Vocal Fremitus

VOCAL FREMITUS (fremitus vocalis s. pectoralis), vibration of the chest wall during phonation, perceptible by palpation. It is caused by vibrations of the vocal cords, transmitted to the underlying column of air in the bronchi, bronchioles, and finally to the chest wall, and depends on the ability of the lungs and chest wall to resonate. This ability manifests more distinctly with a deep and strong voice, consequently in women and children vocal fremitus is almost absent. It is examined by comparative palpation (firm application of the palm) of symmetrical areas of the chest wall while the subject being examined pronounces words rich in vowels and the letter r. It is somewhat stronger in the upper part of the chest wall, where the large bronchi are located, and on the right side, since the right bronchus is wider and shorter. Vocal fremitus is enhanced in 1) strong, low voice, 2) infiltrative processes in the lungs, if the conducting bronchus is not obstructed, 3) above cavities and bronchiectases, 4) along the upper border of pleural exudate, 5) under lung areas bordering a large pericardial exudate. Vocal fremitus is diminished or absent in 1) aphonia, weak and high voice, 2) with well-developed subcutaneous fat tissue, its edema, 3) in the area of pneumothorax, hydrothorax, pleural exudate, pleural tumors, 4) in lung tumors compressing the conducting bronchus, 5) in obstruction of the conducting bronchus. Often accompanying bronchophony and bronchial breathing, vocal fremitus usually does not run parallel to them when there is air, liquid, or dense tissue between the lung and chest wall.