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Anatomy of the auricle

As with other areas of human anatomy, there are specific terms for identifying opposing directions of the
ear and for indicating alternative perspectives. Because other texts on the topic of auricular acupuncture
have used a variety of different terms to describe the same regions of the ear, this section will define the
anatomical terms used in this manual. Taking the time to learn the convoluted structure of the auricle
facilitates a deeper understanding of the corresponding connections between specific regions of the ear
to specific organs of the body.
The spiral of life
The ear consists of a series of concentric circles that spiral from the center of the auricle to a series of
curving ridges and deep valleys that spread outwards like an undulating wave. This configuration is very
similar to the rings of water waves that radiate out from a splash on a pond. Sound waves are similar to
waves on water, consisting of oscillating increases then decreases in the compression of air molecules.
The external ear is shaped like a funnel to direct these subtle motions of air into the ear canal. Focused
sound waves then vibrate against the eardrum like a baton pounding against a bass drum. After being
amplified by the serial activation of the ossicle bones of the middle ear, the sound signal generates a
traveling wave that produces deflections in the bending of membranes within the snail-shaped inner ear.
The basic shape of both the inner ear and the external ear reiterates the spiral pattern that is a common
archetypal symbol. Different examples of this spiral image are shown in Figure 3.2, from the double helix
shape of the DNA molecule, to the swirl of cloud formations, to the curving embryo. The Latin word for the
shape of a spiral is helix. Just as there are two spiraling helices which form the structure of DNA, there
are two helices for the auricle, an outer helix and an opposing anti helix. The other common pattern which
is represented on the ear is that of a sea shell, and the term for the deep central region of the auricle is
the concha, which is Latin for shell. From the different sea shells one can recognize a basic spiral shape
common to all of them.
Neuro-embryological innervations of the external ear
The biological life of the human embryo begins as the union of cells that divide and multiply into a
complex ball of embryonic tissue. The auricle of the ear results from the coalescence of six buds which
appear on the 40th day of embryonic development. Shown in Figure 3.4 is a representation of the cellular
buds that transform into the external ear during the fourth month of fetal development. These fetal buds
are the expressions of mesenchymal proliferation of the first two bronchial arches that subsequently
develop into the cranial nerves that ultimately innervate the auricle. The superior regions of the auricle are
innervated by the auricular-temporal branch of the mandibular trigeminal nerve. The concha is innervated
by the auricular branch of the vagus nerve. A third region is supplied by the lesser occipital nerve and the
great auricular nerve, both branches of the cervical plexus. The seventh cranial nerve which regulates
facial muscles sends neuronal connections to the posterior side of the auricle.
Bossy (1979) has summarized the studies which delineate the three territories of the auricle. The superior
somesthetic region is innervated by the trigeminal and sympathetic nerves, a central visceral region is
innervated by the parasympathetic vagus nerve, and a lobular region is innervated by the superficial
cervical plexus. The lobular area has no pronounced autonomic nerve manifestation. The differential
dispersement of cranial nerves provides an embryological basis for the functional divisions between
specific auricular regions and corresponding parts of the gross anatomy. The somatosensory trigeminal
nerve innervates cutaneous and muscular regions of the actual face and also supplies the region of the
auricle that corresponds with musculoskeletal functions. The autonomic vagus nerve innervates thoracic
and abdominal visceral organs and also supplies the central region of the auricle associated with internal
organs. The concha of the ear is the only region of the body where the vagus nerve comes to the surface

