Introduction
Physical Examination
General
Cyanosis
Labored respirations
Tachypnea
Chest wall retractions
Nasal Flaring
Coughing/Sneezing
Grunting
Stridor
Differential Diagnosis
Specific Diseases
References
Other Lectures
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Grunting is an extremely valuable diagnostic sign. It occurs during expiration, when the glottis is partially closed, causing a delay and then a forceful, noisy expiration (the "grunt"). It seems to be the physiological counterpart of end-expiratory pressure in mechanically ventilated patients. In fact, it was through observations of neonates who grunted that continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) first came to be used in the treatment of neonatal hyaline membrane disease.
Grunting localizes the respiratory disease to the lower respiratory tract. That is, patients who grunt have pneumonia, asthma or bronchiolitis. Patients with URT obstruction do NOT grunt. Therefore, grunting is not only specific to the airway and an early sign of disease that correlates with disease severity, but is also specific to a particular location in the respiratory tract. A valuable sign indeed!
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