Adverse Events of Auricular Therapy: A Systematic Review

Table 2

Adverse events associated with auricular therapy reported in clinical trials.

Study	Reason for AT and practitioner	Intervention (details of AT) and control	Selected acupoints	AEs (number of Cases) of AT and outcome	Quality of AEs
Studies on auricular acupuncture
Prisco et al., 2013 [26]; RCT (); Department of Veterans Affairs Medical Center, Washington DC, USA	R: PTSD-related insomnia; P: physician	Intervention (true AT): (i) Method: auricular acupuncture with spring handle needles (0.16 × 15 mm); (ii) Duration: two treatments weekly (45 minutes per treatment) for 8 weeks; Control 1 (sham AT): auricular acupuncture at nonacupuncture points; Control 2: waiting-list control	True AT: shenmen, liver, kidney, sympathetic, hippocampus; Sham AT: nonacupuncture points located on the helix of the ear	Uncomfortable at the needling site (); Outcome: withdrawal	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Adequate; (7) Not reported
Lua and Talib, 2013 [27]; RCT (); Three Methadone Maintenance Treatment (MMT) Centers, Terengganu, Malaysia	R: drug dependence; P: acupuncturist	Intervention (MMT + AT): (i) Method: auricular acupuncture (needles: 0.25 × 12.55 mm); (ii) Duration: three treatments weekly (30 minutes per treatment) for 8 weeks; Control: MMT only	Shenmen, sympathetic, kidney, liver, lung	Light headache (); Slight bleeding (); Tingling sensations (); Pain () and nausea (); Drowsiness () and dizziness (); Dry mouth () and slight fever (); Outcome: not reported	(1) Adequate; (2) Adequate; (3) Not reported; (4) Adequate; (5) Adequate; (6) Inadequate; (7) Adequate
Hunter et al., 2012 [28]; RCT (); Primary Care & A University Population, Northern Ireland, UK	R: chronic low back pain; P: physiotherapist	Intervention (exercise + AT): (i) Method: auricular acupuncture with; Seirin Pyonex ear needles (1.80 × 0.26 mm); (ii) Duration: one treatment (48 hours) weekly for 6 weeks; Control: exercise only	Shenmen, lumbar spine, cushion	Pain and redness (not reported); Minor bleeding (not reported); Swelling around the needling site ()^#; Outcome: (i) NR (for pain, redness, and bleeding); (ii) Recovery (for swelling)	(1) Adequate; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Partially adequate
Michalek-Sauberer et al., 2012 [29]; RCT (); Outpatient Clinic, Medical; University; of Vienna, Vienna, Austria	R: state anxiety before dental treatment; P: investigator with a diploma of acupuncture	Intervention (true AT): (i) Method: auricular acupuncture (needles: 0.2 × 15 mm); (ii) Duration: twenty minutes until the start; of dental treatment; Control 1 (sham AT): auricular acupuncture at nonspecific points; Control 2: no intervention	True AT: relaxation, tranquilizer, master cerebral; Sham AT: tonsil, finger, shoulder	Warmth or a strange feeling at the treated ear or dizziness (); Outcome: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Not reported; (7) Not reported
Lien et al., 2012 [30]; RCT (); Taipei City Hospital, Taiwan	R: obesity; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupuncture (needles: 2 mm tip and 10 mm annular-shaped body); (ii) Duration: three treatments weekly for 4 weeks; Control 1: auricular stimulation using magnetic pellets; Control 2 (sham AT): needles with the tips removed	Shenmen, stomach, hunger, endocrine	Dizziness (); Outcome: withdrawal	(1) Adequate; (2) Partially adequate; (3) Not reported; (4) Not reported; (5) Not reported; (6) Adequate; (7) Not reported
Hsu et al., 2009 [31]; RCT (); Taipei Hospital, Taiwan	R: obesity; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupuncture (needles: 2 mm tip and 10 mm annular-shaped body); (ii) Duration: two treatments weekly (3 days per treatment) for 6 weeks; Control (sham AT): needles with the tips removed	Shenmen, stomach, hunger, endocrine	Minor inflammation at the needling site (); Mild tenderness at the needling site (); Outcome: not reported	(1) Adequate; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Adequate; (7) Not reported
