Evidence-Based Complementary and Alternative Medicine / 2014 / Article / Tab 2

Review Article

Adverse Events of Auricular Therapy: A Systematic Review

Table 2

Adverse events associated with auricular therapy reported in clinical trials.

StudyReason for AT and practitionerIntervention (details of AT) and controlSelected acupointsAEs (number of Cases) of AT and outcomeQuality 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, lungLight 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, cushionPain 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, endocrineDizziness ()
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, endocrineMinor 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, kidneyTransient 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 reportedExperiencing 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, sympatheticMinor 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, lungDizziness, 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, subcortexMinor 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 nerveMild 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, subcortexMild, 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, subcortexSensation 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, subcortexObvious 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, occiputSevere 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, sympatheticItchiness 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, palateAuricle 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).

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