Risks and Safety of Extended Auricular Therapy: A Review of Reviews and Case Reports of Adverse Events

Arya Nielsen, Sezelle Gereau, Heather Tick

Research output: Contribution to journalReview articlepeer-review

13 Scopus citations


Objective: Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT. Methods: Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for "auriculotherapy,""auricular acupuncture"or "auricular acupressure,""safety,""adverse events,""chondritis,"and "perichondritis,"with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-Analyses if they evaluated AEs associated with AT. Results: Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included. Conclusions: The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.

Original languageEnglish
Pages (from-to)1276-1293
Number of pages18
JournalPain Medicine
Issue number6
StatePublished - 1 Jun 2020


  • Acupuncture
  • Adverse Events
  • Auricular Acupressure
  • Auriculotherapy
  • Pain Management


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