Wang et al., 2009 [32]; RCT (); Yale-New Haven Hospital, New Haven, USA	R: pregnant women with low back pain and posterior pelvic pain; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupuncture with; Seirin Pyonex ear needles; (ii) Duration: one week; Control 1 (sham AT): auricular acupuncture at nonspecific points; Control 2: no treatment	True AT: shenmen, kidney, analgesia; Sham AT: shoulder, wrist, extra-auricular point	Transient ear tenderness (); Outcome: resolved spontaneously	(1) Not reported; (2) Not reported; (3) Adequate; (4) Adequate; (5) Not reported; (6) Not reported; (7) Partially adequate
Harding et al., 2008 [33]; Non-RCT (); James Cook University Hospital, Middlesbrough, UK	R: hot flushes in prostate cancer patients with LHRH agonist treatment; P: not reported	Intervention (AT): (i) Method: auricular acupuncture with 0.20 g sterile single-use needles; (ii) Duration: weekly treatment (40 minutes) for 10 weeks; Control: not applicable	Shenmen, liver, lung, autonomic, kidney	Transient exacerbation of vasomotor symptoms (); Outcome: resolved spontaneously (lasted only seconds)	(1) Adequate; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Adequate; (7) Partially adequate
Courbasson et al., 2007 [34]; Non-RCT (); The Jean Tweed Centre, Toronto, Ontario, Canada	R: women with concurrent substance use problems and anxiety and depressive symptoms; P: acupuncturist	Intervention (AT + usual treatment): (i) Method: auricular acupuncture (details not described); (ii) Duration: three treatments weekly (45 minutes per treatment) (length of treatment not mentioned); Control: usual treatment	Not reported	Experiencing pain from needles (not reported); Outcome: not reported	(1) Not reported; (2) Inadequate; (3) Not reported; (4) Partially adequate; (5) Not reported; (6) Inadequate; (7) Not reported
Wu et al., 2007 [35]; RCT (); Smoking Cessation Clinics, Taipei Veterans General Hospital, Taiwan	R: smoking cessation; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupuncture with 36 gauge 0.5 inch ear-piercing needles; (ii) Duration: weekly treatment for 8 weeks; Control (sham AT): auricular acupuncture at nonspecific points	True AT: shenmen, lung, mouth, sympathetic; Sham AT: eye, elbow, shoulder, knee	Hematoma (); Feeling of residual needling (); Tenderness sensation (); Minor bleeding (); Minor infection (); Nausea () and dizziness (); Outcome: gradually declined	(1) Adequate; (2) Not reported; (3) Adequate; (4) Adequate; (5) Adequate; (6) Inadequate; (7) Adequate
Usichenko et al., 2007 [36]; RCT (); Ambulatory Orthopedic Surgery Center of the Ernst Moritz Arndt University, Greifswald, Germany	R: postoperative pain; P: acupuncturist	Intervention (true AT + analgesia): (i) Method: auricular acupuncture with indwelling steel needles (0.22 × 1.5 mm); (ii) Duration: inserted before surgery and; kept until the following morning; Control (sham AT + analgesia): auricular acupuncture at nonacupuncture points	True AT: shenmen, lung, knee joint; Sham AT: nonacupuncture points located on the helix ipsilateral to the site of surgery	Dizziness and nausea (); Pain at insertion and sleep disturbance (); Outcome: (i) Disappeared after withdrawal of the needles (for dizziness and nausea); (ii) Not reported (for pain and sleep disturbance)	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Partially adequate; (6) Partially adequate; (7) Adequate
Kunz et al., 2007 [37]; RCT (); Clinic of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany	R: alcohol withdrawal; P: psychiatrists or mental-health nurses	Intervention (AT + usual treatment): (i) Method: auricular acupuncture with stainless-steel acupuncture needles (0.2 × 0.15 mm); (ii) Duration: daily treatment (45 minutes) for 5 consecutive days; Control: aromatherapy + usual treatment	Shenmen, sympathetic,; kidney, liver, lung	Pain and mild bleeding (); Outcome: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Adequate; (5) Partially adequate; (6) Inadequate; (7) Adequate
