What is tactile fremitus?

"Say ninety-nine please"
"again"

(or whatever, you're trying to feel a difference in vibration when you have your hands on the pt's back)

as for your indications, i forgot that already

tactile fremitus is a vibration that you can feel with the palm of your hands when someone says "blue moon" or "99". increased fremitus is a sign of consolidation. decreased fremitus is a sign of pneumothorax or pleural effusion. think of physics and impedence.

dullness to percussion: pleural effusion, pneumonia
hyper-resonance - pneumothorax

egophony is when the patient says EEEEEEE and you hear AAAAAAA via ascultation over a consolidated area. present in pneumonia, absent in pneumothorax, above area of effusion in pleural effusion (skodiac band).

Long Dong said:

I was told what it was once but forgot? And what is egophony (not sure of spelling) is it they say a and you hear e or the other way around? And what does dullness to percussion with tactile fremitus indacate vs dullness without tacticle fremitus? I know that's alot of questions but I'm pretty clueless, thanks in advance.

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Tactile fremitus is the increased transmission of sound waves through a consolidated lung. This means if you have your hands on a patient's chest or back and have them say "99," if an area of consolidation exists, the sound should travel more strongly over that area.

Egophony is the conversion of a "EEE" sound to an "Ay" sound. Also caused by consolidation in the lung fields.

Dullness with fremitus or egophony or bronchophony = consolidation
Dullness without the rest = effusion
Hyperresonance = pneumothorax or hyperinflated lung (Emphysema or acute
asthma exacerbation)

Hope this helps. As always, use this information with the usual disclaimers. If it doesn't sound right - look it up. God knows I don't always have a perfect memory.

cheers, jd

Ok, looks like automaton and I posted the same thing at about the same time... sorry for the repeat post.

all things that *ONLY* medical students do.

Do you not have a clinical examination book? All this and more is quite clearly detailed in any one of them, esp. as this particular topic forms an essential part of the resp. exam. A good book is the one by Talley and O'Connor (although has a UK approach)

Hey, it's pretty simple..the guys above have told you the right stuff.

Tactile fremitus (tactile=touch=use your hands): ask the patient to say 99, tat's the standard, you can use something that sounds like tat as well, and put your hands on the chest wall bilaterally..oh yah, there are about 3 major ways to put your hands on the chest, so, figure out which is most comfortable method for you, some use their full palms, i only use the side of my palms, like a karate chop with the ball of my palms facing together, (like a lotus shape) the other is a version of what I do, except the tips of the left hand touches the base of the palm, it's like what Ultraman does when he shoots that laser thingy..sounds confusing..look at a book
To report, in a normal patient, tactile fremitus is present and equal on both sides

Vocal fremitus (vocal=voice): This time, you auscultate while he says 99
To report, in a normal patient, vocal fremitus is present and equal on both sides

Egophony= say eeee...and in certain conditions, you'll hear aa/aaayy...in normal persons you hear eee
To report, in a normal patient, egophony is absent

roja said:

all things that *ONLY* medical students do.

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I've often suspected as much; it doesn't seem very specific.

chameleonknight said:

I've often suspected as much; it doesn't seem very specific.

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We got an earful the other day, it's small things that count..people are relying on too much tech to make a diagnosis

I wonder if it'd be cheaper in the long run though actually to do the CXR:

on the one hand you have a physical exam skill that costs the patient (or his insurance) simply the cost of the office visit (with the risk of missing the consolidation and the medical costs of complications resulting from missing the finding)

vs

doing the CXR


in some sense...if you can do it cheaply...most places would probably have you do that just to save the patient or his insurance some money. Kinda sucks that it's not as sensitive or specific compared to the chest xray. half the things we learn in physical exam skills though...the 4th years and the residents tell us they really don't do them on the wards (like a JVP -- they only look for distension and never actually measure the height of the column).

funky.

ericdamiansean said:

Vocal fremitus (vocal=voice): This time, you auscultate while he says 99
To report, in a normal patient, vocal fremitus is present and equal on both sides

Egophony= say eeee...and in certain conditions, you'll hear aa/aaayy...in normal persons you hear eee
To report, in a normal patient, egophony is absent

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To add to this, normal fremitus can be extremely variable, and abnormal findings can be either increased or decreased sound conduction. Also, the engineer in me has to point out that this is not exactly an impedance thing... the speed of sound is higher in tissue than water, but the difference in volume is probably due to reflection (air/tissue boundary) and possibly some interference and refraction since the sound can take multiple paths through mediums of different densities to get to the stethescope. If the lung is consilidated with no air/tissue interface, the sound would presumably travel faster and through a more homogenous medium, which would decrease the possiblities for refraction and interference.

(why am I thinking about this on a saturday night???)

I would love for one of these attendings that say that 'technology' is to much actually base a decision on tactile fremitus. Are you really going to decide to give abx or admit for pneumonia based on the absence of tactile fremitus????? Good way to get sued.

The reason you don't base a clinical decision on things like tactile fremitus is that the sensitivity and specificity, as well as kappa (agreement btwn examiners) is HORRIBLE.

Its great to learn in case you are ever in a country where you don't have access to it and you need SOMETHING to help you out. But if you are practicing in the US, you will need something other than 'no tactile fremitus' on exam to justify your assessment and plan.

JAMA did a great serious on physical exams a few years back.....