Modeling and measurement of flow effects on tracheal sounds

The analysis of breathing sounds measured over the extrathoracic trachea offers a noninvasive technique to monitor obstructions of the respiratory tract. Essential to development of this technique is a quantitative understanding of how such tracheal sounds are related to the underlying tract anatomy, airflow, and disease-induced obstructions. In this study, the first dynamic acoustic model of the respiratory tract was developed that takes into consideration such factors as turbulent sound sources and varying glottal aperture. Model predictions were compared to tracheal sounds measured on four healthy subjects at target flow rates of 0.5, 1.0, 1.5, and 2.0 L/s, and also during nontargeted breathing. Both the simulation and measurement spectra depicted increasing sound power with increasing flow, with smaller incremental increases at the higher flow rates. A sound power increase of approximately 30 dB between a flow rate of 0.5 and 2.0 L/s was observed in both the simulated and measured spectra. Variations of as much as 15 dB over the 300-600 Hz frequency band were noted in the sound power produced during targeted and nontargeted breathing maneuvers at the same flow rates. We propose that this variability was in part due to changes in glottal aperture area, which is known to vary during normal respiration and has been observed as a method of flow control. Model simulations incorporating a turbulent source at the glottis with respiratory cycle variations in glottal aperture from 0.64 cm2 to 1.4 cm2 explained approximately 10 dB of the measured variation. This study provides the first links between spatially distributed sound sources due to turbulent flow in the respiratory tract and noninvasive tracheal sounds measurements.