Earring Auriculotherapy For Congenital Nystagmus
Eric Petterson, MD
Background Congenital nystagmus is an inherited disorder that has been treated with various modalities in an effort to ameliorate symptoms, with varying degrees of success. Auriculotherapy has a wide variety of uses, and it is possible that auriculotherapy has an application in the treatment of congenital nystagmus.
Objective To assess the applicability of auriculotherapy to the treatment of congenital nystagmus.
Design and Patient Observational case report of a 56-year-old man who presented for acupuncture treatment of congenital nystagmus.
Results Prior to the application of magnets on the patient's oculomotor ear point, the patient's visual acuity was 20/50 to 20/60. Following the placement of earrings on that point, the patient's visual acuity was measured as 20/30 in both eyes. Congenital nystagmus in this study was successfully ameliorated by the application of varying modalities involving auriculotherapy.
Conclusion Auriculotherapy has a potential application in the treatment of congenital nystagmus. Earring application is a potentially useful modality in the administration of auriculotherapy. Further investigation is warranted.
Congenital Nystagmus, Auriculotherapy, Magnets
Congenital nystagmus is a heterogeneous eye movement disorder that occurs in 1/1000 males and 1/2800 females and is characterized by conjugate, rhythmic, horizontal oscillations of both eyes.1 All nystagmus degrades visual acuity by reducing the stability of fixation and lessening foveation time.2 Good visual acuity in the presence of the high-velocity oscillations of pendular nystagmus requires that the oculomotor system be capable of reliable and repeatable foveation of the target.3
Auriculotherapy is a branch of acupuncture in which the various parts of the body, including the oculomotor muscles, have a point of influence on the external ear. Our hypothesis proposes that stimulation of the oculomotor point on the external ear would result in the diminution of the amplitude of congenital nystagmus, and that such stimulation might effectively be provided by the placement of earrings in the oculomotor point.
Oral consent was implied and obtained prior to the initiation of treatment. A 56-year-old man presented for acupuncture treatment of congenital nystagmus. The patient is a physician, and 2 physicians were paired to explore ear points during an introduction to auriculotherapy course. The paired partner noted decreased resistance with the Pointer Plus point detector at the patient's oculomotor point. (The Pointer Plus was provided with the course and had been obtained through OMS Oriental Medical Supply, Weymouth, MA, now doing business as Lhasa OMS.) The paired partner also observed that stimulation of the oculomotor point resulted in a decrease of amplitude of the patient's nystagmus when the points were stimulated, followed by a return to "normal" nystagmus movement on cessation of the stimulation of the point. (The oculomotor point was identified by referencing Acupuncture Energetics, page 139, by Joseph Helms, MD, and following the point detection function of the Pointer Plus.)
Later, the patient verified the findings by the insertion of acupuncture needles at the oculomotor points identified with the Pointer Plus. The patient then placed spot magnets on the appropriate point on the ear in an effort to decrease the magnitude of the nystagmus and improve visual acuity. (He had been following an organic food diet for other reasons with varying degrees of compliance for about 2 years prior to using magnets on the ear points for oculomotor muscles.) Prior to application of the magnets, the patient's visual acuity was 20/50 to 20/60 in both eyes, and had been so for his entire adult life with corrective lenses. The patient's obvious eye movement adversely affected his interpersonal relationships, possibly related in part to anomalous head posture.4
With the placement of the magnets, the patient noted subjective improvement sporadically and his nystagmus was measured at 4 mm. The use of magnets was complicated by slippage and the need to reposition the magnet over the oculomotor point on the ear. Because of these difficulties, the patient had his ears pierced at the oculomotor point on the pinna, reasoning that earrings were less likely to change position than had been the case with the magnets. Gold-plated (tonifying) earrings were then placed in the oculomotor ear points.
Following the placement of the earrings, the patient's visual acuity was measured as 20/30 in both eyes. Subjective observation by a close contact of the patient revealed lessening of the eye movement, and the patient noted subjectively that he could read a church bulletin board from the back of the church rather than having to go to the front. In addition, after several months of wearing the earrings and then removing the earrings, the decreased amplitude of the nystagmus and the resultant improvement in visual acuity remained for 4-10 days. The visual acuity decreased gradually over that time and reverted to therapeutic levels on the insertion of the earrings. As recently as July 2004, this gradual reversion to more pronounced nystagmus on removal of the earrings, followed by diminuition of the nystagmus on reinsertion of the earrings, is still present.
