--- title: "Signs in the Ear | Frank's Sign, Leudet's Sign, Milian's Ear Sign & Tragal Sign" description: "ENT notes on Frank's Sign, Leudet's Sign, Milian's Ear Sign & Tragal Sign." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/frank-sign-tragal-sign-milian-ear-sign-leudet-sign" categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT", "Otology"] video: "https://www.youtube.com/watch?v=tKqZecnqWWM" image: "https://media.theentresident.com/og-images/frank-sign-tragal-sign-milian-ear-sign-leudet-sign.png" --- # Signs in the Ear | Frank's Sign, Leudet's Sign, Milian's Ear Sign & Tragal Sign ENT notes on Frank's Sign, Leudet's Sign, Milian's Ear Sign & Tragal Sign. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=tKqZecnqWWM ### 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**. > What is the most common organism in erysipelas? > How will you differentiate between Milian's Ear Sign and [Perichondritis of ear](https://www.theentresident.com/ent-notes-lectures/perichondritis-pinna-boxer-cauliflower-ear.md)? --- ### Tragal Sign #### 📌 Type of Sign 👉 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. --- ## About This Note This free ENT note on Signs in the Ear | Frank's Sign, Leudet's Sign, Milian's Ear Sign & Tragal Sign was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/frank-sign-tragal-sign-milian-ear-sign-leudet-sign When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Signs, Syndromes, Triads, and Compilation Lists in ENT: https://www.theentresident.com/ent-notes-lectures/category/signs-syndromes-triads-lists-in-ent.md - Otology: https://www.theentresident.com/ent-notes-lectures/category/otology.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. 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