To interpret abnormal ear findings, one must first have an appreciation of the characteristics of the normal ear and how to systematically examine it.
The practitioner may select any of the following as a starting point. You do not need to adhere to this order all of the time because we want to follow the Chinese maxim of treating what we see. Humans, as energetic beings, present differently at different times.
1. Prior to ear diagnosis, do not clean the ear with alcohol as this procedure changes manifestations in the ear. Ear cleansing removes pathological suppurations or scales, or changes the electrical conductivity of the ear. If you see an abnormal color in the ear, it is probably a positive pathological sign. Try to coordinate it with your other diagnostic data. If you are not sure the pathology visible in the ear is accurate, press on the point with the ear probe. If the color does not disappear upon pressure, it is pathological.
2. In performing ear diagnosis, carefully and systematically scan the ear from top to bottom, from medial to lateral, and from front to back. Remember to inspect the back of the ear as well as the underside of the tragus, the antitragus, and the helix. Peruse the ear looking for the most common presentations of ear pathology discussed below.
Make a list of your findings on your diagnosis form. As the patient’s condition improves or declines, ear pathology changes as well.
3. According to the Law of the Unity of Opposites (Yin/Yang theory), conventionally, ear diagnosis is initially performed on the side of the body that corresponds to the patient’s gender. Since the right is Yin and relates to females, ear diagnosis is performed on a woman’s right ear. Since the left is Yang and male, ear diagnosis is performed on a male’s left ear. However, anatomy is not destiny. Therefore, pay close attention to any anatomical morphology you see in both ears. Such morphology can indicate an existing condition or a constitutional tendency.
4. If the patient complains of pain on a certain side of the body, (i.e., right-sided elbow pain), regardless of gender, inspect the ear on the same side of the body for pathology (in this case, look at the right ear). However, pathology can appear in the opposite ear. This is due to channel and collateral pathways crossing the body. For instance, because the Large Intestine’s divergent meridian emerges from the shoulder at LI 15 and crosses over to the opposite side of the body, right-sided tooth problems may appear in the left ear at the Lower Tooth point. Thus, inspecting the ear on the opposite side of the complaint is an option. Ideally, the practitioner inspects both ears in order to learn as much as possible about the patient.
5. Try to connect the pathology you see with the patient’s major complaint, accompanying symptoms, other active complaints, past problems,or family medical history. In virtually every ear there is some pathology, especially in older patients. Data derived from inspection of the ear and the patient interview helps focus one’s diagnosis.
6. For example, a diagonal crease in a certain place on the ear lobe is called Frank’s sign (Figure 7.1). This particular crease indicates heart disease, stress, and high cholesterol. If you see this groove, ask the patient if he or she has any “Heart” pathology. In particular, ask about high cholesterol, stress, and any diagnosed heart problem that he/she may have or that runs in the family. According to classical Oriental theory, such pathology indicates more than the obvious physical heart problems and covers the domain of functions that relate to the Heart in Oriental medicine. Therefore, ask questions such as, “Do you have tightness in the chest, chest pain, palpitations, profuse daytime sweat, chronic persistent cough, insomnia, memory or concentration problems, or emotional problems?” If the patient says “no,” check his or her pulse, tongue, and complexion, which also may indicate Heart conditions. If the patient still does not make an affirmative answer, inquire about any family history of heart problems. The patient may have a genetic predisposition to heart problems, even though bodily signs and symptoms have not yet developed. Thus, the ear can be a valuable tool in revealing constitutional predispositions.
7. At first, patients might answer your questions in the negative. However, probe more deeply. Patients frequently report back at a later time that after having thought about your questions they do indeed have some of these conditions. These disorders simply were not at the top of the patient’s list of complaints at the time of questioning.
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