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July 14, 2015

Earlobe Crease Associated with Heart Attacks

Check out the Earlobe Crease in this bust of
Roman Emperor Hadrian
It is a factoid that all medical students memorize and is even tested on exams... at least I remember doing so sometime during my first 2 years of medical school. This findings is also known as "Frank's Sign" named after Dr. Sanders Frank based on a paper he authored in 1973.

This risk of heart attack associated with a diagonal earlobe crease has reported numerous times over the years.  In a 1989 study of 303 consecutive autopsies in one particular district in England:
"A cardiovascular cause of death was present in 154 (73%) of 211 with and 41 (45%) of 92 without diagonal creases and was associated with an increased risk of a cardiovascular cause of death of 1.55 in men and 1.74 in non-diabetic women." [link]
In 1992, another study tried to quantify what the risk of coronary disease is in the presence of an earlobe crease and found:
"The observed sensitivity of the sign for the diagnosis of CAD was 65%, the specificity 72%, the positive predictive value 42% and the negative predictive value 87%." [link]
This association was also confirmed in Chinese as well as in Japanese populations.

2015 study suggested that an earlobe crease is even associated with increased risk of stroke as well.

Although interesting, I'm not sure whether this finding has any clinical relevance. As far as I know, the presence of an earlobe crease is not an indicator for more frequent and earlier heart checkups than those without an earlobe crease.

Certainly as an ENT, I don't mention anything to patients I see who have this finding as I'm not quite sure what to make of it and I'm not quite sure how patients would make of it either if I suggest a cardiology consultation for "earlobe crease."

I should also mention that there's also a few studies refuting this association including this one published in 1987 which felt that the earlobe crease was more a reflection of age rather than heart problems.


Reference:
Diagonal earlobe creases and fatal cardiovascular disease: a necropsy study. Br Heart J. 1989 Apr; 61(4): 361–364.

Earlobe Crease Shapes and Cardiovascular Events. Am J Cardiol. 2015 Jul 15;116(2):286-93. doi: 10.1016/j.amjcard.2015.04.023. Epub 2015 Apr 23.

Diagonal earlobe crease and coronary artery disease in a Chinese population. BMC Cardiovasc Disord. 2014 Apr 4;14:43. doi: 10.1186/1471-2261-14-43.

The earlobe crease, coronary artery disease, and sudden cardiac death: an autopsy study of 520 individuals. Am J Forensic Med Pathol. 2006 Jun;27(2):129-33.

Diagonal earlobe crease as a marker of the presence and extent of coronary atherosclerosis. Am J Cardiol. 1992 Dec 1;70(18):1417-20.

A new wrinkle to the earlobe crease. Arch Intern Med. 1987 Jan;147(1):65-6.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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