MEDICAL ACUPUNCTURE

Volume 32, Number 4, 2020

COMMENTARY
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2020.29152.com

Clinical Commentary on an Auricular Marker

Associated with COVID-19

Terry Oleson, PhD,1,2 Richard C. Niemtzow, MD, PhD, MPH,3 and Arnyce Pock, MD4

G iven the rapidly escalating nature of the COVID-

19 pandemic, there are continued acute challenges
stressing our medical professionals on the front lines.1 Con-
the supratragic notch of the external ear. What made this
finding particularly intriguing is that a cohort of patients
who did not have COVID-19 and had been admitted to the
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sequently, there is universal interest in developing a rapid and same ICU with other health conditions did not have any
reliable means of proactively identifying and treating hospi- evidence of swelling and deformation in this same area of the
talized patients with COVID-19 who are at the greatest risk for external ear. The medical team also noted that the degree of
developing exceptionally severe sequalae to this infection.2,3 anatomical swelling over the supratragic area was particu-
The Guest Editorial by Nadia Volf, MD, PhD, and colleagues larly pronounced in patients with severe coronavirus illness,
included in this issue of Medical Acupuncture, describe some whereas the degree of tragal edema declined progressively in
preliminary—but exceptionally intriguing—observations in- patients who subsequently demonstrated clinical improve-
volving critically ill patients with COVID-19. These ob- ment as they recovered from COVID-19.
servations could herald an entirely new era with regard to This same auricular region had previously been described as
the collaborative diagnosis and treatment of critically ill the Interferon Point by the German physician–acupuncturist,
patients, especially as they relate to the practice of med- Frank Bahr, although the methodology used to identify this
ical acupuncture. Interferon Point is considered somewhat controversial from
In particular, a team of physicians from the scientific a scientific perspective.4 An ampule of a homeopathic version
acupuncture department at the Paris XI University, in France, of interferon was placed next to a patient’s external ear. As this
described the results of a recent observational study. These was being done, Dr. Bahr looked for a corresponding change in
researchers noted a striking correlation between changes in the Nogier vascular autonomic signal pulse. This procedure is
the appearance of the auricular acupoint known as the In- used by practitioners of auricular medicine as a means of
terferon Point on the external ears of patients admitted with identifying many other ear acupuncture points, including the
particularly severe forms of COVID-19. Although these ob- somatotopic auricular representations of the occiput, knee, el-
servations are preliminary, the findings are intriguing and bow, thalamus, cingulate gyrus, and cerebellum, as well as
could be clinically significant. This is because they raise the functional points, such as the Nicotine point, the Prostaglandin
question regarding the auricular Interferon point’s potential point, and the Barbiturate point.5
to serve as a visible anatomical marker that could readily While many of these European-derived ear acupuncture
be noted on the external ears of patients hospitalized with points have been utilized effectively in a number of aur-
COVID-19. iculotherapy treatment protocols, to the best of our knowl-
The specific findings were that a prominent swelling on edge, there have not yet been any formal investigations of
the supratragic notch near the ascending helix root was visible changes in auricular points and their correspondence
noted in 34 patients hospitalized with COVID-19 related with neurophysiologic measurements of specific brain ac-
disease in the university’s intensive care unit (ICU). Each of tivity or bioelectrical activity in a human or animal model.
the 34 patients who had the coronavirus had a distinctive In China, as in other parts of the world, the precise location
auricular marker—a pronounced focal edema in the area of of auricular acupoints are aided by the detection of focal
1
Emperor’s College of Traditional Oriental Medicine, Santa Monica, CA, USA.
2
Auriculotherapy Certification Institute, Los Angeles, CA, USA.
3
United States Air Force Acupuncture and Integrative Medicine Center, Joint Base Andrews, MD, USA.
4
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
The views expressed are those of the authors and do not reflect the official policy or position of the Department of Defense, the United
States Air Force, the Uniformed Services University of the Health Sciences, or the United States Government.

