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A Guide To Stethoscopes: 8 Common Scopes in Review

Preamble
These are common questions often asked by budding medical students when tasked with buying their first stethoscope – Which stethoscope should I buy? Are they all the same? Do I really need one? This article will attempt to quantify and qualify a group of common stethoscopes used.

Do I need a stethoscope?
Auscultation is an important part of the physical examination and every medical student should have one with them on the wards. Even if you don’t know what to listen for, it’s great to have one with you just in case something interesting comes up. Doctors are usually keen to show you cool signs and it’d be a shame if you couldn’t hear that cool murmur or weird breath sound because you didn’t have your steth on you.

Are they all the same?
While interpretation of the findings is entirely dependent on the skill and experience of the examiner, stethoscopes are as different and individual as a musical instrument. Often the differences are subtle but they’re definitely there.

What colour should I get?
No one cares what colour your steth is, buy the one you want. Plenty of guys run around with the hot pink ones.

Testing

Note that everything written here is subjective and based on my own “listening” and “handling”, my perception if you will, of the scopes, you may get different results and I recommend trying different ones out from friends or colleagues before buying

I’ve used all of these scopes for at least a day each (I’ve carried a Classic II SE along each time as a baseline). I’ll be the first to admit that I’m not the best at recognising difficult signs so I’ve compared these scopes by listening to the most obvious and loudest signs available on different patients/students – apex beat and the lung apices where the sounds are the loudest.

All results are either a yes/no or are ranked out of 5.

  • The lighter a stethoscope is, the higher the score for weight. Lower weight reduces fatigue when carrying it around your neck.
  • The length of tubing I discovered is very important in determining usability, too long and the stethoscope becomes unwieldy to use and difficult to carry but too short and examinations may become awkwardly intimate.
  • Diaphragms will be described as tunable or non tunable. A tunable diaphragm will pickup lower sounds on light pressure and higher sounds on heavier pressure. In practice however, the results will vary from patient to patient, some doctors not noticing much difference between the modes.
  • A non chill rim is one in which metal does not directly contact the patient’s skin making the examination more comfortable. That being said, you should always ensure that you warm your scope before using it on a patient, they ALWAYS appreciate that.
  • A bell is sometimes useful for bony patients or auscultating small or uneven surfaces like the carotids. Your diaphragm will only work with a good contact and seal between it and the surface of the skin.
  • A higher pricetag nets a lower score though a low score does not indicate poor subjective value
  • Remarks will be made at the end


Littmann Classic II SE

Loudness – 4/5
Clarity – 4/5
Build quality – 4/5
Ergonomics/Other features
-Weight – 3/5
-Tubing length – good
-Non chill rim – yes
-Diaphragm – tunable
-Bell – yes
Price – 3/5 – But a reasonable ask considering quality.

The Littmann Classic II SE is the “standard” and most popular stethoscope among medical students and is also widely used by practicing doctors – indeed this scope was used as the benchmark against which all other scopes in this article were measured. With it’s solid build quality and above average loudness and clarity (it’s actually above average in every way), the only thing I don’t like about this is the join between the tubing and the head of the steth, the part that you twist to select between the bell and diaphragm, it doesn’t feel like it would break, far from it and definitely good quality compared to other steths but it feels weedy to me and I’m not sure the way it clicks into each position is as solid as I would like. Wearing this steth, it’s difficult to clip the earpieces (very comfortable) into the bell sort of a like a lanyard but this is a very minor complaint. This is the stethoscope I’ve worn thus far in my medical training (now replaced by a Cardio III) and remains the stethoscope that I recommend to everyone.

Littmann Master Classic
Loudness – 4.5/5
Clarity – 4.5/5
Build quality – 4.5/5
Ergonomics/Other features
-Weight – 5/5
-Tubing length – good
-Non chill rim – yes
-Diaphragm – tunable
-Bell – no
Price – 2.5/5

Considered the “upgrade” of the Classic II SE (C2SE)in the Littmann lineup costing a little more, this is less popular than the C2SE though still common among students. It’s loudness and clarity are marginally better than the C2SE with the tradeoff of lacking a switchable bell/diaphragm head which I’ve noted sometimes makes auscultating uneven surfaces a bit more difficult. However, this also means that it feels a little more solid than the C2SE and gains points on build quality. Subjectively, wearing this steth is very comfortable, it’s lightweight but the lack of a bell makes it impossible to clip into a secure lanyard though it should be acknowledged that not everyone wears their steth in this manner. As with all Littmann scopes, the earpieces are interchangeable and are extremely comfortable.

Littmann Cardiology III
Loudness – 5/5
Clarity – 5/5
Build quality – 5/5
Ergonomics/Other features
-Weight – 2/5
-Tubing length – good
-Non chill rim – yes
-Diaphragm – tunable
-Bell – Yes, can be switched to paediatric diaphragm
Price – 1/5

This is one of the best acoustic stethoscopes around and definitely the most common among senior doctors (that I’ve noticed). When students talk about “good” stethoscopes, this is always the one mentioned. Loudness and clarity are top notch as is the faultless build quality. Wearing this steth, it’s noticeably heavier than the others with a very large head but it clips into the earpieces comfortably if you so choose. The bell is able to be switched out into a paeds diaphragm which may be useful and as with all Littmann scopes, the earpieces are interchangeable and are extremely comfortable. The only thing truly wrong with this scope is the high price tag.

