Named Signs, Syndromes,

Tests Procedures and Structures

in ENT
Dr. Akshita Goyal
Dr. Apurva Palatkar
 Tragal Sign
Furuncle of the EAC-
Tragal tenderness

Rior tragal crease( anterior tragal

crease)-- created by the superficial
displacement of the parotid gland and
the downward angle of the tragus
Importance of tragal pointer:
identifying the extratemporal branch of
the facial nerve during a parotidectomy
procedure ( lies medial and inferior to
this pointer.
 Cauliflower Ear
Hematoma of the Pinna
followed by blunt trauma
Click icon to add picture
Aka Boxer’s ear

Collection of fluid or blood

between the skin and
cartilage disrupting blood
flow

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 Swimmer’s ear
Aka telephonist ear

Diffuse otitis externa

Infection of eac and external
ear

Organism- Pssuedomonas
Aeruginosa

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 Skull base osteomyelitis
Seen in malignant otitis externa

Most common organism – P.

aeruginosa Click icon to add picture

Davis staging depending on the

extension

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 Prussak’s space
Prussak's space is a small recess in
the middle ear . It is bordered by
different parts of the eardrum, the
neck of the malleus bone, and the
scutum, a bony spur. It can only be
ventilated posteriorly and is part of
the lateral epitympanic space.

Importance: Most common site of

primary cholesteatoma

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 Donaldson’s Line
Surgical landmark for
endolymphatic sac
Click icon to add picture
Passes through horizontal
semicircular canal bisecting
the posterior SCC.
Endolymphatic sac is situated
inferior to the line

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 Trautman’s Triangle
Is a landmark on medial wall of
mastoid antrum to approach the
posterior cranial fossa

Boundaries

Superiorly: superior petrosal sinus

Posteriorly: Sigmoid Sinus
Anteriorly: semi circular canals

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 Macewan’s triangle
AKA suprameatal triangle

Landmark for mastoid antrum

Boundaries

Superiorly: Temporal line

Anteriorly: Posterior superior margin of Bony
EAC
Posteriorly: Tangent drawn to posterior wall of
EAC

Content: Spine of henle. Mastoid antrum lies

1.5cm deep to triangle

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 Canal of Huguier
Opening on the anterior wall of middle
ear for exit of the chorda tympani.

Aka civinini canal Click icon to add picture

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 Bill’s bar
Vertical crest in the internal auditory meatus

Aka crista verticalis.

Divides the superior compartment of IAM Click icon to add picture
into and anterior and posterior
compartments.

IAM Diameter-12mm

Most common site of origin of acoustic

neuroma or vetibular schawannoma or
benign schwann cell tumor is Inferior
vestibular nerve

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 Korner’s Septum
Persistent petrosquamosal suture
formed at the junction of mastoid
and temporal squama Click icon to add picture
Can be taken up as a false medial
wall of antrum during surgery

Osseous lamina within the

temporal bone

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 Arnold’s Nerve
Auricular branch of the vagus nerve aka
Alderman’s nerve

Evokes cough reflex

Named after Friedrich Arnold as he described Click icon to add picture

the cough reflex

Supplies sensory nerve supply to the skin of

ear canal tragus and auricle

Arnold’s canal: passage of petrous portion of

temporal bone for the auricular branch of
vagus
Arnold’s ganglion: otic ganglion

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 Jacobson’s nerve
Tympanic branch of
glossopharyngeal nerve.

Arising from its inferior ganglion

Click icon to add picture
Enters the middle ear though
inferior tympanic canaliculus.

Main sensory innervation to mucosa

of mesotympanum and et.

Named after Ludwig Jacobson.

