Frank described diagnonal creases on the ear lobe. He considered this a possible sign of coronary artery disease (CAD). It has been hypothesized that creases are due to changes in subcutaneous microvasculature occurring at the same time as vascular changes in the heart.


Synonyms: aural sign, ear lobe crease (ELC) sign, diagonal ear lobe crease (DELC)


The sign consists of one or more diagnonal or vertical creases in the ear lobe, running from the tragus.


The presence of bilateral ear lobe creases may be more specific for coronary artery disease.


Controversy about the significance of the finding:

(1) Some say that the sign is a nonspecific change related to aging..

(2) Some state that the finding has no significance in certain racial populations such as Orientals and American Indians.

(3) Some of the early studies may have involved populations with a higher-than-normal prevelance of coronary artery disease (prevalence of 76% in Pasternac and Sami, 1982).


The finding is neither sensitive nor specific for coronary artery disease. Tranchesi et al reported a sensitivity of 65% and specificity of 72%. Motamed and Pelekoudas reported a sensitivity of 48% and specificity of 88%.


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