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.
How to Assess
- Palpate the patient's posterior chest and ask them to say ‘ blue balloons'. Start at the top of the chest and move to the bottom, comparing both sides.
Increased Tactile Fremitus
Increased vocal sounds on palpation of the chest.
Significance
- Occurs due to increased density within the lung parenchyma.
Causes of Increased Tactile Fremitus
- Pneumonia
- Atelectasis
- Lung cancer
Decreased Tactile Fremitus
Reduced vocal sounds on palpation of the chest.
Significance
- Occurs due to reduced density within the lung parenchyma.
Causes of Decreased Tactile Fremitus
- Pneumothorax
- Empysema
- Haemothorax
- Pleural effusion
- Obesity
Overview
Tactile 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].
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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 fremitus
See rhonchal fremitus below.
Hepatic fremitus
Hepatic 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 fremitus
Hydatid fremitus is a vibratory sensation felt on palpating a hydatid cyst.
Pectoral fremitus
See vocal fremitus below.
Pericardial fremitus
Pericardial 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 fremitus
Periodontal 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 fremitus
Pleural 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 fremitus
Rhonchal 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 fremitus
Subjective fremitus is a vibration felt by the patient on humming with the mouth closed.
Tactile fremitus
See vocal fremitus below.
Tussive fremitus
Tussive fremitus is a vibration felt on the chest when the patient coughs.
Vocal fremitus
Vocal 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
- ↑ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 12
- Sohn C, Baudendistel A [1995]. "Differential diagnosis of mammary tumors with vocal fremitus in sonography: preliminary report". Ultrasound Obstet Gynecol. 6 [3]: 205–7. PMID 8521071.
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