and money and is highly recommended.

Rehan Haque, MD, Reviewer
Pennsylvania State University
Milton S. Hershey Medical Center
State College

Robert Gillio, MD, Reviewer
Pennsylvania State University
Milton S. Hershey Medical Center
State College
InnerLink (
Lancaster, Pa

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor; adviser for new media, Robert Hogan, MD, San Diego.

© 2003 American Medical Association. All Rights Reserved. Original article is at JAMA