EAR ACUPUNCTURE – AURICULOTHERAPY

Ear acupuncture is the best known of the so-called microsystems of acupuncture, which hold that there is a representation of the body in a small area. The story of ear acupuncture begins with a French doctor, Paul Nogier, of Lyon (see Kenyon 1983a). In the early 1950s Nogier was intrigued to find that some of his patients had apparently been cured of their sciatica by a non-medical practitioner who had cauterized an area on their ears. On looking further into the matter he found that this form of treatment had been used in France during the nineteenth century but had largely died out by 1870. Intrigued, he began to search the ears of patients who were suffering from various kinds of pain. Eventually he came to the conclusion that the body is represented upside down in a fetal position, with the head on the ear lobe and the spine on the ridge of the ear known at the anti-helix. This recalls the motor and sensory homunculi in the cerebral cortex first described by Wilder Penfield.

Charts of the ear acupuncture points are available but the situation has been made complicated by the fact that there are different versions of the charts. Nogier’s claims were taken up by the Chinese, who claimed that there were ancient Chinese texts describing this method of treatment; they then produced their own charts, which were not identical with Nogier’s, and which came back to the West. Thus we now have at least two sets of charts: Nogier’s and Chinese charts, the latter probably based to a greater or lesser extent on Nogier’s though not identical with them.

Few attempts have been made to investigate Nogier’s claims objectively. Melzack (1984) tried, but failed, to find evidence for the specific correlations described by Nogier. On the other hand, researchers at UCLA School of Medicine have found such evidence (Oleson et al., 1980). Forty patients suffering from musculoskeletal pain in various parts of their body were tested. They were draped with a sheet to conceal any visible physical problems and then a doctor who knew nothing about their illness examined their ears for areas of increased electrical conductance or tenderness. A correct identification was obtained in 361 of 480 individual comparisons (75.2%). There were 12.9% false positive points and 11.9% false negative points.

This is an interesting study and its results are striking enough to prevent one from dismissing the idea of an ear representation of the body out of hand. The ear does have an exceptionally complicated nerve supply (greater auricular branch of the cervical plexus, lesser occipital nerve, auricular branch of the vagus, and auriculotem- poral nerve). It is therefore at least conceivable that the ear is connected with centres in several different parts of the brain and thus with remote parts of the body. But while this fact – if it is a fact – would certainly be very interesting for neuroanatomists, would it have any practical importance? The authors of the study think that it would not help much in diagnosis, since generally it would be easier simply to ask patients where they felt pain. However it could be useful for unconscious patients or children, and they also found some patients who, when told of the findings of the ear examination, suddenly remembered previously forgotten pains or problems in the relevant area, and they therefore suggest that ear examination could be useful in the general assessment of a patient.

The main claim made on behalf of Nogier’s work, however, is that it is an effective method of treatment. When a reactive point is found in the ear this is treated by needling, sometimes with electrical stimulation of the needle. Nogier has in fact developed a complete sub-system of acupuncture based on the ear. Moreover he has moved on considerably from the simple initial method of examining the ear for tender points. He has designed a number of electrical instruments for detecting points in the ear, and in 1966 he described the “auricular cardiac reflex” (Kenyon 1983b): that is, changes in the amplitude of the radial pulse in response to various stimuli. Perhaps the most startling of his ideas concerns the use of coloured filters which are applied to the skin of the ear; different colours are said to have various effects on the pulse.

One problem with ear acupuncture, which is admitted even by its advocates, is that relief of pain often lasts only a short time. Semi-permanent needles are therefore sometimes inserted in the ear and left in situ for about seven days in an attempt to make the effect more lasting. A similar approach is often used by people who try to treat smoking or obesity with acupuncture. As noted earlier, there is a risk of local infection and bacterial endocarditis if indwelling needles are inserted.