Usichenko et al., 2005 [38]; RCT (); Department of Anesthesiology and Orthopedic Surgery, University of Greifswald, Germany	R: postoperative pain; P: acupuncturist	Intervention (true AT + analgesia): (i) Method: auricular acupuncture with permanent press steel needles (0.22 × 1.5 mm); (ii) Duration: inserted the evening before surgery and kept for 3 days after surgery; Control (sham AT + analgesia): auricular acupuncture at nonacupuncture points	True AT: shenmen, lung, thalamus, hip joint; Sham AT: nonacupuncture points on the auricular helix	Pain at the needling site (); Minor bleeding at the needling site (); Headache (); Hip pain after needle withdrawal (); Outcome: (i) One withdrew, not reported for another 2 (for pain); (ii) Recovery after treatment (for bleeding); (iii) Recovery after surgery (for headache); (iv) Not reported (for hip pain)	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Inadequate; (6) Adequate; (7) Inadequate
Berman et al., 2004 [39]; RCT (); Two Medium-Security Institutions (Jails), Sweden	R: drug use problem, psychological symptoms, and physical discomfort in prison inmates; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupuncture with stainless-steel disposable needles (0.22 × 0.13 mm); (ii) Duration: a total of 14 treatments (40 minutes per treatment) for 4 weeks; Control (sham AT): auricular acupuncture; at nonspecific points	True AT: shenmen, lung, liver, kidney, sympathetic; Sham AT: nonspecific points on the auricular helix	Pain at insertion (); Outcome: forty-two dropped out and 2 completed treatment even though they found it painful	(1) Adequate; (2) Adequate; (3) Adequate; (4) Adequate; (5) Partially adequate; (6) Inadequate; (7) Adequate
Bier et al., 2002 [40]; RCT (); Arizona, USA	R: smoking cessation and cigarette consumption; P: acupuncturist	Intervention 1 (true acupuncture + education): (i) Method: auricular acupuncture with 36 gauge 0.5 inch needles; (ii) Duration: five treatments weekly (30 minutes per treatment) for 4 weeks; Intervention 2 (true acupuncture); Control (sham acupuncture + education): auricular acupuncture at nonacupuncture points	True AT: shenmen, lung, liver, kidney, sympathetic; Sham AT: nonacupuncture points located within 5 mm; of the true points	Infrequent minor bleeding upon; needle removal (not reported); Outcome: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Adequate; (5) Not reported; (6) Inadequate; (7) Not reported
Gurevich et al., 1996 [41]; Non-RCT (); North Shore University Hospital at Glen Cove, USA	R: substance-abuse problem; P: psychiatrist and nurses	Intervention (receiving AT for 5 or more times): (i) Method: auricular acupuncture with sterile disposable needles; (ii) Duration: daily treatment (20–40 minutes); Control: receiving AT for 4 or fewer times	Shenmen, lung, liver, kidney, sympathetic	Minor local bleeding (not reported); Local pain (not reported); Outcome: (i) Treatment was not required (for bleeding); (ii) Stopped AT temporarily or had less frequent treatments (for local pain)	(1) Partially adequate; (2) Inadequate; (3) Partially adequate; (4) Not reported; (5) Not reported; (6) Partially adequate; (7) Not reported
