The Shape Of The Outer Ear As A Possible Expression Of Different Modeling Factors

Two German anthropologists from Munich, Ludwig and Ilse Burkhardt, were fascinated by the peculiar shape of the outer ear and its great variability according to the individual constitution. In previous literature they found only the well known association between long and slim ears with a slightly curled helix and a leptosomic constitutional body type (Greek leptos, slender), and similarly between large and oval-shaped ears with a pronounced curled helix and a pyknic constitutional body type (Greek pyknic, thick). They may well have felt dissatisfied with this limited information when they started an observational study on 1206 deceased patients in the clinical departments at Schwabinger Hospital in Munich, observing them during autopsy.11 Their aim was first to confirm the upper reported variability and at the same time to discover an innovative way to classify the different morphological types of ear. The parameters chosen were sex, age, profession, weight, height and other anthropometrical measurements such as the circumference of the head and of the thorax. The left ear of all subjects was photographed and the following measurements taken: length, width and angle of inclination of the pinna with respect to the scalp.

Chapter 3 Morphology of the outer ear 43

Fig. 3.9 (A) Classification of Darwin's tubercle according to Schwalbe.3

1 = Macacus shaped

2 = Cercopithecus shape

4 = rounded tip

5 = sketched tip

6 = not visible

(B) Different degrees of curling of the helix according to the same author.

Fig. 3.9 (A) Classification of Darwin's tubercle according to Schwalbe.3

1 = Macacus shaped

2 = Cercopithecus shape

4 = rounded tip

5 = sketched tip

6 = not visible

(B) Different degrees of curling of the helix according to the same author.

For the purpose of classification a ranking was proposed for the following parameters:

1. aspect of the pinna as a whole (less developed, fleshy, slim, protruding)

length of the ear (short: up to 60 mm in males, 58 mm in females; medium size: 61-68 mm in males, 59-66 mm in females; long: >68 mm in males, >66 mm in females) aspect of the helix (more or less curled) tragus (hairy or not)

aspect of the ear lobe (small, fleshy, close to the skull)

6. angle of inclination of the pinna (up to 95°, >95°)

7. index of thoracic circumference x 100 ^ height (small: up to 48 mm; medium: 49-55 mm; large: >55 mm).

The authors classified the data on 1132 subjects, excluding those of children, who were studied separately. From the beginning they were aware of the difficulty in defining clearly a series of morphological types of the ear. Nevertheless they identified at least five types: two of these had the most marked opposite characteristics and were

— Drills, Incisures, creases | Depressions ^ Nodules, protuberances

Fig. 3.10 Descriptive non-hereditary characters reported in the literature by anatomists and anthropologists. 1,2 = indentation or nodules of the helix border

3 = protuberances of the anthelix

4 = processus cruris helicis ad anthelicum

5 = deepening of the scaphoid groove

6 = sulcus obliquus

7 = tuberculum retrolobulare

8 = sulcus retrolobularis

9 = eminentia anonyma

10 = sulcus supralobularis

11 = depressed areas of the upper ear lobe

12 = torus trago-antitragus

13 = sulcus lobuli verticalis named 'cranial' and 'caudal', making up 23.5% and 26.1% of the total, respectively. A third group, for the type with intermediate characteristics, was named 'indifferent' and made up 41% of the total. Two more groups were added: the 'dorsal' and 'sickle-shaped' types, totaling only 5.3% and 4.1%

Fig. 3.11 Example of the 'cranial' type of ear: when the picture was taken the female patient was aged 66, her weight was 65 kg and her height was 165 cm (BMI = 24). Now she is 78 years old and the only disorders developed during the intervening time are a gastro-esophageal reflux syndrome and a mild cognitive impairment.

Fig. 3.11 Example of the 'cranial' type of ear: when the picture was taken the female patient was aged 66, her weight was 65 kg and her height was 165 cm (BMI = 24). Now she is 78 years old and the only disorders developed during the intervening time are a gastro-esophageal reflux syndrome and a mild cognitive impairment.

respectively. Examples of caudal and cranial types are shown in Figures 3.11 and 3.12. The recurrent characteristics in these groups are listed in Table 3.1.

