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 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.