Tactile vocal fremitus, chest vibration and resonance sounds

DEFINITION:
The assessment of chest vibration sounds assessed by applying the hands over the patient’s chest wall whilst they say out loud words of resonating quality.

TEST PROCEDURE:
Apply the ulnar borders of your hands on both sides of the patient’s chest. Alternatively you can place the heels of your hands. As you need to press firmly in order not to push the patient off their sitting position get them to actively press against your hands. Some practitioners place one hand at a time and then repeat from left to right sides to compare. Using both hands enables you to compare simultaneously both sides. After applying the hands ask the patient to say out loud 99-99-99 or 1-1-1.

TEST FINDINGS:
Dense or consolidated lung tissue will transmit the vibrations much more readily to the surface thus conditions like pneumonia, Reduced tactile fremitus bilaterally can be found with chronic obstructive pulmonary disease (COPD) but if just unilateral consider pneumothorax, pleural effusion (fluid in the lining of the lung), atelectasis or may be due to bronchial expansion. Increased fremitus can be found with consolidated/dense states like pneumonia, pulmonary oedema, pulmonary haemorrhage,

CONSIDERATIONS:
Poor technique, light pressure, speaking softly and a thick chest wall will affect the amount of vibrations produced.

(Full details and demonstration of the procedure is provided with the DVD/videos and associated study material)