What are three factors that affect the normal intensity of tactile fremitus?
Tactile fremitus is an assessment of the low-frequency vibration of a patient's chest, which is used as an indirect measure of the amount of air and density of tissue present within the lungs. Show
Increased Tactile FremitusIncreased vocal sounds on palpation of the chest.
Decreased Tactile FremitusReduced vocal sounds on palpation of the chest.
OverviewTactile fremitus was first described by a German physician who called for the patient to say “neunundneunzig†(ninety-nine). “Blue Balloons†is an English phrase that closely resembles the sound and vibration emitted from the lungs when saying “neunundneunzig†(a low frequency ‘diphthong' phrase). Next Page ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Fremitus is a palpable vibration on the human body. In common medical usage, it usually refers to (tactile) vocal fremitus, although there are several other types. Bronchial fremitusSee rhonchal fremitus below. Hepatic fremitusHepatic fremitus is a vibration felt over the patient's liver. It is thought to be caused by a severely inflamed and necrotic liver rubbing up against the peritoneum. The name 'Monash sign' has been suggested for this clinical sign, after the Monash Medical Centre in Melbourne, Australia (Nagappan et al, 2001). Hydatid fremitusHydatid fremitus is a vibratory sensation felt on palpating a hydatid cyst. Pectoral fremitusSee vocal fremitus below. Pericardial fremitusPericardial fremitus is a vibration felt on the chest wall due to the friction of the surfaces of the pericardium over each other. See pericardial friction rub for the auditory analog of this sign. Periodontal fremitusPeriodontal fremitus occurs in either of the alveolar bones when an individual sustains trauma from occlusion. It is a result of teeth exhibiting at least slight mobility rubbing against the adjacent walls of their sockets, the volume of which has been expanded ever so slightly by inflammatory responses, bone resorption or both. As a test to determine the severity of periodontal disease, a patient is told to close his or her mouth into maximum intercuspation and is asked to grind his or her teeth ever so slightly. Fingers placed in the labial vestibule against the alveolar bone can detect fremitus.[1] Pleural fremitusPleural fremitus is a palpable vibration of the wall of the thorax caused by friction between the parietal and visceral pleura of the lungs. See pleural friction rub for the auditory analog of this sign. Rhonchal fremitusRhonchal fremitus, also known as bronchial fremitus, is a palpable vibration produced during breathing caused by partial airway obstruction. The obstruction can be due to mucus or other secretions in the airway, bronchial hyperreactivity, or tumors. See rhonchus (rhonchi) for the auditory analog of this sign. Subjective fremitusSubjective fremitus is a vibration felt by the patient on humming with the mouth closed. Tactile fremitusSee vocal fremitus below. Tussive fremitusTussive fremitus is a vibration felt on the chest when the patient coughs. Vocal fremitusVocal Fremitus, also called pectoral fremitus, or tactile vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat the phrase 'boy oh boy' (or any other diphthong such as 'toy boat' and 'blue balloons') while the examiner attempts to detect vibrations on the chest wall. The phrase 'ninety-nine' is also commonly used. The German language equivalent neun und neunzig, is a diphthong, and is appropriate. Vocal fremitus is normally more intense in the right second intercostal space, as well as in the interscapular region, as these areas are closest to the bronchial bifurcation. Vocal fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (collapsed lung). The reason for increased fremitus in a consolidated lung is the fact that the sound waves travel quicker through liquid (the consolidation) than air. Conversely, the reason for decreased fremitus in a pleural effusion (or any pathology separating the pleura), is that this increased space between the pleura acts as a barrier to the sound waves. It has recently been suggested that the artifacts caused by eliciting vocal fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors (Sohn and Baudendistel, 1995). References
Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs What affects tactile fremitus?Increased intensity of tactile fremitus generally occurs as a result of increased density within the lung tissue. This commonly occurs as a result of lung consolidation, which refers to the replacement of the air within healthy lung tissue with another substance; either inflammatory exudate, blood, pus, or cells.
What are 2 reasons your patient may have decreased tactile fremitus?Causes of Decreased Tactile Fremitus. Causes of Decreased Tactile Fremitus.. Pneumothorax.. Empysema.. Haemothorax.. Pleural effusion.. Obesity.. What are 3 types of normal breath sounds?Normal breath sounds are classified as tracheal, bronchial, bronchovesicular, and vesicular sounds.
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