Introduction
An association between a diagonal ear lobe crease (DELC) and cardiovascular disease was first suggested by Sanders T. Frank in 1973 in the New England Journal of Medicine(1). Since then there have been numerous further studies that have investigated the association of ‘Frank’s Sign’ with carotid disease, cerebral vascular disease and diabetic retinopathy. Whilst almost all of the studies since then have found a correlation between DELC and cardiovascular disease, there is disagreement on whether this is an independent association or whether both of these are related to increasing age or other potential confounding cardiovascular risk factors (2).
The purpose of this meta-analysis is therefore to determine if there is a significant association between the presence of a diagonal ear lobe crease (Fig. 1) and coronary artery disease (CAD) independent of other risk factors. Although there have been other reviews that have looked into this (3), these have included autopsy studies or clinically diagnosed CAD and none have specifically looked at studies solely using coronary angiography which is the gold standard for confirming CAD(4-6). At the same time, although this is an aural sign, there have been no studies in any otology journals and no reports in any otolaryngology literature. We believe this is the first literature review and meta-analysis that solely looks at patients with DELC undergoing angiography and the first article about this topic in an otology publication.