Otosclerosis Signs Explained | Schwartz sign, Carhart’s notch, Halo sign, Paracusis willisii

👂 Otosclerosis Signs - Schwartz sign, Carhart’s notch, Paracusis willisii, Halo sign

Otosclerosis is a disorder of abnormal bone remodeling in the otic capsule, most commonly affecting the stapes footplate, leading to conductive hearing loss.

There are several important signs seen in otosclerosis which we will discuss in this post:

• Carhart’s notch
• Halo sign
• Paracusis Willisii
• Schwartz sign

🎧 Carhart’s Notch

📌 Type of Sign

👉 Audiological sign seen on Pure Tone Audiogram

📊 What is the Sign?

• A dip in bone conduction threshold at 2000 Hz

What is the other name of Carhart’s Notch?

🧠 Why does it occur?

• Due to stapes fixation → Alters ossicular resonance at 2000 Hz

• Stapes normally contributes to bone conduction at this frequency → Fixation leads to reduced bone conduction

⭐ Important: ✅ Improves after stapedotomy / stapedectomy

👨‍⚕️ Eponym

Named after Raymond Carhart, an audiologist.

🎯 High Yield MCQs

• Tympanogram in Otosclerosis → Type As curve

• Stapedial reflex absent in Otosclerosis

• Typical patient in Otosclerosis:

  • Middle-aged female

  • Progressive bilateral conductive hearing loss

  • Worse during pregnancy

What is the most common site of otosclerosis?

In which condition do you see a dip in air conduction at 4000 Hz?

🩻 Halo Sign (Double Ring Sign)

📌 Type of Sign

👉 Radiological sign seen on CT Temporal Bone

🔍 What is the Sign?

• Radiolucent ring surrounding the cochlea

• Appears like a halo or double ring

🧠 Why does it occur?

• Due to demineralization of the otic capsule
• Seen in cochlear otosclerosis

⭐ Indicates inner ear involvement → Sensorineural hearing loss

Which is the best CT View to see the Halo sign on a HRCT Temporal Bone?

Which other condition do you see Halo sign on filter paper?

🗣️ Paracusis Willisii

📌 Type of Sign

👉 Clinical sign (history based)

🔍 What is the Sign?

• Improved hearing in noisy environment

• Typical feature of conductive hearing loss

🧠 Mechanism

• In noisy surroundings → People speak louder

• Increased sound intensity overcomes conductive block

• Inner ear function remains normal → Hearing improves

👨‍⚕️ Eponym

Named after Thomas Willis

What is Recruitment? Which kind of Hearing loss shows Recruitment?

🔴 Schwartz Sign (Flamingo Pink Sign)

📌 Type of Sign

👉 Clinical sign seen on Otoscopy

🔍 What is the Sign?

• Pinkish blush over promontory seen through tympanic membrane

• Also called Flamingo pink blush sign

🧠 Why does it occur?

• Seen in active phase of otosclerosis

• Due to increased vascularity of otospongiotic bone

• Located in submucosa of promontory

⭐ Very Important: Presence of Schwartz sign = Active disease

👨‍⚕️ Eponym

Named after Schwartz

What is Rising Sun Sign? Which condition is it seen in?

⭐ High Yield Rapid Revision ENT Table

🧠 Viva Pearls

• Most common site of Otosclerosis → Fissula ante fenestram
• Tympanogram seen in Otosclerosis → Type As
• Stapedial reflex → Absent in Otosclerosis
• Pregnancy worsens otosclerosis
• Active stage of Otosclerosis → Schwartz sign
• Inner ear involvement in Otosclerosis → Halo sign