Washburn et al., 1993 [42]; RCT (); The Bayview-Hunters Point Foundation, San Francisco, USA	R: heroin addiction; P: acupuncturist	Intervention (true AT + support service): (i) Method: auricular acupuncture with single-use disposable needles; (ii) Duration: twenty-one days (20–45 minutes per treatment); Control (sham AT + support service): auricular acupuncture at nonacupuncture points	True AT: shenmen, lung, kidney, sympathetic; Sham AT: nonacupuncture points located close to the true points	Slight bleeding at insertion (not reported); Mild nausea and dizziness (not reported); Outcome: relief when the needles were removed	(1) Not reported; (2) Inadequate; (3) Partially adequate; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Zhang and Fan, 1986 [43]; Non-RCT (); TCM Academy of Shanxi Province, China	R: cholecystolithiasis; P: TCM practitioner	Intervention (AT): (i) Method: auricular acupuncture for main points and auricular acupressure for adjunct points (details were not described); (ii) Duration: not reported; Control: not applicable	Liver, gallbladder, stomach, duodenum, shenmen, sympathetic, lung	Dizziness, upper limb numbness, and minor nausea (not reported); Outcome: disappeared after removing stimulation on acupoint “sympathetic”	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Studies on auricular acupressure
Vas et al., 2014 [44]; RCT (); Ten Primary Healthcare Centres, Seville, Spain	R: chronic nonspecific spinal pain; P: doctors and nurses with AT training	Intervention (true AT): (i) Method: auricular acupressure using auricular plaster with vaccaria seeds; (ii) Duration: weekly treatment (seeds kept for 7 days) for 8 weeks; Control (placebo AT): auricular acupressure using auricular plaster with inactive black plastic discs	Main acupoints: shenmen, thalamus; Adjunct acupoints: not reported	Pressure ulcers in the pinna (); Worsened symptoms (); Outcome: (i) Healed within 10 days of removal (for pressure ulcers); (ii) Not reported (for worsened symptoms)	(1) Adequate; (2) Adequate; (3) Not reported; (4) Adequate; (5) Inadequate; (6) Inadequate; (7) Partially adequate
Li et al., 2014 [45]; RCT (); Elderly Residential Care Home,; Hong Kong	R: constipation; P: not reported	Intervention (true AT): (i) Method: auricular acupressure using auricular plaster with magnetic pellets; (ii) Duration: ten days; Control 1 (placebo AT): auricular acupressure using auricular plaster with vaccaria seeds; Control 2 (usual care): auricular acupressure using auricular plaster only	Large intestine, rectum, San Jiao, spleen, lung, sympathetic, subcortex	Minor local itchiness (); Minor dizziness (); Outcome: (i) Spontaneously subsided after AT (25) and 2 withdrew (for itchiness); (ii) Spontaneously subsided after AT (1) and 1 withdrew (for dizziness)	(1) Partially adequate; (2) Partially adequate; (3) Adequate; (4) Not reported; (5) Inadequate; (6) Adequate; (7) Partially adequate
Zhang et al., 2013 [46]; RCT (); RMIT University, Australia	R: smoking cessation; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupressure with stainless-steel press-pellet tapes; (ii) Duration: weekly treatment for 8 weeks; Control (sham AT): auricular acupressure at nonspecific points	True AT: shenmen, lung, mouth, extra, liver; Sham AT: helix 2, shoulder, clavicle, occiput, tooth	Mild to moderate local discomfort (); Slight headache and dizziness (); Outcome: (i) All AEs were resolved without any medical intervention (for both); (ii) One subject withdrew (for ear discomfort)	(1) Adequate; (2) Adequate; (3) Not reported; (4) Adequate; (5) Inadequate; (6) Adequate; (7) Partially adequate
Kong, 2012 [47]; RCT (); Foshan Hospital of TCM, Foshan, China	R: postoperative pain; P: not reported	Intervention (AT + intravenous analgesia): (i) Method: auricular acupressure using auricular plaster with vaccaria seeds; (ii) Duration: one treatment (5 hours after surgery), seeds kept for 3 days; Control: intravenous analgesia only	Shenmen, liver, kidney, heel, lesser occipital nerve, great auricular nerve	Mild skin irritation (); Outcome: no obvious discomfort and AT continued	(1) Adequate; (2) Partially adequate; (3) Not reported; (4) Adequate; (5) Partially adequate; (6) Inadequate; (7) Inadequate
