Physical Exam

Tactile Fremitus

also known as Vocal fremitus

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Video coming September 2026

How to Perform

Place the ulnar edge or palmar base of your hands over symmetric upper, middle, and lower posterior lung fields while the patient repeatedly says a resonant phrase such as “ninety-nine.” Compare the intensity of the vibrations side to side at each level, and assess additional areas as clinically indicated. Note any area of increased or decreased fremitus.

How to Interpret

Pleural Effusion

Decreased tactile (vocal) fremitus over the affected hemithorax

Rule in

HelpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Limited

References

Heckerling PS, Tape TG, Wigton RS, Hissong KK, Leikin JB, Ornato JP, Cameron JL, Racht EM. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med. 1990;113(9):664-670. doi:10.7326/0003-4819-113-9-664. PMID: 2221647.
Kalantri S, Joshi R, Lokhande T, Singh A, Morgan M, Colford JM Jr, Pai M. Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med. 2007;101(3):431-438. doi:10.1016/j.rmed.2006.05.017. PMID: 16965906. Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317. PMID 19155458. · Simel DL, Wong CL, Holroyd-Leduc J, Straus SE. Pleural Effusion. In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. McGraw-Hill Education; 2009.
Singal BM, Hedges JR, Radack KL. Decision rules and clinical prediction of pneumonia: evaluation of low-yield criteria. Ann Emerg Med. 1989;18(1):13-20. PMID: 2642673.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.