• Tactile vocal fremitus:
• To assess tactile vocal fremitus, use the ulnar side of the hand, by the hypothenar eminence with the palms facing upwards. Place it at various levels over the back, each time asking the patient to say "ninety-nine". Note how the sound is transmitted to the hand.
• Tactile vocal fremitus is increased over areas of consolidation and decreased or absent over areas of effusion or collapse.
• Feel for the apex beat of the heart; it will be displaced if the mediastinum is displaced or distorted.