This is a very inexpensive stethoscope. Sound quality is not bad, but the ear pieces are not manufactured to a reasonable tolerance. Specifically, I am worried that one will become unscrewed and injure my ear when I don't realize the rubber earpiece is gone. Trust me, this can and does happen in a busy ED environment. There is a workaround -- I used Loctite on the earpiece, and I think that will be sufficient. This stethoscope will be used only when my better ones have been lost or stolen.