Stage Vb patients, on the other hand, either have adapted to their perforation and acute disease, or alternatively they have developed their perforation so gradually that there is very little structural alteration of the articular cartilage. These patients typically have a lower level of pain overall. Either of the Stage V groups can have crepitant noise in their temporomandibular joint. In the more acute phase of chondromalacia, there is a rougher level of crepitation in the joint space. Alternatively, in the more chronic scenario, there is an eburnation of the articular surface and although crepitation is present, it doesn't have the variability that one notes in the Stage Va patient. These levels of crepitation can also be defined with Doppler auscultation.