Environmental and External Determinants of Human Auscultation and Implications for Digital Stethoscope Development
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Abstract
Background: Cardiac and pulmonary auscultation, a cornerstone of clinical examination since Laennec’s invention of the stethoscope in 1816, is profoundly influenced by a constellation of environmental and external determinants that are rarely systematically addressed. Understanding these factors is essential both for optimizing human auscultatory performance and for guiding the rational design of digital stethoscopes incorporating artificial intelligence (AI).
Methods: We conducted a comprehensive narrative review of the PubMed/MEDLINE literature, integrating evidence from acoustic physics, clinical medicine, signal processing, and biomedical engineering to characterize the key environmental, patient-related, operator-related, and technological determinants of auscultatory quality and their implications for digital stethoscope development.
Results: Ambient acoustic noise in clinical environments—routinely exceeding WHO recommendations by 10–50 dB—constitutes the primary extrinsic impediment to reliable auscultation. Patient-related factors (body habitus, chest wall composition, clothing) and operator-related factors (hearing capacity, training level, diagnostic fatigue) further degrade performance. The design of digital stethoscopes must integrate adaptive noise cancellation, broadband frequency capture (20–2000 Hz), and AI-powered signal classification to overcome these limitations. Telemedicine and wearable applications add further constraints including Bluetooth transmission fidelity, sensor-skin coupling, and motion artifact management.
Conclusions: A systematic understanding of environmental and external determinants of auscultation is essential to harness the full diagnostic potential of AI-integrated digital stethoscopes and to standardize their development, validation, and deployment across diverse clinical settings.
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Copyright (c) 2026 Andrès E, et al.
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Andrès E, Hajjam El Hassani A, Talha S, et al. Use of a digital stethoscope (eStetho) compared to conventional acoustic stethoscopes for auscultation in internal medicine: a concordance study in 857 patients. J Intern Med. 2026. [In press].
Andrès E, Talha S, Ervé S, Hajjam El Hassani A. Current and future use of smartphones and mobile applications in the practice of medicine and patient management: focus on clinical tools, artificial intelligence and telemedicine for follow-up and care. J Clin Med. 2023;12(21):6700.