StethoLM: Audio Language Model for Cardiopulmonary Analysis Across Clinical Tasks

Auscultation is a vital diagnostic tool, yet its utility is often limited by subjective interpretation. While general-purpose Audio-Language Models (ALMs) excel in general domains, they struggle with the nuances of physiological signals. We propose a framework that aligns multi-site auscultation recordings directly with a frozen Large Language Model (LLM) embedding space via gated cross-attention. By leveraging the LLM's latent world knowledge, our approach moves beyond isolated classification toward holistic, patient-level assessment. On the CaReSound benchmark, our model achieves a state-of-the-art 0.865 F1-macro and 0.952 BERTScore. We demonstrate that lightweight, domain-specific encoders rival large-scale ALMs and that multi-site aggregation provides spatial redundancy that mitigates temporal truncation. This alignment of medical acoustics with text foundations offers a scalable path for bridging signal processing and clinical assessment.

In this work, we present Au-M-ol, a novel multimodal architecture that extends Large Language Models (LLMs) with audio processing. It is designed to improve performance on clinically relevant tasks such as Automatic Speech Recognition (ASR). Au-M-ol has three main components: (1) an audio encoder that extracts rich acoustic features from medical speech, (2) an adaptation layer that maps audio features into the LLM input space, and (3) a pretrained LLM that performs transcription and clinical language understanding. This design allows the model to interpret spoken medical content directly, improving both accuracy and robustness. In experiments, Au-M-ol reduces Word Error Rate (WER) by 56% compared to state-of-the-art baselines on medical transcription tasks. The model also performs well in challenging conditions, including noisy environments, domain-specific terminology, and speaker variability. These results suggest that Au-M-ol is a strong candidate for real-world clinical applications, where reliable and context-aware audio understanding is essential.

Deep learning-based respiratory auscultation is currently hindered by two fundamental challenges: (i) inherent information loss, as converting signals into spectrograms discards transient acoustic events and clinical context; (ii) limited data availability, exacerbated by severe class imbalance. To bridge these gaps, we present Resp-Agent, an autonomous multimodal system orchestrated by a novel Active Adversarial Curriculum Agent (Thinker-A$^2$CA). Unlike static pipelines, Thinker-A$^2$CA serves as a central controller that actively identifies diagnostic weaknesses and schedules targeted synthesis in a closed loop. To address the representation gap, we introduce a modality-weaving Diagnoser that weaves clinical text with audio tokens via strategic global attention and sparse audio anchors, capturing both long-range clinical context and millisecond-level transients. To address the data gap, we design a flow matching Generator that adapts a text-only Large Language Model (LLM) via modality injection, decoupling pathological content from acoustic style to synthesize hard-to-diagnose samples. As a foundation for this work, we introduce Resp-229k, a benchmark corpus of 229k recordings paired with LLM-distilled clinical narratives. Extensive experiments demonstrate that Resp-Agent consistently outperforms prior approaches across diverse evaluation settings, improving diagnostic robustness under data scarcity and long-tailed class imbalance. Our code and data are available at https://github.com/zpforlove/Resp-Agent.