Semi-Permanent Ear (Aguille SP) Needle “Migration” into the External Auditory Canal

Abstract

Background:

Auricular acupuncture (AA) is commonly used by acupuncturists as stand-alone therapy or as an adjunctive to body acupuncture. AA is considered to be safe, with rare complications. The most commonly reported complications are usually transient and include: pain at insertion; minor bleeding; local tenderness; dizziness; and nausea. No reported cases of an Aiguille Semi-Permanente^® (ASP^®) needle retained in the external auditory canal (EAC) has been found in the medical literature.

Case:

As part of a treatment for complex regional pain syndrome, auricular ASP needles were placed. When the patient returned 6 weeks later for continued treatment, he reported feeling slightly dizzy at times and that he had a sensation that something might be in his ear canal.

Results:

This patient appeared to be in his usual good health with normal vital signs. The external ear had no visible ASP needles. An otoscopic examination revealed a yellow reflection from the base of the tympanic membrane (TM), and a gold ASP needle was identified. It was recovered with a normal saline flush of the canal. The TM and EAC were otherwise normal.

Conclusions:

In this first report of an ASP needle being “lost” in an EAC, perhaps it may have occurred while the patient slept. The event seems to be rare enough, but acupuncturists should be aware of the possibility, and if patients mention a foreign-body sensation in their ears, hearing unusual sounds, or have persistent discomfort or dizziness, the external auditory canal should be examined.

INTRODUCTION

Auricular acupuncture (AA) is a diagnostic and treatment system using needles to stimulate specific points on the external ear.¹ Different auricular regions correspond to particular somatotopic areas of the body,² and, thus, AA can be used for a wide range of indications.

AA dates back to ∼500 bc, when initially noted in The Yellow Emperor's Classic of Internal Medicine,³ and, in all likelihood, has been used since antiquity. Modern AA developed in the 1950s, mostly due to discoveries made by French physicians, principally Paul Nogier, MD, who is considered the father of modern AA.¹ In 1973, AA gained recognition with the discovery that auricular needles placed for preoperative anesthesia also stopped physical withdrawal symptoms from opium.⁴

In 1978, a French company worked with Dr. Nogier to develop the first semi-permanent ear needle (Aiguille Semi-Permanente^®; ASP^®) shown in Figure 1. It is a 2-mm needle with a mini-barb at its end. ASP needle use began in the 1980s and became more common after the publication of a study in Nigerian men that showed significant improvement in acute torticollis and no associated earlobe infection or scarification.⁵ Because ASP needles eventually fall out spontaneously, they are convenient and offer a unique way of extending therapy at home. This prolonged point stimulation may possibly confer an additional benefit beyond acute standard needling and may reduce the need for a patient to return more frequently for additional treatments.

FIG. 1.

Gold Aiguille Semi Permante^® needle.

A very common AA treatment using ASP needles is Battlefield Acupunture (BFA)⁶ (Fig. 2), deployed by Richard C. Niemtzow, MD, PhD, MPH, for treating acute and chronic pain. BFA became a standard in military acupuncture, which has helped to popularize the use of ASP needles. Typically, ASP gold needles are used and remain in the ear for up to 3–4 days or longer before being pushed out to the surface as the epidermis grows. Of the original 9 patients Dr. Niemtzow treated with BFA, none had a complication.⁶

FIG. 2.

Battlefield Acupuncture points. Figure used with permission from Niemtzow.⁶

CASE

Mr. W was a 52-year-old man who came in for treatment of complex regional pain syndrome involving his left leg. He mentioned that, since his last treatment, he was feeling a little dizzy at times and had “a sensation something might be in my ear.” His symptoms had started ∼7–8 days post insertion of the ASP needles used in his AA treatment. He asked: “Could one of those needles have gotten in there?”

In the beginning, after trials of different acupuncture inputs his standard treatment became Mega Mu Shu and BFA (mostly in alternating ears). Over time, his treatment transitioned to include KB 2 in the affected leg. In recent years, KB 2 and BFA alone had been adequate. A treatment session frequency of about every 6 weeks minimized his symptoms. However, for a variety of reasons, over the past 11.5 years he did not receive treatments consistently at that frequency. Now, it was necessary to address these new symptoms.

A head, eyes, ears, nose, and throat examination was performed. A single gold ASP needle was found, resting against the mid inferior portion of the right tympanic membrane (TM) just as it sloped to join the floor of the external auditory canal.

The ear canal was flushed gently with tepid water, but the ASP was not seen in the canal or against the TM, nor was the needle found in the rinsed solution. Further inspection located it in the concha, from where it was retrieved.

RESULTS

The assessment was that he had a foreign body (the ASP needle) in his right EAC, which was recovered.

No specific treatment or follow-up was planned, except for reinspection of his EAC and TM during the next visit (both appeared to be normal).

DISCUSSION

To this author's knowledge, no cases of an ASP needle becoming a foreign body in the EAC have been reported. The author and patient suspect that the ASP needle had migrated into his EAC while he was asleep. Since 2009, the patient had had 300 ASP needles inserted into his ears with no complications, until the incident reported here. He had occasionally had transient generalized soreness of the ear, a tiny rim of blood along the edge the needle without bleeding, and rare local inflammation.

The peer-reviewed acupuncture literature shows that AA is exceedingly safe and well-tolerated. Most side-effects are transitory and minor.⁷ The most-common side-effects are discomfort, pain, inflammation at the insertion site (redness, swelling, warmth), and local minor bleeding or bruising. More globally, dizziness, nausea, and headache can occur. Sometimes, there can be a euphoric feeling, lightheadedness, and, uncommonly, fainting. Most of these events are brief, mild, and tolerable, and serious adverse events are uncommon. This author has had some patients mention generalized aching/soreness of the ear with ASP needles, usually on the day and evening of treatment, with resolution by the following day, if not, the next day.

The event described here seems to be rare and not dangerous, and, thus, one might consider it debatable to include it in the list of the common potential complications given to patients. Doing so may only cause undue patient worry. However, acupuncturists should know of this possibility, and, if a patient mentions a foreign-body sensation in the ear, unusual sounds, atypical discomfort, or persistent dizziness, the external auditory canal should be examined.

CONCLUSIONS

Auricular therapy appears to be exceedingly safe. A loose ASP needle in the EAC seems to be an uncommon event and it is not hazardous. If a patient complains of atypical ear symptoms after articular ASP treatment, investigating the patient's concern with an otoscopic examination is warranted.

ACKNOWLEDGMENTS

The author thanks the patient for his encouragement, and Anthony F. Valdini, MD, MS, MPH and David S. Groopman, MD for their expert advice.

AUTHOR DISCLOSURE STATEMENT

No competing financial interests exist.

FUNDING INFORMATION

No funding was received for the work on this article.