Signs in the Ear | Frank's Sign, Leudet's Sign, Milian's Ear Sign & Tragal Sign
Frank's Sign
📌 Type of Sign
👉 Clinical Sign seen on Examination of the ear lobe.
🔍 What is the Sign?
Frank's Sign refers to a diagonal crease in the ear lobe, running backwards from the tragus to the edge of the ear lobe.
⭐ May be unilateral or bilateral.
🧠 What Does it Indicate?
A possible marker for cardiovascular disease, especially:
Coronary artery disease
Atherosclerosis
⚠️ It is only a risk marker, ❌ not a definitive diagnostic sign.
⭐ The likelihood of this sign increases with age.
What is the mechanism behind Frank sign?
👨⚕️ Eponym
Named after Dr. Sanders T. Frank, who first described this diagonal ear lobe crease as a marker of coronary artery disease.
Leudet's Sign
📌 Type of Sign
👉 Clinical Sign seen during Otoscopy.
🔍 What is the Sign?
Leudet's Sign refers to a bright clicking sound heard by the examiner through the otoscope, produced by reflex spasm of the tensor veli palatini muscle.
⭐ The patient experiences this as objective tinnitus.
Seen in Eustachian tube inflammation.
How will you elicit Leudet's Sign?
🧠 Why Does it Occur?
Eustachian tube inflammation
→ Reflex spasm or contraction of the tensor veli palatini
→ Production of a clicking sound
→ Perceived by the patient as tinnitus and heard by the examiner
👨⚕️ Eponym
Named after Leudet, who described this audible clicking tinnitus due to tensor palatini muscle spasm.
What is the type of tinnitus in Leudet's Sign?
What is the most common cause of subjective tinnitus?
What is the most common vascular cause of pulsatile tinnitus?
A patient comes to you with tinnitus with vertigo and fluctuating sensorineural hearing loss. What is your provisional diagnosis?
Milian's Ear Sign
📌 Type of Sign
👉 Clinical Sign seen on Inspection of the ear.
🔍 What is the Sign?
Milian's Ear Sign refers to redness and swelling of the pinna in erysipelas.
⭐ It is used to differentiate erysipelas from cellulitis of the ear.
How will you differentiate erysipelas from cellulitis of the ear?
👨⚕️ Eponym
Named after Milian, who described ear involvement as a clue favouring the diagnosis of erysipelas over cellulitis.
👉 Clinical Sign seen during Examination of the ear.
🔍 What is the Sign?
Tragal Sign refers to pain on pressing the tragus.
Seen in Otitis Externa.
🩺 How is it Elicited?
The examiner gently presses the tragus.
Response
Result
Interpretation
Sharp pain
Tragal sign positive
Otitis externa
No pain
Tragal sign negative
Rules out otitis externa
👆 Why is it Called Tragal Sign?
Tragal pressure is applied to elicit the pain, hence the name Tragal Sign.
⭐ High Yield Rapid Revision Table
Sign
Elicited By
Finding
Seen In
Frank's Sign
Examination of the ear lobe
Diagonal crease from the tragus to the edge of the lobe
Marker of coronary artery disease and atherosclerosis
Leudet's Sign
Otoscopy with a sealed speculum
Bright clicking sound heard by the examiner
Eustachian tube inflammation
Milian's Ear Sign
Inspection of the ear
Redness and swelling of the pinna
Erysipelas
Tragal Sign
Pressing the tragus
Sharp pain
Otitis externa
🧠 Viva Pearls
Frank's sign is a diagonal crease in the ear lobe running from the tragus to its edge.
Frank's sign is only a risk marker for coronary artery disease and atherosclerosis, not a diagnostic sign.
Frank's sign becomes more likely with increasing age.
Leudet's sign is a bright clicking sound heard by the examiner during otoscopy.
Leudet's sign is due to reflex spasm of the tensor veli palatini and is a form of objective tinnitus.
Leudet's sign is seen in eustachian tube inflammation.
Milian's ear sign is redness and swelling of the pinna in erysipelas.
Tragal sign is pain on pressing the tragus, seen in otitis externa.
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