The Representation Of The Ear On The

The representation of the Chinese internal ear (LO6 neier) differs greatly in location from Nogier's internal ear, which is represented on the internal portion of the tragus where the Chinese instead locate the pharynx and larynx (TG3 yanhou) and internal nose (TG4

neibi) (see Figs A1.1 and A1.2). These confounding interpretations are probably caused by the lack of any of these anatomical structures in Bachmann's historical map. As had happened for the uterus and ovary, every school was forced to make its own interpretation, leading to divergent conclusions.

My contribution to this issue was focused on examining various disorders of the external, middle and internal ear, trying also to identify the areas involved in vestibular dysfunctions.

As is well-known, a hearing impairment may be caused by various factors. The female patient in Figure 5.31 came to my practice presenting a bilateral hearing loss due to two different factors: the

Fig. 5.31 Auricular sensitization in a 51-year-old female patient with bilateral hearing impairment; the tender points on the right ear were related to otitis media (A); the tender points on the left ear were related to a plug of wax (B).

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Fig. 5.31 Auricular sensitization in a 51-year-old female patient with bilateral hearing impairment; the tender points on the right ear were related to otitis media (A); the tender points on the left ear were related to a plug of wax (B).

right ear (left side of Fig. 5.31) was affected by otitis media catarrhalis, the left (right side of the same figure) by a plug of earwax. Both ears showed two tender points: those on the left side disappeared soon after removing the plug but those on the right persisted for as long as medication was necessary to free the obstructed Eustachian tube. This case shows that there is consistent overlapping of tender points related to inflammation of the external auditory canal and otitis media, but also an overlapping in hearing loss from exposure to noise for professional reasons.

Dr Pierluigi Mazzini57 made an interesting evaluation of 189 workers exposed to noise for professional reasons. The recommended exposure limit (REL) proposed by the National Institute for Occupational Safety and Health (NIOSH) is 85 decibels as an 8 hour time-weighted average. By means of audiometric testing Mazzini identified four groups of workers:

a. 57 without hearing loss and without any tender point of the auricle b. 18 without hearing loss, with at least one tender point c. 67 with hearing loss, without any tender point d. 47 with hearing loss, and with at least one tender point.

The workers in group d showed a higher number of tender points than workers in group b (P<0.05). In the former group the workers with moderate impairment showed a higher average of tender points vs. the rest of subjects with severe hearing loss (respectively 4.1 to 3.2). Even if the difference was only basically significant (P=0.057), we may nevertheless suppose that greater acoustic damage may determine reduced sensitization of the auricle. This phenomenon is in agreement with the hypothesis that an irreversible lesion of an organ or a nerve may interfere with the diagnostic power of PPT and the electrical skin resistance test (ESRT). However, if we examine the distribution of tender points found in group d we can identify some clusters possibly associated with hearing loss. The area with the highest concentration of points is the Chinese internal ear (39%) followed by an area on the antitragus (24.7%) which appears to be aligned on the same sectors 5-7 of the first area (on the left of Fig. 5.32,

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Fig. 5.32 Clusters of tender points in 47 workers with hearing loss due to exposure to noise (left image) (with permission of Mazzini); distribution of tender points in 10 patients (average age 61.8 years) with chronic tinnitus (right image).

numbers 1 and 2). In following order we can find the sensitization of the whole tragus in 16.8% and a concentration of tender points in the superior concha on sectors 18-20 in 10.5% (on the left of Fig. 5.32, numbers 3 and 4). These two minor areas seem to correspond partially to Nogier's internal ear and to Chinese kidney and pancreas-gallbladder areas. The relationship between kidney and ear is well known by practitioners introduced to TCM, but it must be stressed that both areas, according to the Chinese standardization, hold a double indication for hypacusis and tinnitus.

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