Yeh et al., 2012 [48]; RCT (); A Large; Children’s Hospital, Taiwan	R: chemotherapy-induced nausea and vomiting; P: therapist	Intervention (true AT + standard care): (i) Method: auricular acupressure using auricular plaster with plant seeds; (ii) Duration: one treatment, seeds kept; for 7 days; Control (sham AT + standard care): auricular acupressure at nonspecific points	True AT: Shenmen, sympathetic, cardia, stomach, digestive subcortex; Sham AT: external knee point, vision, shoulder joint, eye	Local itchiness (); Outcome: continued to complete the study	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Li et al., 2012 [49]; RCT (); Elderly Residential Care; Home, Hong Kong	R: constipation; P: not reported	Intervention (true AT): (i) Method: auricular acupressure using auricular plaster with magnetic pellets; (ii) Duration: three weeks; Control (placebo AT): auricular acupressure using auricular plaster with vaccaria seeds	Large intestine, rectum, San Jiao, spleen, lung, sympathetic, subcortex	Mild, tolerable, and short-term itchiness of the ears (); Outcomes: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Partially adequate; (5) Not reported; (6) Inadequate; (7) Not reported
Jin et al., 2012 [50]; RCT (); Cangnan TCM Hospital of; Zhejiang Province, Cangnan, China	R: severe insomnia; P: TCM practitioner	Intervention (AT): (i) Method: auricular acupressure using auricular plaster with magnetic pellets; (ii) Duration: one treatment, seeds kept for 7 days; Control: standardized medication	Main acupoints: shenmen, occiput, subcortex, sympathetic; Adjunct acupoints: (based on TCM syndrome) heart, spleen, kidney, liver, stomach	Local redness at the taped site (); Outcome: recovery after treatment	(1) Inadequate; (2) Not reported; (3) Not reported; (4) Adequate; (5) Not reported; (6) Inadequate; (7) Not reported
Kung et al., 2011 [51]; Non-RCT (); Taipei Veterans General; Hospital, Taiwan	R: women with postmenopausal insomnia; P: acupuncturist	Intervention (AT): (i) Method: auricular acupressure using auricular plaster with magnetic pellets; (ii) Duration: daily treatment (every night before sleep) for 4 weeks; Control: not applicable	Shenmen, kidney, heart, brainstem, subcortex	Sensation of auricular tenderness (); Outcome: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Xia et al., 2011 [52]; RCT (); Baoan Hospital Affiliated to; South Medical University,; Shenzhen, China	R: low back pain; caused by lumbar strain; P: not reported	Intervention (AT + Chinese medicine plaster): (i) Method: auricular acupressure using auricular plaster with vaccaria seeds; (ii) Duration: two treatments weekly for 2 weeks; Control: Chinese medicine plaster only	Ashi point, kidney, liver, lumbosacral vertebrae, shenmen, subcortex	Obvious pain at the taped site when receiving AT for the first time (); Outcome: completed the study by reducing pressing frequency and intensity	(1) Adequate; (2) Not reported; (3) Partially adequate; (4) Partially adequate; (5) Not reported; (6) Inadequate; (7) Not reported
Xue et al., 2011 [53]; RCT (); Two Metropolitan RMIT; Campus in Melbourne, Australia	R: persistent allergic rhinitis; P: acupuncturist	Intervention (true AT): (i) Method: auricular acupressure using auricular plaster with stainless-steel pellets; (ii) Duration: eight weeks; Control (sham AT): auricular acupressure at nonspecific points	True AT: shenmen, internal nose, lung, wind stream; Sham AT: adrenal gland, helix 2, shoulder, clavicle, occiput, teeth	Mild to moderate local and short-term discomfort (); Sore ear (); Ear itch (); Outcome: well tolerated	(1) Not reported; (2) Not reported; (3) Not reported; (4) Partially adequate; (5) Not reported; (6) Inadequate; (7) Inadequate