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 Nerve of Wrisberg
Aka nervus intermedius or
intermediate nerve of Wrisberg
or glossopalatine nerve Click icon to add picture
Sensory and parasympathetic
bundle of facial nerve

Known as intermedius as the

intermediate position of nerve
between the superior part of
vestibular nerve and facial nerve

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 Fissures of Santorini
Named after Giovanni Santorini
They are natural openings in the lateral
cartilaginous ear canal which are a
potential route of spread for malignancy Click icon to add picture
or infection to the parotid area.
These are defects in the cartilaginous
(lateral 1/3) part of the external auditory
canal
Foramen of Huschke aka foramen
tympanicum, which is an embryologic
remnant in the medial bony ear canal
which is another potential route of
spread

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 Hennebert Sign
False positive fistula sign in absence of
labyrinthine fistula.

Meniere’s disease Click icon to add picture

Hypermobile stapes footplate:
congenital syphilis
Idiopathic

False negative fistula sign in presence

of labyrinthine fistula : cholesteatoma,
dead labyrinth, impacted wax

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 Light house sign
Pulsatile discharge from middle ear with
each arterial dilation in asom patients.

Seen during stage of suppuration.

Stages:
Stage of hyperemia—cartwheel sign
Stage of exudation---nipple sign-impending
perforation
Stage of suppuration—light house sign
Stage of coalescent mastoiditis—mastoid
reservoir sign—pus fills up on mopping
Stage of resolution
Stage of complications—Gradenigo
syndrome

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 Pulsatile tinnitus
Pulsatile tinnitus: synchronous
with pulse decreases on carotid
occlusion
Rising sun sign: red reflex on otoscopy
Click icon to add picture
Browne’s pulsation sign on siegalization: Positive
pressure  tumor engorges  tumor blanches 
pressure released  tumor engorges

High resolution C.T. scan with contrast:

erosion of carotico-jugular spine (Phelp’s sign)

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 Bezold’s abscess
Types of subperiosteal abscess

Bezold---over scm
Citelli---posterior belly of
Click icon to add picture
digastric
Zygomatic
Luc—swelling in eac
Retromastoid---swelling over
occipital?
Parapharyngeal and
Retropharyngeal---via et tube

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 Citelli’s angle
Aka sinodural angle

Angle between sigmoid sinus and

middle fossa dural plate.

Angle is acute in primary sclerosis

but obtuse in secondary sclerosis
of csom cases.

Formed by tegmen surperiorly

and transverse sinus inferiorly.

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 Gradenigo’s triad
Dorello’s canal :  bow-shaped bony
Persistent otorrhoea: despite adequate cortical enclosure surrounding the abducens
nerve and the inferior petrosal sinus as
mastoidectomy the two structures merge with the
cavernous sinus. It is sometimes found
 Retro-orbital pain: Trigeminal nv involvement at the tip of the temporal bone.

 Diplopia: convergent squint due to lateral rectus

palsy by injury to abducent nv in Dorello’s canal under

Gruber’s petro-sphenoid ligament, at petrous apex

Aka APEX PETROSITIS

 Giuseppe Gradenigo

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 Griesinger’s sign
Edema over the mastoid region due to thrombosis
of the mastoid emissary vein

Queckenstedt or Tobey-Ayer test: compression of

I.J.V.  rapid rise of C.S.F. pressure (50 – 100 mm
water  rapid fall on release of compression. In
L.S.T. no rise / rise by only 10 – 20 mm water.
Click icon to add picture

Delta/ Empty triangle sign—seen in contrast ct

mri contrast scans in LST

Lillie – Crowe - Beck test: pressure on I.J.V. on

normal side  engorgement of retinal veins +
papilloedema seen in fundoscopy due to L.S.T. on
opposite side.
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 Schwartz Sign
Aka Flamingo pink sign

Seen in active otosclerosis

Indicates active focus with increased vascularity.
Click icon to add picture
Vanderhoeve syndrome—otosclerosis + osteogenesis
imperfecta + blue sclera

Surgery contraindicated if sign present. Sodium

fluoride used instead

Carhart’s notch—dip in BC at 2000hz

*Schwartz surgery: Cortical mastoidectomy*

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 Acoustic dip
Also known as boiler’s notch