176
 COMMENTARY
tenderness to applied pressure and enhanced electrical
conductivity in patients with pain in specific body areas.6
This finding was supported further by the alleviation of a
patient’s presenting symptoms when the ear point was
stimulated that corresponded to that specific part of the
body. When dealing with musculoskeletal conditions, such
as neck or shoulder pain, clinical efficacy can be verified
by having the patient move the neck or shoulder, and no-
ticing, for example, whether the patient experiences pain or
discomfort when pressure is applied to the affected body
part. In such cases, a reactive auricular point in the scaphoid
fossa region has been shown to correspond reliably with the
presence or the absence shoulder pain.
The potential utility of a visible auricular marker was
described previously in the medical literature. One of the
best-known auricular markers, identified as Frank’s Sign,7,8
is the presence of a diagonal ear-lobe crease in patients at
high risk for coronary artery disease.9,10 Although the
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consistency of this sign is still a topic of discussion,11 the
observational findings have been well-described in the lit-
erature from 1974 to today.5
If the presence and subsequent resolution of this supra-
tragal swelling on the external ear in patients who are criti-
cally ill with COVID-19 can eventually be confirmed by
double-blinded controlled trials, then this finding could not
only represent a unique attribute of the COVID-19 infection,
but may even have noninvasive diagnostic and therapeutic
implications as well. The Interferon Point in patients with
COVID-19 definitely merits further study. If these findings
are substantiated, it could allow for closer collaboration be-
tween acupuncturists and their ICU-based colleagues.
REFERENCES
1. World Health Organization (WHO). WHO Coronavirus Dis-
ease (COVID 19) Dashboard. Online document at: https://
covid19.who.int Accessed July 19, 2020.
2. Centers for Disease Control and Prevention. Interim Gui-
dance for Management of Patients with Confirmed Cor-
177
onavirus Disease (COVID-19). Updated June 30, 2020.
Online document at: www.cdc.gov/coronavirus/2019-ncov/
hcp/clinical-guidance-management-patients.html Accessed
July 17, 2020.
3. National Institutes of Health. COVID 19 Treatment Guidelines.
Online document at: www.covid19treatmentguidelines.nih.gov/
Accessed July 17, 2020.
4. Strittmatter B. Das Storfeld in Diagnostik und Therapie.
Stuttgart: Hippokrates Verlag Gmblt; 1998:104.
5. Oleson T. Auriculotherapy Manual: Chinese and Western
Systems of Ear Acupuncture, 4th ed. London: Churchill Li-
vingstone; 2014.
6. Oleson T, Kroening R, Bresler D. An experimental evaluation
of auricular diagnosis: The somatotopic mapping of muscu-
loskeletal pain at ear acupuncture points. Pain. 1990;8(2):217–
229.
7. Frank ST. Aural sign of coronary artery disease. N Engl J Med.
1973;289(6):327–328.
8. Stanford Medicine. Frank’s Sign—Diagonal Earlobe Crease
(DELC). Online document at: https://stanfordmedicine25
.stanford.edu/blog/archive/2015/what-is-the-name-of-this-
sign.html Accessed July 17, 2020.
9. Elliott WJ. Ear lobe crease and coronary artery disease: 1,000
patients and review of the literature. Am J Med. 1983;75(6):
1024–1032.
10. Lin AN, Lin K, Kyaw H, Abboud J. A myth still needs to be
clarified: A case report of the Frank’s sign. Cureus. 2018;
10(1):e2080.
11. Shmilovich H, Cheng VY, Rajani R. et al. Relation of diag-
onal ear lobe crease to the presence, extent, and severity of
coronary artery disease determined by coronary computed
tomography angiography. Am J Cardiol. 2012;109(9):1283–
1287.
Address correspondence to:
Terry Oleson, PhD
Auriculotherapy Certification Institute
PMB 270, 8033 Sunset Boulevard
Los Angeles, CA 90046
USA
E-mail: terry.oleson@gmail.com