A 30-year-old woman presents with progressive bilateral conductive hearing loss worse during pregnancy. Otoscopy shows a flamingo pink hue of the promontory through the tympanic membrane (Schwartze sign). This positive Schwartze sign indicates:

• A Glomus tympanicum tumor behind the anterior superior quadrant of the TM
• B Aberrant internal carotid artery coursing through the middle ear
• C Inactive 'fenestral' otosclerosis with calcified plaque at the anterior oval window niche
• D Active otosclerosis with increased vascularity of the spongy bone overlying the active focus near the oval window (endosteal type) — indicating active disease suitable for sodium fluoride therapy ✓

Explanation

Schwartze sign (flamingo pink hue = 'blush' of the promontory) seen through the tympanic membrane indicates active otosclerosis — the vascular spongy bone (otospongiosis phase) produces a reddish discoloration. This indicates active disease and is an indication for sodium fluoride therapy (10-25 mg/day for 2 years) to convert active spongy bone to compact bone and arrest progression. The most common site is the 'fissula ante fenestram' (anterior to the oval window). Glomus tympanicum appears as a reddish-blue pulsatile mass, typically behind the anterior inferior quadrant.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.