--- title: "Guttman Sign Explained | Nose, Larynx and Thyroid" description: "ENT notes on the different Gutman signs seen in the nose, larynx and thyroid." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/guttman-sign-thyroid-larynx-nose" categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT"] video: "https://www.youtube.com/watch?v=kdD6T8RpZZY" image: "https://media.theentresident.com/og-images/guttman-sign-thyroid-larynx-nose.png" --- # Guttman Sign Explained | Nose, Larynx and Thyroid ENT notes on the different Gutman signs seen in the nose, larynx and thyroid. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=kdD6T8RpZZY ## Guttman Sign Explained - Nose, Larynx & Thyroid One of the most confusing eponyms in ENT is **Guttman Sign**, because it refers to **three entirely different clinical findings** in three different subspecialties: * Nose * Larynx * Thyroid --- ### Guttman Sign (Nose) #### 📌 Type of Sign 👉 **Clinical sign** #### 🔍 What is the Sign? * Development of **ipsilateral nasal stuffiness or congestion** * Occurs after a **successful stellate ganglion block** ⭐ Indicates that the sympathetic block has worked. #### 🧠 Why does it occur? * Stellate ganglion block causes **sympathetic denervation** * Loss of sympathetic tone leads to: * Vasodilatation * Increased nasal mucosal congestion * As a result, the patient develops: - Ipsilateral nasal obstruction - Nasal stuffiness #### 👨‍⚕️ Eponym Named after **Guttman**, who described nasal congestion as a marker of successful sympathetic blockade. > What is the most important sign of successful stellate ganglion block? > What is the classical triad of Horner syndrome? > What is the earliest indicator of successful stellate ganglion block? > What is the Stellate Ganglion? --- ### Guttman Sign (Larynx) #### 📌 Type of Sign 👉 **Clinical test** Used for detecting **Superior laryngeal nerve palsy**. #### 🔍 What is the Sign? Abnormal pitch changes produced when pressure is applied over the thyroid cartilage during phonation. #### 🩺 How is it elicited? 1. Ask the patient to sustain a vowel sound (e.g. "eeee") 2. Apply pressure over the thyroid cartilage: * Laterally * Anteriorly 3. Observe the resulting pitch changes #### 🎵 Normal Response | Direction of Pressure | Normal Response | | --- | --- | | Lateral pressure | Increase in pitch | | Anterior pressure | Decrease in pitch | #### 🚨 Response in Superior Laryngeal Nerve Palsy The normal response becomes **reversed**. This reversal constitutes the **Guttman Test**. #### 🧠 Why does it occur? The **external branch of the superior laryngeal nerve** supplies the **Cricothyroid muscle**. The cricothyroid muscle is responsible for: - Increasing vocal cord tension - Controlling pitch of voice Paralysis causes abnormal pitch modulation resulting in reversal of the expected response. #### 👨‍⚕️ Eponym Named after **Guttman**, who described this pressure induced pitch reversal. > What is the commonest ENT cause of Superior Laryngeal Nerve Palsy? --- ### Guttman Sign (Thyroid) #### 📌 Type of Sign 👉 **Clinical sign** Detected bycAuscultation of thyroid gland. #### 🔍 What is the Sign? Presence of a Thyroid bruit. Most classically heard in **Graves disease**. #### 🧠 Why does it occur? In Graves disease there is: * Increased vascularity * Increased blood flow This creates turbulent blood flow producing **Systolic thyroid bruit**. #### 🩺 How is it elicited? 1. Ask the patient to hold their breath 2. Auscultate over both thyroid lobes 3. Listen for a bruit #### 👨‍⚕️ Eponym Named after **Guttman**, who described thyroid bruit as a marker of hypervascular thyrotoxicosis. > What is the most common cause of thyrotoxicosis? > Graves disease is caused by antibodies against? > What is the classical triad of Graves disease? > What is the most characteristic eye finding in Graves disease? > What is the most characteristic dermatological finding in Graves disease? --- ### ⭐ High Yield Rapid Revision Table | Guttman Sign | Type | Finding | Clinical Significance | | --- | --- | --- | --- | | Nose | Clinical sign | Ipsilateral nasal congestion after stellate ganglion block | Indicates successful sympathetic blockade | | Larynx | Clinical test | Reversal of pitch changes on thyroid cartilage manipulation | Superior laryngeal nerve palsy | | Thyroid | Clinical sign | Thyroid bruit on auscultation | Graves disease / thyrotoxicosis | --- ### 🧠 Viva Pearls * Guttman sign has different meanings in ENT depending on the organ involved. * **Nasal Guttman sign** indicates successful stellate ganglion block. * **Laryngeal Guttman sign** evaluates superior laryngeal nerve function. * External branch of superior laryngeal nerve supplies the cricothyroid muscle. * **Thyroid Guttman sign** refers to a thyroid bruit, classically heard in Graves disease. * Graves disease is caused by antibodies against the TSH receptor. * Pretibial myxedema is specific for Graves disease. --- ## About This Note This free ENT note on Guttman Sign Explained | Nose, Larynx and Thyroid was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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