The Validation Of Auricular Diagnosis

The term auricular diagnosis was first proposed officially by Terry Oleson in 1980.1 His study, conducted at the department of anesthesiology at the UCLA School of Medicine in Los Angeles, belongs to the history of ear acupuncture. Its aim was to evaluate the claims by French and Chinese acupuncturists that a somatotopic mapping of the body is represented upon the external ear. Forty patients were examined by a physician to determine which of 12 reported areas of their body suffered musculoskeletal pain (Fig. 9.1). Each patient was then covered with a sheet to conceal any visible physical problems. A second physician afterwards carried out a blind examination of the patient's auricles for areas of higher tenderness or reduced electrical skin resistance. The ear points corresponding to body areas where the subject reported musculoskeletal pain were designated as 'reactive points', while 'non-reactive points' corresponded to areas of the body where the patient experienced no discomfort.

The results of Oleson's study were as follows:

1. The correct identifications summed to 75.2%. In 12.9% of the total the points were false-positive and in 11.9% the points were false-negative; the association was highly significant with W2 (P<0.001). In 37 of the 40 subjects there were more correct identifications than incorrect, which was rated as significant by the sign test (P<0.01).

2. Both mean electrical conductivity and dermal tenderness at ear points related to specific areas

Muschi Gro Zur Schau Stellen
Fig. 9.1 The somatotopic mapping of musculoskeletal pain on the auricle according to Oleson (with permission of the author).

of the body where pain problems were present were significantly higher with t-test (P<0.01).

3. As regards the laterality for ear points relative to the side of a body problem, the mean electrical conductance was significantly higher if the problem was ipsilateral (P<0.01); the mean tenderness of ear points, in the case of unilateral problems, did not differ between the right and left ear.

4. There were no significant differences in either auricular conductance or auricular tenderness between recent and old pain problems. Recent pain problems were defined as having occurred within the 6 months prior to the study, old problems as having occurred more than 6 months previously.

5. It was observed in 15% of the subjects that there was a localized region of white, flaky scaling of the dermis on the auricular areas corresponding to the part of the body where musculoskeletal pain was present. Oleson wrote on this subject: 'although infrequently observed, abnormal morphological characteristics on the auricular surface were highly predictive of the presence of pathology in the corresponding area of the body'.

The interesting conclusions of the article by

Oleson and colleagues were that:

this study also indicated that the auricular diagnosis technique is often sensitive to pathological problems of which the patient is only minimally aware. When some patients were told of their auricular diagnosis results, they suddenly remembered having a minor or old pain problem in that bodily area, a problem which they had neglected to mention during the medical evaluation. Since these post-hoc results were derived after the ear diagnosis had been made, these instances were not included in any statistical analyses. Nonetheless, such observations do suggest that auricular diagnosis may be effectively employed as part of a general medical evaluation designed to reveal all organic aspects of a patient's pain complaint. Since there are also ear points for abdominal and thoracic bodily organs, auricular diagnosis could also be utilized with standard diagnostic procedures for analyzing pathological conditions related to internal pain or referred pain.1

Since then Oleson's research has become the major reference study and has been cited in several articles on ear acupuncture. A recent paper, however, re-examined the question of whether auricular maps were reliable for chronic musculoskeletal pain disorders.2 Fortunately the authors had no intention of replicating Oleson's study but only of proposing a different method for validating auricular diagnosis by using a 250 g algometer. The main shortcomings of this study were the limited number of patients examined (only 25), the lack of importance given to the posterior surface of the ear, which was not examined at all, and the adoption of an arbitrary somatotopic arrangement of the auricular zones which does not faithfully correspond either to the French or to the Chinese map. For example the knee was reproduced twice on two different areas roughly representing it, according to the schools just mentioned. It is not reported in the article which of the two the blind assessor had to consider as corresponding to a painful knee, or whether both corresponded. In contrast, in Oleson's study the 12 different auricular regions chosen for the research were the faithful somatoto-pic representation of the body according to the Chinese map.

In my opinion the concept of parallelism between a topographical area of the body and the corresponding somatotopic auricular area expressed by Oleson has to be considered innovative. Actually, in the diagnostic process we need to speak about areas, especially if we are learning, or teaching beginners to select the most effective points for treatment within each area.

Fetal Ear Homunculus
Fig. 9.2 The representation of the homunculus according to Bossy (with permission of the author).

Bourdiol in particular introduced the concept of somatotopic area early, but the most interesting interpretation of the body's representation on the auricle is probably that of Jean Bossy,3 former director at the Montpellier Institute of Anatomy and author of several books and articles on the neurophysiological basis of acupuncture. His representation of the homunculus on the auricle4 is probably more realistic and useful for the practitioner than the well proportioned fetus which we see on the common drawings of the ear. As in the homunculus sensitivus and motorius of Penfield, the hand and the thumb have a large representation as well as the lips, the nose and the jaws (Fig. 9.2).

Starting from Oleson's historical paper I tried to create a project for validating auricular diagnosis which could be acceptable and reproducible.

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