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of the skin. The cervical plexus nerves regulate blood supply to the brain and are associated with
diencephalic and telencephalic brain centers represented on the inferior ear lobe.
While it seems logical that the auricle is part of the auditory pathway, examination of other animal species
shows that the external ear is not only used for the function of hearing. The ears of animals are used to
protect against the elements and against predators. The desert hare, desert fox and desert mouse all
have very large auricles compared to their non-desert relatives, the purpose of which is to facilitate heat
loss through the skin over the ears. African elephants that live in the hot plains have larger ears than
Indian elephants for a similar purpose of heat exchange. The series of electro conductive points that have
been identified on the shaved skin of rodents suggest that the occurrence of body acupoints and ear
points may relate to the lateral line system of fish. This same system by which fish sense the subtle
movements of water may provide the evolutionary foundation for acupuncture points on the body and the
ear.
Anatomical views of the external ear
To refer to any object in three dimensional spaces, there must be certain points of reference. As a
complex convoluted structure, the auricle must be viewed from different angles and from different depths.
Specific terms will be used to indicate these different perspectives of the ear which are indicated in Figure
3.5.
Surface view: The front side of the external ear is easily available to view. The auricle is diagonally
angled from the side of the skull such that it extends from both the anterior aspects and the lateral sides
of the head.
Hidden view: Vertical or underlying surfaces of the external ear are not easy to view, thus the auricle
must be pulled back by retractors in order to reveal the hidden regions.
Posterior view: The back side of the external ear faces the mastoid bone behind the ear.
External surface: The higher regions of the external ear form the external surface view.
Internal surface: The vertical or underlying surface regions of the ear form the hidden view.
Superior side: The top of the ear is directed toward the upper or dorsal position.
Inferior side: The bottom of the ear is directed toward the lower or ventral position.
Central side: The medial, proximal side of the ear is directed inward toward the midline of the head.
Peripheral side: The lateral, distal side of the ear is directed outward from the midline of the head.
Depth view of the external ear
Because two-dimensional paper cannot adequately represent the three-dimensional depth of the auricle,
certain symbols have been developed to represent changes in depth. If one were to think of the rising and
falling swells of a wave or the ridges of a hill, the top of the peak is the highest position, indicated by an
open circle, the descending slope is indicated by a square, and the lowest depths are shown as a filled
circle. The deeper, central concha contains areas represented by filled circles, the surrounding wall of the
concha is represented by squares, and the peaks of the antihelix and antitragus are shown with open
circles.
Raised ear point: Regions of the ear which are elevated ridges or are flat surface protrusions.
Represented by open circle symbols. 0
Deeper ear point: Regions which are lower in the ear, like a groove or depression. Represented by

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Solid circle symbol.
Hidden ear point: Regions of the ear which are hidden from view because they are perpendicular to the
deeper, auricular, surface regions or they are on the internal, underside of the auricle. Some texts use a
broken circle symbol to represent these hidden points. Represented by solid square symbols.
Posterior ear point: Regions of the back side of the ears that face toward the mastoid bone.
Represented by open square symbols.
Anatomical regions of the external ear.
Classic anatomical texts have presented specific anatomical terms for certain regions of the external ear.
This appendage is also known as the pinna or auricle. Latin terms were used to describe designated
regions of the ear as well as specific terms that were developed at the meetings of the World Health
Organization on acupuncture nomenclature.
The outer ridge of the auricle is referred to as the helix, which is the Latin term for a spiral pattern. A
middle ridge within this outer rim is called the antihelix. The helix is subdivided into a central helix root, an
arching superior helix, and the outermost helix tail. The cauda, or tail, refers to a long. Trailing hind
portion, like the tail of a comet. The subsections of the antihelix include an antihelix tail at the bottom of
the middle ridge, an antihelix body in the center, and two limbs that extend from the antihelix body, the
superior crus and the inferior crus. A fossa in Latin refers to a fissure, or groove. Between the two limbs of
the antihelix lies a sloping valley known as the triangular fossa, whereas the scaphoid fossa is a long,
slender groove that separates the higher ridges of the antihelix from the helix tail.
Adjacent to the face and overlying the auditory canal is a flat section of the ear known as the tragus.
Opposite to the tragus is another flap, labeled the antitragus. The latter is a curving continuation of the
antihelix, forming a circular ridge that surrounds the central valley of the ear. A prominent crease
separates the antihelix from the antitragus. Below the antitragus is the soft, fleshy ear lobe, and between
the antitragus and the tragus is a V-shaped curve known as the inter tragic notch. The deepest region of
the ear is called the concha, indicating its shell-shaped structure. The concha is further divided into an
inferior concha below and a superior concha above.
Superior concha and inferior concha were more useful designations. These two major divisions on the
concha are separated by a slight mound. This prolongation of the helix onto the concha floor is identified
in this text as the concha ridge. A vertical elevation that surrounds the whole concha floor has been
designated as the concha wall. This hidden wall area of the auricle is not identified in most anatomical
texts. Two other hidden areas of the external ear include the sub-tragus underneath the tragus and the
internal helix beneath the helix root and superior helix.