Physical Exam

Bronchophony

also known as Vocal resonance

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Video coming September 2026

How to Perform

Using the diaphragm of the stethoscope directly on the skin, listen over symmetric upper, middle, and lower posterior lung fields while the patient repeatedly says a word such as “ninety-nine.” Compare the transmitted voice sounds side to side at each level, and assess additional areas as clinically indicated. Normally, the spoken voice is heard as a muffled, indistinct sound. Bronchophony is present when the spoken words are heard louder and more distinctly over an area of the chest.

How to Interpret

Pleural Effusion

Diminished vocal resonance

Rule in

Helpful

Rule out

Somewhat helpful

Evidence:Limited

References

Ebell MH, Chupp H, Cai X, Bentivegna M, Kearney M. Accuracy of signs and symptoms for the diagnosis of community-acquired pneumonia: a meta-analysis. Acad Emerg Med. 2020;27(7):541-553. doi:10.1111/acem.13965. PMID 32329557.
Kalantri S, Joshi R, Lokhande T, Singh A, Morgan M, Colford JM Jr, Pai M. Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med. 2007;101(3):431-438. doi:10.1016/j.rmed.2006.07.014. PMID: 16965906. Tabulated in: Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317. doi:10.1001/jama.2008.937. PMID: 19155458.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.