Littmann Master Cardiology
Loudness – 5/5
Clarity – 5/5
Build quality – 5/5
Ergonomics/Other features
-Weight – 5/5
-Tubing length – good
-Non chill rim – yes
-Diaphragm – tunable
-Bell – No
Price – 0.5/5

Where the Master Classic was the upgrade of the C2SE, this is the “upgrade” of the Cardio III. Loudness and clarity are top notch as is the faultless build quality, to me it sounds pretty much the same as a Cardio III, friends and doctors came to the same conclusion or that it’s only very, very marginally better in clarity. Ergonomically, it’s identical to the Master Classic and the lack of a bell or paeds diaphragm is a serious fault considering that the Cardiology III performs so well. The massive pricetag makes this difficult for me to justify.

No brand basic nursing stethoscope
Loudness – 2/5
Clarity – 1/5
Build quality – 0.5/5
Ergonomics/Other features
-Weight – 5/5 – Lightest I’ve seen
-Tubing length – too short
-Non chill rim – no
-Diaphragm – basic
-Bell – yes
Price – 5/5
I’ve seen these sold online and they’re basically the same ones sold under a different brand each time very cheaply – the silver ones with the black thin tubing and white earbuds. They are also usually the ones found at the bedside on wards. Make no mistake, it is possible to use these for auscultation and examination, they’re just extremely cheap and uncomfortable (even painful) to use with very stiff plastic earpieces that dig into the side of your head. Use them on contact precaution patients if you must but you should not have one of these to carry around.

Heine Gamma 2.2
Loudness – 3/5
Clarity – 2.5/5
Build quality – 2.5/5
Ergonomics/Other features
-Weight – 4/5
-Tubing length – good
-Non chill rim – yes
-Diaphragm – basic
-Bell – yes
Price – 4.5/5

This feels like a very “average” scope to me. Average loudness and clarity compared to other scopes of it’s price range. Ergonomics are nearly identical to the Classic II SE being of roughly the same shape and dimensions with the exception of a far lower build quality. I wouldn’t call this flimsy but it certainly isn’t solid. The earpieces aren’t as good as the Littmann ones and is consequently less comfortable than all of the Littmann scopes. This should be considered usable but there are definitely better choices.

Omron Sprague Rappaport
Loudness – 4.5/5
Clarity – 4.5/5
Build quality – 2/5
Ergonomics/Other features
-Weight – 2.5/5
-Tubing length – too long
-Non chill rim – no
-Diaphragm – basic
-Bell – yes
Price – 6/5

Surprise, surprise. Not all cheap scopes are rubbish! The Omron Sprague Rappaport costs about the same as the no-name nursing stethoscope but performs better than the Littmann Classic II SE in terms of loudness and clarity. I wasn’t expecting this result at all. However, there are some concerns (understandably, given cost) with ergonomics and build quality. The dual tubing is far too stiff and far too long making it a bit difficult to wear around the neck compared to other scopes. The dual tubing also has a tendency to rub together on auscultation (creating sound artefacts) though this issue was mitigated by forcibly taping the pair of tubes together, ugly but effective. Material quality was an issue, the diaphragm felt flimsy in my hands the liberal use of plastic to join the different parts of the stethoscope together, head to tube, rim of the bell and from neck pieces to the tubes made the scope feel much poorer and much more like a toy than the serious piece of gear it actually is. When all’s said and done, it is superior in every way to it’s price competitor, the no-name scope and is comparable to scopes costing 4 or 5 times as much and for that reason, earns a 6/5 in price.

Allheart Cardiology
Loudness – 3/5
Clarity – 3/5
Build quality – 1.5/5
Ergonomics/Other features
-Weight – 4/5
-Tubing length – not sure, feels short though there’s some variations depending on source
-Non chill rim – yes
-Diaphragm – basic
-Bell – yes
Price – 4/5

A Chinese copy of the Littmann Cardiology models, this can be found online as sold as “Cardiology Stethoscope” (take care when shopping for a Littmann Cardiology III, don’t mix these up) often given out for free by sponsors and various companies. I’m gonna put it out there now, I do NOT recommend spending your own money on this scope, if you get it free like a lot of people (like me) do then use it but don’t buy it yourself. Acoustically, it was probably let down by the earbuds which didn’t seem to fit on the stethscope correctly, friends have models with correctly fitted buds and those performed slightly worse than my C2SE but for the purposes of this review, I’m going to score it based on the one I have on hand. Ergonomically however, this scope falls flat on it’s face. Considering the performance, it is far too bulky and heavy and there are obvious quality control issues. It doesn’t have the fancy tunable diaphragm (though it does cost less) and I noticed that you do have to push a little harder than normal with the scope in order for the diaphragm to make adequate contact to skin which may make this a little uncomfortable for the patient. Earbuds are the hard, plastic type which are uncomfortable. I would not take this over a Littmann though it may be comparable to the Heine scope. In terms of “wearing” the steth and carrying it, it feels the same as a Littmann Cardio, which it should given that it’s a cheap imitation.

