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Suggest Tests To Diagnose Frank's Sign

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Posted on Mon, 26 May 2014
Question: As you're probably aware, there's an earlobe crease phenomenon known as Frank's Sign that consists of a prominant vertical(ish) crease on the lower part of the ear lobe that can be indicative of heart disease. From what I've read, this crease is generally described as "pronounced" and only really applicable if it's around 45 degrees in angle from the lower part of the canal all the way to the lobe. There's a YouTube video that seems to indicate similar creases at other angles are not of the same concern, but I'm not sure how true that is - see https://www.youtube.com/watch?v=e9yIiidZOWU

I noticed my mom, at 67, has it quite prominently in both ears, and I'm not sure if I should mention it to her. She's already seeing a doctor, on aspirin therapy, and working to manage her high cholesterol. My first question is if this is important information for her, or if given she's already seeing a doctor, this is something that might worry her more than necessary and wouldn't be helpful. I've also read than in people above 60, this isn't a concern as it's a part of the natural aging process.

Secondly, I've been trying to determine if I have this starting. At 33, I see no extremely prominent fold-like crease (ie, nothing like a creased piece of paper) like I see on mom or pictures used as examples of the phenomenon. However, depending on the light, etc., I can see a slight indentation where this crease would be (at least where it would start), and with the right lighting, I can almost see where it would lead. However, it doesn't seem to go all the way to the edge (rounded part) of the earlobe like in most of the pictures, definitely isn't deep, and it's hard to assess the angle; it seems like sometimes I can sort of see it and sometimes I don't think there's anything there. Is some indentation or slight wrinkling around this area something everyone has, or is this concerning as the possible beginnings of Frank's Sign?

I should note my father is Indian (Eastern, from the country of India), though my mother is Caucasion, and I've heard this isn't a relevant feature in Asian people, so I'm not sure if that comes into play at all with me.
doctor
Answered by Dr. Benard Shehu (1 hour later)
Brief Answer:
No Frank's sign noted in your photo...

Detailed Answer:
Hi there,

I have gone through the medical history of your mother and feel sorry for the situation she is in.

With regards to the Frank's sign, it is a very important marker (as we call it) to identify coronary diseases with 75% specificity and 57% sensitivity. If it is really present in your mother, further cardiac tests are needed to diagnose ischemic heart disease:
- ECG
- Stress test
- Cardiac echo

I have also looked at your photo, and I did not notice any Frank's sign. So, nothing to be worried about. I highly advise to conduct a healthy lifestyle and diet regimen.

Hope it was of help! Let me know if you need further clarifications!
Dr.Benard
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Benard Shehu (38 minutes later)
Thank you. I may mention it to my mom and have her talk to her doctor about it. But I'll try not to alarm her too much either. Unfortunately, in my mom it looks pretty textbook from everything I've seen. Is it any less of a concern since she is 67, or is it still alarming no matter the age?

Just to clarify as per my own ears, is a slight wrinkle/indentation in the area below the ear canal normal as we age? Is it only "Frank's Sign" if it is fairly deep and goes completely across from the lower part of the canal to the edge of the rounded part of the lobe? As I said, it depends what I see based on lighting (which is difficult in a self-photo of the ear), but I'm glad you don't notice anything - would you think it to be fairly unmistakeable (even in a photo) if it was there?

Thanks!

doctor
Answered by Dr. Benard Shehu (14 hours later)
Brief Answer:
Do not alarm your mom...

Detailed Answer:
Hi back,

Thank you for following up.

I'd suggest not to alarm your mom. I advise to run further cardiac tests as mentioned earlier.

With regards to yourself, do not worry in extensiveness. It is difficult to misdiagnose from the photo. I repeat, no Frank's sing in you.

Enjoy life as healthy as you are now!
Dr.Benard
If it answered at your satisfaction, kindly rate my answer while closing this thread. If you have further queries, I'll welcome them!
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Benard Shehu

Cardiologist

Practicing since :2004

Answered : 2257 Questions

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Suggest Tests To Diagnose Frank's Sign

Brief Answer: No Frank's sign noted in your photo... Detailed Answer: Hi there, I have gone through the medical history of your mother and feel sorry for the situation she is in. With regards to the Frank's sign, it is a very important marker (as we call it) to identify coronary diseases with 75% specificity and 57% sensitivity. If it is really present in your mother, further cardiac tests are needed to diagnose ischemic heart disease: - ECG - Stress test - Cardiac echo I have also looked at your photo, and I did not notice any Frank's sign. So, nothing to be worried about. I highly advise to conduct a healthy lifestyle and diet regimen. Hope it was of help! Let me know if you need further clarifications! Dr.Benard