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Fremitus is a vibration transmitted through the body.[1] In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall (tactile fremitus) and/or heard by a stethoscope on the chest wall with certain spoken words (vocal fremitus), although there are several other types.


Vocal fremitus

When a person speaks, the vocal cords create vibrations (vocal fremitus) in the tracheobronchial tree and through the lungs and chest wall, where they can be felt (tactile fremitus).[2] This is usually assessed with the healthcare provider placing the flat of their palms on the chest wall and then asking a patient to repeat a diphthong such as "blue balloons" or "toys for tots" (the original diphthong used was the German word Neunundneunzig but the translation to the English 'ninety nine' was not a diphthong and thus not as effective in eliciting fremitus). An increase in tactile fremitus indicates denser or inflamed lung tissue, which can be caused by diseases such as pneumonia. A decrease suggests air or fluid in the pleural spaces or a decrease in lung tissue density, which can be caused by diseases such as chronic obstructive pulmonary disease or asthma.[2]

Hepatic fremitus

Hepatic fremitus is a vibration felt over the person's liver. It is thought to be caused by a severely inflamed and necrotic liver rubbing up against the peritoneum. The name 'Monash sign' has been suggested for this clinical sign, after the Monash Medical Centre in Melbourne, Australia.[3]

Dental fremitus

Fremitus appears when teeth move. This can be assessed by feeling and looking at teeth when the mouth is opened and closed.[4]


  1. "fremitus" at Dorland's Medical Dictionary
  2. 1 2 Kacmarek, Robert M.; Stoller, James K.; Heuer, Al (2016-02-05). Egan's Fundamentals of Respiratory Care. Elsevier Health Sciences. p. 336. ISBN 9780323393850.
  3. Nagappan R, Parkin G, Tsui A, Sievert W (2001). "Hepatic fremitus: 'Monash sign'". Intern Med J. 31 (9): 567–8. doi:10.1046/j.1445-5994.2001.00145.x. PMID 11767877.
  4. Jr, Paul A. Levi; Rudy, Robert J.; Jeong, Y. Natalie; Coleman, Daniel K. (2015-12-29). Non-Surgical Control of Periodontal Diseases: A Comprehensive Handbook. Springer. pp. 213–214. ISBN 9783662466230.
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