The Representation Of The Symptom Of Dizziness On The Auricle

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Dizziness and vertigo are not well-defined entities, but rather symptoms of a multisensory syndrome.

This may be induced by stimulation of the intact sensori-motor system through motion (i.e. motion sickness) or by pathologic dysfunction of any of the stabilizing sensory systems, for example the peripheral vestibular in the case of neuritis or Meniere's disease and the central vestibular in the case of vertebral-basilar ischemia. As differential diagnosis is not customary for a physician, an empirical approach is usually followed in which the symptom rather than the underlying disorder is treated. This uneasiness may be one of the reasons why acupuncturists limit themselves to treating only the symptom. The lack of differential diagnosis is also reflected on the auricle where we are at a loss to understand if central disorders have a different representation from peripheral dysfunctions.

Chinese standardization reports three points/ areas carrying the indication of Meniere's disease: the internal ear, the occiput and the brainstem. The whole antitragus (forehead, temple, occiput) with the central rim point are furthermore recommended for treating dizziness.

On Western maps the points indicated for dizziness and vertigo are really scanty: Nogier proposed a point on the lower end of the scapha coinciding with the maxillary point and several German authors reported a motion sickness point near the Chinese brainstem point. Two otologists from Munich, Rolf and Detlef Pildner von Steinburg,59 however, carried out an interesting study on 100 patients with vestibular dysfunctions. With the help of a Punctoscope, the device produced by Sedatelec before the Agiscop, they identified an almost vertical line of points which could efficiently reduce lateral nystagmus and the accompanying dizziness (on the left of Fig. 5.33, line A). Another line starting from the anthelix-antitragus notch and extending forward along the rim of the antitragus (on the same figure, line B) was moreover effective in reducing purely vertical nystagmus which is usually central in origin. What is interesting in this study is the convergence of these lines on the brainstem point which the authors defined as the 'mesencephalic point of the fasciculus longitudinalis medialis' (on the same figure, M).

Together with the otologist Fabio Caporiccio, we tried to make our contribution to the issue of vestibular representation on the auricle. We examined a series of consecutive patients undergoing caloric reflex test for dizziness and vertigo. The Fitzgerald-Hallpike test (FHT) consists of introducing

250 cc of warm water (44° C) into the ear canal in 40 s, one ear after the other, and counting the number of eye movements at the culminating moment between the 60th and 90th second after the beginning of the FHT. We made the following observations on 30 consecutive subjects:

1. In healthy subjects, approximately 2 minutes after the caloric reflex test the ipsilateral ear became sensitive in one or two points. Sensitiza-tion lasted for about 3-5 minutes and then disappeared entirely. The sensitized area corresponded partially to the Chinese internal ear but frequently shifted toward the border of the ear lobe and the helix on sectors 7-9 (on the right of Fig. 5.33).

2. In the case of asymmetric vestibular activity, the auricle with a number of eye movements exceeding 2.5-3/s was basically also tender before performing the FHT, whereas the auricle on the hypoactive side never became sensitized if the beats/sec were less than 1.

3. In those cases in which the nystagmus gave a stronger indication of a central disorder, we identified further tender points corresponding not only to the brainstem but also to the internal border of the antitragus and the anthelix. It is on these that the Chinese locate the most caudal portion of the spleen (CO13 pi) and where Bourdiol1 located the vertebral artery. He said about its representation: 'it passes forwards to reach, as in macrosopic anatomy, the cervical vertebrae from C6 to C1, at the level of the claustrum, running alongside the para-vertebral sympathetic chain. At the level of the post-antitragal sulcus, it penetrates behind the posterior pole of the antitragus to attain the mastoid face, where it gives off the basilar trunk' (Fig. 5.34). My observations on patients with vertigo caused by central vestibular disorders are basically in agreement with Bourdiol's hypothesis, but further research is urgently required to unveil the potentialities of ear acupuncture in this field.

Caloric Test
Steinburg (left image); sensitized area during caloric test in nine healthy subjects (right image).

Principal artery of the thumb

Dorsalis pedis Posterior tibial Lateral carpal Medial carpal Femoral Heart

Internal mammary Brachial

Thyrocervical trunk Common carotid Vertebral Internal carotid External carotid Superficial temporal Facial

Fig. 5.34 Representation of the cardiovascular system according to Bourdiol (with permission). The arrows indicate the possible sites of sensitization in cases of central vestibular disorders.

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