Anatomo-Physiologic Basis for Auricular Stimulation. Citation: (Mercante 2018, 141-150)

The human ear (the auricle) offers access for neuromodulation in support of a broad range of therapeutic approaches. Auricular methods work well under both biomedical and biopsychosocial models (for pain and other conditions). From Transcutaneous Electrical Nerve Stimulation,[1] to acupuncture,[3][6] to psychological frameworks such as Polyvagal Theory, Trauma-Informed Care, and Somatic Psychology,[2-3] auricular methods provide an integrative pathway to healing that is grounded in a holistic mind-body connection.

The main theoretical basis for auricular stimulation is explained by the anatomy and innervation of the ear, a microsystem of the human body that arises from all three germ layers and neural crest cells to represent all the tissue types of the human system, as well as which receives all of the major nerve branches.[3][4-5] This theoretical basis is supported by several sources of evidence including:

  • Long-standing clinical experience with auricular acupuncture;[3][6]
  • Case-control observational studies dealing with the therapeutic effects of auricular stimulation;[7-13]
  • Neurophysiologic and fMRI studies in humans showing that auricular stimulation modulates the functional state of brain areas that are the target of the vagus and trigeminal nerves;[14-16] and,
  • Experimental studies with animal models, proving that auricular stimulation influence produces effects in the CNS that are comparable to those produced by invasive VNS and TNS.[17-18]

Link to the article on PMC (



[1] Coffey GH, Mahon MV. Pain: theories and a new approach to treatment. J Natl Med Assoc. 1982;74(2):147–153.

[2] Oleson T. Application of Polyvagal Theory to Auricular Acupuncture. Medical Acupuncture. 2018;30(3): 123-124

[3] He W, Wang X, Shi H, Shang H, Li L, Jing X. Auricular acupuncture and vagal regulationEvid Based Complement Alternat Med. 2012;2012:786839. [PMC free article] [PubMed[]

[4] Peuker ET, Filler TJ. The nerve supply of the human auricle. Clinical Anatomy2002;15(1):35–37. [PubMed[]

[5] Ueno N, Sudo H, Hattori Y, Yuge K, Miyaki T, Ito H. Innervation of the external ear in humans and the musk shrew. Journal of Otolaryngology of Japan1993;96(2):212–218. [PubMed] []

[6] da Silva MAH, Dorsher PT. Neuroanatomic and clinical correspondences: Acupuncture and vagus nerve stimulationJ Altern Complement Med. 2013;20(4):233–240 [PubMed] []

[7] Rush AJ, Marangell LB, Sackeim HA, Vagus nerve stimulation for treatment-resistant depression: A randomized, controlled acute phase trialBiol Psychiatry. 2005;58(5):347–354 [PubMed] []

[8] Yiming C, Changxin Z, Ung WS, Lei Z, Kcan LS. Laser acupuncture for adolescent smokers—a randomized double-blind controlled trial. American Journal of Chinese Medicine2000;28(3-4):443–449. [PubMed] []

[9] Wang JF, Bao HX, Cai YH, Zhang JH, Tong PJ. Case-control study on application of auricular acupuncture for the treatment of analgesia during perioperative period in total hip arthroplasty. Zhongguo Gu Shang2012;25(3):220–223. [PubMed] []

[10] Usichenko TI, Kuchling S, Witstruck T, et al. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. Canadian Medical Association Journal2007;176(2):179–183. [PMC free article] [PubMed] []

[11] D’Alberto A. Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the national acupuncture detoxification association protocol, and the selection of sham points. Journal of Alternative and Complementary Medicine2004;10(6):985–1000. [PubMed] []

[12] Bullock ML, Kiresuk TJ, Sherman RE, et al. A large randomized placebo controlled study of auricular acupuncture for alcohol dependence. Journal of Substance Abuse Treatment2002;22(2):71–77. [PubMed] []

[13] Asher GN, Jonas DE, Coeytaux RR, et al. Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine2010;16(10):1097–1108. [PMC free article] [PubMed] []

[14] Kraus T, Hösl K, Kiess O, Schanze A, Kornhuber J, Forster C. BOLD fMRI deactivation of limbic and temporal brain structures and mood enhancing effect by transcutaneous vagus nerve stimulationJ Neural Transm (Vienna). 2007;114(11):1485–1493 [PubMed] []

[15] Kraus T, Kiess O, Hösl K, Terekhin P, Kornhuber J, Forster C. CNS BOLD fMRI effects of sham-controlled transcutaneous electrical nerve stimulation in the left outer auditory canal—a pilot studyBrain Stimul. 2013;6(5):798–804 [PubMed] []

[16] Frangos E, Ellrich J, Komisaruk BR. Non-invasive access to the vagus nerve central projections via electrical stimulation of the external ear: fMRI evidence in humansBrain Stimul. 2014;8(3):624–636 [PMC free article] [PubMed] []

[17] Ma J, Zhang L, He G, Tan X, Jin X, Li C. Transcutaneous auricular vagus nerve stimulation regulates expression of growth differentiation factor 11 and activin-like kinase 5 in cerebral ischemia/reperfusion rats. J Neurol Sci. 2016;369:27–35 [PubMed] []

[18] Hays SA, Khodaparast N, Hulsey DR, Ruiz A, Sloan AM, Rennaker RL, 2nd, Kilgard MP. Vagus nerve stimulation during rehabilitative training improves functional recovery after intracerebral hemorrhage. Stroke. 2014;45(10):3097–3100 [PMC free article] [PubMed] []

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