Egophony in Bronchitis
No, egophony is not a characteristic finding in bronchitis; its presence suggests pneumonia rather than bronchitis and should prompt chest radiography. 1
Why Egophony Indicates Pneumonia, Not Bronchitis
The absence of egophony is actually one of the key criteria used to rule out pneumonia and confirm a diagnosis of bronchitis. Multiple clinical guidelines from the American College of Chest Physicians establish that when egophony is absent (along with three other findings), pneumonia is sufficiently unlikely that you can confidently diagnose acute bronchitis without obtaining a chest X-ray. 1
The Four Critical Findings That Distinguish Pneumonia from Bronchitis
The American College of Chest Physicians and American College of Physicians specify that if ALL four of the following are absent, pneumonia is ruled out and bronchitis can be diagnosed clinically: 1, 2
- Heart rate >100 beats/min
- Respiratory rate >24 breaths/min
- Oral temperature >38°C
- Chest examination findings of focal consolidation, egophony, or fremitus
The Pathophysiology: Why Egophony Means Consolidation
Egophony is a change in voice timbre (the classic "E to A" change) caused by solid tissue—including consolidated lung from pneumonia—interposed between the resonating airways and your stethoscope. 3 This physical finding reflects lung consolidation with fluid or inflammatory exudate filling the alveoli, which is the hallmark of pneumonia, not bronchitis. 4, 3
In bronchitis, the pathology is inflammation of the large airways (bronchi) without alveolar consolidation, so egophony should not occur. 1, 2, 5
Expected Lung Sounds in Bronchitis
When you examine a patient with bronchitis, you should hear: 6
- Scattered wheezes (high-pitched continuous sounds from airway narrowing)
- Rhonchi (low-pitched continuous sounds from secretions in larger airways)
- Possibly crackles (discontinuous sounds from small airway inflammation)
- Diffuse findings throughout both lung fields—NOT focal consolidation
Critical Clinical Pitfall
If you detect egophony during your chest examination, you must suspect pneumonia rather than bronchitis. 1 This finding warrants chest radiography to confirm or exclude pneumonia, as pneumonia requires different management and carries significant morbidity and mortality if untreated. 1, 2
The American College of Physicians emphasizes that focal chest examination findings (including egophony) distinguish pneumonia from bronchitis and change your diagnostic approach entirely. 1, 2