The patient was self-referred in 1998 on the basis of the findings in an acupuncture course. Using the same Pointer Plus, the oculomotor points were stimulated 1st on the left side, then on the right side. Observations were made by the paired physician. Later, in 2000, the ear points were identified using the same Pointer Plus, and acupuncture needles were inserted at the points described as oculomotor in
Oleson's Auriculotherapy Manual,22 utilizing Carbo gauge 0.20 x13mm needles. Observations were made by the physician-patient. Follow-
ing this trial, magnets were placed on the oculomotor points using Accu-Band AB 800 GP gold-plated 800 gauss magnets (Ito Company, Japan, and obtained from OMS Oriental Medical Supply, now doing business as Lhasa OMS). Later, the same Pointer Plus was used to identify the oculomotor point, the tip of the Pointer Plus apparatus was pressed into the ear lobes to make an impression, and the ears were pierced at the indicated site at a local ear piercing establishment. Observations were made by the physician-patient.
As a result of the intervention(s), the amplitude of the patient's nystagmus was decreased and at the same time and probably also due to the intervention, the patient's visual acuity improved.
Current therapy for congenital nystagmus is divided into 2 categories: the 1st category consists of measures to reduce the nystagmus itself. In this category are drug therapies. The neural network involved in gaze fixation contains GABA-ergic receptors,5 and one suggested line of treatment involves the use of GABA-ergic drugs such as gabapentin.6,7 In this category, cannabis has unacceptable adverse effects as do injections of botulinum toxin8 and surgical weakening of the extraocular muscles (diplopia).9 Some patients experience a reduction in nystagmus with appropriate prisms, whether based in or for near or far vision.9 Tenotomy represents a new theoretical approach.10 Initial reports associate tenotomy with a decrease in visual acuity.11 Subsequent reports indicate little effect.12
The 2nd category consists of measures to stabilize the retinal image. An optical stabilizing device consisting of a strong positive spectacle lens in conjunction with a strong negative contact lens helps some patients. However, this device also negates normal eye movements.13 An experimental servo device was used to move prisms in phase with movements of pendular nystagmus, resulting in diminished eye movements and improved visual acuity. Currently, such a device is not portable.13
Other types of treatment have included body acupuncture,14 auditory feedback,15 afferent stimulation,16 photic stimulation,17 vertical lines,18 5-hydroxytryptophan,19 and dietary modifications including elimination of synthetic food colors, flavors, and preservatives.20 A recent article reports that gene therapy in dogs improved the vision of the dogs with no adverse effects, accompanied by a reduction of the nystagmus.21
Auriculotherapy represents a branch of acupuncture in which the auricle of the external ear is stimulated to alleviate health conditions in other parts of the body. Reference to ear points first appeared in the Chinese text The Yellow Emperor's Classics of Internal Medicine, compiled in 500 BC. These ear points were then organized into a somatotopical map of the various parts of the body onto the ear. The utility of these points was verified by Oleson22 and subsequently by many others.
One of the ear points is the somatotopical map of the oculomotor motor nerve. The application of auriculotherapy to this point is a simple matter known readily to all auriculotherapists.
The placement of needles in acupuncture perhaps exerts its effect through the generation of minute electrical currents at the acupoint. A needle in dispersion generates 1 to 4 mA of current for about 10-15 minutes (by virtue of the temperature difference across the length of the needle from outside the body to inside the body). Applying heat (moxibustion) or manual rotation of the needle generates about 10-15 mA of current. The application of an electrical stimulator renders 1-40 mA of current for the duration of the use of the stimulator. Each voltage range causes activity in different parts of the cerebral cortex.
The placement of a magnet over an acupoint generates an electrical current beneath the magnet by virtue of the generator effect caused by the relative motion between the magnets and the acupoint, caused by small movements of the body leading to relative movements between the surface and the deeper acupoint. Similarly, an earring will not remain stationary in relationship to the deep parts of the ear due to small movements, lying on a pillow, etc. It is proposed that the presence of the earring generates frequent intermittent pulsations of electricity corresponding to the stimulation of the acupoint; in this case, the ear oculomotor point. The result is the observed decrease in the amplitude of the nystagmus.
Of interest is an article on another subject describing the regulating of brain-derived neurotrophic factor on application of high- frequency electrical stimulation in animal models of parkinsonism and the consequent halting of neural degeneration.23 Apparently, in the animal model, acupuncture was effective at the cellular and nuclear level. In addition, stimulation of BL 67 increased c-fos in the visual cortex of binocularly deprived rat pups.24 This cellular and nuclear effect was seen in the visual cortex as well.
We note the longer-term effect of the placement of the earrings compared to magnet stimulation. We suggest that the long-term effect of the earrings is due to changes in genetic expression; in the case studied, at the level of the oculomotor neural network. This type of mechanism is on par with the mechanism involved in gene transfer therapy of the RPE65 null mutation in dogs. The areas of research have some potential for overlap and further study is warranted.
