Evaluate Tactile Fremitus

Speech creates vibrations that can be heard when the examiner listens to the chest and lungs. These vibrations are termed vocal fremitus. When the examiner palpates the patient's chest wall while the patient is speaking, these vibrations can be felt and are termed tactile fremitus. Sound is conducted from the larynx through the bronchial tree to the lung parenchyma and the chest wall. Tactile fremitus provides useful information about the density of the underlying lung tissue and chest cavity. Conditions that increase the density of the lung and make it more solid, such as consolidation, increase the transmission of tactile fremitus. Clinical states that decrease the transmission of these sound waves result in reduced tactile fremitus. If there is excess fat tissue on the chest, air or fluid in the chest cavity, or overexpansion of the lung, tactile fremitus is diminished.

Tactile fremitus can be evaluated in two ways. In the first technique, the examiner places the ulnar side of his or her right hand against the patient's chest wall, as demonstrated in

Figure 13-11 Technique for evaluating posterior chest excursion. A, Placement of the examiner's hands during normal expiration. B, Placement of the examiner's hands after normal inspiration.

Figure 13-11 Technique for evaluating posterior chest excursion. A, Placement of the examiner's hands during normal expiration. B, Placement of the examiner's hands after normal inspiration.

Figure 13-12 Technique for evaluating tactile fremitus.

Figure 13-12, and asks the patient to say, ''Ninety-nine.'' Tactile fremitus is evaluated, and the examiner's hand is moved to the corresponding position on the other side. Tactile fremitus on the opposite side is then evaluated and compared. By moving the hand from side to side and from top to bottom, the examiner can detect differences in the transmission of the sound to the chest wall. ''Ninety-nine'' is one of the phrases used because it causes good vibratory tones. If the patient speaks either louder or deeper, the tactile sensation is enhanced. Tactile fremitus should be evaluated in the six locations illustrated in Figure 13-13.

The other method of evaluating tactile fremitus is to use the fingertips instead of the ulnar side of the hand. The same side-to-side and top-to-bottom positions illustrated in Figure 13-13 are used. The evaluation of tactile fremitus should be performed with only one of these techniques. The examiner should try both methods initially to determine which one is preferable.

Table 13-5 lists some of the important pathologic causes of changes in tactile fremitus.

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