I used to have a Littmann Cardiology III, until I used my partner's stethescope one day and I was sold. He had a Doctor's Research Group (DRG) Puretone Cardiology stethescope, and it ran circles around my Littmann. Not only that, but it is cheaper. The DRG Puretone Cardiology has a metal coil wrapped in neoprene that runs the length of the stethescope to help block out external noise. Also, it has gel seal ear tips to help get a better seal in your ear and block noise. It is amazing. I used to have trouble determining tube placement with my Litman, but I haven't had any doubts since I bout my DRG. The cardiology model is $135, and they have a traditional model, which I bought for my wife and I can't tell a difference between her's and mine. The traditional is $78. Here is a link to Emergency Medical Products, which is where I bought mine: Emergency Medical Products