Auriculotherapy may be an effective method for treatment of congenital nystagmus and earring placement may be effective for administering auriculotherapy. Further study is warranted for both aspects.
- Strabismus. Congenital study in identical twins: discordant feature. J Pediatr Ophthalmol. 1986;23:115-119.
- Lee J. Surgical management of nystagmus. J R Soc Med. 2002;95:236-241.
- Jacobs JB, Dell'osso LF. A hypothetical of fixation system capable of extending foveation in congenital nystagmus. Ann N Y Acad Sci. 2002;96:608-610.
- Stevens DJ, Hertle RW. Relationships between visual acuity and anomalous head posture in patients with congenital nystagmus. J Pediatr Ophthalmol Strabismus. 2003;40:259-264.
- Abadi RV. Mechanisms underlying nystagmus. J R Soc Med. 2002;95:231-234.
- Das VE, Oruganti P, Kaner PD, Leigh RJ. Experimental tests of the neural network model for ocular oscillations caused by a disease of the central myelin. Exp Brain Res. 2000;133:189-197.
- Fabre K, Smet-Dielman H, Zeyen T. Improvement of the acquired pendular nystagmus by gabapentin: case report. Bull Soc Bege Ophthalmol. 2001;282:43-46.
- Glasner L, Benezra D. Injection of botulism toxin into the oculomotor muscles in disorders of ocular motility. Klin Oczna. 1991;93:264-265.
- Stahl JS, Leigh RJ. Nystagmus. Curr Neurol Neurosci Reports. 2001;1:471-477.
- Dell'osso LF. Development of new treatments for congenital nystagmus. Ann N Y Acad Sci. 2002;95:361-379.
- Wong AM, Tycheon L. JAAPOS. 2002;6:100-107.
- Miura K, Hertle RW, FitzGibbon EJ, Optican LM. Effects of tenotomy surgery on congenital nystagmus waveforms in adult patients, part II: dynamical systems analysis. Vision Res. 2003;43:2357-2362.
- Stahl JS, Lehmkuhle M, Wu K, et al. Prospects for treating acquired pendular nystagmus with servo-controlled optics. Invest Ophthalmol Vis Sci. 2000;41:1084-1090.
- Blekher T, Yamaba T, Yee R, Abel LA. Effects of acupuncture on foveation characteristics in congenital nystagmus. Br J Ophthalmol. 1998;82:115-120.
- Kirschen DG. Auditory feedback in the control of congenital nystagmus. Am J Optom Physiol. 1983;60:364-368.
- Sheth IV, Dell'osso LF, Leigh RJ , van Doren CA, Peckham HP. The effects of afferent stimulation on congenital nystagmus foveation periods. Vis Res. 1995;35:2371-2382.
- Mallett RF. The treatment of congenital idiopathic nystagmus by intermittent photic stimulation. Ophthal Physiol. 1983;3:341-356.
- Daroff RB, Hoyt WF, Bettman JW Jr, Lessell S. Suppression and facilitation of congenital nystagmus by vertical lines. Neurology. 1973;23:530-533 .
- Larmande P, Pautrizel B. Treatment of congenital nystagmus with 5-hydroxy tryptophan [in French]. Nouvelle Presse Med. 1981;10:316.
- Feingold BF. Dietary management of the nystagmus. Neural Transm. 1979; 45:107-115.
- .Narfstrom K, Katz ML, Bragadottir R, et al. Functional and structural recovery of the retina after gene therapy in the rpe65 null mutation dog. Invest Ophthalmol Vis Sci. 2003;4:1663-1672.
- .Oleson T. Auriculotherapy Manual. Los Angeles, Calif: Health Care Alternative Press; 1996;121-122.
- Liang XB, Liu XY, Li PQ, et al. Long term high-frequency electroacupuncture stimulation prevents neuronal degradation and up-regulates BDNF mRNA in the substantia nigra and ventral tegmental area following medial forebrain bundle axotomy. Brain Res Mol Brain Res. 2002;19:51-59.
- Lee H, Park HJ, Kim SA, et al. Acupuncture stimulation of the vision related acupoint. (BL-67) increases c-fos expression in the visual cortex of binocularly deprived rat pups. Am J Chin Med. 2002;30:379-385.
Dr Eric Petterson is Board-certified in Internal Medical and Medical Acupuncture, and has been in private practice in acupuncture since 1999. Dr Petterson's special interests are pain management, Traditional Chinese Medicine (TCM) acupuncture treatment of medical disorders, and auriculotherapy.
Eric Petterson, MD*
218 So Main St
Shenandoah, PA 17976
Phone: 570-462-1470 • Fax: 570-462-1477
*Correspondence and reprint requests