Dip at 4000hz both AC and BC

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 Tulio’s Phenomenon
• Seen in Meniere’s disease. • Lermoyez’s reverse Meniere syndrome:
• Dizziness induced by loud low frequency
sound. Sound induced disequilibrium or Deafness  vertigo  improvement in
oscilliopsia.
hearing

• Distortion of sound frequency, called • Tumarkin’s sudden drop attack:

diplacusis binauralis dysharmonica
Pt falls without vertigo / loss of

consciousness
• PTA: rising curve in early disease
• Meyerhoff’s oculo-vestibular response:

Vertigo due to opto-kinetic stimulus

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 Paracusis Willisii
• Pt has better hearing in noisy
surroundings (people increase
their voice intensity & pt’s
speech discrimination becomes
better).

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 Dix Hallpike Maneuver
• Aka Nylen – Barany maneuver
• Epley’s canalith repositioning

• Diagnostic test for BPPV maneuver—treatment for

BPPV

• Semont’s liberatory maneuver

—if epley’s fails.

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 Fitzgerald Hallpike caloric Test
Tests for vestibular function. • Modified Kobrak’s test
Pt supine + 30° head elevation. Each ear
E.A.C. irrigated for 60 sec with ice cold
irrigated in turn for 40 sec with warm water
water in increasing quantity (5, 10, 20 &
at 44°C & then cold water at 30°C.
40 ml) till nystagmus is noticed.
Duration of nystagmus is from start of
Nystagmus noticed with:
irrigation to end point of nystagmus. Normal
= 90–140 sec
• 5 ml = Normal vestibular labyrinth.

Direction of fast component: • 10 / 20 / 40 ml = Hypoactive labyrinth.

Cold → Opposite ear; Warm → Same ear • No nystagmus (40 ml) = Dead labyrinth

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 Dundas Grant cold air caloric test
• Done in cases with TM
• Air in coiled copper tube is perforation as water syringing is
contraindicated.
cooled by pouring ethyl chloride

in it

• Effluent cool air is blown into

E.A.C. to produce vertigo +

nystagmus
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 Kernigs and Brudzinski’s Sign
• KErnigs: resistance to extension • BrudziNsKi’s : Flexion of hips
of leg while hip is flexed. Sign of and knees in response to neck
meningitis. flexion. Seen in meningitis.

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 Hitzelberger’s Sign
• Seen in acoustic neuroma/ • Trigeminal nerve first to be
Vestibular schwanoma involved in acoustic neuroma
• Hypoaesthesia of posterior cases.
external auditory canal wall
• As a result of facial nerve • AKA NEURILEMMOMA
weakness.

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 Furstenberg Test
• Seen in meningocoele and
meningoencephalocoele.
• Apply pressure on ipsilateral
jugular vein to elicit swelling
or pulsation of the lesion

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 Ethmoidal air cells
• ONODI CELLS: posterior
ethmoidal cells lateral to
sphenoid sinus
• HALLER CELLS: intraorbital
anterior ethmoidal cells
• AGGER NASII CELL: anterior
most ethmoidal air cell

• Cottle’s test: Patency of nasal

valve
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 Mulberry Signs in ENT
• Mulberry turbinate: aka inferior
turbinate hypertrophy.

• Mulberry mass in nose:

Rhinosporidiosis

• Mulberry like vocal cord: Also in

rhinosporidiosis

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 • Potato nose: Rhinophyma
• Hard/Woody/Hebra/Tapir
nose: Rhinoscleroma
• Frisch Bacillus in
Rhinoscleroma( Klebsiella
rhinoscleromatis) aka von
Frisch bacillus
• Mickulikz cells and Russell
bodies– Rhinoscleroma.
(warthin starry stain)
• Gothic sign: obliteration of
nasopharynx due to adhesions.

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 Rhinosporidiosis
• Rhinosporidium Seeberi (aquatic
parasite? Or unicellular
prokaryotic cyanobacterium
• Strawberry mass/ Mulberry mass
in the nose. Bleeds.
• Gomory Methanamine silver
staining done.

