Schwartze Sign


Article Author:
Lukas Koenen


Article Editor:
Gunjan Gupta


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
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Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
1/16/2019 10:26:37 AM

Definition/Introduction

The Schwartze sign is named after the German otologist Hermann Schwartze (1837-1910) who in his day was the first otologic Professor in Germany. His work focussed on different otologic diseases one of which being the ankylosis of the stapes now known as otosclerosis, a name defined several years later by Adam Politzer. Modern literature credit Hermann Schwartze with the discovery of a characteristic coloration of the promontory related to otosclerosis, but it remains unclear whether he used the term himself.[1][2]

Other terms used are Flemingo's flush sign and Rising sun sign.[3]

The terms Schwartze and Schwartz are used interchangeably by different authors. To avoid any confusion, we will use the term Schwartze named after the discoverer.

Issues of Concern

Otosclerosis is a disease of the bony structures in the middle and inner ear, most prominent involving the stapes but also the promontory. This leads to characteristic conductive and/or sensorineural hearing loss. Differentiating between stapedial and inner ear involvement is crucial in determining the choice of treatment. Stapedectomy is therefore only an option in cases with fixation of the stapes, and there is no known treatment for symptom improvement in cochlear or sensorineural otosclerosis[4]

The Schwartze sign is a characteristic reddish discoloration of the promontory seen during an otoscopic examination. This discoloration results from the increased blood flow to the promontory due to the characteristic otosclerotic lesion. Observation of the phenomenon occurs in up to 10% of patients with otosclerosis.[1]

Patients with a positive Schwartze sign may be more likely to have sensorineural (cochlear) otosclerosis.[5][6]

Clinical Significance

The finding of a reddish discoloration in a patient with hearing loss may suggest otosclerosis especially of the sensorineural (cochlear), but there have been no studies about the sensitivity and the specificity of the symptom. A reddish discoloration of outer and middle ear structures, mimicking the Schwartze sign, may result from a variety of different otologic diseases. Some authors, therefore, question the clinical significance of the finding and advocate not to use it in clinical decision making.[4]


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Schwartze Sign - Questions

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A 22-year-old male presents to you in the outpatient clinic with right-sided hearing loss. Audiometric evaluation reveals a conductive hearing loss of 25 dB in average with a notch at 2000 Hertz. Otoscopic examination reveals a reddish discoloration of the promontory in the right ear. What is the most likely diagnosis?



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Which structures are involved in otosclerosis?



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A 40-year-old patient presents to the clinic for decreased hearing. Examination of the right ear shows a reddish discoloration through the tympanic membrane. Audiometric evaluation reveals a sensorineural hearing loss of approximately 35 dB without conductive component on the right side with a prominent notch at 2000 kHz and negative stapedial reflexes. What is the best initial therapy for this patient?



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Schwartze Sign - References

References

Peng KA,House JW, Schwartze sign. Ear, nose,     [PubMed]
Mudry A, Adam Politzer (1835-1920) and the description of otosclerosis. Otology     [PubMed]
Nourollahian M,Irani S, Bilateral schwartze sign, decision-making for surgery. Iranian journal of otorhinolaryngology. 2013 Sep     [PubMed]
Lippy WH,Berenholz LP, Pearls on otosclerosis and stapedectomy. Ear, nose,     [PubMed]
Sellari-Franceschini S,Ravecca F,De Vito A,Berrettini S, [Progressive sensorineural hearing loss in cochlear otosclerosis]. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 1998 Aug     [PubMed]
Nakashima T,Sone M,Fujii H,Teranishi M,Yamamoto H,Otake H,Sugiura M,Naganawa S, Blood flow to the promontory in cochlear otosclerosis. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology     [PubMed]

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