The second part of the research is probably the most interesting for this book. The authors searched for an association between the morphological type of the ear and the main pathological findings at autopsy. Among the most frequent diseases they found were cardiovascular disorders, luetic (syphilitic) aortitis, tuberculosis, carcinomas, gallstones, prostate hypertrophy, pneumonia, endocarditis and sepsis. As shown in Table 3.2, a higher number of cases with cardiovascular diseases, gallstones, prostate hypertrophy and endocarditis were associated with the caudal type; lung tuberculosis, lung and stomach carcinomas, on the other hand, were more

Fig. 3.12 Example of the 'caudal' type of ear: when the picture was taken the female patient was 67 years old, her weight was 130 kg and her height was 175 cm (BMI = 42). The patient had diabetes and hypertension and died 3 years later with acute congestive heart failure.

frequently associated with the cranial type (see Table 3.2). As no statistical analysis was carried out by the authors themselves, we tried to identify a possible association between the morphological type and the disease using the W test. The hypothesis of independence could be discarded both for males and females (P<0.005). It was therefore possible to measure an association with the Kramer index (range 0 to 1), which yielded only 0.20 for males and 0.16 for females. The association therefore did not seem relevant but, limiting the analysis only to caudal and cranial groups, the W test was still significant for males and females (P<0.025) and the level of association increased to 0.5 and 0.4 respectively. The effort made to separate two morphological types with opposite characteristics did indeed produce a better understanding of the connections between the shape of the ear and the tendency toward specific groups of health disorders. The authors wrote:

Table 3.1 The opposite characteristics of the cranial and caudal type of ear according to the Burkhardts

Cranial ear

Caudal ear

Tendency to proportionally higher dimensions of the upper (cranial) part of the ear

Tendency to proportionally higher dimensions of the lower (caudal) part of the ear

On the whole a slimmer aspect; the pinna is closer to the skull

On the whole a fleshy aspect; the pinna protrudes more from the skull

Tendency to a leptosomic constitution (see text)

Tendency to a pyknic constitution (see text)

The helix is less curled

The helix is more curled

The tragus is less hairy

The tragus is hairier

The lobe is smaller, thinner and closer to the skull

The lobe is larger, fleshier and protrudes more from the skull

we have to consider the possibility that life conditions and diseases can modify the constitution of a subject including the shape of his auricle.

Moreover, a third interesting observation was made on the population examined with regard to the possible association between ear type and profession. Excluding the negligible number of people with dorsal and sickle-shaped ears, the authors found some curious associations in 500 male subjects aged over 18. The cranial type was more frequent among farmers and blue-collar workers; the caudal type was more often found among dealers, white-collar workers and those occupying positions calling for brainwork, or leaders (Table 3.3). The Burkhardts concluded their extensive study hypothesizing that besides the other already reported factors, lifestyle linked to a profession representing it could possibly act as a modeling factor of the outer ear.11

This study was published in 1949, several years before Nogier's discovery and at least 20 years before Chinese acupuncturists reported their experiences concerning the diagnostic value of auricular inspection.

Table 3.2 The association

in 1132 subjects (581 male and 551 female) between ear

type and pri

ncipal

pathology; according to the Burkhardts

Male

Ear type

Cardiovascular

Luetic

Tuberculosis

Carcinomas

Gallstones

Prostatic

Pneumonia

Endocarditis

aortitis

hypertrophy

Indiff.

B9

13

32

B7

17

1B

1O

21

Caudal

66

B

4

11

21

11

3

11

Cranial

36

6

37

B4

12

4

6

4

Dorsal

11

O

e

11

6

4

1

2

Sickle-shaped

4

1

3

3

1

3

O

1

Total

176

28

85

136

57

40

20

39

Female

Ear type

Cardiovascular

Luetic

Tuberculosis

Carcinomas

Gallstones

Prostatic

Pneumonia

Endocarditis

aortitis

hypertrophy

Indiff.

73

B

36

4O

B3

-

1O

17

Caudal

62

B

4

22

43

-

4

17

Cranial

27

1

22

32

1B

-

1

1O

Dorsal

4

1

4

4

1

-

O

2

Sickle-shaped

7

O

7

6

7

-

1

2

Total

173

18

73

104

119

-

16

48

Table 3.3 The association in 500 male subjects aged over 18 between ear type and profession, according to the Burkhardts11

Ear type

Profession

Indifferent (%)

Caudal (%)

Cranial (%)

Farmer

2.7

1.7

5.7

Blue-collar worker

27.B

13.4

29.1

Labourer

6.7

B.1

12.7

Baker

O.e

1.7

O

Tailor

2.2

3.4

O.6

Trader

7.2

15.9

7.6

White-collar worker

22.4

2B.2

15.2

Leader-manager

4.B

7.6

4.4

Regular soldier

6.7

e.2

5.7

Artist, medical doctor, intellectual

4.1

6.7

4.4

Other profession

13.B

B.4

13.9

Unemployed

1.3

1.7

1OO (223 subjects)

100 (119 subjects)

100 (158 subjects)

Total

1OO (223 subjects)

100 (119 subjects)

100 (158 subjects)

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