Schwartze Sign

Article Author:
Lukas Koenen
Article Editor:
Gunjan Gupta
1/16/2019 10:26:37 AM
PubMed Link:
Schwartze Sign


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]


[1] Peng KA,House JW, Schwartze sign. Ear, nose,     [PubMed PMID: 29554394]
[2] Mudry A, Adam Politzer (1835-1920) and the description of otosclerosis. Otology     [PubMed PMID: 16437001]
[3] Nourollahian M,Irani S, Bilateral schwartze sign, decision-making for surgery. Iranian journal of otorhinolaryngology. 2013 Sep     [PubMed PMID: 24303451]
[4] Lippy WH,Berenholz LP, Pearls on otosclerosis and stapedectomy. Ear, nose,     [PubMed PMID: 18561115]
[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     [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     [PubMed PMID: 16620329]