Tools
Author: Lukas Koenen Editor: Gunjan Gupta
Updated: 9/4/2023 7:55:20 PM
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 areused interchangeably by different authors. To avoid any confusion, we will use theterm Schwartze, named after the discoverer.
Issues of Concern
Register For Free And Read The Full Article
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed. Earn CME/CE by searching and reading articles.
Search engine and full access to all medical articles- 10 free questions in your specialty
- Free CME/CE Activities
Search engine and full access to all medical articles- Free daily question in your email
- Save favorite articles to your dashboard
- Emails offering discounts
Learn more about a Subscription to StatPearls Point-of-Care
Already have an account? Log in
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 condition leads to characteristic conductive and/or sensorineural hearing loss. Differentiating between stapedial and inner ear involvement is crucial in determining the choice of treatment. A 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 characteristically reddish discoloration of the promontory seen during an otoscopic examination. This discoloration is the result of 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) area, 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]
Nursing, Allied Health, and Interprofessional Team Interventions
Nursing staff who work in the ENT area should familiarize themselves with the Schwartze sign so that they can report it to the clinician when they encounter it. This ability to see a potential concern will expedite necessary care, as well as provide an "extra set of eyes" for the condition should it be present, leading to further investigation and prompt therapeutic intervention.
References
[1]
Peng KA, House JW. Schwartze sign. Ear, nose, & throat journal. 2018 Mar:97(3):54 [PubMed PMID: 29554394]
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A2)"]').popover( { content: "A: Benefits outweigh the risks
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B2)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A3)"]').popover( { content: "A: Benefits outweigh the risks
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B3)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); });
[2]
Mudry A. Adam Politzer (1835-1920) and the description of otosclerosis. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2006 Feb:27(2):276-81 [PubMed PMID: 16437001]
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A2)"]').popover( { content: "A: Benefits outweigh the risks
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B2)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A3)"]').popover( { content: "A: Benefits outweigh the risks
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B3)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); });
[3]
Nourollahian M, Irani S. Bilateral schwartze sign, decision-making for surgery. Iranian journal of otorhinolaryngology. 2013 Sep:25(73):263 [PubMed PMID: 24303451]
", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B1)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A2)"]').popover( { content: "A: Benefits outweigh the risks
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B2)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A3)"]').popover( { content: "A: Benefits outweigh the risks
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B3)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); });
[4]
Lippy WH, Berenholz LP. Pearls on otosclerosis and stapedectomy. Ear, nose, & throat journal. 2008 Jun:87(6):326-8 [PubMed PMID: 18561115]
", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B1)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A2)"]').popover( { content: "A: Benefits outweigh the risks
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B2)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
2: Moderate level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(A3)"]').popover( { content: "A: Benefits outweigh the risks
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); $('a[refgrade*="(B3)"]').popover( { content: "B: Benefits and risk equivocal or uncertain
3: Low level of evidence", html: true, placement: "top", trigger:'hover' } ); });
[5]
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:18(4 Suppl 59):59-65 [PubMed PMID: 10205935]
[6]
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 & Cervico-Facial Surgery. 2006 Apr:31(2):110-5 [PubMed PMID: 16620329]
Level 2 (mid-level) evidence