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 • Lupus vulgaris: apple jelly • Sarcoidosis: Lupus pernio.
appearance on diascopy. Reddish discoloration of nasal
• Syphilis : Hutchinson’s incisors, tip
Moon’s mulberry molars,
interstitial keratitis, corneal
opacities, SNHL, Palate
perforation
• Leprosy: Saddle Nose deformity

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 Heerfordt’s syndrome
• Waldenström’s uveo-parotid fever—aka

Special form of sarcoidosis with:

1. Transient B/L Facial palsy

2. Parotid enlargement

3. Uveitis

4. Fever

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 CHARGE Syndrome
• coloboma, heart defects,
atresia choanae (also known
as choanal atresia), growth
retardation, genital
abnormalities, and ear
abnormalities.
• caused by a mutation in the
CHD7 gene

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 • Samter’s triad: Nasal polyp,
Bronchial asthama and aspirin
intolerance • Darrier’s Crease/Hilton’s Line
• Young’s syndrome: Recurrent • Frequent twitching of face
sinusitis, bronchiectasis and (bunny nose)
azoospermia • Dennie-Morgan creases (in
• Kartagener’s syndrome: lower eyelid skin)
Recurrent sinusitis, bronchiectasis
and situs inversus
• Churg – Strauss syndrome:
Asthma + eosinophilia + vasculitis
+ granuloma + nasal polypi

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 Double ring/Halo sign/ Target sign
• Seen in CSF rhinorrhea • Handkerchief sign: Nasal
• CSF mixed with blood discharge causes stiffening of
produces peripheral CSF halo hanky (due to presence of
around central blood on filter mucin), but not CSF
paper / pillow cover
• Reservoir Sign / Tea Pot Sign:

Bending forward produces

watery nasal discharge

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 Double density sign
• Seen in allergic fungal sinusitis

• Presence of allergic mucin

produces the characteristic
intrasinus hyperdensity in a
background of hypodense
polypoidal mucosal disease.

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 Tear Drop Sign
Refers to appearance of herniated
intraorbital fat +/- inferior rectus
muscle. Which has protruded
through fracture of inferior orbital
wall.

Blunt trauma to orbit.

Le fort 1/2/3
Transverse/Pyramidal
Craniofacial dysjunction
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 Rodent Ulcer
• Locally invasive carcinoma of
basal layer of skin and
mucocutaneous junction

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 African continent sign
• Seen in inverted Papilloma—
contrast Ct pns

• AKA ringertz tumour

• Dodd’s/ Crescent sign: xray

finding- crescent of air between
mass and posterior pharyngeal
wall– seen in AC POLYP

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 Carcinoma Maxilla
• An imaginary plane extending
between medial canthus of eye &
angle of mandible—ohngren’s line
• 2 horizontal lines of Sebileau pass
through floors of orbits & maxillary
sinus—producing supra meso and
infrastructure
Weber Fergusson Incision taken for
total maxillectomy.
Weber Fergusson Diffenbach incision
for orbital fat involvement

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 Frog facies
• Proptosis + nasal bridge
broadening in nasal
angiofibroma patients
Holman miller sign: anterior
bowing of posterior wall of
maxillary sinus on ct.

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 Trotter’s triad
• Seen in nasopharyngeal • Trotter’s or Hippocratic
carcinoma manuever- nasal pinching in
epistaxis
• Conductive deafness due to et • Woodruff’s Plexus: Venous
dysfunction plexus Posterior to inf turbinate
• Ipsilateral temporoparietal • Kisselbach’s Plexus: arterial
neuralgia—d/t 5th nerve palsy plexus at little’s area
• Palatal paralysis—d/t 10th nerve
palsy

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 Irwin Moore Sign Moure’s Sign
• Pressure on anterior • Seen in Post cricoid Carcinoma
pillar will cause release of • Absence of Laryngeal crepitus
puss or cheesy material in when larynx moved side to
chronic follicular tonsillitis side.

