What is Fremitus? How do you perform the test? What can this assessment technique identify?

What is Fremitus? How do you perform the test? What can this assessment technique identify?

What is Fremitus? How do you perform the test? What can this assessment technique identify?

Fremitus

Fremitus is a vibration transmitted through the bronchi and lung parenchyma to the surface of the chest where it can be felt through palpation. The vibrations are usually a result of turbulence caused by airflow from the lungs against the larynx. The vibrations are then transmitted through the tracheobronchial path to the lungs and then through the lung parenchyma to the surface where they can be felt by palpation (Modi &Tolat, 2021). Low-pitched voices are easily conducted through the lungs as compared to high-pitched voices.

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The test is performed by asking the patient to repeat certain numbers such as ninety-nine in a constant tone. During the procedure, the healthcare provider simultaneously palpates the chest wall of the patient using the palm of his or her hands to feel for sound vibrations when the patient breathes quietly (Modi &Tolat, 2021). Palpation is normally done on both sides of the chest wall and comparison is made based on the frequency of vibrations.
The fremitus test can be used to identify the changes in the intensity of tactile fremitus. The principle of the test is that vibrations are conducted better in solid and liquid as compared to air. Therefore, increased tactile fremitus are noticed in increased lung tissues, while decreased tactile fremitus are noticed in air-filled lungs (Modi &Tolat, 2021). Changes in the intensity of tactile fremitus act as an early indicator of underlying lung pathology which can then be confirmed by relevant laboratory and imaging tests. Only asymmetrical tactile fremitus is considered to be pathological. Disorders that result in hyperinflation of the lungs cause decreased tactile fremitus. For instance, chronic obstructive pulmonary disease (COPD), emphysema, severe airway obstruction, and asthma (Modi &Tolat, 2021). Disorders that result in increased lung tissues cause an increase in tactile fremitus. Lung consolidation due to pneumonia causes increased tactile fremitus. Lung tumors and atelectasis are other known causes.
References
Modi, P., & Tolat, S. (2021). Vocal Fremitus. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499838/