Ji et al., 2010 [54]; RCT (); Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China	R: functional constipation; P: nurse	Intervention (AT + usual care): (i) Method: auricular acupressure using auricular plaster with Liu Shen Wan (for excess syndrome) or magnetic pellets (for deficiency syndrome); (ii) Duration: one month; Control: usual care	Main acupoints: large intestine, small intestine, rectum; Adjunct acupoints: Lung, San Jiao, stomach (for excess syndrome), spleen, kidney, endocrine (for deficiency syndrome)	Mild redness and skin breakdown at the taped site (); Outcome: recovery two days later after using entoiodine	(1) Adequate; (2) Not reported; (3) Not reported; (4) Adequate; (5) Not reported; (6) Inadequate; (7) Not reported
Wing et al., 2010 [55]; RCT (); Outpatient Clinics and The Community, Hong Kong	R: smoking cessation; P: not reported	Intervention (true AT + hand acupressure): (i) Method: auricular acupressure using auricular plaster with hard beads; (ii) Duration: three weeks; Control (sham AT + sham hand acupressure): auricular acupressure at nonmeridian points	True AT: shenmen, lung, month, brain; Nonmeridian points: away from those selected for the treatment group	Skin irritation (allergy) at the site; of the adhesive tapes (); Outcome: withdrawal	(1) Adequate; (2) Partially adequate; (3) Not reported; (4) Not reported; (5) Not reported; (6) Adequate; (7) Partially adequate
Sun, 2010 [56]; RCT (); Department of TCM, Xuzhou First Hospital of Jiangsu Province, Xuzhou, China	R: insomnia; P: not reported	Intervention (AT + psychological support): (i) Method: auricular acupressure using auricular plaster with vaccaria seeds; (ii) Duration: twenty days; Control: AT only	Main acupoints: shenmen, sympathetic, endocrine, heart, subcortex; Adjunct acupoints: liver, stomach, spleen, kidney, pancreas and gallbladder, heart of dorsal surface	Skin irritation (allergy) at the site; of the adhesive tapes (); Outcome: changed to desensitization tapes and treatment continued	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Peng, 2009 [57]; Non-RCT (); Hanguang Hospital of Handan City, Handan, China	R: neurasthenia; P: not reported	Intervention (AT): (i) Method: auricular acupressure using auricular plaster with magnetic pellets; (ii) Duration: three days per treatment, 20 treatments in total (60 days); Control: not applicable	Main acupoints: shenmen, subcortex, endocrine, anterior ear lobe; Adjunct acupoints: (based on TCM syndrome) liver, gallbladder, San Jiao, stomach, lung, heart	Skin allergy and itchiness of the ear (not reported); Outcome: symptom disappeared after changing magnetic pellets to vaccaria seeds	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Chen et al., 2009 [58]; RCT (); TCM Hospital of Hainan Province, Haikou, China	R: vascular dementia; P: TCM practitioner	Intervention (AT): (i) Method: auricular acupressure using auricular plaster with vaccaria seeds; (ii) Duration: daily treatment for 12 weeks; Control: standardized medication	Shenmen, brain, kidney, occiput	Severe skin allergy and itchiness at; the taped site (); Outcome: withdrawal	(1) Adequate; (2) Partially adequate; (3) Not reported; (4) Inadequate; (5) Not reported; (6) Adequate; (7) Not reported
Wang et al., 2007 [59]; RCT (); People’s Hospital of Baoshan City, Baoshan, China	R: myopia; P: not reported	Intervention (AT): (i) Method: auricular acupressure using auricular plaster with vaccaria seeds; (ii) Duration: four weeks for one treatment; Control: standardized medication	Apex of ear, kidney, liver,; eye, eye 2, spleen,	Skin allergy and local redness at the taped site (); Outcome: not reported	(1) Adequate; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Ding et al., 2006 [60]; RCT (); TCM Hospital of Hebei Province, Shijiazhuang, China	R: motion sickness; P: acupuncturist	Intervention (AT + Neiguan acupressure): (i) Method: auricular acupressure using auricular plaster with magnetic pellets; (ii) Duration: not reported; Control: standardized medication	Stomach, occiput, shenmen, sympathetic	Itchiness at the taped site (); Outcome: not reported	(1) Adequate; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Studies on auricular electroacupuncture
