Glomus Tumor Signs Explained | Aquino Sign, Brown Sign, Phelps Sign & Rising Sun Sign

Signs in Glomus Tumors

Glomus tumors are highly vascular paragangliomas of the temporal bone and middle ear.

Several classical signs are associated with these tumors. In this post, we will discuss:

• Aquino Sign
• Brown Sign
• Phelps Sign
• Rising Sun Sign

Aquino Sign

📌 Type of Sign

👉 Clinical Sign

Seen during:

• Otoscopic examination
• Microscopic examination of ear

🔍 What is the Sign?

Aquino Sign refers to Blanching of a tympanic mass on compression of the ipsilateral carotid artery.

🩺 How is it Elicited?

The examiner applies gentle pressure over the Ipsilateral carotid artery and observes the middle ear mass.

A positive sign is:

✅ Temporary blanching or paling of the mass

🧠 Why Does it Occur?

Glomus tumors are highly vascular lesions.

Compression of the carotid artery causes:

• Temporary reduction in blood flow
• Reduced vascular filling of the tumor

This leads to Transient blanching of the mass.

👨‍⚕️ Eponym

Named after Dr. G. N. Aquino who first described this maneuver in vascular middle ear tumors.

What is the clinical significance of Aquino sign?

Brown's Sign

📌 Type of Sign

👉 Clinical Sign

Seen during Otoscopic examination.

🔍 What is the Sign?

Brown's Sign refers to:

✅ Blanching of a reddish pulsatile middle ear mass when positive pressure is applied in the external auditory canal.

🩺 How is it Elicited?

Pressure is applied using Siegel's Pneumatic Speculum.

The examiner increases pressure in the External auditory canal & Middle ear cavity.

What Happens?

The vascular mass becomes Pale or blanched temporarily.

After release of pressure, the reddish color returns.

🧠 Why Does it Occur?

Glomus tumors are highly vascular.

Positive pressure:

• Compresses the tumor
• Displaces blood temporarily
• Reduces vascular filling

Resulting in Temporary blanching.

👨‍⚕️ Eponym

Named after Brown who first described this blanching response in vascular middle ear tumors.

What is the clinical significance of Brown sign?

Which instrument is used to elicit Brown Sign?

Phelp's Sign

📌 Type of Sign

👉 Radiological Sign

Seen on HRCT Temporal Bone.

🔍 What is the Sign?

Phelps Sign refers to Erosion of the caroticojugular spine.

What is the Caroticojugular Spine?

🧠 Why Does it Occur?

Glomus Jugulare tumors arise from the Jugular bulb region.

As the tumor enlarges it causes:

• Bony erosion
• Destruction of surrounding structures

including Caroticojugular Spine

👨‍⚕️ Eponym

Named after Phelps who described this characteristic bony erosion.

⚠️ Important Viva Point

Phelp's Sign is seen in:

✅ Glomus Jugulare

❌ Not seen in Glomus Tympanicum

Why is Phelps sign seen in Glomus Jugulare, but not in Glomus Tympanicum?

What is the classic MRI Finding in Glomus tumors?

Rising Sun Sign

📌 Type of Sign

👉 Clinical Sign

Seen during Otoscopy.

🔍 What is the Sign?

Rising Sun Sign refers to a reddish vascular pulsatile mass seen behind an intact tympanic membrane.

🧠 What Does it indicate?

The sign indicates the presence of a Highly vascular lesion within:

• Middle ear
• Jugular bulb region

🌅 Why is it Called Rising Sun Sign?

The red vascular mass behind the tympanic membrane resembles rising sun on the horizon, hence the name Rising Sun Sign.

Seen In

1- Glomus Tumor (Most classical association)

2- High Jugular Bulb - May produce a similar reddish retrotympanic mass.

3- Aberrant Internal Carotid Artery

⚠️ Important Viva Pearl

Rising Sun Sign is ❌ Not specific for glomus tumors

Always confirm with HRCT Temporal Bone before planning surgery.

⭐ High Yield Rapid Revision Table

🧠 Viva Pearls

• Glomus tumors are highly vascular paragangliomas.
• Aquino Sign is elicited by compressing the ipsilateral carotid artery.
• Brown Sign is elicited using Siegle's pneumatic speculum.
• Phelps Sign is erosion of the caroticojugular spine.
• Phelps Sign is specific for Glomus Jugulare.
• Salt and Pepper appearance is the characteristic MRI finding in glomus tumors.
• Rising Sun Sign is not specific for glomus tumors.
• High jugular bulb and aberrant internal carotid artery can also produce Rising Sun Sign.
• HRCT Temporal Bone should be performed before surgery in any patient with a retrotympanic vascular mass.