I'm a bit confused; I'm asking you the question. You made a claim it's a bad sign that a >20person company has no CTO.

I've seen this occur in practice, and I'm asking you why that's a bad sign.

I'll take a stab: it means that either (a) the CEO has ego problems and refuses to allow other C-suite titles, or (b) the CEO has failed to hire the appropriate talent for a true CTO role (often because they're trying to do too much themselves).