Difference between vocal af remitus and tactile fremitus
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"vocal fremitus" OR "tactile fremitus"
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Vocal fremitus and tactile fremitus are the same clinical sign. They are two names for one examination, so there is no true difference between them.
- Tactile fremitus names the method: you feel the vibration with your palm.
- Vocal fremitus names the source: the vibration comes from the patient's voice.
Murray & Nadel's Textbook of Respiratory Medicine (Palpation section) defines fremitus as a palpable vibration felt on the body, usually over the chest. It describes vocal fremitus as elicited by having the patient say "one, two, three" while the examiner moves the palms or sides of the hands from top to bottom over both hemithoraces. Other books in the library use the two terms side by side. Textbook of Family Medicine 9e (History and Physical Examination) says "vocal fremitus and tactile fremitus are increased in lung consolidation but decreased in pleural effusion."
How to elicit it
- Use the ulnar edge or the palm of the hand.
- Ask the patient to repeat "ninety-nine" (or "one, two, three").
- Compare corresponding points on the two sides, front and back.
Interpretation
| Fremitus | Cause | Examples |
|---|---|---|
| Increased | Better sound transmission through solid lung | Lobar pneumonia and other consolidation |
| Decreased or absent | Impaired transmission | Pleural effusion, pneumothorax, emphysema or hyperinflation, pleural thickening, a bronchial obstruction |
Related terms that are not the same thing
- Vocal resonance is the auscultatory counterpart. You listen with the stethoscope instead of palpating. Its variants are bronchophony, whispering pectoriloquy and egophony.
- Rhonchal fremitus is a palpable vibration from secretions in large airways, and it often clears with coughing.
- Pleural fremitus is a palpable friction rub.
- Thrills are cardiac, palpable murmurs. They are not the same as lung fremitus.
A search of PubMed from the last 2 years found no recent meta-analyses or systematic reviews on fremitus. The few results were unrelated, and nothing there updates the textbook description.
Sources:
- Murray & Nadel's Textbook of Respiratory Medicine, 2-Volume, Palpation section
- Textbook of Family Medicine 9e, History and Physical Examination
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