Vocal fremitus

Vocal fremitus is a medical term referring to the palpable vibration transmitted through the bronchopulmonary system to the chest wall when a person speaks. It is an important aspect of the physical examination, particularly in the assessment of the lungs and pleura. The evaluation of vocal fremitus can help in diagnosing various pulmonary diseases and conditions.

Mechanism

Vocal fremitus is generated by the vocal cords during speech, creating sound waves that travel through the airways within the lungs. When these sound waves encounter areas of increased density, such as in pneumonia, or decreased density, as seen in pneumothorax, the transmission of vibrations to the chest wall is altered. The mechanism relies on the continuity of the air column from the larynx to the surface of the chest wall.

Assessment

To assess vocal fremitus, a healthcare provider places their hands on the patient's chest and asks the patient to repeat a phrase such as "ninety-nine" or "blue balloons." The examiner feels for the intensity and symmetry of the vibrations. Increased fremitus may suggest consolidation of lung tissue, whereas decreased fremitus could indicate air or fluid in the pleural space, obstructing the transmission of sound vibrations.

Clinical Significance

Vocal fremitus is a valuable diagnostic tool in the physical examination of patients with respiratory complaints. It can help differentiate between different types of lung pathology:

• Increased Vocal Fremitus: Conditions like pneumonia can increase the density of lung tissue, enhancing the transmission of vibrations. This is often found in areas where lung consolidation is present.
• Decreased Vocal Fremitus: Conditions that cause a separation of the lung from the chest wall, such as pleural effusion, pneumothorax, or severe COPD, can lead to a decrease in the palpable vibrations.
• Asymmetrical Vocal Fremitus: Any asymmetry in vocal fremitus can indicate a unilateral lung problem and warrants further investigation.

Limitations

The assessment of vocal fremitus can be subjective and is influenced by the patient's body habitus, the examiner's experience, and the patient's ability to speak loudly and clearly. Additionally, the presence of chest hair, thick chest wall, or severe airflow obstruction can diminish the palpability of fremitus.

Conclusion

Vocal fremitus is a non-invasive, simple, and valuable component of the physical examination of the respiratory system. It provides clues to the presence and nature of pulmonary and pleural diseases. However, it should be interpreted in the context of the entire clinical picture and, if necessary, followed up with further diagnostic testing.

‎

---

Translate: - East Asian 中文, 日本, 한국어, South Asian हिन्दी, தமிழ், తెలుగు, Urdu, ಕನ್ನಡ, Southeast Asian Indonesian, Vietnamese, Thai, မြန်မာဘာသာ, বাংলা
European español, Deutsch, français, Greek, português do Brasil, polski, română, русский, Nederlands, norsk, svenska, suomi, Italian
Middle Eastern & African عربى, Turkish, Persian, Hebrew, Afrikaans, isiZulu, Kiswahili,
Other Bulgarian, Hungarian, Czech, Swedish, മലയാളം, मराठी, ਪੰਜਾਬੀ, ગુજરાતી, Portuguese, Ukrainian