Conclusion
The build quality and performance on all of the Littmann scopes are superb and the brand certainly deserves it’s benchmark reputation. Comfort and ergonomics are second to none though the standout buy in this group is the Littmann Classic II SE which above all else remains the best value for money scope around. If you want the “best” acoustic scope though, go for the Cardio III. I don’t think it’s worth not having a bell with the patients that are a little more difficult to auscultate so avoid the two “Master” scopes. The hassle and cost don’t really justify the minuscule performance benefit.

The basic bedside nursing steth sucks, use it when you need it and no other time.

The Heine Gamma 2.2 is a priced as a mid range stethoscope and from what I’ve handled, feels very similar to other scopes at it’s pricerage – at around $50AUD apiece and performs as such. Considering how long a scope will service you as a medical professional, I don’t think it’s worth buying one of these. Most of the students who bought these (or something very similar not reviewed in this article) in first year have upgraded at least to a Littmann Classic II SE which speaks volumes about it’s perceived performance and quality.

The Omron Sprague Rappaport was the surprise performer in this group, priced similarly to the basic nursing stethoscope (<$20AUD), I see very little reason to buy that one over this. Performance-wise, I felt it was superior to the venerable Littmann Classic II SE and slightly below the Littmann Master Classic. Noise artifacts were often produced by the dual tubes rubbing together but this is easily solved by taping them together which incidentally makes less unwieldy to carry. Build quality and longevity is the only issue with this scope but at it’s price range, this may be a moot point.

The Allheart Cardiology is an imitation of the Littmann Cardiology series of steths, performance is average but the inconsistent build quality and therefore performance as well as inferior ergonomics makes it difficult to recommend.

In short if in doubt, buy a Littmann Classic II SE and if you have a bit more money then buy the Littmann Cardiology III. You won’t regret those purchases.

I've been using a Littman Master Classic for 7 years and love it (well I've had 2, first one was stolen, this one I got engraved).
    <span style="color:#222222" class="colored"><span style="font-family: Times">By far the best stethoscope I've ever used has to be the Littmann 9200 electronic. As a paramedic trying to auscultate in a noisy environment, ie: back of a moving ambulance, the sound quality is unbeatable. It has active noise suppression built in so you can hear clearly without being distracted by ambient sounds. It comes with 3 selectable diaphragm settings and awesome volume control. I find it much easier to auscultate large people with this. Another bonus is that it counts heart rate for you. I now don't have to try and count a paeds rate, I just place the steth on their chest for 10 sec and it does the rest. No more trying to count to 150 with everything else going on for me. Expensive in Aus ($700 - $900), but buy it from the States and you can get delivered for around $300.<br />
    I have had mine for many years and find it easy to use, comfortable and very reliable.<br />
    just my 2 cents worth though.</span></span>
      Most examiners in my experience won't let a student use an electronic scope in an OSCE and an acoustic scope is encouraged for learning purposes (99% of ward doctors will probably go with an acoustic). I've had a go with an electronic one once, pretty sweet bit of kit :)
      My Littmann was stolen and I was looking to buy a new one, the electronic one sounded great in the ER, but I wasn't sure how it'd handle in the back of the ambulance and I wanted to buy it before I left the States (for cost purposes), so I opted to get another Master Classic, my next one will prob be electronic though, glad to know it's good in the back of the rig, thanks!<br />
      <br />
      <br />
      <blockquote><span style="color:#222222" class="colored"><span style="font-family: Times">By far the best stethoscope I've ever used has to be the Littmann 9200 electronic. As a paramedic trying to auscultate in a noisy environment, ie: back of a moving ambulance, the sound quality is unbeatable. It has active noise suppression built in so you can hear clearly without being distracted by ambient sounds. It comes with 3 selectable diaphragm settings and awesome volume control. I find it much easier to auscultate large people with this. Another bonus is that it counts heart rate for you. I now don't have to try and count a paeds rate, I just place the steth on their chest for 10 sec and it does the rest. No more trying to count to 150 with everything else going on for me. Expensive in Aus ($700 - $900), but buy it from the States and you can get delivered for around $300.<br />
      I have had mine for many years and find it easy to use, comfortable and very reliable.<br />
      just my 2 cents worth though.</span></span></blockquote>
and here I was picking my steth because it was the one I could get in a pretty colour.......
Just an addendum to the above - I'd like to vouch for Spirit steths over Littmann as it's very similar build quality (probably very slightly worse in quality but acoustically indistinguishable) but significantly cheaper. I have a Spirit Cardiology (as does isuru last time I checked) which is their version of the Littmann Cardiology 3 with two advantages - one it's about half the price and two the paeds diaphragm and bell are interchangeable with a simple screw-on screw-off mechanism rather than having to destroy the paeds diaphragm to use the bell.
M