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 Plummer Vinson Syndrome
• Aka PATTERSON KELLY
BROWN SYNDROME

• Hypopharyngeal webs
• Iron deficiency anemia
• Post crcicoid dysphagia

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 Boyce’s position Rose’s position
• In DLSCOPY Bronchoscopy and • In tonsillectomy tracheostomy
esophagoscopy surgeries and surgery
• Extension of head in relation to • Extension of both head and neck
cervical spine and flexion of
neck in relation to chest
• Boyce’s sign: seen in zenker’s
• Aka sniffer’s position diverticulum: gurgling sound
• For best visualization of larynx due to noise of splashing
fluid accumulated in a large
Zenker's diverticulum, can be
heard on palpation.
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 Bryce’s Sign Thumb Sign
• a hissing or gurgling • edematous and
sound produced by manual enlarged epiglottis which is
pressure on an external seen on lateral soft-tissue
laryngocele- radiograph of the neck
• Seen in acute epiglottitis

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 Church steeple sign/ Pencil tip sign
• tapering of the upper
trachea on a frontal chest
radiograph reminiscent of a
church steeple. The
appearance is suggestive of
croup, which should be
obvious clinically.
• Glottic ans subglottic
narrowing of airway
• Aka laryngotracheobroncheitis

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 Elongated omega epiglottis
• Seen in laryngomalacia
• supraglottic collapse during the
inspiratory phase of respiration,
resulting in intermittent upper
airway obstruction and stridor.
LM is the most common
source of stridor in infants and
the most common congenital
laryngeal anomaly.
• Self resolving

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 Space of Boyer
• Pre epiglottic space

• Anterior and lateral to epiglottis

• Inferiorly in continuation with
paraglottic space
• Contains fat

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 Space of Tucker
•`

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 Reinke’s space
• potential space between the
vocal ligament and the
overlying mucosa. It is not an
empty space, but contains
cells, special fibers and
extracellular matrix.
• Swelling is called reinke’s
edema
• Role in vibration of vocal
cords

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 Turban epiglottis
• Mouse nibbled appearance
• Mammilated arytenoids.

• All seen in TB LARYNX

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 Space of Gillette
• Retropharyngeal compartment
divided into two lateral
compartments space of Gillette
by a fibrous raphe.
• Extends from base of skull to
tracheal bifurcation. B
• Between two parapharyngeal
spaces.

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 Nodes of Rouviere
• Lateral retropharyngeal lymph
nodes lie between carotid artery
and prevertebral muscles.
• The upper most positioned nodes
anterior to the atlas are called as
NOR

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 Dohlman’s Procedure—for zenker’s
diverticulum
• The diverticulum is exposed • Killian’s dehiscence- site of
with a bivalved (two-blade) diverticulum( triangular area of
endoscope with one blade in the wall of pharynx between
pouch and the other blade in the cricopharyngeus and
cervical esophagus. Under thyropharyngeus
direct visualization, the
common wall between the
pouch and the esophagus is
ablated (usually with the carbon
dioxide, CO2, laser). Endoscopic
staple diverticulotomy.

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 Ortner’s/ Cardiovocal syndrome
• Mitral stenosis • Galen anastomosis: connects
• Left recurrent laryngeal nerve superior and recurrent laryngeal
palsy nerve

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 • Frey’s syndrome aka • Sludder’s neuralgia-
Baillarger's syndrome, sphenopalatine neuralgia. Unilateral
Dupuy's syndrome– gustatory sweating headache with pain in upper jaw and
due to damage to auriculotemporal nerve soft palate. Caused due to irritation
of sphenopalatine ganglion
• Crocodile tears/ Bogorad syndrome
( gustatory lacrimation) shedding of
tears while drinking or eating. Faulty • First bite syndrome: severe pain in
regeneration of superior salivatory preauricular region initiated on first
nucleus to lacrimal gland via superior bite of meal. Imbalanced
petrosal nerve leads to improper sympathetic and parasympathetic
stimulation. innervation of partoid gland.

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