Schukro et al., 2013  [61]; RCT (); Department of Special Anesthesia and Pain Management; at the Medical University; of Vienna, Vienna, Austria	R: obesity in female patients; P: not reported	Intervention (AT + diet based on TCM): (i) Method: auricular acupuncture with electrical stimulation using P-stim electroacupuncture device (needle: 27 gauge, 3 mm length); (ii) Duration: 4-day treatment per week for 6 weeks; Control (placebo AT + diet based on TCM): auricular acupuncture with a P-stim dummy	Hunger, stomach,; colon	mild skin irritations behind the ear caused by the adhesive patch of the P-stim/placebo device (); Outcome: resolved immediately after the end of application	(1) Adequate; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Fritz et al., 2013 [62]; RCT (); St. Louis Veterans Affairs Medical Center, USA	R: smoking cessation; P: registered nurse	Intervention (AT): (i) Method: auricular acupuncture with the Stim Flex 400A Transcutaneous Electrical Nerve Stimulation Unit (active, 80 Hz); (ii) Duration: weekly treatment (20 minutes per treatment) for 5 consecutive weeks; Control (sham AT): auricular acupuncture with the Stim Flex 400A Transcutaneous Electrical Nerve Stimulation Unit (inactive, 0 Hz)	Lung, shenmen, nicotine, point zero, palate	Auricle discomfort without redness or swelling (); Outcome: not reported	(1) Adequate; (2) Not reported; (3) Not reported; (4) Partially adequate; (5) Not reported; (6) Partially adequate; (7) Partially adequate
Bernateck et al., 2008 [63]; RCT (); Outpatient Clinic of the; Department of Rheumatology, Hannover; Medical School, Hannover,; Germany	R: rheumatoid arthritis; P: doctor with profound acupuncture experience	Intervention (AT): (i) Method: auricular acupuncture with electrical stimulation using P-stim device (needle: 27 gauge, 3 mm length); (ii) Duration: weekly treatment; (48 hours per treatment) for; 6 weeks; Control: autogenic training	Shenmen, cushion, an individual point depending; on the main pain spots	Pain and discomfort at the; needling site (); Outcome: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported
Studies on auricular bloodletting therapy
Yuan and Qiao, 1998 [64]; Non-RCT (); Chinese PLA 34260 Hospital, Xiangfan, China	R: acute tonsillitis; P: not reported	Intervention (AT): (i) Method: auricular bloodletting; therapy with three-edged needle; (ii) Duration: not applicable; Control: not applicable	Helix 6 (Ashi point)	Minor infection at the needling site (); Outcome: not reported	(1) Not reported; (2) Not reported; (3) Not reported; (4) Not reported; (5) Not reported; (6) Inadequate; (7) Not reported

AT: auricular therapy, AE: adverse event, RCT: randomized controlled trial, R: reason for AT, PTSD: posttraumatic stress disorder, P: practitioner, LHRH: luteinizing hormone releasing hormone, and TCM: traditional Chinese medicine.
The CONSORT Recommendation for AEs: (1) report of data on harms in the title or abstract, (2) report of AT-related harms in the introduction section, (3) prespecification of potential adverse events of AT (clinical and/or laboratory), (4) specification of approach for collecting harms-related information, (5) description of plans for presenting and analyzing adverse events of AT, (6) description of participant withdrawals due to adverse events of AT, and (7) report of the particular denominators for analyses on AT-related harms. Quality grades for each item: adequate—item was properly described in detail in the article or in the study protocol; partially adequate—item was properly described but only in a brief format; inadequate—item failed to be properly described; not reported—item was not described.
^#Happened in one participant who did not disclose a history of rheumatoid arthritis (one of the exclusion criteria for that study).